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Foot and Ankle Clinics Jun 2015
Topics: Humans; Subtalar Joint
PubMed: 26043249
DOI: 10.1016/j.fcl.2015.03.001 -
Foot and Ankle Clinics Sep 2018Subtalar joint biomechanics are primarily driven by the shape of the articulations with contributions from the surrounding soft tissues. The joint motion occurs about a... (Review)
Review
Subtalar joint biomechanics are primarily driven by the shape of the articulations with contributions from the surrounding soft tissues. The joint motion occurs about a single axis oriented medially and superiorly. Joint contact forces change during different stages of gait and are affected by hindfoot alignment and traumatic alterations to their normal anatomy. A valgus subtalar joint axis is likely a contributing, and perhaps primary, risk factor for progression to adult acquired flat foot. The subtalar joint axis also contributes to the clinical picture of a cavus foot and a special subset of patients with dynamic varus.
Topics: Biomechanical Phenomena; Gait; Humans; Subtalar Joint; Weight-Bearing
PubMed: 30097078
DOI: 10.1016/j.fcl.2018.04.002 -
Foot and Ankle Clinics Mar 2015The emergence of subtalar arthroscopy has improved the understanding and accuracy of diagnosing several hindfoot pathologic conditions, in particular, sinus tarsi... (Review)
Review
The emergence of subtalar arthroscopy has improved the understanding and accuracy of diagnosing several hindfoot pathologic conditions, in particular, sinus tarsi syndrome. Subtalar arthroscopy has evolved into a useful diagnostic and therapeutic tool. The surgeon's experience is still essential to achieve good results. This article reviews the clinical indications, surgical techniques, and outcomes of subtalar arthroscopy.
Topics: Arthroscopy; Debridement; Foot Diseases; Humans; Subtalar Joint; Syndrome; Synovitis; Tattooing; Treatment Outcome
PubMed: 25726486
DOI: 10.1016/j.fcl.2014.10.010 -
Clinics in Podiatric Medicine and... Jul 2024Subtalar dislocations, ankle dislocations, and total talar dislocations are high-energy injuries. As such, there may be associated osseous or soft tissue injuries that... (Review)
Review
Subtalar dislocations, ankle dislocations, and total talar dislocations are high-energy injuries. As such, there may be associated osseous or soft tissue injuries that can be diagnosed with advanced imaging such as computed tomography (CT) or MRI. With closed injuries, closed reduction may require sedation or general anesthesia, flexion of the knee to release the tension of the gastrocnemius-soleus complex, distraction is applied, the deformity is accentuated, then the deformity is corrected. Open injuries are usually associated with a higher level of energy and a higher rate of infection. It is important to thoroughly irrigate and debride open dislocations both before and after reduction.
Topics: Humans; Joint Dislocations; Ankle Injuries; Subtalar Joint; Tomography, X-Ray Computed
PubMed: 38789170
DOI: 10.1016/j.cpm.2024.01.010 -
Clinics in Podiatric Medicine and... Jul 2023The utilization of subtalar joint arthroscopy in intra-articular calcaneal fractures provides optimal visualization of articular surfaces for a more precise anatomical... (Review)
Review
The utilization of subtalar joint arthroscopy in intra-articular calcaneal fractures provides optimal visualization of articular surfaces for a more precise anatomical reduction, thus yielding better surgical outcomes. Current literature shows good functional and radiographic outcomes, fewer wound complications, and low incidence of post-traumatic arthritis with this technique than when utilizing an isolated lateral extensile incision of the calcaneus. As subtalar joint arthroscopy continues to grow in popularity and technological advancement, patients may benefit when surgeons incorporate this tool in conjunction with a minimally invasive technique for treatment of intra-articular calcaneal fractures.
Topics: Humans; Ankle; Subtalar Joint; Arthroscopy; Fracture Fixation, Internal; Treatment Outcome; Fractures, Bone; Calcaneus; Ankle Injuries; Intra-Articular Fractures
PubMed: 37236688
DOI: 10.1016/j.cpm.2023.03.004 -
Foot and Ankle Surgery : Official... Jul 2021The only classification of Müller-Weiss disease (MWD) is based primarily on Méary's talo-first metatarsal angle. It describes increasing sag of the medial longitudinal...
BACKGROUND
The only classification of Müller-Weiss disease (MWD) is based primarily on Méary's talo-first metatarsal angle. It describes increasing sag of the medial longitudinal arch with greater degrees of compression and fragmentation of the navicular. Purportedly, the talar head pushes the subtalar joint into varus and drives the medial pole of the navicular medially, as it protrudes inferiorly and laterally. Its authors stipulated heel varus as a pre-requisite, coining the term 'paradoxical pes planus varus' to define heel varus and flatfoot as hallmark deformities of the condition.
METHODS
We measured Méary's and Kite's talocalcaneal angles, heel offset, anteroposterior thickness of the navicular at each naviculocuneiform (NC) joint, medial extrusion of the navicular and calculated percentage compression at each NC joint in 68 consecutive feet presenting with MWD. Morphology and activity at the various peri-navicular joints were studied using SPECT-CT in 45 feet.
RESULTS
Inverse relationships between Méary's angle and degree of navicular compression reach statistical significance at NC2 but not at NC3. Strong correlation exists between medial extrusion and percentage compression at NC2 and NC3. Medial extrusion is significantly greater on the affected side in unilateral cases and on the more compressed side in bilateral cases. Significant inverse relationships exist between Kite's angle and percentage compression at both NC2 and NC3 and degree of medial extrusion of the navicular. No correlation was detected between Kite's angle and either heel offset or Méary's angle. Varus heel offset was present in only 33% of cases. The combination of heel varus and negative Méary's angle was present in just 26% of cases, the commonest combination being heel valgus with sagging at 56%.
CONCLUSION
Our findings confirm part of Maceira's hypothesized pathomechanism of MWD. Reductions in Kite's talocalcaneal angle confirm that lateral and inferior protrusion of the talar head causes increasing compression and medial extrusion of the navicular. However, such shift of the talar head does not always lead to heel varus. As such, we caution against universal advocacy of lateral displacement calcaneal osteotomy, as the heel is not always in varus in MWD.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases; Female; Flatfoot; Follow-Up Studies; Foot; Foot Diseases; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Subtalar Joint; Tarsal Bones; Treatment Outcome; Young Adult
PubMed: 32600969
DOI: 10.1016/j.fas.2020.06.009 -
Foot and Ankle Clinics Sep 2018The subtalar joint plays an important role for the hindfoot when accommodating during gait. Joint degeneration may be caused by posttraumatic, inflammatory, and... (Review)
Review
The subtalar joint plays an important role for the hindfoot when accommodating during gait. Joint degeneration may be caused by posttraumatic, inflammatory, and pathologic biomechanical changes. Once conservative treatment has failed, subtalar fusion should be considered. The indication for surgery is based on thorough clinical and radiographic evaluation. Several techniques for subtalar fusion are published in literature. This article aims to describe a technique for in situ arthrodesis of the subtalar joint, paying special attention to biomechanical aspects as well as preoperative clinical and radiological work-up.
Topics: Arthrodesis; Humans; Joint Diseases; Subtalar Joint
PubMed: 30097085
DOI: 10.1016/j.fcl.2018.04.003 -
Journal of Orthopaedic Trauma Aug 2021Subtalar distraction arthrodesis is a hindfoot reconstructive procedure designed to treat posttraumatic sequelae of certain calcaneal fractures. This video demonstrates...
Subtalar distraction arthrodesis is a hindfoot reconstructive procedure designed to treat posttraumatic sequelae of certain calcaneal fractures. This video demonstrates one method of performing this procedure which resulted in dramatic pain improvement and functional restoration.
Topics: Arthrodesis; Calcaneus; Fractures, Bone; Humans; Subtalar Joint; Treatment Outcome
PubMed: 34227613
DOI: 10.1097/BOT.0000000000002172 -
Foot & Ankle International Dec 2021The mobile subtalar joint (STJ) may compensate for supra- and inframalleolar deformities and counteract the effect of realigning calcaneal or distal tibial osteotomies....
BACKGROUND
The mobile subtalar joint (STJ) may compensate for supra- and inframalleolar deformities and counteract the effect of realigning calcaneal or distal tibial osteotomies. The purpose of this study was to evaluate the compensatory effect of the mobile STJ after supramalleolar osteotomy (SMOT) and calcaneus osteotomy (COT) and whether the extent of the compensation correlates with STJ shape and orientation.
METHODS
In 10 human lower leg cadavers without evidence of deformity or prior trauma 700 Newton load were applied as a simulated standing pose. The center of force (COF) migration, maximum pressure (Pmax), and the area loaded were measured with high-resolution sensors in the ankle before and after 10-mm varus/valgus sliding COT and 10-degree varus / valgus SMOT. A computed tomographic evaluation of subtalar anatomy was conducted to correlate posterior facet curvature, its varus/valgus orientation in the coronal plane, and the effect on COF, Pmax, and area loaded.
RESULTS
The COF migration was significant for both varus and valgus SMOTs (varus SMOT: 1.78 mm, = .0029; valgus SMOT: 1.85 mm, = .0018) but not for COT (varus COT: 0.45 mm, = .85; valgus COT: 1.15 mm, = .11). Pmax and area loaded changed but not significantly. The radius of the posterior STJ surface showed a moderate correlation (varus SMOT: = 0.61, = .063; valgus SMOT: = 0.28, = .43, varus COT: = -0.61, = .063; valgus COT: = 0.13, = .38) and the axis a weak inverse correlation (varus SMOT: = -0.51, = .013; valgus SMOT: = 0.58, = .079; varus COT: = -0.51, = .14; valgus COT: = 0.38, = .28) with the COF migration after the osteotomies.
CONCLUSION
The compensatory capacity of a mobile STJ is relatively small but appears to limit the effect of COT more than SMOT. The COT is less effective in influencing ankle joint pressure for realignment purposes than SMOT in mobile STJ and clinically more consistent in stiff STJ. Correlations are moderate to weak, whereas the curvature more than orientation of posterior facet inversely correlates with osteotomy's effects.
LEVEL OF EVIDENCE
Level IV, biomechanical cadaver study.
Topics: Ankle; Ankle Joint; Calcaneus; Humans; Osteotomy; Subtalar Joint
PubMed: 34378429
DOI: 10.1177/10711007211027295 -
The Journal of Foot and Ankle Surgery :... 2016Subtalar joint arthrodesis is a commonly performed procedure for the correction of hindfoot deformity and/or the relief of pain related to osteoarthritis. The purpose of...
Subtalar joint arthrodesis is a commonly performed procedure for the correction of hindfoot deformity and/or the relief of pain related to osteoarthritis. The purpose of the present study was to provide preoperative and intraoperative objective radiographic parameters to improve the accuracy and long-term success of realignment arthrodesis of the subtalar joint. We retrospectively reviewed the data from 16 patients, 11 male (57.9%) and 8 female (42.1%) feet, who had undergone realignment subtalar joint arthrodesis. A total of 19 fusions were performed in 9 (47.4%) right and 10 (52.6%) left feet, with a mean follow-up period of 2 (range 1 to 4.8) years. The mean age at surgery was 54.5 (range 14 to 77) years. Statistically significant improvement in radiographic alignment was found in the anteroposterior talo-first metatarsal angle (p = .002), lateral talo-first metatarsal angle (p < .001), tibial-calcaneal angle (p < .001), and tibial-calcaneal distance (p < .001). A positive correlation was observed between the tibial-calcaneal angle and tibial-calcaneal distance (r = 0.825, p < .001). The statistically significant improvement in tibial-calcaneal alignment, in both angulation and distance, support our conclusions that proper realignment of the calcaneus to vertical and central under the tibia will lead to short-term success and, likely, long-term success of subtalar joint arthrodesis.
Topics: Adolescent; Adult; Aged; Arthrodesis; Female; Follow-Up Studies; Foot Deformities, Acquired; Humans; Male; Middle Aged; Radiography; Range of Motion, Articular; Reoperation; Retrospective Studies; Subtalar Joint; Time Factors; Treatment Outcome; Young Adult
PubMed: 26028600
DOI: 10.1053/j.jfas.2015.02.018