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Foot & Ankle International Feb 2024In progressive collapsing foot deformity (PCFD), an internal and plantar rotation of the talus relative to the calcaneus may result in painful peritalar subluxation....
BACKGROUND
In progressive collapsing foot deformity (PCFD), an internal and plantar rotation of the talus relative to the calcaneus may result in painful peritalar subluxation. Medial soft tissue procedures (eg, spring ligament repair) aim to correct the talar position via the navicular bone if bony correction alone is not sufficient. The effect of the medial soft tissue reconstruction on the talar reposition remains unclear. We hypothesized that a subtalar talocalcaneal ligament reconstruction might be favorable in PCFD to correct talar internal malposition directly. This pilot study aims to evaluate the anatomical feasibility and kinematic behavior of a subtalar ligament reconstruction in PCFD.
METHODS
Three-dimensional surface model from 10 healthy ankles were produced. A total of 1089 different potential ligament courses were evaluated in a standardized manner. A motion of inversion/eversion and talar internal/external in relation to the calcaneus were simulated and the ligament strain, expressed as a positive length variation, for each ligament was analyzed. The optimal combination for the ligament reconstruction with increased length in internal rotation of the talus, isometric kinematic behavior in inversion/eversion, and extraarticular insertion on talus and calcaneus was selected.
RESULTS
A laterodistal orientation of the talar insertion point in respect to the subtalar joint axis and laterodistal deviation of the calcaneal insertion point presents the highest ligament lengthening in internal talar rotation (+0.56 mm [3.8% of total length]) and presented a near-isometric performance in inversion/eversion (+0.01 to -0.01 mm [0.1% of total length]).
CONCLUSION
This kinematic model shows that a ligament reconstruction in the subtalar space presents a pattern of length variation that may stabilize the internal talar rotation without impeding the physiological subtalar motion.
CLINICAL RELEVANCE
This study investigates the optimal location, feasibility, and kinematic behavior of a ligament reconstruction that could help stabilize peritalar subluxation in progressive collapsing foot deformity.
UNLABELLED
[Formula: see text].
Topics: Humans; Ankle Joint; Biomechanical Phenomena; Pilot Projects; Talus; Ligaments, Articular; Foot Deformities
PubMed: 38083852
DOI: 10.1177/10711007231213361 -
Orthopadie (Heidelberg, Germany) Jan 2024Minimally invasive calcaneal osteotomy (MICO) is already an established surgical procedure for correcting hindfoot deformities using a lateral approach. So far, no...
INTRODUCTION
Minimally invasive calcaneal osteotomy (MICO) is already an established surgical procedure for correcting hindfoot deformities using a lateral approach. So far, no description of a medial approach for MICO has been published.
MATERIAL AND METHODS
Between August 2022 and March 2023, 32 consecutive patients (MICO with medial approach, MMICO: n = 15; MICO with lateral approach, LMICO: n = 17) underwent MICO as part of complex reconstructive surgery of the foot and ankle with concomitant procedures. The amount of correction in the axial view of the calcaneus and consolidation rates were evaluated radiographically. Subjective satisfaction, stiffness of the subtalar joint, and pain level (numeric rating scale, NRS) at the level of the heel were assessed clinically. The last follow-up was at 6 months.
RESULTS
All osteotomies consolidated within 6 months after surgery. Displacement of the tuber was 9 mm on average in either group. Relevant subtalar joint stiffness was detected in 5 MMICO and 6 LMICO patients. No relevant differences between the groups were detected for wound healing problems, nerve damage, heel pain or patient satisfaction.
CONCLUSION
In this study lateral and medial approaches for MICO were performed. Similar degrees of correction and low complication rates were found in both groups. The medial approach for MICO is safe and can be beneficial regarding patient positioning and arrangement of the C‑arm.
Topics: Humans; Case-Control Studies; Flatfoot; Feasibility Studies; Osteotomy; Pain
PubMed: 38078936
DOI: 10.1007/s00132-023-04460-9 -
Journal of Clinical Medicine Dec 2023Pes planovalgus, or flexible flatfoot, deformity is a common problem in pediatric orthopedic patients. There is no consensus on using the technique of arthroereisis in...
BACKGROUND
Pes planovalgus, or flexible flatfoot, deformity is a common problem in pediatric orthopedic patients. There is no consensus on using the technique of arthroereisis in the treatment of symptomatic pes planovalgus. The aim of our study was to prospectively assess the functional outcomes following symptomatic pes planovalgus treatment with the use of the Spherus talar screw.
METHODS
Twenty-seven patients (11 females, 16 males), at a mean age of 10.5 years (7-14 years) were included in the prospective study. We assessed the level of physical activity (including sports) based on the University of California, Los Angeles (UCLA) activity scale, a 10-point level-of-activity VAS scale, and the Grimby physical activity scale. Pain was assessed based on a VAS pain scale; foot function was assessed with the revised Foot Function Index (FFI-R); and ankle joint mobility was measured.
RESULTS
The mean follow-up period was 18 months (14-26 months). There was a significant improvement in VAS-measured physical activity scores from 5.47 to 7 at follow-up, = 0.048. There was a significant improvement in UCLA activity scale scores from 4.78 to 6.05 at follow-up, = 0.045. Pain levels decreased from a mean VAS score of 4.73 prior to surgery to a mean score of 2.73 at follow-up, = 0.047. The functional FFI-R scores showed a significant improvement from 140 points prior to surgery to 97.75 points at follow-up, = 0.017. Comparison of the preoperative and follow-up values of the range of plantar flexion, adduction, and abduction in the operated limb also showed no significant changes in those individual parameters. The mean values of dorsiflexion, plantar flexion, adduction, and abduction at the ankle joint at follow-up, compared individually between the operated and non-operated foot showed no statistically significant differences.
CONCLUSIONS
The use of a talar screw in the treatment of symptomatic pes planovalgus helps reduce pain and improve functional outcomes after treatment. Foot function assessments showed diminished pain, improved levels of physical and sport activity, and no effect on the range of motion after surgery in comparison with preoperative data. Arthroereisis with a talar screw is a valid surgical technique for the treatment of symptomatic pes planovalgus.
PubMed: 38068527
DOI: 10.3390/jcm12237475 -
Cureus Nov 2023Introduction The subtalar joint anatomy is complex and heterogeneity in its morphology creates unique challenges for foot and ankle surgeons. Anatomical metrics used for...
Introduction The subtalar joint anatomy is complex and heterogeneity in its morphology creates unique challenges for foot and ankle surgeons. Anatomical metrics used for prosthesis design are well established. However, there is a paucity of literature quantifying foot and ankle measurement techniques and metrics used for prosthesis design. The aim of this study was to document reproducible measurement techniques and quantify talar and calcaneal metrics in a sample of Irish patients on computed tomography imaging to aid in the design of a novel hindfoot plate. Methods A retrospective analysis of consecutive foot and ankle computed tomography images performed at our institution was undertaken. Five measurements were performed on each foot and ankle image. Statistical analysis was performed to identify if a correlation existed between measurements. Results Sixty-four CTs met the inclusion criteria. Talar body height 27.1 mm (SD 2.17 mm), talar neck width 32.7 mm (3.16 mm), talar head height 25.41 (SD 2.16 mm), lateral process to posterior talus 23.6 (2.64 mm), calcaneal height 43.8 mm (SD 3.9 mm). A positive correlation was identified between all measurements. Conclusion This study identified that there was a low degree of heterogeneity in talar and calcaneal measurements in an Irish cohort. Furthermore, the metrics used in this study will provide valuable information for the preliminary design of a novel hindfoot plate.
PubMed: 38046704
DOI: 10.7759/cureus.48118 -
Cartilage Mar 2024In contrast to osteochondral lesion (OCL) of the ankle, OCLs in other joints of the foot, such as subtalar joint, talonavicular joint, calcaneocuboid joint, and the...
Current Lack of Evidence on Treatment Strategies and Clinical Outcomes for Osteochondral Lesions of the Subtalar, Talonavicular, and Calcaneocuboid Joints: A Systematic Review.
OBJECTIVE
In contrast to osteochondral lesion (OCL) of the ankle, OCLs in other joints of the foot, such as subtalar joint, talonavicular joint, calcaneocuboid joint, and the midfoot, are rare conditions, but they can also lead to significant morbidity. The objective of this systematic review was to summarize the clinical evidence for the treatment of OCLs of the subtalar, talonavicular, calcaneocuboid, and the other midfoot joints.
DESIGN
A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases was performed in January 2021 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by 2 independent reviewers. Included studies were evaluated with regard to LOE (level of evidence) and QOE (quality of evidence). Variable reporting outcome data, clinical outcomes, and complications were evaluated.
RESULTS
Seventeen studies with 21 patients were included, all of which were case reports (level 5) without any case series reporting greater than 3 patients. There were 5 patients with OCL in the subtalar joint, 15 patients in the talonavicular joint, and 1 patient in the calcaneocuboid joint. Thirteen case reports (4 subtalar joint, 8 talonavicular joint, and 1 calcaneocuboid joint) reported surgical treatment. Surgical procedures mainly included debridement, bone marrow stimulation, fixation, and bone grafting, through open or arthroscopy, all of which resulted in successful outcomes. Four case reports (1 subtalar joint, 3 talonavicular joint) reported successful conservative treatment. Other 13 case reports reported successful surgery after failed conservative treatment. No complications and reoperations were reported.
CONCLUSIONS
The current systematic review revealed that there is no available evidence to ascertain clinical outcomes of both conservative and surgical treatments for cartilage lesions in the talonavicular joint, subtalar joint, and the midfoot joints, owing to the extreme paucity of literature. Both nonoperative and operative treatments can be considered, but no treatment strategies have been established.
Topics: Humans; Tarsal Joints; Subtalar Joint; Ankle Joint; Research Design
PubMed: 38032011
DOI: 10.1177/19476035231216182 -
Cureus Oct 2023Simultaneous talocalcaneal and talonavicular joint dislocation, in other words, subtalar joint dislocation, and navicular bone lateral process fracture are rare...
Simultaneous talocalcaneal and talonavicular joint dislocation, in other words, subtalar joint dislocation, and navicular bone lateral process fracture are rare orthopedic injuries. In this case, we aimed to discuss the effectiveness and ergonomics of non-surgical follow-up with a short leg splint after reduction of talonavicular, talocalcaneal joint dislocation, and lateral process fracture of the navicular bone. A 17-year-old male patient was admitted to the emergency department with swelling and pain in his left foot after spraining his left foot while playing football. Pain, swelling, and deformity in the left foot were evident without a neurovascular deficit. Radiographs showed simultaneous left foot talonavicular joint dislocation, talocalcaneal joint dislocation, and navicular lateral process fracture. The patient underwent closed reduction and a short leg splint. We followed the patient regularly, removed the leg splint in the fourth week, and started various movement exercises. We started muscle strengthening exercises in the sixth week and reached full range of motion with full muscle strength without any deformity in the eighth week. In this case, closed reduction and short leg splint with traction along the axis of the left foot and manipulation of the talus laterally by everting the ankle were sufficient. We restricted the movement of the ankle and tarsometatarsal joint with a short leg splint and reached full range of motion with follow-ups and exercises.
PubMed: 38022376
DOI: 10.7759/cureus.47848 -
Cureus Oct 2023Purpose The goal of the current study was to ascertain whether there is an association between foot pronation and anterior cruciate ligament (ACL) injury in a group of...
Purpose The goal of the current study was to ascertain whether there is an association between foot pronation and anterior cruciate ligament (ACL) injury in a group of elite professional soccer players. Methods Two groups of soccer players were studied, all of whom played in the Greek Super League. The ACL group included players who had suffered an ACL injury in the last 2 years. The non-ACL group was composed of players who had never suffered an ACL injury. We used a 3D baropodometric laser scanner to measure pronation or overpronation (navicular drop phenomenon) of the subtalar joint and how this affects the subtalar joint while standing. We assessed ACL laxity using the Genourob Rotab. Results ACL-injured patients, regardless of the mechanism of injury, exhibited greater navicular drop values than a randomly selected group of subjects with no history of ACL injury. Conclusion Greater knee joint laxity and subtalar pronation may be associated with an increased risk of ACL injury. Pronation of the foot appears to be a risk factor for ACL injury. These findings should be integrated into future studies to better define how neuromuscular control related to lower extremity biomechanics is associated with ACL injury.
PubMed: 38021974
DOI: 10.7759/cureus.47850 -
Journal of Foot and Ankle Research Nov 2023A comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb's biomechanical characteristics during walking is lacking. Our...
BACKGROUND
A comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb's biomechanical characteristics during walking is lacking. Our goal was to assess joint kinematics and kinetics and compensatory mechanisms in patients with subtalar and mid-tarsal joint osteoarthritis.
METHODS
Patients with symptomatic and radiographically confirmed osteoarthritis of the subtalar and mid-tarsal (n = 10) and an asymptomatic control group (n = 10) were compared. Foot joint kinematics and kinetics during the stance phase of walking were quantified using a four-segment foot model.
RESULTS
During pre-swing phase, the tibio-talar range of motion in the sagittal plane of the patient group decreased significantly (P = 0.001), whereas the tarso-metatarsal joint range of motion in the sagittal plane was greater in the pre-swing phase (P = 0.003). The mid-tarsal joint showed lower transverse plane range of motion in the patient group during the loading response and pre-swing phase (P < 0.001 resp. P = 0.002). The patient group showed a lower Tibio-talar joint peak plantarflexion moment (P = 0.004), peak plantarflexion velocity (P < 0.001) and peak power generation in the sagittal plane (P < 0.001), and a lower mid-tarsal joint peak adduction and abduction velocity (P < 0.001 resp. P < 0.001) and peak power absorption (P < 0.001).
CONCLUSIONS
These findings suggest that patients with subtalar and mid-tarsal joint osteoarthritis adopt a cautious walking strategy potentially dictated by pain, muscle weakness, kinesiophobia and stiffness. Since this poorly responding population faces surgical intervention on the short term, we recommend careful follow-up after fusion surgery since biomechanical outcome measures associated to this post-surgical stage is lacking.
Topics: Humans; Biomechanical Phenomena; Conservative Treatment; Subtalar Joint; Foot; Walking; Osteoarthritis; Tarsal Joints; Ankle Joint; Range of Motion, Articular
PubMed: 38017488
DOI: 10.1186/s13047-023-00689-x -
PloS One 2023Tibiotalocalcaneal (TTC) arthrodesis is a procedure to treat severe ankle and subtalar arthropathy by providing pain free and stable fusion using IM nails. These nails...
Tibiotalocalcaneal (TTC) arthrodesis is a procedure to treat severe ankle and subtalar arthropathy by providing pain free and stable fusion using IM nails. These nails can be manufactured with multiple materials and some feature the ability to dynamize the arthrodesis construct. However, the impact of IM nail material and nail dynamization on load-sharing and in the setting of bone resorption have not been quantified. This work utilized a patient-specific finite element analysis model of TTC arthrodesis to investigate IM nails with differing material moduli and the impact of nail dynamization on load-sharing and intersegmental compression in the setting of bone resorption. Each nail was virtually inserted into a patient-specific model of a hindfoot, which was segmented into the three bones of the TTC complex and assigned material properties based on the densitometry of the bone. Compression, amount of load-sharing, and stress distributions after simulated bone resorption were quantified and compared between the varying IM nails. Simulations revealed that bone segments were only subjected to 17% and 22% of dynamic gait forces in the titanium and carbon fiber nail constructs, whereas the pseudoelastic NiTi nail constructs allowed for 67% of the same. The titanium and carbon fiber nails lost all initial compression in less than 0.13mm of bone resorption, whereas the NiTi nail maintained compression through all simulated values of bone resorption. These data highlight the poor load-sharing of static nail TTC arthrodesis constructs and the ability of a pseudoelastic IM nail construct to maintain intersegmental compression when challenged with bone resorption.
Topics: Humans; Titanium; Bone Nails; Finite Element Analysis; Carbon Fiber; Ankle Joint; Arthrodesis; Bone Resorption
PubMed: 37972050
DOI: 10.1371/journal.pone.0288049 -
Journal of Clinical Medicine Oct 2023Sinus tarsi syndrome (STS) is defined as pain located at the lateral opening of the tarsal sinus. The exact etiology of sinus tarsi syndrome is not completely... (Review)
Review
Sinus tarsi syndrome (STS) is defined as pain located at the lateral opening of the tarsal sinus. The exact etiology of sinus tarsi syndrome is not completely understood. Some do not believe it to be a true pathology. This review aims to clarify the definition of sinus tarsi syndrome to better understand the underlying pathologies. We further propose an algorithm to evaluate sinus tarsi pain and provide advice for consecutive treatment options. : This is a narrative review. By searching PubMed, the available current literature was reviewed. Articles were critically analyzed to determine the pathoanatomy, biomechanics, and etiology of sinus tarsi pain. Algorithms for clinical evaluation, diagnosis, and treatment were also recorded. Finally, the authors approach to evaluating and treating sinus tarsi pain was included in this review. : Reviewing the available literature, STS seems to be a catch-all phrase used to describe any pain in this anatomic region. Many causes of sinus tarsi pain were listed, including impingement, subtalar instability, and many other pathologies around the ankle. : A thorough evaluation of patients presenting with pain in the sinus tarsi or instability of the hindfoot is essential to determining the underlying cause. When the cause of pain is still not clear after clinical exam and radiologic assessment, subtalar arthroscopy can be helpful as both a diagnostic and treatment tool. We propose that the term of STS should be avoided and that a more accurate diagnosis be used when possible. Once a diagnosis is made, appropriate treatment can be initiated.
PubMed: 37959343
DOI: 10.3390/jcm12216878