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Foot & Ankle International Jun 2024Cadaver biomechanical testing suggests that the morphology of articulating bones contributes to the stability of the joints and determines their kinematics; however,...
BACKGROUND
Cadaver biomechanical testing suggests that the morphology of articulating bones contributes to the stability of the joints and determines their kinematics; however, there are no studies examining the correlation between bone morphology and kinematics of the subtalar joint. The purpose of this study was to investigate the influence of talar and calcaneal morphology on subtalar kinematics during walking in healthy individuals.
METHODS
Forty ankles (20 healthy subjects, 10 women/10 men) were included. Participants walked at a self-selected pace while synchronized biplane radiographs of the hindfoot were acquired at 100 images per second during stance. Motion of the talus and calcaneus was tracked using a validated volumetric model-based tracking process, and subtalar kinematics were calculated. Talar and calcaneal morphology were evaluated using statistical shape modeling. Pearson correlation coefficients were used to assess the relationship between subtalar kinematics and the morphology features of the talus and calcaneus.
RESULTS
This study found that a shallower posterior facet of the talus was correlated with the subtalar joint being in more dorsiflexion, more inversion, and more internal rotation, and higher curvature in the posterior facet was correlated with more inversion and eversion range of motion during stance. In the calcaneus, a gentler slope of the middle facet was correlated with greater subtalar inversion.
CONCLUSION
The morphology of the posterior facet of the talus was found to a primary factor driving multiplanar subtalar joint kinematics during the stance phase of gait.
CLINICAL RELEVANCE
This new knowledge relating form and function in the hindfoot may assist in identifying individuals susceptible to subtalar instability and in improving implant design to achieve desired kinematics after surgery.
Topics: Humans; Calcaneus; Subtalar Joint; Biomechanical Phenomena; Talus; Walking; Male; Female; Adult; Range of Motion, Articular; Young Adult
PubMed: 38491768
DOI: 10.1177/10711007241231981 -
Medical Archives (Sarajevo, Bosnia and... 2024Isolated subtalar joint dislocations without associated fractures are rare in the medical literature. They occur when the talus bone remains in place while the calcaneus... (Review)
Review
BACKGROUND
Isolated subtalar joint dislocations without associated fractures are rare in the medical literature. They occur when the talus bone remains in place while the calcaneus and navicular bones shift out of place. These dislocations account for about 15% of talus bone injuries and 1 to 2% of all joint dislocations. They are more common in young men following inversion trauma.
OBJECTIVE
This study aims to improve the understanding of diagnosis, treatment, and management of these rare injuries for better patient care.
CASE PRESENTATION
17-year-old male patient with type 1 diabetes mellitus presented to the emergency department with severe ankle pain and swelling following an inversion injury, which rendered him unable to walk or stand. Despite his chronic condition, he was hemodynamically stable, with no neurovascular deficits but an apparent deformity in the left ankle. Treatment involved pain management with morphine, successful closed reduction under ketamine sedation, and immobilization. Follow-up radiographs and a CT scan revealed no fractures but indicated soft tissue edema, joint effusion, and subsequent osteopenia. At a three-month follow-up, the patient experienced ongoing pain and weight-bearing difficulties, diagnosed as complicated pain syndrome requiring further physiotherapy and rehabilitation.
CONCLUSION
This case highlights the clinical challenges and complications in managing isolated subtalar joint dislocations, particularly in patients with systemic health issues, and contributes valuable insights to the sparse literature on this topic.
Topics: Humans; Male; Adolescent; Fractures, Bone; Joint Dislocations; Talus; Radiography; Pain
PubMed: 38481580
DOI: 10.5455/medarh.2024.78.71-74 -
The Journal of Bone and Joint Surgery.... May 2024Reduced hindfoot eversion motion has been proposed as a cause of increased lateral foot pressure following lateral column lengthening (LCL) for progressive collapsing...
BACKGROUND
Reduced hindfoot eversion motion has been proposed as a cause of increased lateral foot pressure following lateral column lengthening (LCL) for progressive collapsing foot deformity (PCFD). A subjective intraoperative assessment of passive eversion has been suggested to help evaluate correction; however, it is unclear how passive eversion correlates with objective measurements of foot stiffness. Our objectives were to quantify the relationship between the maximum passive eversion in hindfoot joints following LCL with plantar pressure during stance and to determine the influence of wedge size on these outcomes.
METHODS
Ten cadaveric specimens extending from the mid-tibia distally were tested on a 6-degrees-of-freedom robot to simulate the stance phase of level walking. Five conditions were tested: intact, simulated PCFD, and 3 LCL wedge conditions (4, 6, and 8 mm). Outcomes included the lateral-to-medial forefoot plantar pressure (LM) ratio during stance and the maximum passive eversion measured in the hindfoot joints. Simple linear regressions were performed to evaluate relationships between outcomes and wedge sizes.
RESULTS
A strong negative relationship was found between passive subtalar eversion and the LM ratio during stance (r[38] = -0.46; p = 0.0007), but not between passive talonavicular eversion and the LM ratio (r[38] = -0.02; p = 0.37). Wedge size was strongly related to subtalar eversion (r[38] = -0.77; p < 0.0001), talonavicular eversion (r[38] = -0.55; p = 0.0003), and the LM ratio (r[38] = 0.70; p < 0.0001). Increased wedge size resulted in average decreases in subtalar and talonavicular eversion of 1.0° (95% confidence interval [CI]: 0.8° to 1.3°) and 1.2° (95% CI: 0.6° to 1.6°), respectively. Increased wedge size also increased the LM ratio by 0.38 (95% CI: 0.25 to 0.50), indicating a lateral shift in plantar pressure.
CONCLUSIONS
Decreased hindfoot eversion following LCL was related to increased lateral plantar pressure during stance. Increasing wedge size correlated with decreasing passive hindfoot eversion and increasing lateral plantar pressure, suggesting that intraoperative preservation of eversion motion may be important for preventing excessive lateral loading.
CLINICAL RELEVANCE
To avoid overcorrection or undercorrection of the deformity, hindfoot eversion assessment in addition to radiographic evaluation may be important for optimizing the amount of lengthening to achieve successful LCL.
Topics: Humans; Biomechanical Phenomena; Cadaver; Female; Male; Bone Lengthening; Aged; Middle Aged; Foot Deformities; Pressure; Range of Motion, Articular
PubMed: 38470951
DOI: 10.2106/JBJS.23.00866 -
Journal of the American Academy of... Mar 2024In the United States, rates of Mycobacterium tuberculosis infection have been declining for decades. Osteoarticular tuberculosis of the ankle is rarely observed. We...
In the United States, rates of Mycobacterium tuberculosis infection have been declining for decades. Osteoarticular tuberculosis of the ankle is rarely observed. We present the case of a 65-year-old man who immigrated to the United States from India 24 years before the onset of symptoms. The patient initially reported atraumatic swelling and pain of the left ankle and foot and was treated for venous insufficiency. Later, the patient was referred to a nonsurgical orthopaedic clinic for additional workup and was found to have elevated inflammatory markers. MRI showed septic arthritis and osteomyelitis of the talus, distal tibia, and calcaneus. Joint aspiration revealed elevated white blood cell counts with predominately PMNs. The patient was then referred to an orthopaedic foot and ankle surgeon and underwent extensive irrigation and débridement. The patient was discharged on empiric antibiotics. Culture results from the original joint aspirate returned 14 days after surgery as positive for acid-fast bacillus, later identified as M tuberculosis by sequencing. Empiric antibiotics were discontinued, and the patient was started on appropriate antituberculotic therapy. This case report illustrates the challenge in the diagnosis of skeletal tuberculosis and the importance of including this condition on the differential for patients with atypical foot and ankle presentations.
Topics: Male; Humans; Aged; Ankle; Mycobacterium tuberculosis; Subtalar Joint; Arthritis, Infectious; Tuberculosis, Osteoarticular; Anti-Bacterial Agents
PubMed: 38466986
DOI: 10.5435/JAAOSGlobal-D-23-00273 -
The Journal of Foot and Ankle Surgery :... 2024The optimal extent of arthrodesis for severe and rigid progressive collapsing foot deformity is controversial. Traditionally, triple arthrodesis has been recommended;... (Comparative Study)
Comparative Study
The optimal extent of arthrodesis for severe and rigid progressive collapsing foot deformity is controversial. Traditionally, triple arthrodesis has been recommended; however, good results have been reported using subtalar arthrodesis only. We compared the results of triple arthrodesis and isolated subtalar repositional arthrodesis. A total of 22 symptomatic feet were evaluated retrospectively. Isolated subtalar repositional arthrodesis was performed in 13 cases (the subtalar group) and double or triple arthrodesis in 9 cases (the triple group). Various radiographic variables for assessing flatfoot and osteoarthritic changes in ankle and tarsal joints were measured and compared between the 2 groups at 3 time points: preoperatively, 3 months postoperatively, and 4 y postoperatively. Additionally, we analyzed various factors that affect postoperative valgus talar tilt in the ankle joint, which has been associated with poor prognosis. There were no differences in preoperative demographic data and the severity of the disease between the 2 groups; both groups showed improvement in radiographic parameters postoperatively compared with preoperative results. With the numbers available, no significant differences could be detected in postoperative radiographic measurements between the 2 groups. Of all the variables analyzed, postoperative hindfoot alignment angle was associated with postoperative talar tilt development. Additionally, postoperative talar tilt was observed more in triple group than in subtalar group. In conclusion, isolated subtalar repositional arthrodesis is an effective procedure to correct advanced progressive collapsing foot deformity. In addition, Chorpart joint arthrodesis with improper position can cause valgus talar tilt in the ankle joint.
Topics: Humans; Arthrodesis; Male; Female; Retrospective Studies; Middle Aged; Subtalar Joint; Adult; Aged; Radiography; Treatment Outcome; Flatfoot; Foot Deformities, Acquired; Ankle Joint
PubMed: 38447799
DOI: 10.1053/j.jfas.2024.02.002 -
Journal of the American Podiatric... 2024We aimed to find probable correlation between postoperative radiologic variables and clinical outcomes of surgically treated calcaneal fractures.
BACKGROUND
We aimed to find probable correlation between postoperative radiologic variables and clinical outcomes of surgically treated calcaneal fractures.
METHODS
In a retrospective study, 70 unilateral displaced intraarticular calcaneal fractures in adults with follow-up more than 1 year were asked to have a visit. Weightbearing radiographs of both ankles were taken and radiologic parameters, including the differences in values in Böhler and Gissane angles in comparison with the uninjured side, and calcaneocuboid and subtalar joint arthritis based on the Kellgren-Lawrence grading scale, were evaluated. They were considered to find any correlation with clinical outcomes assessed by American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, visual analogue scale, Foot Function Index, and Tegner Activity Scale.
RESULTS
A total of 61 men (87.1%) and nine women (12.9%) with a mean age of 38.9 ± 12.7 years (range, 18-67 years) were included. Mean follow-up visit for the patients was 25.1 ± 12.7 months. Mean scores of American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, visual analogue scale, Foot Function Index, and Tegner Activity Scale were 86.7 ± 12.9, 21.3 ± 22.2, 13.1 ± 15.4, and 5.2 ± 1.1, respectively. The mean Gissane angle and Böhler angle differences were -0.2 ± 8.6 and -3.7 ± 7.2, respectively. Regarding the calcaneocuboid arthritis, 50 (71.4%), 14 (20.0%), and six patients (8.6%) were categorized in grades 0, 1, and 2, respectively. Also, subtalar arthritis was seen in 15 (21.4%), 24 (34.3%), 20 (28.6%), and 11 patients (15.7%), categorized as grades 0, 1, 2, and 3, respectively. No statistical correlation was found between any of the radiologic variables and clinical scores.
CONCLUSIONS
There was no significant correlation between Böhler and Gissane angles and the clinical outcomes in surgically treated calcaneal fractures. Also, functional outcomes do not change considerably among different grades of arthritis in calcaneocuboid and subtalar joints, at least during short- to mid-term follow-up periods. Radiologic findings after open reduction and internal fixation of calcaneal fractures are not predictors of function of the patients.
Topics: Adult; Male; Humans; Female; Middle Aged; Retrospective Studies; Fractures, Bone; Foot; Fracture Fixation, Internal; Ankle Injuries; Arthritis
PubMed: 38446548
DOI: 10.7547/22-085 -
RMD Open Mar 2024To assess the validity of an ultrasonographic scoring system in juvenile idiopathic arthritis (JIA) by comparing ultrasound detected synovitis with whole-body MRI and...
Validity of an ultrasonographic joint-specific scoring system in juvenile idiopathic arthritis: a cross-sectional study comparing ultrasound findings of synovitis with whole-body magnetic resonance imaging and clinical assessment.
OBJECTIVE
To assess the validity of an ultrasonographic scoring system in juvenile idiopathic arthritis (JIA) by comparing ultrasound detected synovitis with whole-body MRI and clinical assessment of disease activity.
METHODS
In a cross-sectional study, 27 patients with active JIA underwent clinical 71-joints examination, non-contrast enhanced whole-body MRI and ultrasound evaluation of 28 joints (elbow, radiocarpal, midcarpal, metacarpophalangeal 2-3, proximal interphalangeal 2-3, hip, knee, tibiotalar, talonavicular, subtalar and metatarsophalangeal 2-3). One rheumatologist, blinded to clinical findings, performed ultrasound and scored synovitis (B-mode and power Doppler) findings using a semiquantitative joint-specific scoring system for synovitis in JIA. A radiologist scored effusion/synovial thickening on whole-body MRI using a scoring system for whole-body MRI in JIA. At patient level, associations between ultrasound synovitis sum scores, whole-body MRI effusion/synovial thickening sum scores, clinical arthritis sum scores, and the 71-joints Juvenile Arthritis Disease Activity Score (JADAS71) were calculated using Spearman's correlation coefficients (r). To explore associations at joint level, sensitivity and specificity were calculated for ultrasound using whole-body MRI or clinical joint examination as reference.
RESULTS
Ultrasound synovitis sum scores strongly correlated with whole-body MRI effusion/synovial thickening sum scores (r=0.74,p<0.01) and the JADAS71 (r=0.71,p<0.01), and moderately with clinical arthritis sum scores (r=0.57,p<0.01). Sensitivity/specificity of ultrasound in detecting synovitis were 0.57/0.96 and 0.55/0.96 using whole-body MRI or clinical joint examination as reference, respectively.
CONCLUSION
Our findings suggest that ultrasound is a valid instrument to detect synovitis, and that ultrasound synovitis sum scores can reflect disease activity and may be an outcome measure in JIA.
Topics: Humans; Arthritis, Juvenile; Magnetic Resonance Imaging; Cross-Sectional Studies; Whole Body Imaging; Synovitis
PubMed: 38428979
DOI: 10.1136/rmdopen-2023-003965 -
Journal of Biomechanics Mar 2024Induced acceleration analyses have expanded our understanding on the contributions of muscle forces to center of mass and segmental kinematics during a myriad of tasks....
Induced acceleration analyses have expanded our understanding on the contributions of muscle forces to center of mass and segmental kinematics during a myriad of tasks. While these techniques have identified a subset of major muscle that contribute to locomotion, most analyses have included models with only one frontal plane degree of freedom (dof) actuated by the hip joint. The purpose of this study was to define the impact of including knee and subtalar joint frontal plane dof on model superposition accuracy and muscle specific contributions to mediolateral accelerations. Induced acceleration analyses were performed using OpenSim with the Lai model on a freely available dataset of one subject running at 4 m/s. Analyses were performed on four models (standard, with subtalar joint, with frontal plane knee, and combined frontal plane knee with subtalar) with the kinematic constraint and perturbation analyses. Root mean square error and correlations were computed against experimental kinematics. Adding frontal plane dofs improved mediolateral acceleration correlations on average by > 0.25 while only minimally impacting errors. The constraints method performed better than the perturbation method for mediolateral accelerations. Including frontal plane knee dof resulted in muscle and method specific responses. All muscles presented with a complete flip of polarity for constraint method, imparted by allowing the medial/lateral muscles to contribute according to their anatomical function. Only the gluteus medius flipped for the perturbation method. This study provides significant support for the inclusion of frontal plane knee and subtalar dof and the need for reevaluation of muscle contributions via induced acceleration.
Topics: Humans; Knee Joint; Knee; Movement; Lower Extremity; Thigh; Muscle, Skeletal; Biomechanical Phenomena
PubMed: 38417193
DOI: 10.1016/j.jbiomech.2024.112026 -
Foot & Ankle Orthopaedics Jan 2024Hindfoot fusion procedures are common for the treatment of end-stage arthritis or deformity. Surgical treatments for these conditions include talonavicular joint...
BACKGROUND
Hindfoot fusion procedures are common for the treatment of end-stage arthritis or deformity. Surgical treatments for these conditions include talonavicular joint (single) arthrodesis, talonavicular and subtalar (double) arthrodesis, or talonavicular, subtalar, and calcaneocuboid (triple) arthrodesis. This study evaluated the complication rate, revision surgery rate, and hardware removal rate for those treated with either single, double, or triple arthrodesis.
METHODS
A retrospective review was conducted for patients who underwent single ( [] code 28740), double ( 28725 and 28740), or triple ( 28715) arthrodesis to treat hindfoot arthritis/deformity ( [] code: 734, [] codes: M76821, M76822, and M76829) from 2005 to 2022 using the South Carolina Revenue and Fiscal Affairs databank. Data collected included demographics, comorbidities, procedure data, and postoperative outcomes within 1 year of principal surgery. Student test, chi-squared test, and multivariable logistic regression analysis were utilized during data analysis.
RESULTS
A total of 433 patients were identified, with 248 undergoing single arthrodesis, 67 undergoing double arthrodesis, and 118 undergoing triple arthrodesis. There was no significant difference between single, double, and triple arthrodesis in the rate of complications, hardware removals, revision surgeries, or 30-day readmission when controlling for confounding variables. However, a decrease in Charlson Comorbidity Index (CCI) was found to be predictive of an increase in the revision surgery rate (OR = 0.46, 95% CI 0.22-0.85, = .02).
CONCLUSION
We found no difference in the rate of complications, hardware removals, or revision surgeries in those undergoing single, double, or triple arthrodesis. Surprisingly we found that a lower Charlson Comorbidity Index, indicating a healthier patient had a significant relationship with a higher rate of revision surgery. Further study including radiographic indications for surgery or the impact of overall health status on revision surgery rates may further elucidate the other components of this relationship.
LEVEL OF EVIDENCE
Level III, cohort study.
PubMed: 38405386
DOI: 10.1177/24730114241231559 -
Medicina (Kaunas, Lithuania) Feb 2024This study aimed to evaluate the effects of subtalar joint axis-based balance exercises on the anterior talofibular ligament (ATFL) thickness, ankle strength, and ankle... (Randomized Controlled Trial)
Randomized Controlled Trial
Enhancing Post-Surgical Rehabilitation Outcomes in Patients with Chronic Ankle Instability: Impact of Subtalar Joint Axis Balance Exercises Following Arthroscopic Modified Broström Operation.
This study aimed to evaluate the effects of subtalar joint axis-based balance exercises on the anterior talofibular ligament (ATFL) thickness, ankle strength, and ankle stability after an arthroscopic modified Broström operation (AMBO) for chronic ankle instability (CAI). The study included 47 patients diagnosed with CAI who underwent AMBO and were randomly divided into three groups: control ( = 11), general balance exercise ( = 17), and subtalar joint axis balance exercise ( = 19), regardless of the affected area. Participants in the exercise rehabilitation group performed exercises for 60 min twice a week for six weeks, starting six weeks after AMBO. ATFL thickness, ankle strength, and ankle dynamic stability were measured using musculoskeletal ultrasonography, Biodex, and Y-balance test, respectively, before and after treatment. Compared with the remaining groups, the subtalar joint axis balance exercise group had reduced ATFL thickness ( = 0.000), improved ankle strength for eversion ( = 0.000) and inversion ( = 0.000), and enhanced ankle stability ( = 0.000). The study results suggest that subtalar joint axis-based balance exercises may contribute to the early recovery of the ankle joint after AMBO.
Topics: Humans; Ankle; Subtalar Joint; Ankle Joint; Lateral Ligament, Ankle; Treatment Outcome; Joint Instability
PubMed: 38399615
DOI: 10.3390/medicina60020328