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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 -
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 -
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 -
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 -
Biomimetics (Basel, Switzerland) Jan 2024Powered ankle prostheses have been proven to improve the walking economy of people with transtibial amputation. All commercial powered ankle prostheses that are...
Powered ankle prostheses have been proven to improve the walking economy of people with transtibial amputation. All commercial powered ankle prostheses that are currently available can only perform one-degree-of-freedom motion in a limited range. However, studies have shown that the frontal plane motion during ambulation is associated with balancing. In addition, as more advanced neural interfaces have become available for people with amputation, it is possible to fully recover ankle function by combining neural signals and a robotic ankle. Accordingly, there is a need for a powered ankle prosthesis that can have active control on not only plantarflexion and dorsiflexion but also eversion and inversion. We designed, built, and evaluated a two-degree-of-freedom (2-DoF) powered ankle-foot prosthesis that is untethered and can support level-ground walking. Benchtop tests were conducted to characterize the dynamics of the system. Walking trials were performed with a 77 kg subject that has unilateral transtibial amputation to evaluate system performance under realistic conditions. Benchtop tests demonstrated a step response rise time of less than 50 milliseconds for a torque of 40 N·m on each actuator. The closed-loop torque bandwidth of the actuator is 9.74 Hz. Walking trials demonstrated torque tracking errors (root mean square) of less than 7 N·m. These results suggested that the device can perform adequate torque control and support level-ground walking. This prosthesis can serve as a platform for studying biomechanics related to balance and has the possibility of further recovering the biological function of the ankle-subtalar-foot complex beyond the existing powered ankles.
PubMed: 38392122
DOI: 10.3390/biomimetics9020076 -
Clinics in Orthopedic Surgery Feb 2024To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the three-dimensional (3D), in other words, stereoscopic...
BACKGROUND
To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the three-dimensional (3D), in other words, stereoscopic alignment of the ankle, subtalar, and foot arches. Generally, measurement of radiological parameters use two-dimensional (2D) anteroposterior and lateral radiographs in a weight-bearing state; however, computer-aided 3D analysis (Disior) using weight-bearing cone-beam computed tomography (CBCT) has recently been introduced.
METHODS
In this study, we compared the 2D human radiographic method with a stereoscopic image in patients with ankle arthritis. We enrolled 57 patients diagnosed with OA (28 left and 29 right) and obtained both standing radiographs and weight-bearing CBCT. Patients were divided by the Takakura stage. The interclass correlation coefficient (ICC) for each result was confirmed.
RESULTS
On the ICC between 2D radiographs and 3D analysis, the tibiotalar surface angle and lateral talo-1st metatarsal angle showed a good ICC grade (> 0.6), while other parameters did not have significant ICC results. Three-dimension was superior to radiographs in terms of statistical significance.
CONCLUSIONS
We demonstrated that 2D and stereoscopic images are useful for the diagnosis of OA. Our study also confirmed that the radiographic features affected by ankle OA varied. However, according to the results, the typical radiography is not sufficient to diagnose and determine a treatment plan for ankle OA. Therefore, the method of using 3D images should be considered.
Topics: Humans; Ankle; Radiography; Ankle Joint; Osteoarthritis; Weight-Bearing; Computers; Reproducibility of Results
PubMed: 38304214
DOI: 10.4055/cios23221 -
Journal of Orthopaedic Surgery and... Feb 2024Evans and Hintermann lateral column lengthening (LCL) procedures are both widely used to correct adult acquired flatfoot deformity (AAFD), and have both shown good...
BACKGROUND
Evans and Hintermann lateral column lengthening (LCL) procedures are both widely used to correct adult acquired flatfoot deformity (AAFD), and have both shown good clinical results. The aim of this study was to compare these two procedures in terms of corrective ability and biomechanics influence on the Chopart and subtalar joints through finite element (FE) analysis.
METHODS
Twelve patient-specific FE models were established and validated. The Hintermann osteotomy was performed between the medial and posterior facets of the subtalar joint; while, the Evans osteotomy was performed on the anterior neck of the calcaneus around 10 mm from the calcaneocuboid joint surface. In each procedure, a triangular wedge of varying size was inserted at the lateral edge. The two procedures were then compared based on the measured strains of superomedial calcaneonavicular ligaments and planter facia, the talus-first metatarsal angle, and the contact characteristics of talonavicular, calcaneocuboid and subtalar joints.
RESULTS
The Hintermann procedure achieved a greater correction of the talus-first metatarsal angle than Evans when using grafts of the same size, indicating that Hintermann had stronger corrective ability. However, its distributions of von-Mises stress in the subtalar, talonavicular and calcaneocuboid joints were less homogeneous than those of Evans. In addition, the strains of superomedial calcaneonavicular ligaments and planter facia of Hintermann were also greater than those of Evans, but both generally within the safe range (less than 6%).
CONCLUSION
This FE analysis study indicates that both Evans and Hintermann procedures have good corrective ability for AAFD. Compared to Evans, Hintermann procedure can provide a stronger corrective effect while causing greater disturbance to the biomechanics of Chopart joints, which may be an important mechanism of arthritis. Nevertheless, it yields a better protection to the subtalar joint than Evans osteotomy.
CLINICAL RELEVANCE
Both Evans and Hintermann LCL surgeries have a considerable impact on adjacent joints and ligament tissues. Such effects alongside the overcorrection problem should be cautiously considered when choosing the specific surgical method.
LEVEL OF EVIDENCE
Level III, case-control study.
Topics: Adult; Humans; Flatfoot; Case-Control Studies; Finite Element Analysis; Calcaneus; Osteotomy
PubMed: 38303071
DOI: 10.1186/s13018-024-04584-4