Study of fifty human tali for calcaneal articular facets

Fifty adult dry human tali from the Department of anatomy, Nepalgunj Medical College Chisapani, were studied. Observations were made on different types of articular facets of calcaneus for the tali. They were classified into four groups and their percentages of incidences were calculated. These findings were well correlated and compared with the literatures available.

Influence of age and osteoporosis on calcaneus trabecular bone structure: a preliminary in vivo MRI study by quantitative texture analysis

Recent developments in high-resolution MR imaging techniques have opened up new perspectives for structural characterization of trabecular bone by non-invasive methods. In this study, 3-D MR imaging was performed on 17 healthy volunteers and 6 osteoporotic patients. Two different MR sequences were used to evaluate the impact on MR acquisition on texture analysis results. Images were analyzed with four automated methods of texture analysis (grey level histogram, cooccurrence, runlength and gradient matrices) enabling quantitative analysis of grey level intensity and distribution within three different regions of interest (ROI). Texture analysis is not very frequently used since the interpretation of the large number of calculated parameters is difficult. We applied multiparametric data analyses such as principal component analysis (CFA) and hierarchical ascending classification (HAC) to determine the relevant parameters to differentiate between three sets of images (healthy young volunteers, healthy postmenopaused and osteoporotic patients). The results suggest that relevant texture information (depending on the ROI localization in the calcaneus) can be extracted from calcaneus MR images to evaluate osteoporosis and age effects on trabecular bone structure if strictly the same acquisition sequences are used for all patients' examination.

Analgesic effects of a soy-containing diet in three murine bone cancer pain models

Bone is a common metastatic site for prostate and breast cancer, and bone cancer is usually associated with severe pain. Traditional treatments for cancer pain can sometimes be ineffective or associated with side effects. Thus an increasing number of patients seek alternative therapies. In this study we investigated the analgesic effects of a soy diet on 3 experimental models of bone cancer pain. Mice were fed a diet in which the protein source was either soy or casein. After 1 week on the diet, sarcoma cells (NCTC 2472) were injected into the medullary cavity of the humeri, femur, or calcaneus. Experimenters blinded to diet of the animal assessed the pain behavior in these animals, forelimb grip force in the humerus model and paw withdrawal frequency to mechanical stimuli in the calcaneus and femur models. The effect of morphine on cancer-induced pain behavior was investigated in calcaneus and femur models. In addition, in the femur model, the effects of soy on tumor size and bone destruction were studied. The soy diet reduced secondary mechanical hyperalgesia in the femur model but had no effect on primary mechanical hyperalgesia in the calcaneus model or on movement-related hyperalgesia in the humerus model. No dietary impact was discerned in measurements of tumor size, bone destruction, and body weight in the femur model, suggesting that the soy diet had no effect on cancer growth. Morphine dose-dependently reduced hyperalgesia with no diet-based difference. These results suggest that a soy diet might provide analgesia in certain forms of hyperalgesia associated with bone cancer.

PERSPECTIVE

The study raises the possibility of dietary supplements influencing aspects of cancer pain. Further research will help determine if use of nutritional supplements, such as soy proteins, can reduce opioid analgesic use in chronic pain states and help minimize the side effects associated with long term use of opioids.

Optical biopsy of bone tissue: a step toward the diagnosis of bone pathologies

In vivo absorption and reduced scattering spectra of the human calcaneous from 650 to 1000 nm were assessed using a laboratory system for time-resolved transmittance spectroscopy. Measurements were performed on the calcaneous of seven female volunteers ranging from 26 to 82 years of age. The analysis of the absorption spectra, using a linear combination of the key tissue absorbers (bone mineral, water, lipids, oxy- and deoxyhemoglobin), revealed a general decrease in bone mineral content and an increase in lipids with age, which is in agreement with the aging transformations that occur in bone tissues. The scattering spectra were less effective in detecting such changes in older subjects, showing only a minor decrease in the coefficient for these subjects. The capability to noninvasively quantify bone tissue composition suggests a possible use of optical biopsy for the diagnosis of bone pathologies such as osteoporosis, which are characterized by a progressive reduction and transformation of the mineral in the bone matrix.

[Surgical indications in intraosseous lipoma of the calcaneus. Case report and critical review of the literature]

Intraosseous lipomas represent a small number of benign bone tumors with incidence rates of approximately 0.1%. In about 15% these neoplasias are localized within the calcaneus, mostly at Ward's triangle. The tumors usually remain clinically inapparent and diagnosis is often obtained incidentally. Although CT scan and MRI provide specific and sensitive diagnostic tools that can distinguish morphology and dignity, surgical treatment is not standardized yet. In conjunction with a case report, we summarize and critically compare current treatment strategies.

[Non-Hodgkin lymphoma of the calcaneus and ovary in an infant]

The authors report a case of non-Hodgkin lymphoma with involvement of the calcaneus and ovary in a 4 year- old girl. Calcaneal involvement by this tumor is unusual and ovarian involvement is infrequent.

Evaluation of calcaneal malposition by magnetic resonance imaging in the infantile clubfoot

Magnetic resonance imaging (MRI) can clearly visualize both the ossification centers and surrounding cartilage of growing bones and enable a three-dimensional analysis of their positional relationships by using overlapping images. The calcaneal position was evaluated based on five newly proposed parameters of magnetic resonance images in 30 clubfeet of 18 infants with the bimalleolar and lower leg axes as reference lines. Sixteen unaffected feet in the unilateral cases were analyzed as normal feet. MRI showed that the calcaneus in clubfoot rotated internally, medially and posteriorly with reference to the bimallelar axis and that it took an equinus and a varus position with reference to the lower leg axis as compared with the normal foot. These five parameters and their normal values on the calcaneal position should be useful for the evaluation of infantile clubfeet.

Use of bone marrow stromal cells for tendon graft-to-bone healing: histological and immunohistochemical studies in a rabbit model

BACKGROUND

Despite increasing attention on the issue of tendon-to-bone integration, there has been no animal study on the use of cell therapy for promoting the insertion healing of tendon to bone.

PURPOSE

To determine the efficacy of using a large number of bone marrow stromal cells (bMSCs) to enhance tendon-to-bone healing.

STUDY DESIGN

Controlled laboratory study.

METHODS

The hallucis longus tendons were translated into 2.5-mm diameter calcaneal bone tunnels in a New Zealand white rabbit model. The bone tunnels were treated with or without bMSCs. Three specimens from each group were harvested at 2, 4, and 6 weeks postoperatively and evaluated by conventional histological and immunohistochemical methods.

RESULTS

At 4 weeks, the specimens with bMSCs exhibited more perpendicular collagen fiber formation and increased proliferation of cartilage-like cells, which was indicated by positive collagen type-II immuno-staining of the tendon-bone interface. In contrast, the specimens without bMSCs demonstrated progressive maturation and reorganization of fibrous tissue aligned along the load axis.

CONCLUSION

Introduction of a large number of bone marrow stromal cells to the bone tunnel have shown to improve the insertion healing of tendon to bone in a rabbit model through formation of fibrocartilagenous attachment at early time points.

[Limb salvage by excision of calcaneus in diabetic atherosclerotic gangrene]

We treated a 49-year-old female patient, who developed diabetic, arteriosclerotic gangrene. Only after the extensive wet gangrene extended to the proximal half sole, she was finally consenting to surgery, and a femoropopliteal Dacron bypass graft was performed. The area of the osteomyelitic calcaneus was removed by necrectomy (slough cutting) but the calcaneus fractured spontaneously after two weeks. Therefore the calcaneus was excised and the half-sole defect was covered by the available skin of the posterior heel and forefoot region. The wound required meticulous local treatment for two months. She has been able to walk without a frame using an orthopedic shoe fitted with a total contact insole with proper lifting of the heel region. Our aim was limb saving and recovery favourable to crural amputation, which could have been justified in such extensive gangrene. We would like to highlight to the possibility of the excision of the calcaneus, as no data has been found about it in the Hungarian literature. Walking after the excision of the calcaneus is possible with the help of a specially developed orthopaedic shoe, properly fitted with a total contact insole.

Evaluation of an osteoporosis self-referral program to enhance management outcomes

Osteoporosis is a common but undertreated condition. While bone density is known to predict fracture risk, there is currently no economical way of measuring general population risk. This study examined whether an economical screening technique could improve diagnosis and lead to appropriate outcomes in the management of osteoporosis. A self-referral program was established to provide women with information about osteoporosis and an individualized risk assignment. A high-risk designation was provided for postmenopausal women below the lower tertile of a calcaneal broadband ultrasound attenuation (BUA) (< or = 58 db/MHz) or those with a SCORE value > or = 6. A telephone survey was conducted 6 mo after program registration to evaluate osteoporosis management outcomes. Of 271 women surveyed, 181 (67%) were postmenopausal and thus potential candidates for estrogen replacement, and 21% and 63% were assigned a high-risk profile by either calcaneal ultrasound or SCORE, respectively. Women at higher risk were significantly more likely to discuss osteoporosis with their family physician (p < 0.001), and to undergo further testing with dual X-ray absorptiometry measurement (p < 0.005). Utilization of estrogen replacement by postmenopausal women at time of survey was significantly increased compared to registration (p = 0.01). The self-referral program positively impacted decisions women made about preventing osteoporosis, particularly if they considered themselves at higher risk.

Chondrosarcoma of calcanaeum in a 12-year-old male patient: A case report

Chondrosarcoma is distinctly uncommon and tends to be located often in the extremities in young patients more than in its adult counterpart. Cartilaginous tumors involving the small bones of the hands and feet are benign tumors such as enchondromas, chondromyxoid fibroma (CMF), and chondroblastoma. Chondrosarcomas involving calcanaeum in young adults are largely covered in the literature as single case reports. A young 12-yr-male patient presented with complaints of pain and mild swelling in the ankle. Radiological examination revealed a dense irregular lesion in the calcanaeum. Fine-needle aspiration was performed and a possibility of chondrosarcoma was suspected, which later was confirmed on histopathological examination. The cytopathologist should be aware of the occurrence of malignant chondroid tumors in the younger age group at this rare site. Correlation to radiological findings is essential in these cases.

Sonographic study of calcaneal entheses in erosive osteoarthritis, nodal osteoarthritis, rheumatoid arthritis and psoriatic arthritis

OBJECTIVE

To establish by ultrasonography (US) the frequency of calcaneal entheses involvement in erosive osteoarthritis (EOA), nodal osteoarthritis (NOA), RA and PsA, and to compare these results in order to aid clinicians in the differential diagnosis among these diseases. A comparison between US results and radiography was also made.

METHODS

The heels of 56 consecutive outpatients with EOA, 209 with NOA, 158 with RA and 125 with PsA were studied by US and radiography. A control group of 50 subjects was examined by US.

RESULTS

US showed no significant difference in inferior calcaneal enthesophytosis among the four diseases. The frequency of posterioinferior enthesophytosis was lower in RA (34%) in comparison with the other diseases (57% in EOA, 47% in NOA, 49% in PsA). Achilles enthesitis was found in 8% of PsA and in 2% of RA. Retrocalcaneal bursitis was found in 18% of RA and in 6% of PsA. Posterior erosions were present in 12% of RA and 5% of PsA. Inferior erosions were present in 6% of RA and in 1% of PsA. Plantar fasciitis was found in 26% of RA, in 37% of PsA, and in 15% of NOA and 12% of EOA. Subcalcaneal panniculitis was observed in 10% of RA and in 1% of PsA. In the control group, only posterioinferior and inferior enthesophytosis (22% and 18% respectively) were found. Kappa statistics show excellent agreement between US and radiography in detecting posterioinferior (kappa = 0.89) and inferior enthesophytosis (kappa = 0.83), and entheseal erosions (kappa = 0.86).

CONCLUSIONS

The calcaneal lesions that could be found in EOA are similar to those observed in NOA. The frequency of calcaneal enthesophytosis is similar in EOA, NOA, and PsA, but inflammatory lesions of calcaneal entheses and of the adjacent bursae are more frequent in RA and in PsA. In terms of heel involvement, EOA seems to be similar to NOA. US shows an excellent concordance with radiography in detecting entheseal cortical bone abnormalities.

Misdiagnosed iuxta-articular osteoid osteoma of the calcaneus following an injury

The diagnosis of osteoid osteoma, in usual localizations, is generally simple. In iuxta-articular localizations this tumor may be unrecognized and the diagnosis delayed. Injury has been sometimes correlated with the onset of symptoms and this can make the diagnosis even more difficult. We present a case of osteoid osteoma of the calcaneus iuxta-articular to the subtalar joint in a 17-year-old basketball player. He had a history of initial injury, ankle sprain during training, followed by pain and swelling. He was initially treated for lateral ligament lesion of the ankle with unsatisfactory results. After acute trauma the pain changed becoming chronic and mostly nocturnal disappearing when rofecoxib was taken. Standard x-ray didn't show the lesion. Nuclear Magnetic Resonance (NMR) and scintigraphic results were not well interpreted but these clinical changes and Computed Tomography (CT) images supported the diagnosis of osteoid osteoma. The complete resection of the bone lesion resolved all the symptoms and the histological report confirmed the suspected diagnosis.

Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits

Despite the success in clinical application, the exact mechanism of shock wave therapy remains unknown. We hypothesized that shock wave therapy induces the ingrowth of neovascularization and improves blood supply to the tissues. The purpose of this study was to investigate the effect of shock wave therapy on neovascularization at the tendon-bone junction. Fifty New Zealand white rabbits with body weight ranging from 2.5 to 3.5 kg were used in this study. The right limb (the study side) received shock wave therapy to the Achilles tendon near the insertion to bone. The left limb (the control side) received no shock wave therapy. Biopsies of the tendon-bone junction were performed in 0, 1, 4, 8 and 12 weeks. The number of neo-vessels was examined microscopically with hematoxylin-eosin stain. Neovascularization was confirmed by the angiogenic markers including vessel endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS) expressions and endothelial cell proliferation determined by proliferating cell nuclear antigen (PCNA) expression examined microscopically with immunohistochemical stains. The results showed that shock wave therapy produced a significantly higher number of neo-vessels and angiogenesis-related markers including eNOS, VEGF and PCNA than the control without shock wave treatment. The eNOS and VEGF began to rise in as early as one week and remained high for 8 weeks, then declined at 12 weeks; whereas the increases of PCNA and neo-vessels began at 4 weeks and persisted for 12 weeks. In conclusion, shock wave therapy induces the ingrowth of neovascularization associated with early release of angiogenesis-related markers at the Achilles tendon-bone junction in rabbits. The neovascularization may play a role to improve blood supply and tissue regeneration at the tendon-bone junction.

[Quantitative bone ultrasound: impact of the application of two different reference databases to a population of 5.195 postmenopausal women]

BACKGROUND AND OBJECTIVE

The application of different reference databases to calculate the T-score values of the bone mineral density (BMD) using dual-energy X-ray absorptiometry techniques may result in variations in the number of subjects diagnosed with osteoporosis. There are no similar dataregarding quantitative bone ultrasound. To compare the results of the application of two different reference databases: the manufacturer's normal range and the Spanish normative data.

PATIENTS AND METHOD

Evaluation of the heel ultrasound with a Sahara sonometer in 5,195 women >= 65 year-old who were attended for any reason in primary care centers.

RESULTS

Bone ultrasound estimated BMD T-score mean values were 1.27 and 1.29 when applying the manufacturer's normal range and the Spanish normative data, respectively (p = 0.001). Percentages of women with a T-score below 2.50 standard deviations were 12.7% and 12.8% respectively.

CONCLUSIONS

The application of these two reference databases shows very similar results which, although statistically different, are clinically irrelevant.

Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis

Accessory ossicles and sesamoid bones are frequent findings in routine radiographs of the ankle and foot. They are commonly considered fortuitous and unrelated to the patient's complaint; however, they may eventually cause painful syndromes or degenerative changes in response to overuse and trauma. They may also suffer or simulate fractures. Our aim was to review, illustrate and discuss the imaging findings of some of the more frequent accessory ossicles and sesamoid bones of the ankle and foot region, with particular emphasis on those that may be of clinical significance or simulate fractures.

Bone homogeneity factor: an advanced tool for the assessment of osteoporotic bone structure in high-resolution magnetic resonance images

RATIONALE AND OBJECTIVES

Osteoporosis is characterized by low bone mass and inferior structural competence. In this study we introduce the bone homogeneity factor (BHF) as a quantitative measurement of bone structure, which could be equally important as bone mineral density.

METHODS

BHF represents an advanced texture analysis tool based on the spatial autocorrelation function calculated in 9 different directions. These calculations were performed on high-resolution magnetic resonance images of the calcaneus at 3.0 T and compared with dual-energy x-ray absorptiometry measurements of the femoral neck.

RESULTS

The quality and resolution of the high-resolution magnetic resonance images is sufficient for reliably calculating BHF. The mean BHF of the control group (n = 5, mean BHF = 525,0) with normal bone is significantly (P = 0.009, Mann-Whitney U test) higher than in the osteoporotic group (n = 7, mean BHF = 137,8). The BHF correlates with the DXA measurements of the femoral neck (correlation coefficient = 0.75).

CONCLUSIONS

By calculating the BHF, it was possible to distinguish between osteoporotic and nonosteoporotic bone structure. Hence, BHF could be a possible candidate for noninvasive assessment of osteoporotic bone structure giving additional information to routinely used bone mineral densitometry.

Multimodality imaging features of primary xanthoma of the calcaneus

Secondary xanthomatous features are histologically observed in various bone lesions, but primary xanthoma of bone is rare. We present a primary xanthoma of the right calcaneus in a 51-year-old woman who had no aberrant lipid metabolism. Roentgenograms showed a small osteolytic lesion in the calcaneal triangle, partially surrounded by bone sclerosis. Computed tomographic scans of the calcaneus showed multiple osteolytic areas, with an irregular trabecular pattern in the surrounding sclerotic bone. T1-weighted magnetic resonance images showed a lesion with central low signal intensity, surrounded by a peripheral ring with high signal intensity. The entire lesion showed high signal intensity on T2-weighted images, partially surrounded by areas with low signal intensity, concordant with reactive bone sclerosis. Histologically, the lesion consisted of numerous lipid-laden histiocytes arranged in sheets, scattered multinucleated giant cells and lymphocytes, and granulation tissues. There was no evidence of pre-existing lesions. Total excision of the tumor was curative.

Antiinflammatory and chondroprotective effects of the aminobisphosphonate incadronate (YM175) in adjuvant induced arthritis

OBJECTIVE

Incadronate is a third-generation bisphosphonate that suppresses bone resorption and is used to treat skeletal disorders and prevent bone loss in pathological conditions. We evaluated its therapeutic potential and antiinflammatory effects in established adjuvant induced arthritis (AIA), a rat model of rheumatoid arthritis (RA).

METHODS

Rats were administered incadronate subcutaneously at a dose of either 0.1 or 1.0 mg/kg/day, or 0.1 or 1.0 mg/kg/week, while a positive control group received phosphate buffered saline alone from Day 14 (after the onset of arthritis) to Day 42. The destruction of bone and cartilage and the antiinflammatory effects of incadronate in rats with established AIA were assessed during treatment, with reference to the arthritis index, hind paw volume, and radiological and histological examinations. To establish whether incadronate affects the migration of inflammatory cells, a chemotaxis assay was carried out using macrophage-like RAW 264.7 cells. Results. In vivo, incadronate suppressed the clinical manifestations of AIA in a dose-dependent manner. In vitro, the various concentrations of incadronate suppressed the migration of macrophages, but the viability and adhesion of these cells were not suppressed.

CONCLUSION

Incadronate not only inhibits bone destruction but also reduces cartilage degeneration and joint inflammation in rats with established AIA. The mechanism underlying these antiinflammatory actions of incadronate may be attributable to the inhibition of macrophage migration to the site of inflammation. Bisphosphonates might be effective in preventing the progressive joint destruction and inflammation seen in patients with RA.

Trabecular bone structure of the calcaneus: preliminary in vivo MR imaging assessment in men with osteoporosis

PURPOSE

To use magnetic resonance (MR) imaging to evaluate potential differences in bone structure between men with and men without osteoporosis.

MATERIALS AND METHODS

Sagittal MR images of the calcaneus were obtained in 50 men (26 patients with osteoporosis and 24 age-matched healthy control subjects). Osteoporosis was defined as a low bone mineral density (at least 2.5 SDs below the normal value for young adults at either the lumbar spine or proximal femur) as measured with dual-energy x-ray absorptiometry. Seventeen patients had a history of osteoporotic fractures. For each participant, 10 consecutive sagittal three-dimensional gradient-echo MR sections were analyzed by using a rectangular region of interest. Twenty structural measurements were obtained from these images. Additionally, density measurements at the calcaneus were obtained in 46 participants. The significance of differences between the two groups was calculated by using the unpaired Student t test. The odds ratios for fracture per 1 SD decrease in the control group were calculated with logistic regression analysis. Adjustment for participant weight and height was performed if necessary.

RESULTS

Thirteen of 20 structural parameters, especially connectivity parameters, showed significant differences between control subjects and patients (P <.05). Differences between the two groups were more significant (P <.001) for apparent bone marrow skeleton length, apparent node count, apparent node-to-node strut count, and apparent terminus-to-terminus strut count. Odds ratios for 11 of 13 structural parameters but not for calcaneus density were significant (P <.05). After adjustment for calcaneus density, these parameters were still significant predictors of osteoporotic fracture.

CONCLUSION

Structural measurements derived from MR images of the calcaneus may be used in vivo to characterize trabecular bone architecture in men with osteoporosis.

Comparison of imaging-guided and non-imaging-guided quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur

OBJECTIVE

The purpose of our study was to evaluate the diagnostic agreement between imaging-guided and non-imaging-guided quantitative sonography of the calcaneus and dual X-ray absorptiometry of the spine and femur to show osteoporosis.

SUBJECTS AND METHODS

In 113 patients (73 women, 59 +/- 14 years old; 40 men, 48 +/- 16 years old), dual X-ray absorptiometry of the lumbar spine and the proximal femur, imaging-guided quantitative sonography, and non-imaging-guided quantitative sonography of the calcaneus were performed. The percentage of patients having a T-score equal to or less than a threshold of -2.5 SDs (prevalence of osteoporosis) was calculated for each imaging technique. The diagnostic agreement of the three techniques in identifying individuals with osteoporosis was assessed.

RESULTS

Eleven percent of the women and 8% of the men were classified as osteoporotic by imaging-guided quantitative sonography, and 38% of the women and 25% of the men were so classified by non-imaging-guided quantitative sonography. At dual X-ray absorptiometry of the spine, 44% of the women and 38% of the men were classified as osteoporotic, and, at different femoral regions, 19-60% of the women and 8-38% of the men were so classified. Kappa analysis for both quantitative sonography techniques was not significant. Kappa analysis for both quantitative sonography techniques and dual X-ray absorptiometry showed diagnostic agreement to be generally poor.

CONCLUSION

No advantage in diagnostic accuracy could be found for imaging-guided quantitative sonography. The considerable diagnostic disagreement between both quantitative sonography techniques and dual X-ray absorptiometry could be confusing in daily clinical practice.