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Critelli F, Agaoua M, Soares S. A Rare Case of a Medial Peritalar Dislocation on a Rock Climber. J Orthop Case Rep 2024; 14:24-29. [PMID: 39253664 PMCID: PMC11381074 DOI: 10.13107/jocr.2024.v14.i09.4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/17/2024] [Indexed: 09/11/2024] Open
Abstract
Introduction Peritalar dislocations are rare and account for only 1% of all traumatic foot injuries. The talonavicular and the subtalar joints are dislocated; the tibiotalar and calcaneocuboid joints remain intact. Associated injuries are not uncommon. Sports related peritalar dislocations have been reported. However, there are no cases reported on rock climbers. Case Report We report the case of a healthy 38-year-old patient, seen after a climbing accident against the wall. He presented a severe varus deformity of the hindfoot and an ankle hematoma and the talar head was palpable laterally against the skin. The radiological assessment showed a medial peritalar dislocation of the left foot. The dislocation was successfully closed reduced in the emergency room under sedation using axial traction and external translation maneuver. Non-operative treatment with cast immobilization and non-weight-bearing was performed for 6 weeks. At 6 months, the patient walked physiologically, without limping. He returned climbing and the subtalar joint did not show any stiffness. Conclusion An understanding of the mechanism of injury is necessary to attempt a closed reduction which should be performed as quickly as possible to avoid skin necrosis. An open reduction might be necessary. After reduction, a complete radiological assessment is necessary to exclude associated fractures. The direction of the dislocation, the energy of the accident, the timing of the reduction, as well as the joint's stability after reduction have a direct impact on the clinical and functional outcomes.
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Affiliation(s)
- Fernanda Critelli
- Department of Orthopaedics, Centre Hospitalier Bienne, Bienne, Switzerland
| | - Mohand Agaoua
- Department of Orthopaedics, Centre Hospitalier Bienne, Bienne, Switzerland
| | - Sérgio Soares
- Department of Orthopaedics, HFR Fribourg, Villars-sur-Glâne, Switzerland
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2
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Boden AL, Kaplan J, Aiyer A. Subtalar Osteochondral Lesions: Diagnosis, Indications, and Prognosis. Foot Ankle Clin 2024; 29:225-233. [PMID: 38679435 DOI: 10.1016/j.fcl.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Although most commonly found in the knee, elbow, and talar dome, osteochondral lesions can also be found in the subtalar joint and can occur due to either high or low energy trauma. Diagnosis of these lesions in the subtalar joint is typically confirmed with advanced imaging such as computerized tomography and MRI. Although there are a few published case reports, there is otherwise very limited literature on the prevalence, treatment options, prognosis, or outcomes for patients with osteochondral lesions of the subtalar joint, and thus further research is required in this area.
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Affiliation(s)
- Allison L Boden
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jonathan Kaplan
- Department of Orthopedic Surgery, Duke University, 1816 Hillandale Road, Durham, NC 27705, USA
| | - Amiethab Aiyer
- Department of Orthopedic Surgery, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21244, USA.
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3
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Kikuchi K, Nakano N, Ishida K, Kuroda Y, Hayashi S, Tsubosaka M, Kamenaga T, Matsushita T, Kuroda R, Matsumoto T. Influence of Distal Reference Point of the Tibial Mechanical Axis on the Ankle and Hindlimb Alignment Change after Total Knee Arthroplasty. J Knee Surg 2024; 37:409-415. [PMID: 37788675 DOI: 10.1055/s-0043-1774797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
The alignment philosophy in total knee arthroplasty (TKA) has tended to shift from the gold standard of mechanically aligned technique to personalized alignment, such as the kinematically aligned (KA) technique. However, the influences of different surgical techniques on lower limb alignment relative to the ground are not fully investigated. This study investigated the influence of the ankle and hindlimb alignment change after mechanically aligned TKA and KA-TKA. The varus osteoarthritic patients who underwent TKAs were divided into a mechanically aligned TKA group (group M, n = 50) and a KA-TKA group (group K, n = 50). Radiographic parameters (hip-knee-calcaneus [HKC] angle, hip-knee-ankle [HKA] angle, talar tilt angle [TTA], and tibiocalcaneal angle [TCA]) were investigated using full-length standing radiographs. The deviation angle (ΔTA; angle between the tibial mechanical axis [TMA] and the ground tibial mechanical axis [gTMA]) and the change of ΔTA (cΔTA) were also assessed. These parameters were compared between the two groups, along with the correlation between the preoperative HKA angle and other parameters. ΔTA, TTA, and TCA showed no differences between the groups pre- and postoperatively, and no significant changes were observed postoperatively. The preoperative HKA angle showed a significant negative correlation with cΔTA in both groups (group M: r = -0.33, p = 0.02; group K: r = -0.29, p = 0.04) although no correlation was observed the with preoperative TTA and TCA. Despite no change in ΔTA after surgery, the preoperative varus deformity was associated with a change in the deviation between gTMA and TMA after surgery. A severely varus knee may be inappropriate for ground KA-TKA.
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Affiliation(s)
- Kenichi Kikuchi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan
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Kyung MG, Hwang IU, Lee C, Park GY, Lee DY. Clinical outcomes following tibiotalocalcaneal arthrodesis with intramedullary nailing combined with partial fibulectomy and onlay bone graft. Arch Orthop Trauma Surg 2024; 144:567-574. [PMID: 37880455 DOI: 10.1007/s00402-023-05097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Although intramedullary nailing is a popular method for tibiotalocalcaneal arthrodesis, nonunion is one of the most commonly reported complications. This study aimed to evaluate the fusion rate, improvement in functional outcomes, and occurrence of complications in tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing with partial fibulectomy and onlay bone graft technique. MATERIALS AND METHODS Twenty-six consecutive patients using the proposed technique were retrospectively reviewed. For radiographic outcomes, the union rate, alignment, and any related complications were assessed. Functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society hindfoot scale, Foot and Ankle Outcome Score, and visual analog scale, preoperatively and at the final follow-up. RESULTS The mean follow-up period was 38.2 months. The tibiotalar joint achieved complete union in 80.8% at six months postoperatively, while all the cases achieved complete union at 12 months postoperatively. However, the subtalar joint achieved complete union in 26.9% at six months postoperatively, which gradually increased to 73.1% at 12 months postoperatively, and 80.8% at the final follow-up without revision surgery. A subgroup analysis showed there was a trend of higher subtalar fusion rate when an additional screw for the subtalar joint fixation was placed (86.7% vs. 54.5%). The functional outcomes significantly improved at the final follow-up. A few minor complications occurred, including surgical site infection, irritational symptoms, and metal failure; however, they eventually resolved. CONCLUSIONS Our technique of tibiotalocalcaneal arthrodesis with partial fibulectomy and onlay bone grafting could be a good option where both the tibiotalar and subtalar joints need to be fused.
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Affiliation(s)
- Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Il-Ung Hwang
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Changhyon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Gil Young Park
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Raes L, Peiffer M, Leenders T, Kvarda P, Ahn J, Audenaert E, Burssens A. Medializing Calcaneal Osteotomy for progressive collapsing foot deformity alters the three-dimensional subtalar joint alignment. Foot Ankle Surg 2024; 30:79-84. [PMID: 37802663 DOI: 10.1016/j.fas.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND A medializing calcaneal osteotomy (MCO) is considered as one of the key inframalleolar osteotomies to correct progressive collapsing foot deformity (PCFD). While many studies were able to determine the post-operative hind- and midfoot alignment, alternations of the subtalar joint alignment remained obscured by superposition on plain radiography. Therefore, we aimed to assess the hind-, midfoot- and subtalar joint alignment pre- compared to post-operatively using 3D weightbearing CT (WBCT) imaging. METHODS Seventeen patients with a mean age of 42 ± 17 years were retrospectively analyzed. Inclusion criteria consisted of PCFD deformity corrected by a medializing calcaneal osteotomy (MCO) as main procedure and imaged by WBCT before and after surgery. Exclusion criteria were patients who had concomitant calcaneal lengthening osteotomies, mid-/hindfoot fusions, hindfoot coalitions, and supramalleolar procedures. Image data were used to generate 3D models and compute the hindfoot (HA), midfoot (MA) - and subtalar joint (STJ) alignment in the coronal, sagittal and axial plane, as well as distance maps. RESULTS Pre-operative measurements of the HA and MA improved significantly relative to their post-operative equivalents p < 0.05). The post-operative STJ alignment showed significant inversion (2.8° ± 1.7), abduction (1.5° ± 1.8), and dorsiflexion (2.3° ± 1.7) of the talus relative to the calcaneus (p < 0.05) compared to the pre-operative alignment. The displacement between the talus and calcaneus relative to the sinus tarsi increased significantly (0.6 mm±0.5; p < 0.05). CONCLUSION This study detected significant changes in the sagittal, coronal, and axial plane alignment of the subtalar joint, which corresponded to a decompression of the sinus tarsi. These findings contribute to our clinical practice by demonstrating the magnitude of alteration in the subtalar joint alignment that can be expected after PCFD correction with MCO as main procedure.
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Affiliation(s)
- Loïc Raes
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, OVL, Belgium
| | - Matthias Peiffer
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, OVL, Belgium; Foot and Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, USA
| | - Tim Leenders
- Department of Orthopaedics, AZ Monica Hospital, Florent Pauwelslei 21, 2100 Deurne, Antwerp, Belgium
| | - Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Jiyong Ahn
- Foot and Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, USA; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Emmanuel Audenaert
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, OVL, Belgium
| | - Arne Burssens
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, OVL, Belgium.
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Deschamps K, Mercken K, Verschuren P, Eerdekens M, Vanstraelen E, Wuite S, Matricali GA. Foot biomechanics in patients with advanced subtalar- and mid-tarsal joint osteoarthritis and poorly responding to conservative treatment. J Foot Ankle Res 2023; 16:85. [PMID: 38017488 PMCID: PMC10683126 DOI: 10.1186/s13047-023-00689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
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.
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Affiliation(s)
- Kevin Deschamps
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Campus Brugge, Belgium.
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium.
| | | | | | - Maarten Eerdekens
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Eline Vanstraelen
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Wuite
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
- Institute for Orthopaedic Research & Training, University Hospitals Leuven, Leuven, Belgium
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Giovanni A Matricali
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
- Institute for Orthopaedic Research & Training, University Hospitals Leuven, Leuven, Belgium
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
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7
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Fernández-Marín MR, González-Martín D, Herrera-Pérez M, Paulano-Godino F, Vilá-Rico J, Tejero S. Increased subtalar rotational motion in patients with symptomatic ankle instability under load and stress conditions. Knee Surg Sports Traumatol Arthrosc 2023; 31:5214-5221. [PMID: 37770749 DOI: 10.1007/s00167-023-07553-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Differentiating subtalar and ankle instability in the clinical setting is challenging. This study aims to analyze the rotational laxity of the subtalar joint bilaterally in patients with asymptomatic and symptomatic ankle instability under simulated load and stress-induced position of the subtalar joint. METHODS A case-control study was conducted using an adjustable load device (ALD). Patients with chronic ankle instability and healthy volunteers were included. Each subject underwent a CT scan under mechanical stress and simulated weight-bearing conditions, maintaining maximum eversion and inversion hindfoot positions. The images were obtained in a single model, allowing calculations of the motion vector as well as the helical axis. The helical axis was defined by a rotation angle and a translation distance. RESULTS A total of 72 feet were included in the study. Thirty-one patients with unilateral symptoms and five healthy controls were selected, defining two groups: symptomatic (n = 31) and asymptomatic (n = 41). An absolute difference of 4.6º (95%CI 2-11.1) rotation angle was found on the helical axis of the symptomatic vs. asymptomatic group (p = 0.001). No significant differences were detected in the translation distance (n.s.) between the groups. Additionally, a significant positive correlation was found between the rotation angle and translation distance through the helical axis in the asymptomatic group (r = 0.397, p = 0.027). CONCLUSION Patients with chronic ankle instability suspected of having subtalar joint instability showed a wider subtalar range of laxity in terms of rotation about the helical axis. Furthermore, differences in kinematics between symptomatic and asymptomatic hindfeet was demonstrated when both feet were compared. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - David González-Martín
- Orthopedic Surgery and Traumatology Deparment, Origen, Grupo Recoletas, C. Paulina Harriet, 4-6, 47006, Valladolid, Spain.
- Universidad Europea Miguel de Cervantes, Valladolid, Spain.
| | - Mario Herrera-Pérez
- Universidad de La Laguna, La Laguna, Spain
- Foot and Ankle Unit, Orthopedic Surgery and Traumatology Department, Hospital Universitario de Canarias, La Laguna, Spain
| | | | - Jesús Vilá-Rico
- University Hospital 12 de Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Sergio Tejero
- Head Foot Ankle Unit, University Hospital Virgen del Rocío, Sevilla, Spain
- University of Sevilla, Sevilla, Spain
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Willegger M, Bouchard M, Schwarz GM, Hirtler L, Veljkovic A. The Evolution of Sinus Tarsi Syndrome-What Is the Underlying Pathology?-A Critical Review. J Clin Med 2023; 12:6878. [PMID: 37959343 PMCID: PMC10650822 DOI: 10.3390/jcm12216878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/29/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Background and Objectives: 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. Design: 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. Results: 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. Conclusions: 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.
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Affiliation(s)
- Madeleine Willegger
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC V6T 1Z4, Canada;
| | - Maryse Bouchard
- Department of Surgery, Division of Orthopaedics, University of Toronto, Hospital for Sick Children, Toronto, ON M5S 1A1, Canada;
| | - Gilbert M. Schwarz
- Department of Orthopedics and Trauma Surgery, Division of Orthopedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, Währinger Straße 13, 1090 Vienna, Austria
| | - Andrea Veljkovic
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC V6T 1Z4, Canada;
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Tejero S, Fernández-Marín R, González-Martín D, Vallejo-Márquez M, Paulano-Godino F, Herrera-Pérez M. Hindfoot motion through helical axis image-based on dynamic CT scan using an original simulated weightbearing device. Foot Ankle Surg 2023; 29:531-537. [PMID: 36792412 DOI: 10.1016/j.fas.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Determining the treatment of subtalar joint (STJ) instability requires a better understanding of the biomechanical principles underlying the condition and, a proper diagnosis. This study aimed to analyze "in vivo" the range of motion of the subtalar joint (STJ) measured on two (2D) and three dimensions (3D) image-based on CT Scan using an original device that maintains a simulated weightbearing. The secondary goal was to correlate the 2D and 3D measurement. METHODS An observational study was conducted, using an original Dynamic Simulated Weightbearing Device. Asymptomatic ankles were included. Each subject underwent a CT scan under mechanical stress and simulated weightbearing conditions, maintaining maximum eversion and inversion hindfoot positions. The images were obtained, combining both inversion and eversion positions in a single model, which allows for to calculation of the motion vector as well as the helical axis. The helical axis (rotation angle and translation distance), subtalar tilt, anterior drawer, and, subtalar and calcaneocuboid uncoverage were the determinations. RESULTS Forty asymptomatic ankles were included. The average range of motion of the STJ amounts to 31.5° ± 9.1° of rotation and 1.56 ± 0.8 mm of translation distance. The anterior drawer and subtalar uncoverage variables were statistically significantly related to each other (r = 0.57; P = 0.00001). However, these 2-D measured variables were not related to kinematic measures of rotation through the helical axis (3D) (p = 0.14; p = 0.19) CONCLUSIONS: The average range of motion of the STJ amounts to 31.5° ± 9.1° of rotation and 1.56 ± 0.8 mm of translation distance. We found no significant correlation between 2D and 3D measurements. In our opinion, the rotation angle and translation distance should be considered the most accurate measurements and should be calculated on every STJ instability for comparison with the asymptomatic population LEVEL OF EVIDENCE: Observational study. LEVEL OF EVIDENCE III
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Affiliation(s)
- Sergio Tejero
- Head of Foot and Ankle Unit, Orthopedic Surgery and Traumatology Deparment, Hospital Universitario Virgen del Rocío, Sevilla, Spain; University of Sevilla, Sevilla, Spain.
| | - Reyes Fernández-Marín
- Orthopedic Surgery and Traumatology Deparment, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - David González-Martín
- Orthopedic Surgery and Traumatology Deparment, Olympia, Quirón Salud, Madrid, Spain.
| | | | | | - Mario Herrera-Pérez
- School of Medicine (Health Sciences), Universidad de La Laguna, Spain; Foot and Ankle Unit, Orthopedic Surgery and Traumatology Department, Hospital Universitario de Canarias, Spain.
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10
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Cheruvu MS, Narayana Murthy S, Siddiqui RS. Subtalar dislocations: Mechanisms, clinical presentation and methods of reduction. World J Orthop 2023; 14:379-386. [PMID: 37377991 PMCID: PMC10292063 DOI: 10.5312/wjo.v14.i6.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/25/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023] Open
Abstract
Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly. Subtalar dislocations are high-mechanism injuries, which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints, without major fracture of the talus. They are usually classified as medial (most common), lateral, anterior and posterior dislocations, based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury. They are usually diagnosed by X rays, but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively. Majority being closed injuries, can be managed in ED by closed reduction and cast immobilisation, but if they are open, have poor outcomes. Complications that ensue open dislocations are post-traumatic arthritis, instability and avascular necrosis.
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Affiliation(s)
- Manikandar Srinivas Cheruvu
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
| | - Sanjay Narayana Murthy
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
| | - Raheel Shakoor Siddiqui
- Department of Orthopaedics, Birmingham Heartlands Hospital, Birmingham Birmingham Heartlands Hospital, United Kingdom
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11
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Kvarda P, Siegler L, Burssens A, Susdorf R, Ruiz R, Hintermann B. Effect of total ankle replacement on the 3-dimensional subtalar joint alignment in varus ankle osteoarthritis. Foot Ankle Surg 2023:S1268-7731(23)00103-0. [PMID: 37296030 DOI: 10.1016/j.fas.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Varus ankle osteoarthritis (OA) is typically associated with peritalar instability, which may result in altered subtalar joint position. This study aimed to determine the extent to which total ankle replacement (TAR) in varus ankle OA can restore the subtalar alignment. METHODS Fourteen patients (15 ankles, mean age 61 ± 6 years) who underwent TAR for varus ankle OA were analyzed using semi-automated measurements based on weight-bearing computed tomography. Twenty healthy individuals served as a control group. RESULTS All angles improved between preoperative and a minimum of 1 year (mean 2.1 years) postoperative and were statistically significant in 6 out of 8 angles (P < 0.05). CONCLUSIONS Our findings indicate that talus repositioning after TAR restores the subtalar joint alignment which may improve hindfoot biomechanics. Future studies are required to implement these findings for TAR in presence of hindfoot deformity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland.
| | - Lena Siegler
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Arne Burssens
- Department of Orthopaedics, University of Gent, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
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12
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Bell KL, King BW, Sangeorzan BJ. Acute and Chronic Subtalar Joint Instability: Does It Really Exist? Foot Ankle Clin 2023; 28:427-444. [PMID: 37137632 DOI: 10.1016/j.fcl.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute and chronic subtalar instability and commonly coexistent with other hindfoot pathology but can be difficult to diagnose. A high degree of clinical suspicion is required as most imaging modalities and clinical maneuvers are poor at detecting isolated subtalar instability. The initial treatment is similar to ankle instability, and a wide variety of operative interventions have been presented in the literature for persistent instability. Outcomes are variable and limited.
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Affiliation(s)
- Kerri Lynne Bell
- Orthopaedic Surgery, Henry Ford Health, 2799 West Grand Boulevard K12, Detroit, MI 48202, USA
| | - Brandon William King
- Orthopaedic Surgery, Henry Ford Health, 2799 West Grand Boulevard K12, Detroit, MI 48202, USA.
| | - Bruce J Sangeorzan
- Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
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13
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Abstract
Advancements in volumetric imaging makes it possible to generate high-resolution three-dimensional reconstructions of bones in throughout the foot and ankle. The use of weightbearing computed tomography allows for the analysis of joint relationships in a consistent natural position that can be used for statistical shape modeling. Using statistical shape modeling, a population-based statistical model is created that can be used to compare mean bone shape morphology and identify anatomical modes of variation. A review is presented to highlight the current work using statistical shape modeling in the foot and ankle with a future view of the impact on clinical care.
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14
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Liu M, Kang N, Wang D, Mei D, Wen E, Qian J, Chen G. Analysis of Lower Extremity Motor Capacity and Foot Plantar Pressure in Overweight and Obese Elderly Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3112. [PMID: 36833807 PMCID: PMC9965343 DOI: 10.3390/ijerph20043112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Overweight, obesity and falls are major public health problems and old people are the biggest group suffering falls. METHODS 92 females were divided into the overweight or obesity (O) group (68.85 ± 3.85) and regular-weight (R) group (67.90 ± 4.02). Lower extremity motor capacity and plantar pressure were compared between the two groups. The IRB approval number is 20190804. RESULTS (1) Functional Movement Screen and Fugl-Meyer Assessment scores in the O group were significantly lower than in the R group. The time to complete the Timed Up and Go test in the O group was significantly longer than in the R group. (2) Foot flat phase, double support distance, and left foot axis angle in the O group were significantly higher than in the R group. Distance and velocity, left-foot minimum subtalar joint angle and right-foot maximum subtalar joint angle in the O group were significantly shorter than in the R group. (3) Peak force, average force and pressure of metatarsal 1-4, mid-foot, heel medial and lateral, peak pressure of metatarsal l, midfoot, heel medial and lateral in the O group were significantly higher than in the R group. (p < 0.05). CONCLUSIONS Overweight and obese elderly women have a lower sensorimotor function, flexibility and stability in functional movements, but higher loads on the foot.
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Affiliation(s)
- Min Liu
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Ning Kang
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Dongmin Wang
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Donghui Mei
- College of Psychology, Capital Normal University, Beijing 100048, China
| | - Erya Wen
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Junwei Qian
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Gong Chen
- Institute of Population Research, Peking University, Beijing 100871, China
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15
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 2: Treatment Options. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127013. [PMID: 36262470 PMCID: PMC9575443 DOI: 10.1177/24730114221127013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED This second of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey current treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 10, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Topics were chosen by meeting organizers, who then identified and invited the expert speakers. Part 2 overviews the current treatment options, including orthotics, non-joint destructive procedures, as well as arthroscopies and arthroplasties in ankles and feet. Opportunities for future research are also discussed, such as developments in surgical options for ankle and the first metatarsophalangeal joint. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the importance to patients of addressing the foot and ankle with improved basic, translational, and clinical research. LEVEL OF EVIDENCE Level V, review article/expert opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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16
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A prospective comparative study between percutaneous cannulated screws and Kirschner wires in treatment of displaced intra-articular calcaneal fractures. INTERNATIONAL ORTHOPAEDICS 2022; 46:2667-2683. [PMID: 35960344 PMCID: PMC9556432 DOI: 10.1007/s00264-022-05521-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 10/26/2022]
Abstract
Abstract
Purpose
Several minimally invasive procedures were used to treat displaced intra-articular calcaneal fractures (DIACFs). No agreement among different authors about either the ideal fixation method or which technique is minimally invasive. The aim of this study was to compare functional and radiographic outcomes of two minimally invasive techniques in treatment of Sanders type II and III DIACFs by using K-wires or cannulated screws without bone grafts.
Methods
A prospective randomized controlled study was conducted on 28 patients (34 feet) with Sanders type II or III DIACFs, treated by closed reduction and fixation using cannulated screws or K-wires, at the Orthopedics Department of Sohag University Hospital, between April 2020 and February 2022. Functional assessment was done by American Orthopedic Foot and Ankle Society (AOFAS) score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s, and posterior facet inclination angles) and three calcaneal distances (height, length, and width of the calcaneus).
Results
Mean ages of patients at the time of operation were 34.8 years for the cannulated screw group and 36.6 years for the K-wire group. A vast majority of patients were males (78.6%). Involvement of the right side in the cannulated screw group was 57.1% and that in the K-wire group was 47.9%. Mean operative time was significantly shorter among the K-wire group (42 min) compared to the cannulated screw group (57 min). Mean AOFAS score was higher among the cannulated screw group (85.9 points) compared to the K-wire group (75.8 points). Final VAS was significantly better among the cannulated screw group compared to the K-wire group. Mean time of radiographic union in the cannulated screw group was 8.9 weeks and that in the K-wire group was 10.1 weeks.
Conclusion
Both techniques avoided wound complications associated with ORIF with the advantage of a shorter hospital stay. Patients in the cannulated screw group had better functional and radiographic outcomes and a lower rate of subtalar arthritis than patients in the K-wire group. K-wires had advantages of reduced operative time, and easy removal as an outpatient procedure.
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17
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Kanemitsu M, Nakasa T, Ikuta Y, Ota Y, Sumii J, Nekomoto A, Sakurai S, Adachi N. Characteristic Bone Morphology Change of the Subtalar Joint in Severe Varus Ankle Osteoarthritis. J Foot Ankle Surg 2022; 61:627-632. [PMID: 34823970 DOI: 10.1053/j.jfas.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 02/10/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
The subtalar joint has a possible compensatory mechanism for supramalleolar deformities; the failure of this mechanism causes the progression of ankle osteoarthritis. However, the reason for this failure has not been fully elucidated. This study aimed to evaluate the characteristics of the morphologic changes in the subtalar joint in varus ankle osteoarthritis using computed tomography. The study included 30 patients with severe osteoarthritis (modified Kellgren-Lawrence classification grade ≥ 3; mean age: 68.5 years) and 30 patients without- or with early osteoarthritis (grade 0-1; mean age: 43.0 years) as the control group. The location of cysts, osteophyte formation in the subtalar joint, and thickness of the subchondral bone plate were evaluated. In the osteoarthritis group, cyst formation was observed on the posterolateral side of the posterior facet of the calcaneus in 6 cases (20%) and of the talus in 7 cases (23.3%). Osteophyte formation was observed in the talus in 21 cases (70.0%) and in the calcaneus in 29 cases (96.6%). Osteophyte formation was observed on the posterior or lateral side of the posterior facet, and osteophyte contact between the talus and calcaneus was observed. The subchondral bone plate of the posterior medial side of the posterior facet of the talus was significantly thicker in the osteoarthritis group. The subtalar joint is less affected in severe varus ankle osteoarthritis containing a thickened subchondral bone plate in the posteromedial aspect of the posterior talar facet.
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Affiliation(s)
- Munekazu Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan.
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan; Medical Center for Translation and Clinical Research, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Satoru Sakurai
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
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18
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Agudelo-Varela Ó, Vargas-Riaño J, Valera Á. Turmell-Meter: A Device for Estimating the Subtalar and Talocrural Axes of the Human Ankle Joint by Applying the Product of Exponentials Formula. Bioengineering (Basel) 2022; 9:199. [PMID: 35621477 PMCID: PMC9137974 DOI: 10.3390/bioengineering9050199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
The human ankle is a complex joint, most commonly represented as the talocrural and subtalar axes. It is troublesome to take in vivo measurements of the ankle joint. There are no instruments for patients lying on flat surfaces; employed in outdoor or remote sites. We have developed a "Turmell-meter" to address these issues. It started with the study of ankle anatomy and anthropometry. We also use the product of exponentials' formula to visualize the movements. We built a prototype using human proportions and statistics. For pose estimation, we used a trilateration method by applying tetrahedral geometry. We computed the axis direction by fitting circles in 3D, plotting the manifold and chart as an ankle joint model. We presented the results of simulations, a prototype comprising 45 parts, specifically designed draw-wire sensors, and electronics. Finally, we tested the device by capturing positions and fitting them into the bi-axial ankle model as a Riemannian manifold. The Turmell-meter is a hardware platform for human ankle joint axes estimation. The measurement accuracy and precision depend on the sensor quality; we address this issue by designing an electronics capture circuit, measuring the real measurement with a Vernier caliper. Then, we adjust the analog voltages and filter the 10-bit digital value. The Technology Readiness Level is 2. The proposed ankle joint model has the properties of a chart in a geometric manifold, and we provided the details.
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Affiliation(s)
- Óscar Agudelo-Varela
- Facultad de Ciencias Básicas e Ingeniería, Universidad de los Llanos, Villavicencio 500002, Colombia;
| | - Julio Vargas-Riaño
- Instituto Universitario de Automática e Informática Industrial (Instituto ai2), Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Ángel Valera
- Instituto Universitario de Automática e Informática Industrial (Instituto ai2), Universitat Politècnica de València, 46022 Valencia, Spain;
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19
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Burssens A, Krähenbühl N, Lenz AL, Howell K, Zhang C, Sripanich Y, Saltzman CL, Barg A. Interaction of loading and ligament injuries in subtalar joint instability quantified by 3D weightbearing computed tomography. J Orthop Res 2022; 40:933-944. [PMID: 34191355 DOI: 10.1002/jor.25126] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 02/04/2023]
Abstract
Despite decades of research since its first description, subtalar joint instability remains a diagnostic enigma within the concept of hindfoot instability. This could be attributed to current imaging techniques, which are impeded by two-dimensional measurements. Therefore, we used weightbearing computed tomography imaging to quantify three-dimensional displacement associated with subtalar joint instability. Three-dimensional models were generated in seven paired cadaver specimens to compute talocalcaneal displacement after different patterns of axial load (85 kg) combined with torque in internal and external rotation (10 Nm). Sequential imaging was repeated in the subtalar joint containing intact ligaments to determine reference displacement. Afterward, the interosseus talocalcaneal ligament (ITCL) or calcaneofibular ligament (CFL) was sectioned, then the ITCL with CFL and after the ITCL, CFL with the deltoid ligament (DL). The highest translation could be detected in the dorsal direction and the highest rotation occurred in the internal direction when external torque was applied to the foot without load. These displacements differed significantly from the condition containing intact ligaments, with a mean difference of 1.6 mm (95% CI, 1.3 to 1.9) for dorsal translation and a mean of 12.4° (95% CI, 10.1 to 14.8) for internal rotation. Clinical relevance: Our study provides a novel and noninvasive analysis to quantify subtalar joint instability based on three-dimensional WBCT imaging. This approach overcomes former studies using trans-osseous fixation to determine three-dimensional subtalar joint displacement and implements an imaging device and software modalities that are readily available. Based on our findings, we recommend applying torque in external rotation to the foot to optimize the detection of subtalar joint instability.
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Affiliation(s)
- Arne Burssens
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Nicola Krähenbühl
- Department of Orthopaedics, University Hospital Basel, Basel, Switzerland
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Kalebb Howell
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Chong Zhang
- Department of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Yantarat Sripanich
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Trauma Surgery, Orthopaedics, and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
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20
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Lu C, Fan Y, Yu G, Chen H, Sinclair J, Fan Y. Asymptomatic foot and ankle structural injuries: a 3D imaging and finite element analysis of elite fencers. BMC Sports Sci Med Rehabil 2022; 14:50. [PMID: 35346343 PMCID: PMC8962477 DOI: 10.1186/s13102-022-00444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Fencing is a highly asymmetrical combat sport, that imposes high mechanical demands over repeated exposures on the musculoskeletal structures, a primary cause of injuries in fencers. However, there are limited epidemiological studies on the structural injuries of the foot and ankle in fencers. This study aimed to investigate foot and ankle structural injuries, and explore how metatarsophalangeal joint structural changes may affect the mechanisms of foot and ankle injuries in asymptomatic fencers. METHODS 3D images of foot and ankle morphology using computed tomography were obtained from ten elite fencers. We then constructed finite element models of the first metatarsophalangeal joint in the foot of their trail legs. The validated models were used to simulate stress distribution changes from different ankle joint angles during lunging. RESULTS The findings showed that stress distribution changes at the medial and lateral sesamoid may have caused sesamoid fractures, and that habitual and concentrated stress on the metatarsal bones might have flattened the sesamoid groove. This process may damage the integrity of the first metatarsophalangeal joint, and consequently affect the efficiency of the windlass mechanism in fencers. During lunging, different ankle joint angles of the trail foot increased the total stress difference of the medial and lateral foot, and thus influenced the lunging quality and its stability. CONCLUSIONS Our findings revealed that the asymmetric nature of fencing might have caused asymptomatic foot and ankle structural injuries, and finite element analysis results indicated that this might increase the incidence of the serious injuries if unattended. Regular computed tomography examination should be introduced to monitor elite fencers' lower limb alterations, permitting unique angle adjustments in the trail foot without sacrificing technical or physiologic properties based on the exam results and reduce the lower limb injury risk.
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Affiliation(s)
- Congfei Lu
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China
| | - Yuxuan Fan
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China
| | - Genyu Yu
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China
| | - Hua Chen
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China
| | - Jonathan Sinclair
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport and Health Sciences, University of Central Lancashire, Lancashire, Preston, PR1 2HE, UK
| | - Yifang Fan
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China.
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21
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Rusu L, Marin MI, Geambesa MM, Rusu MR. Monitoring the Role of Physical Activity in Children with Flat Feet by Assessing Subtalar Flexibility and Plantar Arch Index. CHILDREN 2022; 9:children9030427. [PMID: 35327799 PMCID: PMC8947427 DOI: 10.3390/children9030427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 12/02/2022]
Abstract
Flat foot is a common pediatric foot deformity which involves subtalar flexibility; it can affect the plantar arch. This study analyzes the evolution of two parameters, i.e., plantar index arch and subtalar flexibility, before and after physiotherapy and orthoses interventions, and examines the correlation between these two parameters. Methods: The study included 30 participants (17 boys, 12 girls, average age 9.37 ± 1.42 years) with bilateral flat foot. We made two groups, each with 15 subjects. Assessments of the subtalar flexibility and plantar arch index used RSScan the platform, and were undertaken at two time points. Therapeutic interventions: Group 1—short foot exercises (SFE); Group 2—SFE and insoles. Statistical analyses included Student’s t-test, Cohen’s D coefficient, Pearson and Sperman correlation. Results: Group 1—subtalar flexibility decreased for the left and right feet by 28.6% and 15.9% respectively, indicating good evolution for the left foot. For both feet, a decrease of the plantar index arch was observed. Group 2—subtalar flexibility decreased for the right and left feet by 43.4% and 37.7% respectively, indicating a good evolution for the right foot. For both feet, a decrease of plantar index arch was observed. Between groups, subtalar flexibility evolved well for Group 2; this was attributed to mixt intervention, physical therapy and orthosis. For plantar arch index, differences were not significant between the two groups. We observed an inverse correlation between subtalar flexibility and plantar arch index. Conclusions: Improvement of plantar index arch in static and dynamic situations creates the premise of a good therapeutic intervention and increases foot balance and postural control. The parameter which showed the most beneficial influence was the evolution is subtalar flexibility.
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Affiliation(s)
- Ligia Rusu
- Sport Medicine and Physical Therapy Department, Faculty of Physical Education and Sport, University of Craiova, 200585 Craiova, Romania; (M.M.G.); (M.R.R.)
- Correspondence: ; Tel.: +40-723-867-738
| | - Mihnea Ion Marin
- Industrial Engineering Department, Faculty of Mechanics, University of Craiova, 200585 Craiova, Romania;
| | - Michi Mihail Geambesa
- Sport Medicine and Physical Therapy Department, Faculty of Physical Education and Sport, University of Craiova, 200585 Craiova, Romania; (M.M.G.); (M.R.R.)
| | - Mihai Robert Rusu
- Sport Medicine and Physical Therapy Department, Faculty of Physical Education and Sport, University of Craiova, 200585 Craiova, Romania; (M.M.G.); (M.R.R.)
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22
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Abstract
The standard for diagnostic radiographic imaging in foot and ankle surgery was until 2012 radiographs with full weight-bearing without any useful alternative. Weight-bearing cone-beam computed tomography (WBCT) was introduced 2012 for foot and ankle use as a new technology that allows 3D imaging with full weight-bearing which should be not influenced by projection and/or foot orientation. The assessment of ankle osteoarthritis with WBCT including the description of healthy status, effect of alignment and7or (in)stability is extensively illustrated in this review article.
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23
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Hernigou P, Safar A, Hernigou J, Ferre B. Subtalar axis determined by combining digital twins and artificial intelligence: influence of the orientation of this axis for hindfoot compensation of varus and valgus knees. INTERNATIONAL ORTHOPAEDICS 2022; 46:999-1007. [PMID: 35138455 DOI: 10.1007/s00264-022-05311-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Previous studies evaluating hindfoot and knee alignment have suggested compensation between the knee and the hindfoot deformities. However, these studies did not investigate the influence of the orientation of the subtalar axis on the results. MATERIAL AND METHODS Using computed tomography data of patients without osteoarthritis, digital twins, and artificial intelligence, we identified the orientation of the axis of the subtalar joint. Compensation was evaluated in the subtalar joint according to angular knee deformity and subtalar axis direction. RESULTS With the inclination angle defined as the angle between the axis and the XY plane (horizontal) and the deviation angle defined as the angle between the projection of axis on the XZ plane, the inclination angle of the subtalar helical axis showed an average angle of 35.3° (range 5° to 48°). The mean deviation angle for the helical axis was 6.4° (range - 4° to + 12°). Our findings indicated that an increase of the inclination angle of the subtalar axis tends to limit adjustment in the hindfoot alignment toward re-balance of the whole lower limb toward a neutral weight-bearing axis when malalignment of the knee occurs. CONCLUSION Malalignment of the knee and different compensations in the hindfoot contribute to various combined deformities in the population: associated valgus or varus deformities and inverse associations of varus/valgus deformities.
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Affiliation(s)
- Philippe Hernigou
- Orthopedic Department, Henri Mondor Hospital, University Paris East, Paris, France.
| | - Adonis Safar
- Orthopedic Department, EpiCURA Baudour Hornu Hospital, Mons, Belgium
| | - Jacques Hernigou
- Orthopedic Department, EpiCURA Baudour Hornu Hospital, Mons, Belgium
| | - Bruno Ferre
- Institut Monégasque de Médecine & Chirurgie Sportive, 98000, Monaco, Monaco
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24
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Peterson AC, Lisonbee RJ, Krähenbühl N, Saltzman CL, Barg A, Khan N, Elhabian SY, Lenz AL. Multi-level multi-domain statistical shape model of the subtalar, talonavicular, and calcaneocuboid joints. Front Bioeng Biotechnol 2022; 10:1056536. [PMID: 36545681 PMCID: PMC9760736 DOI: 10.3389/fbioe.2022.1056536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
Traditionally, two-dimensional conventional radiographs have been the primary tool to measure the complex morphology of the foot and ankle. However, the subtalar, talonavicular, and calcaneocuboid joints are challenging to assess due to their bone morphology and locations within the ankle. Weightbearing computed tomography is a novel high-resolution volumetric imaging mechanism that allows detailed generation of 3D bone reconstructions. This study aimed to develop a multi-domain statistical shape model to assess morphologic and alignment variation of the subtalar, talonavicular, and calcaneocuboid joints across an asymptomatic population and calculate 3D joint measurements in a consistent weightbearing position. Specific joint measurements included joint space distance, congruence, and coverage. Noteworthy anatomical variation predominantly included the talus and calcaneus, specifically an inverse relationship regarding talar dome heightening and calcaneal shortening. While there was minimal navicular and cuboid shape variation, there were alignment variations within these joints; the most notable is the rotational aspect about the anterior-posterior axis. This study also found that multi-domain modeling may be able to predict joint space distance measurements within a population. Additionally, variation across a population of these four bones may be driven far more by morphology than by alignment variation based on all three joint measurements. These data are beneficial in furthering our understanding of joint-level morphology and alignment variants to guide advancements in ankle joint pathological care and operative treatments.
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Affiliation(s)
- Andrew C. Peterson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
| | - Rich J. Lisonbee
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
| | | | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nawazish Khan
- School of Computing, College of Engineering, University of Utah, Salt Lake City, UT, United States
- Scientific Computing and Imaging Institute, College of Engineering, University of Utah, Salt Lake City, UT, United States
| | - Shireen Y. Elhabian
- School of Computing, College of Engineering, University of Utah, Salt Lake City, UT, United States
- Scientific Computing and Imaging Institute, College of Engineering, University of Utah, Salt Lake City, UT, United States
| | - Amy L. Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, United States
- Department of Mechanical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Amy L. Lenz,
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25
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Zhang L, Peng X, He S, Zhou X, Yi G, Tang X, Li B, Wang G, Zhao W, Yang Y. Association between subtalar articular surface typing and flat foot deformity: which type is more likely to cause flat foot deformity. BMC Musculoskelet Disord 2021; 22:979. [PMID: 34814890 PMCID: PMC8611995 DOI: 10.1186/s12891-021-04872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have shown a wide range of anatomical classifications of the subtalar joint (STJ) in the population and this is related to the different force line structures of the foot. Different subtalar articular surface morphology may affect the occurrence and development of flat foot deformity, and there are fewer studies in this area. The main objective of our study was to determine the association of different subtalar articular surface with the occurrence and severity of flat foot deformity. Methods We analyzed the imaging data of 289 cases of STJ. The articular surface area, Gissane’s angle and Bohler’s angle of subtalar articular surface of different types were counted. The occurrence and severity of flat foot deformity in different subtalar articular surface were judged by measuring the Meary angle of foot. Results We classified 289 cases of subtalar articular surface into five types according to the morphology. According to Meary angle, the flat foot deformity of Type I and Type IV are significantly severer than Type II (P < 0.05). Type II (7.65 ± 1.38 cm2) was significantly smaller than Type I (8.40 ± 1.79 cm2) in the total joint facet area(P < 0.05). Type III (9.15 ± 1.92 cm2) was smaller than Type I (8.40 ± 1.79 cm2), II (7.65 ± 1.38 cm2) and IV (7.81 ± 1.74 cm2) (P < 0.05). Type II (28.81 ± 7.44∘) was significantly smaller than Type I (30.80 ± 4.61 degrees), and IV (32.25 ± 5.02 degrees) in the Bohler’s angle (P < 0.05). Type II (128.49 ± 6.74 degrees) was smaller than Type I (131.58 ± 7.32 degrees), and IV (131.94 ± 5.80 degrees) in the Gissane’s angle (P < 0.05). Conclusions After being compared and analyzed the measurement of morphological parameters, joint facet area and fusion of subtalar articular surface were closely related to the severity of flat foot deformity and Type I and IV were more likely to develop severer flat foot deformity. Level of evidence Level III, retrospective comparative study.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Xiaoyao Peng
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Siyuan He
- School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Gang Yi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Xiaogao Tang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Bingkun Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.,Expert Workstation in Luzhou, Luzhou, 646000, China.,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China. .,Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China. .,Expert Workstation in Luzhou, Luzhou, 646000, China. .,Clinical Base of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, 646000, China.
| | - Wanxue Zhao
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Yuening Yang
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
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26
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Radiological assessments and clinical results of intra-articular osteotomy for traumatic osteoarthritis of the ankle. Injury 2021; 52:3516-3527. [PMID: 34462118 DOI: 10.1016/j.injury.2021.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traumatic osteoarthritis of the ankle joint caused after malleolar fractures of the ankle and tibial plafond fractures are frequently observed in comparatively young and highly active patients. Since the ankle movement in these patients is in general, comparatively favorable, orthopedists may sometimes have difficulty in deciding on a treatment policy. In our department, when treating traumatic osteoarthritis patients having a movable range within their ankle joints, we proactively applied distal tibial oblique osteotomy (DTOO) developed by Dr. Teramoto in 1994 or intra-articular osteotomy developed based on DTOO concepts such as distal tibial intra-articular osteotomy (DTIO) and distal fibular oblique osteotomy (DFOO).The objectives of the current study are to radiologically assess the ankle joint after intra-articular osteotomy for traumatic ankle osteoarthritis and evaluate the change in configuration of the ankle joint. This study summarizes the clinical results of intra-articular osteotomy obtained through the above-mentioned study. PATIENTS AND METHODS The subjects of this study were 20 patients diagnosed with traumatic osteoarthritis who were surgically treated for a total of 20 ankles. All patients underwent treatment with intra-articular osteotomy and were evaluated retrospectively for the following parameters: surgical procedure, fixation devices, clinical results based on the Japanese Society for Surgery of the Foot ankle/hindfoot scale (hereafter, JSSF scale) and post-operative adverse events. They were also assessed radiologically with pre- and post-operative anterior-posterior (AP) and lateral weight-bearing ankle radiographs. RESULTS The 20 patients consisted of 12 males and 8 females. The median age at surgery was 49 years old (range 14 - 87 years old) and the average follow-up period was 42 months (range 19 to 121 months). DTOO was applied to 10 cases, DFOO to 2 cases, DTOO and DFOO to 2 cases, medial-distal tibial intra-articular osteotomy (M-DTIO) and DFOO to 1 case, lateral-distal tibial intra-articular osteotomy (L-DTIO) and DFOO to 3 cases, M-DTIO followed by DTOO and DFOO to 1 case, and DTOO followed by low tibial osteotomy (LTO) to 1 case. Fixation devices utilized included circular external fixator for 15 cases, locking compression plate (LCP) to 3 cases, LCP and Kirschner-wire (K-wire) to 1 case, and screw and K-wire to 1 case. Radiological assessment revealed significant changes in the following parameters after surgery: tibial ankle surface angle (TAS, P= 0.0203), tibiotalar surface angle (TTS, P= 0.0021), medial malleolar angle (MMA, P= 0.0217), empirical axis (EA, P= 0.0019), fibular angle (FA, P= 0.0002), talar tilt angle (TTA, P= 0.0374), and tibial lateral surface angle (TLS, P= 0.0279). The JSSF scale also improved significantly after surgery (pre-operative JSSF scale: 51.1±11.0, post-operative JSSF scale: 89.2±8.2), p=0.0001. CONCLUSION Intra-articular osteotomy may change the radiological configuration of the ankle in a weight-bearing state. The present study showed very good short-term clinical results. Intra-articular osteotomy can prove a viable surgical option applicable for treatment of patients with traumatic ankle osteoarthritis having a reasonable range of motion within their ankle joints.
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27
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Wolfe JR, McKee TD, Nicholes M. Use of Calcaneal Osteotomies in the Correction of Inframalleolar Cavovarus Deformity. Clin Podiatr Med Surg 2021; 38:379-389. [PMID: 34053650 DOI: 10.1016/j.cpm.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cavovarus deformity is a complicated condition most commonly resulting from neurologic, posttraumatic, or iatrogenic pathologic conditions. Careful evaluation of the cavovarus patient is necessary in determining appropriate treatment course. Weight-bearing radiographs are necessary, and advances in computed tomographic technology can be beneficial in identifying level of involvement. In the case of operative treatment of inframalleolar deformity, assessment of the subtalar joint position and relation of calcaneocuboid joint can be of assistance. Multiple osteotomies have been described providing uniplanar, biplanar, and triplanar correction and in the appropriate setting can prove beneficial to the surgeon in treating hind-foot cavovarus deformity.
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Affiliation(s)
- Jesse R Wolfe
- Northwest Iowa Bone, Joint, & Sports Surgeons, 1200 1st Avenue E, Suite C, Spencer, IA 51301, USA.
| | - Tyler D McKee
- American Health Network Foot & Ankle Reconstructive Surgery Fellowship, 12188B North Meridian Street, Suite #330, Carmel, IN 46032, USA
| | - Melinda Nicholes
- SSM Health DePaul Hospital Foot and Ankle Surgery Residency, St Louis, MO, USA; SSM Health DePaul Hospital, 12303 DePaul Drive, Bridgeton, MO 63044, USA
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28
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Abstract
Undiagnosed medial ankle instability can be a prerequisite for pathogenic progression in the foot, particularly for adult acquired flatfoot deformity. With the complex anatomy in this region, and the limitations of each individual investigational method, accurately identifying peritalar instability remains a serious challenge to clinicians. Performing a thorough clinical examination aided by evaluation with advanced imaging can improve the threshold of detection for this condition and allow early proper treatment to prevent further manifestations of the instability.
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Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Martinistr. 52, Hamburg 20246, Germany.
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29
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Kim BH, Lee SY. Validity and Reliability of a Novel Instrument for the Measurement of Subtalar Joint Axis of Rotation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105494. [PMID: 34065532 PMCID: PMC8160632 DOI: 10.3390/ijerph18105494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Inclination of the subtalar joint (STJ) in the sagittal and transverse planes may be highly associated with ankle pathology. However, the validity and reliability of measuring the inclination of the STJ axis of rotation (AoR) is not well established. This study aimed to develop a custom-made STJ locator (STJL) and evaluate its reliability and validity. To establish the reliability and validity of the measurement device for STJ AoR, 38 healthy male participants were recruited. For the reliability analysis, test–retest was used, and for validity analysis, Pearson’s correlation and Bland–Altman plot analyses were performed. In the reliability analysis of the STJL, a higher correlation was observed with the sagittal plane (0.930) and transverse plane (0.748) (standard error of measurement: 0.56–0.78; minimal detectable difference: 1.57–2.16). In the validity analysis between radiography and STJL, a significantly higher value of 0.798 was obtained with radiography (42.5) and STJL (43.5) with the sagittal plane. The custom-made STJL may be used in the clinical setting as its validity and intraclass correlation coefficient were high, indicating consistent measurements. Further studies including motion analysis are necessary to provide more information regarding the relationship between STJ AoR inclinations and STJ movements.
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Affiliation(s)
- Byong Hun Kim
- Department of Physical Education, Yonsei University, Seoul 03722, Korea;
- International Olympic Committee Research Centre Korea, Yonsei University, Seoul 03722, Korea
| | - Sae Yong Lee
- Department of Physical Education, Yonsei University, Seoul 03722, Korea;
- International Olympic Committee Research Centre Korea, Yonsei University, Seoul 03722, Korea
- Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2123-6189; Fax: +82-2-2123-8375
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30
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Lenz AL, Krähenbühl N, Peterson AC, Lisonbee RJ, Hintermann B, Saltzman CL, Barg A, Anderson AE. Statistical shape modeling of the talocrural joint using a hybrid multi-articulation joint approach. Sci Rep 2021; 11:7314. [PMID: 33795729 PMCID: PMC8016855 DOI: 10.1038/s41598-021-86567-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/15/2021] [Indexed: 01/16/2023] Open
Abstract
Historically, conventional radiographs have been the primary tool to morphometrically evaluate the talocrural joint, which is comprised of the distal tibia, distal fibula, and proximal talus. More recently, high-resolution volumetric imaging, including computed tomography (CT), has enabled the generation of three-dimensional (3D) reconstructions of the talocrural joint. Weightbearing cone-beam CT (WBCT) technology provides additional benefit to assess 3D spatial relationships and joint congruency while the patient is load bearing. In this study we applied statistical shape modeling, a computational morphometrics technique, to objectively quantify anatomical variation, joint level coverage, joint space distance, and congruency at the talocrural joint. Shape models were developed from segmented WBCT images and included the distal tibia, distal fibula, and full talus. Key anatomical variation across subjects included the fibular notch on the tibia, talar trochlea sagittal plane rate of curvature, tibial plafond curvature with medial malleolus prominence, and changes in the fibular shaft diameter. The shape analysis also revealed a highly congruent talocrural joint with minimal inter-individual morphometric differences at the articular regions. These data are helpful to improve understanding of ankle joint pathologies and to guide refinement of operative treatments.
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Affiliation(s)
- Amy L Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, 84108, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, Kantonsspital Baselland, 4410, Liestal, Switzerland
| | - Andrew C Peterson
- Department of Orthopaedics, University of Utah, Salt Lake City, 84108, USA
| | - Rich J Lisonbee
- Department of Orthopaedics, University of Utah, Salt Lake City, 84108, USA
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, 4410, Liestal, Switzerland
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, Salt Lake City, 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, 84108, USA.,Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, 84108, USA.
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31
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Weight-bearing CT in foot and ankle pathology. Orthop Traumatol Surg Res 2021; 107:102772. [PMID: 33321232 DOI: 10.1016/j.otsr.2020.102772] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 02/09/2023]
Abstract
Cone-beam scanners (CBCT) enable CT to be performed under weight-bearing - notably for the foot and ankle. The technology is not new: it has been used since 1996 in dental surgery, where it has come to replace panoramic X-ray. What is new is placing the scanner on the ground, so as to have 3D weight-bearing images, initially of the foot and ankle, and later for the knee and pelvis. This saves time, radiation and money. It is now increasingly used, but is unfortunately limited by not having specific national health insurance cover in France, and by the psychological reticence that goes with any technological breakthrough. A review of the topic is indispensable, as it is essential to become properly acquainted with this technique. To this end, we shall be addressing 5 questions. What biases does conventional radiography incur? Projecting a volume onto a plane incurs deformation, precluding true measurement. Conventional CT is therefore often associated with an increased dose of radiation. What is the impact of CBCT on radiation dose, costs and the care pathway? The conical beam turns around the limb (under weight-bearing if so desired) in less than a minute, making the radiation dose no greater than in standard X-ray. What does the literature have to say about CBCT, and what are the indications? CBCT is indicated in all foot and ankle pathologies, and indications now extend to the upper limb and the knee, and will soon include the pelvis. How are angles measured on this 3D technique? The recently developed concept of 3D biometry uses dedicated software to identify anatomic landmarks and automatically segment the bones, thereby enabling every kind of measurement. What further developments are to be expected? CBCT may become indispensable to lower-limb surgical planning. Artificial Intelligence will reveal novel diagnostic, prognostic and therapeutic solutions. LEVEL OF EVIDENCE: V; expert opinion.
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32
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Kvarda P, Heisler L, Krähenbühl N, Steiner CS, Ruiz R, Susdorf R, Sripanich Y, Barg A, Hintermann B. 3D Assessment in Posttraumatic Ankle Osteoarthritis. Foot Ankle Int 2021; 42:200-214. [PMID: 33073607 DOI: 10.1177/1071100720961315] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Auto-generated 3-dimensional (3D) measurements based on weightbearing cone-beam computed tomography (CT) scan technology may allow for a more accurate hind- and midfoot assessment. The current study evaluated the reliability and clinical relevance of such measurements in patients with posttraumatic end-stage ankle osteoarthritis. METHODS Seventy-two patients treated at our institution for posttraumatic end-stage ankle osteoarthritis, with available weightbearing conventional radiographs and a cone-beam CT scan, were analyzed. Twenty healthy individuals aged between 40 and 70 years served as controls. Seven variables were measured on weightbearing conventional radiographs (2D) and compared to 3D measurements that were based on reconstructions from weightbearing cone-beam CT scans. The reliability of each measurement was calculated and subgroups formed according to commonly observed deformities. RESULTS Inter- and intraobserver reliability was superior for 3D compared to 2D measurements. The accuracy of 3D measurements performed on osteoarthritic ankles was similar to 3D measurements performed on healthy individuals. Thirty-three of the 72 included patients (46%) evidenced an inframalleolar compensation of a supramalleolar/intra-articular ankle deformity (78% = varus compensation; 22% = valgus compensation), whereas 24 of those 72 patients (33%) showed no compensation or a further increase of a supramalleolar/intra-articular ankle deformity (67% = varus deformity; 33% = valgus deformity). CONCLUSION Auto-generated 3D measurements of the hind- and midfoot were found to be reliable in both healthy individuals and patients with posttraumatic end-stage ankle osteoarthritis. Such measurements may be crucial for a detailed understanding of the location and extent of hindfoot deformities, possibly impacting decision making in the treatment of end-stage ankle osteoarthritis. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Lukas Heisler
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Yantarat Sripanich
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Alexej Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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33
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Liu C, Zhu JX, Hu YL, Jiao C, Guo QW, Ao YF. Secondary Effects of the Rupture and Reconstruction of the Interosseous Talocalcaneal Ligament on the Peritalar Joints. Med Sci Monit 2021; 27:e925292. [PMID: 33402662 PMCID: PMC7798367 DOI: 10.12659/msm.925292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The interosseous talocalcaneal ligament (ITCL) is the main soft-tissue contributor to subtalar joint stability. The role of ITCL reconstruction in retaining this stability is minimally reported. Therefore, we conducted this study to investigate the effects of rupture and reconstruction of the ITCL on the subtalar and peritalar joints. Material/Methods This experimental study randomly divided 72 rabbits into 3 equal groups of 24 rabbits each. Group I underwent reconstruction surgery, group II underwent resection, and group III was the control group. The cartilages between the talocrural and calcaneocrural joints, and between the subtalar and talonavicular joints on both sides were assessed by gross observation, ink staining, histology, and immunohistochemistry at weeks 4, 8, 16, and 32, postoperatively. Results In group II, the quantitative ink staining analysis revealed degeneration of the articular cartilages on the talonavicular joint (T=2.070, P=0.038) and the posterior subtalar joint (T=2.121, P=0.034) compared with the 2 sides of the same rabbit at 4 and 8 postoperative weeks. Comparing the operated sides of all the groups showed the posterior subtalar joints (Hc=9.563, P=0.008) and talonavicular joints (Hc=9.714, P=0.008) had an obvious difference at postoperative week 4; and in the calcaneocrural joints (Hc=6.750, P=0.034), it was noticed at postoperative week 8. Histology and immunohistochemistry findings confirm these observations. Conclusions An ITCL resection can lead to the progressive degeneration of the talonavicular and posterior subtalar joints, while an ITCL reconstruction can be beneficial in restoring the stability of these joints, preventing or postponing their degeneration, and protecting the articular cartilages.
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Affiliation(s)
- Chen Liu
- Department of Orthopaedics, Peking University International Hospital, Beijing, China (mainland)
| | - Jing-Xian Zhu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China (mainland)
| | - Yue-Lin Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China (mainland)
| | - Chen Jiao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China (mainland)
| | - Qin-Wei Guo
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China (mainland)
| | - Ying-Fang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China (mainland)
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Deleu PA, Naaim A, Chèze L, Dumas R, Devos Bevernage B, Goubau L, Besse JL, Leemrijse T. The effect of ankle and hindfoot malalignment on foot mechanics in patients suffering from post-traumatic ankle osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 81:105239. [PMID: 33246795 DOI: 10.1016/j.clinbiomech.2020.105239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle and hindfoot malalignment is a common finding in patients suffering from post-traumatic ankle osteoarthritis. However, no studies have addressed the effect of concomitant foot deformities on intrinsic foot kinematics and kinetics. Therefore, the objective of this study was to investigate the effect of ankle and hindfoot malalignment on the kinematics and kinetics of multiple joints in the foot and ankle complex in patients suffering from post-traumatic ankle osteoarthritis. METHODS Twenty-nine subjects with post-traumatic ankle osteoarthritis participated in this study. Standardized weight-bearing radiographs were obtained preoperatively to categorize patients as having cavus, planus or neutral ankle and hindfoot alignment, based on 4 X-ray measurements. All patients underwent standard gait assessment. A 4-segment foot model was used to estimate intrinsic foot joint kinematics and kinetics during gait. Statistical parametric mapping was used to compare foot kinematics and kinetics between groups. FINDINGS There were 3 key findings regarding overall foot function in the 3 groups of post-traumatic ankle osteoarthritis: (i) altered frontal and transverse plane inter-segmental angles and moments of the Shank-Calcaneus and Calcaneus-Midfoot joints in the cavus compared to the planus group; (ii) in cavus OA group, Midfoot-Metatarsus joint abduction sought to compensate the varus inclination of the ankle joint; (iii) there were no significant differences in inter-segmental angles and moments between the planus and neutral OA groups. INTERPRETATION Future studies should integrate assessment of concomitant foot and ankle deformities in post-traumatic ankle osteoarthritis, to provide additional insight into associated mechanical deficits and compensation mechanisms during gait.
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Affiliation(s)
- P-A Deleu
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France; Foot & Ankle Institute, Brussels, Belgium.
| | - A Naaim
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | - L Chèze
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | - R Dumas
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | | | - L Goubau
- Foot & Ankle Institute, Brussels, Belgium
| | - J-L Besse
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, France
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Graef F, Falk R, Tsitsilonis S, Perka C, Zahn RK, Hommel H. Correction of excessive intraarticular varus deformities in total knee arthroplasty is associated with deteriorated postoperative ankle function. Knee Surg Sports Traumatol Arthrosc 2020; 28:3758-3765. [PMID: 31776626 DOI: 10.1007/s00167-019-05812-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to demonstrate, whether the degree of limb alignment correction in varus knee osteoarthritis correlated with an increase in ankle symptoms and to define a cut-off value concerning the degree of correction above which to expect ankle problems. METHODS Ninety-nine consecutive patients with preoperative intraarticular varus knee deformities who underwent total knee arthroplasty were retrospectively analyzed. Patients were examined clinically (Knee Society Score, Forgotten Joint Score, Foot Function Index, Range of Motion of the knee and ankle joint, pain scales) as well as radiologically. The mean follow-up time was 57 months. RESULTS The degree of operative limb alignment correction strongly correlated with the Foot Function Index (R = 0.91, p < 0.05). Given this, higher degrees of knee malalignment corrections were associated with worse postoperative outcomes in the knee and ankle joint-despite postoperative improved joint line orientations. Subsequently, a cut-off value for arthritic varus deformities (14.5°) could be calculated, above which the prevalence of ankle symptoms increased manifold [OR = 15.6 (3.2-77.2 95% CI p < 0.05)]. Furthermore, ROM restrictions in the subtalar joint were associated with a worse outcome in the ankle joint. CONCLUSIONS When correcting excessive intraarticular varus knee osteoarthritis, surgeons have to be aware of possible postoperative ankle symptoms and should consider ankle deformities or decreased subtalar ROM before operative procedures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Frank Graef
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - R Falk
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
| | - S Tsitsilonis
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - C Perka
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - R K Zahn
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - H Hommel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
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Krahenbuhl N, Lenz AL, Lisonbee R, Peterson AC, Atkins PR, Hintermann B, Saltzman CL, Anderson AE, Barg A. Morphologic analysis of the subtalar joint using statistical shape modeling. J Orthop Res 2020; 38:2625-2633. [PMID: 32816337 PMCID: PMC8713294 DOI: 10.1002/jor.24831] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
Weightbearing computed tomography (WBCT) enables visualization of the foot and ankle as patients stand under load. Clinical measurements of WBCT images are generally limited to two-dimensions, which reduces the ability to quantify complex morphology of individual osseous structures as well as the alignment between two or more bones. The shape and orientation of the healthy/normal subtalar joint, in particular, is not well-understood, which makes it very difficult to diagnose subtalar pathoanatomy. Herein, we employed statistical shape modeling to evaluate three-dimensional (3D) shape variation, coverage, space, and congruency of the subtalar joint using WBCT data of 27 asymptomatic healthy individuals. The four most relevant findings were: (A) talar and calcaneal anatomical differences were found regarding the presence of (a) the talar posterior process, (b) calcaneal pitch, and (c) curvature of the calcaneal posterior facet; (B) the talar posterior facet articular surface area was significantly greater than the calcaneal posterior facet articular surface area; (C) the posterior facet varied in joint space distance, whereas the anteromedial facet was even; and (D) the posterior and anteromedial facet of the subtalar joint was consistently congruent. Despite considerable shape variation across the population, the posterior and anteromedial articular facets of the subtalar joint were consistently congruent. Results provide a detailed 3D analysis of the subtalar joint under a weightbearing condition in a healthy population which can be used for comparisons to pathological patient populations. The described SSM approach also shows promise for clinical evaluation of the subtalar joint from 3D surface reconstructions of WBCT images.
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Affiliation(s)
| | | | - Rich Lisonbee
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew C. Peterson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R. Atkins
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
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Mansur H, Rocha FA, Sousa PGTDE, Castro IMDE. RELATIONSHIP BETWEEN THE KNEE AND HINDFOOT AXES IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:229-232. [PMID: 33144837 PMCID: PMC7580291 DOI: 10.1590/1413-785220202805231351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the correlation between knee axis and hindfoot axis in patients with advanced gonarthrosis, and the association between ankle function and angular deformities. METHODS 72 patients were enrolled in the study: 66% were women, and mean age was 58.7 years. The anatomical axis of the knee and hindfoot were measured by short knee radiographs and long axial view of the hindfoot. RESULTS Among the study group, 79.2% presented varus knee (mean 15º ± 7.69º) and 20.8% valgus (mean 15.9º ± 7.7º). 63.9% had hindfoot varus (mean 8.5º ± 6.07º) and 36.1% valgus (mean 3.9º ± 3.92º) (p < 0.05). The mean value for the American Orthopaedic Foot and Ankle Society (AOFAS) score was 74.26 points, and values were significantly higher among patients with hindfoot varus (p < 0.05). We found no correlation between gender or AOFAS score and knee and hindfoot axes, nor between deformities in the knee and hindfoot axes (p > 0.05). The subgroup genu valgum - hindfoot varus presented a moderate correlation (r = 0.564; p < 0.05). CONCLUSION We found no association between the anatomical axes of the knee and hindfoot. Patients with gonarthrosis and hindfoot varus presented a better ankle function. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
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Affiliation(s)
- Henrique Mansur
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
- Universidade de Brasília, Brasília, DF, Brazil
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Cai G, Liu W, Xiong J, Liu L, Wang D, Yang J. Functional Reconstruction of Hindfoot With Total Calcaneus and Talus Loss by Ilizarov Technique: A Case Report. J Foot Ankle Surg 2020; 59:142-148. [PMID: 31882137 DOI: 10.1053/j.jfas.2019.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/08/2018] [Accepted: 03/11/2019] [Indexed: 02/03/2023]
Abstract
Total calcaneus and talus loss in the hindfoot is an unusual but severe condition encountered in clinical settings. This condition affects lower-extremity function and poses a significant challenge to limb salvage. We present a case of a 43-year-old man with total calcaneus and talus loss in the right foot treated by Ilizarov technique. A staged treatment protocol was planned to reconstruct and optimize the heel for weightbearing and walking. During the 15-month postoperative follow-up, the patient reported no significant discomfort in the targeted foot and regained satisfactory function, including shoe wearing, walking, driving, and climbing stairs. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 71, which was an improvement from a preoperative score of 40. This case is the first reported on the functional reconstruction by Ilizarov technique of hindfoot with total calcaneus and talus loss. This treatment protocol provides an effective approach to reconstructing the hindfoot with massive bone loss, although the long-term outcome remains unknown.
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Affiliation(s)
- Gaorui Cai
- Surgeon, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Wei Liu
- Surgeon, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Jianyi Xiong
- Professor, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Lijun Liu
- Professor, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Daping Wang
- Professor, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Jinxing Yang
- Professor, Department of Traumatic Orthopedics, the First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China.
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Lenz AL, Nichols JA, Roach KE, Foreman KB, Barg A, Saltzman CL, Anderson AE. Compensatory Motion of the Subtalar Joint Following Tibiotalar Arthrodesis: An in Vivo Dual-Fluoroscopy Imaging Study. J Bone Joint Surg Am 2020; 102:600-608. [PMID: 32079879 PMCID: PMC7289138 DOI: 10.2106/jbjs.19.01132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibiotalar arthrodesis is a common treatment for end-stage tibiotalar osteoarthritis, and is associated with a long-term risk of concomitant subtalar osteoarthritis. It has been clinically hypothesized that subtalar osteoarthritis following tibiotalar arthrodesis is the product of compensatory subtalar joint hypermobility. However, in vivo measurements of subtalar joint motion following tibiotalar arthrodesis have not been quantified. Using dual-fluoroscopy motion capture, we tested the hypothesis that the subtalar joint of the limb with a tibiotalar arthrodesis would demonstrate differences in kinematics and increased range of motion compared with the subtalar joint of the contralateral, asymptomatic, untreated ankle. METHODS Ten asymptomatic patients who had undergone unilateral tibiotalar arthrodesis at a mean (and standard deviation) of 4.0 ± 1.8 years previously were evaluated during overground walking and a double heel-rise task. The evaluation involved markerless tracking with use of dual fluoroscopy integrated with 3-dimensional computed tomography, which allowed for dynamic measurements of subtalar and tibiotalar dorsiflexion-plantar flexion, inversion-eversion, and internal-external rotation. Range of motion, stance time, swing time, step length, and step width were also measured. RESULTS During the early stance phase of walking, the subtalar joint of the limb that had been treated with arthrodesis was plantar flexed (-4.7° ± 3.3°), whereas the subtalar joint of the untreated limb was dorsiflexed (4.6° ± 2.2°). Also, during the early stance phase of walking, eversion of the subtalar joint of the surgically treated limb (0.2° ± 2.3°) was less than that of the untreated limb (4.5° ± 3.2°). During double heel-rise, the treated limb exhibited increased peak subtalar plantar flexion (-7.1° ± 4.1°) compared with the untreated limb (0.2° ± 1.8°). CONCLUSIONS A significant increase in subtalar joint plantar flexion was found to be a primary compensation during overground walking and a double heel-rise activity following tibiotalar arthrodesis. CLINICAL RELEVANCE Significant subtalar joint plantar flexion compensations appear to occur following tibiotalar arthrodesis. We found an increase in subtalar plantar flexion and considered the potential relationship of this finding with the increased rate of subtalar osteoarthritis that occurs following ankle arthrodesis.
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Affiliation(s)
- Amy L. Lenz
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Jennifer A. Nichols
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Koren E. Roach
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Radiology, University of California-San Francisco, San Francisco, California
| | - K. Bo Foreman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Alexej Barg
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Charles L. Saltzman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Andrew E. Anderson
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Email address for A.E. Anderson:
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Qin B, Luo J, Zeng Y, Fu S, Zhang L. Classification of the subtalar articular surface and its matching situation: an anatomical study on Chinese subtalar joint. Surg Radiol Anat 2020; 42:1133-1139. [PMID: 32112282 DOI: 10.1007/s00276-020-02444-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The subtalar joint (STJ) is complex in anatomy and function. The purpose of this study is to classify the articular surface of the calcaneus in a sample Chinese population and discuss the relationship between its matching situation and the stability of STJ. METHODS 328 patients with 445 STJs were measured and classified using CT three-dimensional reconstruction. The calcaneal facets were classified according to the morphological characteristics. According to the number, shape, and fusion of the calcaneus and talus facets, the matching situation was determined. The parameters of measurement: the Gissane's angle, the Böhler's angle, the long-axis sum and the short-axis sum, and the average total joint facet area. RESULTS The calcaneal surfaces in a sample Chinese population were classified into five types: Type I (219, 49.2%), Type II (102, 22.9%), Type III (68, 15.3%), Type IV (47, 10.6%) and Type V (9, 2%). The total matching rate of STJ is 98%. In terms of Gissane's angle, there was a significant difference between Type II and Type IV (P < 0.05). The long-axis sum of Type III (4.53 ± 0.58 cm) was significantly smaller than other types (P < 0.05). Type II (3.64 ± 0.47 cm) was statistically larger than other types in the short-axis sum (P < 0.05). The average total joint facet area of Type III (7.05 ± 1.40 cm2) was significantly smaller than other types (P < 0.05). Type V (9.31 ± 3.96 cm2) was statistical differences with Type II, Type III and Type IV (P < 0.05). There was no statistically significant difference between left and right sides of the articular facets in this study (P > 0.05). CONCLUSIONS According to Bunnins's classification, the type with separated facets predominated but the matching situation between STJ was not elaborated, which was closely linked to the stability of STJ and surgical strategy of calcaneus fracture. The calcaneus articular surfaces in a sample Chinese population were divided into five types. Type I was the most common type and Type V was the rarest. Type II have the highest stability, Type V may be the lowest stability and Type III was more prone to osteoarthritis. The STJ articular surfaces were basically matched, contributing to the coordinate movement of the STJ. The matching articular surfaces of STJ were more stable than the mismatching surfaces. To some extent that STJ facet number, shape, facet area, and matching situation are factors in STJ stability, and the anatomical variations of the STJ offer predictive value in determining the predisposition to STI.
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Affiliation(s)
- Bo Qin
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
- Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Academician Workstation in Luzhou, Luzhou, Sichuan, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, Sichuan, China
| | - Jiangqin Luo
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yan Zeng
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Shijie Fu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
- Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Academician Workstation in Luzhou, Luzhou, Sichuan, China
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, Sichuan, China
| | - Lei Zhang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
- Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China.
- Academician Workstation in Luzhou, Luzhou, Sichuan, China.
- Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, Sichuan, China.
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.
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Grant TM, Diamond LE, Pizzolato C, Killen BA, Devaprakash D, Kelly L, Maharaj JN, Saxby DJ. Development and validation of statistical shape models of the primary functional bone segments of the foot. PeerJ 2020; 8:e8397. [PMID: 32117607 PMCID: PMC7006516 DOI: 10.7717/peerj.8397] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Musculoskeletal models are important tools for studying movement patterns, tissue loading, and neuromechanics. Personalising bone anatomy within models improves analysis accuracy. Few studies have focused on personalising foot bone anatomy, potentially incorrectly estimating the foot’s contribution to locomotion. Statistical shape models have been created for a subset of foot-ankle bones, but have not been validated. This study aimed to develop and validate statistical shape models of the functional segments in the foot: first metatarsal, midfoot (second-to-fifth metatarsals, cuneiforms, cuboid, and navicular), calcaneus, and talus; then, to assess reconstruction accuracy of these shape models using sparse anatomical data. Methods Magnetic resonance images of 24 individuals feet (age = 28 ± 6 years, 52% female, height = 1.73 ± 0.8 m, mass = 66.6 ± 13.8 kg) were manually segmented to generate three-dimensional point clouds. Point clouds were registered and analysed using principal component analysis. For each bone segment, a statistical shape model and principal components were created, describing population shape variation. Statistical shape models were validated by assessing reconstruction accuracy in a leave-one-out cross validation. Statistical shape models were created by excluding a participant’s bone segment and used to reconstruct that same excluded bone using full segmentations and sparse anatomical data (i.e. three discrete points on each segment), for all combinations in the dataset. Tali were not reconstructed using sparse anatomical data due to a lack of externally accessible landmarks. Reconstruction accuracy was assessed using Jaccard index, root mean square error (mm), and Hausdorff distance (mm). Results Reconstructions generated using full segmentations had mean Jaccard indices between 0.77 ± 0.04 and 0.89 ± 0.02, mean root mean square errors between 0.88 ± 0.19 and 1.17 ± 0.18 mm, and mean Hausdorff distances between 2.99 ± 0.98 mm and 6.63 ± 3.68 mm. Reconstructions generated using sparse anatomical data had mean Jaccard indices between 0.67 ± 0.06 and 0.83 ± 0.05, mean root mean square error between 1.21 ± 0.54 mm and 1.66 ± 0.41 mm, and mean Hausdorff distances between 3.21 ± 0.94 mm and 7.19 ± 3.54 mm. Jaccard index was higher (P < 0.01) and root mean square error was lower (P < 0.01) in reconstructions from full segmentations compared to sparse anatomical data. Hausdorff distance was lower (P < 0.01) for midfoot and calcaneus reconstructions using full segmentations compared to sparse anatomical data. Conclusion For the first time, statistical shape models of the primary functional segments of the foot were developed and validated. Foot segments can be reconstructed with minimal error using full segmentations and sparse anatomical landmarks. In future, larger training datasets could increase statistical shape model robustness, extending use to paediatric or pathological populations.
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Affiliation(s)
- Tamara M Grant
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Laura E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Claudio Pizzolato
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Bryce A Killen
- Human Movement Biomechanics Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Daniel Devaprakash
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Luke Kelly
- School of Human Movement and Nutritional Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Jayishni N Maharaj
- School of Human Movement and Nutritional Sciences, University of Queensland, Brisbane, QLD, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Abstract
The hindfoot is functionally defined as the articulations between the talus, calcaneus, navicular, and cuboid. It is a biomechanically important peritalar unit for shock absorption and propulsion with the subtalar and talonavicular joint essential to its function. The primary cause of hindfoot arthritis is post-traumatic. Other causes include long-term misalignment such as adult-acquired flatfoot, cavus foot, and inflammatory arthritis. Prevention of post-traumatic hindfoot arthritis is the primary objective. Anatomical reduction and fixation of articular hindfoot fractures is the preferred pathway. This article discusses the principles of treatment of hindfoot arthritis. When post-traumatic changes cannot be managed by nonsurgical means, an anatomical well-aligned arthrodesis is indicated. This article addresses the principles of managing this condition, which have been championed by Professor Sigvard T. Hansen. New approaches and techniques are discussed that achieve the goals of a stable, functional plantigrade foot.
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Peña Fernández M, Hoxha D, Chan O, Mordecai S, Blunn GW, Tozzi G, Goldberg A. Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography. Sci Rep 2020; 10:1035. [PMID: 31974489 PMCID: PMC6978465 DOI: 10.1038/s41598-020-57912-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/06/2020] [Indexed: 11/09/2022] Open
Abstract
Accurate in vivo quantification of subtalar joint kinematics can provide important information for the clinical evaluation of subtalar joint function; the analysis of outcome of surgical procedures of the hindfoot; and the design of a replacement subtalar joint prosthesis. The objective of the current study was to explore the potential of full weight-bearing clinical computed tomography (CT) to evaluate the helical axis and centre of rotation of the subtalar joint during inversion and eversion motion. A subject specific methodology was proposed for the definition of the subtalar joint motion combining three-dimensional (3D) weight-bearing imaging at different joint positions with digital volume correlation (DVC). The computed subtalar joint helical axis parameters showed consistency across all healthy subjects and in line with previous data under simulated loads. A sphere fitting approach was introduced for the computation of subtalar joint centre of rotation, which allows to demonstrate that this centre of rotation is located in the middle facet of the subtalar joint. Some translation along the helical axis was also observed, reflecting the elasticity of the soft-tissue restraints. This study showed a novel technique for non-invasive quantitative analysis of bone-to-bone motion under full weight-bearing of the hindfoot. Identifying different joint kinematics in patients with ligamentous laxity and instability, or in the presence of stiffness and arthritis, could help clinicians to define optimal patient-specific treatments.
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Affiliation(s)
- Marta Peña Fernández
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, PO1 3DJ, UK.
| | - Dorela Hoxha
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, PO1 3DJ, UK
| | - Oliver Chan
- UCL Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Simon Mordecai
- UCL Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Gordon W Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, PO1 2DT, UK
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, PO1 3DJ, UK
| | - Andy Goldberg
- UCL Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
- MSK Lab, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London, SW7 2AZ, UK
- The London Ankle & Arthritis Centre, The Wellington Hospital, Wellington Place, London, NW8 9LE, UK
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Is Lower-limb Alignment Associated with Hindfoot Deformity in the Coronal Plane? A Weightbearing CT Analysis. Clin Orthop Relat Res 2020; 478:154-168. [PMID: 31809289 PMCID: PMC7000051 DOI: 10.1097/corr.0000000000001067] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The goals of lower limb reconstruction are to restore alignment, to improve function, and to reduce pain. However, it remains unclear whether alignment of the lower limb and hindfoot are associated because an accurate assessment of hindfoot deformities has been limited by superposition on plain radiography. Consequently, surgeons often overlook hindfoot deformity when planning orthopaedic procedures of the lower limb. Therefore, we used weight-bearing CT to quantify hindfoot deformity related to lower limb alignment in the coronal plane. QUESTIONS/PURPOSES (1) Is lower-limb alignment different in varus than in valgus hindfoot deformities for patients with and without tibiotalar joint osteoarthritis? (2) Does a hindfoot deformity correlate with lower-limb alignment in patients with and without tibiotalar joint osteoarthritis? (3) Is joint line orientation different in varus than in valgus hindfoot deformities for patients with tibiotalar joint osteoarthritis? (4) Does a hindfoot deformity correlate with joint line orientation in patients with tibiotalar joint osteoarthritis? METHODS Between January 2015 and December 2017, one foot and ankle surgeon obtained weightbearing CT scans as second-line imaging for 184 patients with ankle and hindfoot disorders. In 69% (127 of 184 patients) of this cohort, a combined weightbearing CT and full-leg radiograph was performed when symptomatic hindfoot deformities were present. Of those, 85% (109 of 127 patients) with a median (range) age of 53 years (23 to 75) were confirmed eligible based on the inclusion and exclusion criteria of this retrospective comparative study. The Takakura classification was used to divide the cohort into patients with (n = 74) and without (n = 35) osteoarthritis of the tibiotalar joint. Lower-limb measurements, obtained from the full-leg radiographs, consisted of the mechanical tibiofemoral angle, mechanical tibia angle, and proximal tibial joint line angle. Weightbearing CT images were used to determine the hindfoot's alignment (mechanical hindfoot angle), the tibiotalar joint alignment (distal tibial joint line angle and talar tilt angle) and the subtalar joint alignment (subtalar vertical angle). These values were statistically assessed with an ANOVA and a pairwise comparison was subsequently performed with Tukey's adjustment. A linear regression analysis was performed using the Pearson correlation coefficient (r). A reliability analysis was performed using the intraclass correlation coefficient. RESULTS Lower limb alignment differed among patients with hindfoot deformity and among patients with or without tibiotalar joint osteoarthritis. In patients with tibiotalar joint osteoarthritis, we found knee valgus in presence of hindfoot varus deformity and knee varus in presence of hindfoot valgus deformity (mechanical tibiofemoral angle 0.3 ± 2.6° versus -1.8 ± 2.1°; p < 0.001; mechanical tibia angle -1.4 ± 2.2° versus -4.3 ± 1.9°; p < 0.001). Patients without tibiotalar joint osteoarthritis demonstrated knee varus in the presence of hindfoot varus deformity compared with knee valgus in presence of hindfoot valgus deformity (mechanical tibiofemoral angle -2.2 ± 2.2° versus 0.9 ± 2.4°; p < 0.001; mechanical tibia angle -1.8 ± 2.1° versus -4.3 ± 1.9°; p < 0.001). Patients with more valgus deformity in the hindfoot tended to have more tibiofemoral varus (r = -0.38) and tibial varus (r = -0.53), when tibiotalar joint osteoarthritis was present (p < 0.001). Conversely, patients with more valgus deformity in the hindfoot tended to have more tibiofemoral valgus (r = 0.4) and tibial valgus (r = 0.46), when tibiotalar joint osteoarthritis was absent (p < 0.001). The proximal joint line of the tibia had greater varus orientation in patients with a hindfoot valgus deformity compared with greater valgus orientation in patients with a hindfoot varus deformity (proximal tibial joint line angle 88.5 ± 2.0° versus 90.6 ± 2.2°; p < 0.05). Patients with more valgus deformity in the hindfoot tended to have more varus angulation of the proximal tibial joint line angle (r = 0.31; p < 0.05). CONCLUSIONS In patients with osteoarthritis of the tibiotalar joint, varus angulation of the knee was associated with hindfoot valgus deformity and valgus angulation of the knee was associated with hindfoot varus deformity. Patients without tibiotalar joint osteoarthritis exhibited the same deviation at the level of the knee and hindfoot. These distinct radiographic findings were most pronounced in the alignment of the tibia relative to the hindfoot deformity. This suggests a detailed examination of hindfoot alignment before knee deformity correction at the level of the proximal tibia, to avoid postoperative increase of pre-existing hindfoot deformity. Other differences detected between the radiographic parameters were less pronounced and varied within the subgroups. Future research could identify prospectively which of these parameters contain clinical relevance by progressing osteoarthritis or deformity and how they can be altered by corrective treatment. LEVEL OF EVIDENCE Level III, prognostic study.
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Krähenbühl N, Burssens A, Davidson NP, Allen CM, Henninger HB, Saltzman CL, Barg A. Can Weightbearing Computed Tomography Scans Be Used to Diagnose Subtalar Joint Instability? A Cadaver Study. J Orthop Res 2019; 37:2457-2465. [PMID: 31322749 DOI: 10.1002/jor.24420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/26/2019] [Indexed: 02/04/2023]
Abstract
Chronic hindfoot instability is a frequent problem that includes the ankle and/or the subtalar joint. While ankle joint instability can be diagnosed clinically, accurate assessment of the subtalar joint remains elusive. This study's purpose was to assess the ability of weightbearing computed tomography (CT) scans to detect subtalar joint instability. Seven pairs of fresh frozen male cadavers (tibial plateau to toe-tip) were tested. A radiolucent frame held specimens in a plantigrade position while non-weightbearing and weightbearing CT scans (with and without torque application) were taken. First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent interosseous talo-calcaneal ligament (ITCL) transection, while the contralateral underwent calcaneo-fibular ligament (CFL) transection. Third, the remaining intact ITCL or CFL was transected. Finally, the deltoid ligament was transected in all ankles. Eight radiographic measurements were performed to assess the congruency of the subtalar joint on digitally reconstructed radiographs and single CT images. Axial loading did not impact most measurements, whereas torque did impact most measurements. Radiographic measurements performed at the subtalar joint level were more reliable and better predictors for subtalar joint instability compared with measurements performed at the ankle joint level. While torque application is crucial to identify subtalar joint instability, axial load application should be avoided. Measurements to assess the subtalar joint stability should primarily be performed at the subtalar joint level rather than at the ankle joint level when using weightbearing CT scans. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2457-2465, 2019.
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Affiliation(s)
- Nicola Krähenbühl
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108
| | - Arne Burssens
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108
| | - Nathan P Davidson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108
| | - Chelsea McCarty Allen
- Department of Internal Medicine, Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, Utah, 84108
| | - Heath B Henninger
- Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108
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Influence of the ankle position and X-ray beam angulation on the projection of the posterior facet of the subtalar joint. Skeletal Radiol 2019; 48:1581-1589. [PMID: 31030252 DOI: 10.1007/s00256-019-03220-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Using digitally reconstructed radiographs (DRRs), we determined how changes in the projection angle influenced the assessment of the subtalar joint. MATERIALS AND METHODS Weightbearing computed tomography (CT) scans were acquired in 27 healthy individuals. CT scans were segmented and processed to create DRRs of the hindfoot. DRRs were obtained to represent 25 different perspectives to simulate internal rotation of the ankle with and without caudal angulation of the X-ray beam. Subtalar joint morphology was quantified by determining the joint space curvature, subtalar inclination angle (SIA), calcaneal slope (CS), and projection of the subtalar joint line on three-dimensional (3-D) reconstructions of the calcaneus. RESULTS The curvature of the projected joint space was altered substantially over the different DRR projections. Simulated caudal angulation of the X-ray beam with respect to the ankle decreased the SIA and CS significantly. Internal rotation also had a significant impact on the SIA and CS if the X-ray beam was in neutral or in 10° of caudal angulation. An antero-posterior (AP) view of the ankle showed the posterior area of the posterior facet, whereas a more anterior area was visible with internal rotation of the foot and caudal angulation of the X-ray beam. CONCLUSION Internal rotation of the foot of 20° is recommended to assess the posterior aspect of the posterior facet, whereas a combined 20° internal rotation of the foot and 40° caudal angulation of the X-ray beam is best to assess the anterior aspect of the posterior facet of the subtalar joint.
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Sokolowski M, Krähenbühl N, Wang C, Zwicky L, Schweizer C, Horn Lang T, Hintermann B. Secondary Subtalar Joint Osteoarthritis Following Total Ankle Replacement. Foot Ankle Int 2019; 40:1122-1128. [PMID: 31327242 DOI: 10.1177/1071100719859216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND An advantage of total ankle replacement (TAR) compared to ankle fusion is that by maintaining motion, the occurrence of hypermobility of adjacent joints may be prevented. This could affect the development of symptomatic subtalar joint osteoarthritis (OA). The aim of the study was to determine the incidence of subtalar joint fusion and the progression of subtalar joint OA following TAR. METHODS Secondary subtalar joint fusion rate was determined from a cohort of 941 patients receiving primary TAR between 2000 and 2016. The indication for fusion, the time interval from primary TAR to fusion, and the union rate were evaluated. To assess the progression of subtalar joint OA, degenerative changes of the subtalar joint were classified in 671 patients using the Kellgren-Lawrence score (KLS) prior to TAR and at latest follow-up. RESULTS In 4% (37) of the patients, a secondary subtalar joint fusion was necessary. The indication for fusion was symptomatic OA in 51% (19), hindfoot instability in 27% (10), osteonecrosis of the talus in 19% (7), and cystic changes of the talus in 3% (1) of the patients. Time from primary TAR to subtalar joint fusion due to progressive OA was 5.0 (range, 0.3-10) years and for other reasons 1.6 (range, 0.2-11.6) years (P = .3). In 68% (456) of the patients, no progression of subtalar joint OA was observed. CONCLUSION The incidence of secondary subtalar joint fusion was low. The most common reason for subtalar joint fusion following TAR was symptomatic OA. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Marc Sokolowski
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Nicola Krähenbühl
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Chen Wang
- Huashan Hospital, Orthopaedics Departement, Shanghai, China
| | - Lukas Zwicky
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Tamara Horn Lang
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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Medina McKeon JM, Hoch MC. The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains. J Athl Train 2019; 54:589-602. [PMID: 31184957 DOI: 10.4085/1062-6050-472-17] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.
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Affiliation(s)
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington
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Abstract
A high longitudinal plantar arch, varus position of the heel, forefoot equinus, and pronation of the first ray are characteristic of a cavovarus deformity. Forefoot-driven and hindfoot-driven deformities are distinguished based on pathomechanics. In first ray strong plantarflexion, the forefoot touches the ground first. This leads to compensatory varus heel, lock of the midfoot, reduction of the flexible phase, and decrease in shock absorption. In hindfoot-driven cavovarus deformity, the subtalar joint may compensate for varus deformities above the ankle joint. Overload of the lateral soft tissue structures and degenerative changes may occur in longstanding cavovarus deformity.
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Krahenbuhl N, Lenz AL, Lisonbee R, Deforth M, Zwicky L, Hintermann B, Saltzman CL, Anderson AE, Barg A. Imaging of the subtalar joint: A novel approach to an old problem. J Orthop Res 2019; 37:921-926. [PMID: 30638276 PMCID: PMC7311051 DOI: 10.1002/jor.24220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/02/2019] [Indexed: 02/04/2023]
Abstract
Evaluation of the subtalar joint using conventional radiographs is difficult. The purpose of this study was to assess how the posterior facet of the subtalar joint is projected on eight standard radiographic views of the foot and ankle. Weightbearing computed tomography (CT) scans of 27 volunteers without ankle pathology were performed. Eight standard views of the foot and ankle (antero-posterior [AP] view, mortise view, subtalar view, four different Broden views) were reconstructed using digitally reconstructed radiographs (DRRs). The appearance of the posterior facet of the subtalar joint was assessed for each view. In addition, the position of the joint line was projected onto three-dimensional (3-D) models of the calcaneus. We found (i) on the AP view of the ankle joint, the posterior part of the posterior facet is visualized and appears convex (calcaneal side); (ii) on the mortise view of the ankle joint, a slightly more anterior part (compared to the AP view) is visualized and appears either convex or flat; (iii) on the subtalar view, the anterior part of the posterior facet is visualized and appears either convex, flat or concave; and (iv) using the Broden views, the posterior and anterior part of the posterior facet can be visualized. This study clarifies which parts of the posterior facet of the subtalar joint are visualized on eight standard views of the foot and ankle. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
| | | | - Rich Lisonbee
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Manja Deforth
- Department of Orthopaedics, Kantonsspital Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lukas Zwicky
- Department of Orthopaedics, Kantonsspital Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
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