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Calcaneus Deformity
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Christopher Prior, Nicholas Peterson, Selvadurai Nayagam
Clinical examination showed excessive dorsiflexion of the ankle joint (Figure 3.1) with no plantarflexion beyond the neutral position of the ankle. He stood with a calcaneus posture of the hindfoot with the forefoot barely able to reach the ground. His gait pattern was distinctly abnormal; in the stance phase, only the first of the three rockers of foot progression (i.e., heel strike) was present. He attempted to achieve foot flat by excessively plantarflexing his toes, and push-off was absent. The power of ankle plantarflexion was Grade 3+ on the MRC scale. The power of all other muscles around the foot and ankle were normal. Lateral weight-bearing radiographs of the foot showed that the calcaneal pitch was abnormally high (43 degrees) and that there was a cavus deformity (Figure 3.2).
The cavovarus foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Weight-bearing radiographs of the foot and ankle would demonstrate an increased calcaneal pitch, generally more than 30° (Figure 9.3). The talus-first metatarsal (Meary's) angle may be disrupted with an abnormal plantarflexed first ray by more than 4° (Figure 9.4). The CORA (centre of rotation of alignment) of the deformity is calculated with the weight-bearing lateral view of the foot (+/– weight-bearing CT scan if available), that would help surgical planning to try and correct the deformity at the level of the CORA. A flat domed talus is a common finding on the lateral radiographs. The posterior facet of the subtalar joint, as well as, the Chopart joints are clearly viewed in the lateral radiograph due to the rotation of the hindfoot (Figures 9.3 and 9.4). The distal fibula appears enlarged and posteriorly located. The weight-bearing lateral view demonstrates the increased navicular and medial cuneiform height. Lastly, the heel alignment view confirms the degree of heel varus.
The ankle and foot
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Weight-bearing X-rays of the foot contribute further to the assessment of the deformity and the state of the individual joints. On the lateral view, measurement of the calcaneal pitch and Meary’s angle help to determine the components of the high arch (Figure 21.19). In a normal foot the calcaneal pitch is between 10 and 30 degrees, whereas Meary’s angle, formed by the axes of the talus and first metatarsal, is zero, i.e. these axes are parallel. In a calcaneus deformity, the calcaneal pitch is increased; in a plantaris deformity, Meary’s lines meet at an angle.
Pedobarographic, Clinic, and Radiologic Evaluation after Surgically Treated Lisfranc Injury
Published in Journal of Investigative Surgery, 2021
Engin Eceviz, Hüseyin Bilgehan Çevik, Orhan Öztürk, Tuğçe Özen, Tuğba Kuru Çolak, İlker Çolak, Mine Gülden Polat
All fractures were classified according to the Myerson Classification System, which based on a primarily coronal assessment of divergence at the TMT joint, considered on initial radiographs [24]. Bilateral anteroposterior (AP), lateral, and oblique double leg stance weight-bearing radiographs were completed with the following digital measurements taken: (1) first intermetatarsal angle (the angle between the line drawn bisecting the first metatarsal and bisecting the second metatarsal); (2) Kite’s angle; (3) the first metatarsophalangeal angle on the AP view; (4) Meary’s angle; (5) Hibbs’ angle (the angle between the line bisecting the calcaneus and bisecting the first metatarsal); (6) the calcaneal pitch (inclination) angle (the angle between the line outlining the plantar aspect of the calcaneus and the weight-bearing surface); (7) the medial cuneiform and the fifth metatarsal distance on the lateral view [25]. The radiographic evaluation was performed by the same orthopedic surgeon (I.C.).
Relationship of callosities of the forefoot with foot deformity, Health Assessment Questionnaire Disability Index, and joint damage score in patients with rheumatoid arthritis
Published in Modern Rheumatology, 2020
Takeshi Mochizuki, Koichiro Yano, Katsunori Ikari, Ryo Hiroshima, Mina Ishibashi, Ken Okazaki
This study investigated the clinical course and background variables of patients with RA who fulfilled the American College of Rheumatology (ACR) classification criteria (1987) and/or the ACR/European League Against Rheumatism (EULAR) criteria [13,14]. A total of 202 patients (404 feet) were enrolled from December 2016 to September 2017 in the outpatient clinic. Patients were excluded if they had undergone arthroplasty of the feet or had heart failure, stroke, and/or dementia. We looked at the soles of the patients and examined callosities. Clinical data were measured on the day the plantar callosities of the forefoot were examined. We defined callosity as a well-circumscribed hyperkeratotic lesion. Clinical data included age, sex, disease duration, pain visual analog scale (VAS), C-reactive protein (CRP), DAS28-erythrocyte sedimentation rate (ESR), HAQ-DI, and TSS. The foot deformities included hallux valgus angle (HVA), first metatarsal and second metatarsal angle (M1M2), first metatarsal and fifth metatarsal angle (M1M5), calcaneal pitch angle (CPA), and the severity of destruction in the MTP joints as seen on X-rays in the weight-bearing position. The severity of destruction in the MTP joints was classified according to Larsen grade (LG) [15]. The foot deformities and the TSS were measured by authors T.M. and M.I.
Innovative treatment for pes cavovarus: a pilot study of 13 children
Published in Acta Orthopaedica, 2018
Ignacio Sanpera Jr, Guillem Frontera-Juan, Julia Sanpera-Iglesias, Laura Corominas-Frances
All patients were assessed both clinically and radiologically. Clinically, the foot deformity was monitored dynamically and statically. Pictures from the back in standing position and during the Coleman block test were taken. The heel angle was measured on the photographs, drawing a line bisecting the heel and a second one bisecting the calf and measuring the angle of confluence (Figure 2). Foot callosities were recorded. Patients and caregivers were questioned about the presence of pain and disabilities in daily life. Preoperative front and lateral standing foot radiographs were obtained in all patients. The following parameters were analyzed: Meary’s angle and calcaneal pitch on the lateral film and 1st metatarsal-talus angle on standing AP view (Figure 3).