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Equinovarus
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Nicholas Peterson, Christopher Prior, Selvadurai Nayagam
The procedures were performed under general anaesthesia with regional blocks. Through a postero-medial approach, z-lengthening of the Achilles tendon and the tibialis posterior was performed, but the tendons were not sutured at this stage. A modified Ollier’s4 curvilinear incision was used to perform the triple arthrodesis (Figure 2.2). Care was taken to protect the sural and superficial peroneal nerves. The extensor digitorum brevis (EDB) was elevated with sharp dissection from proximal to distal, and the fat was removed from the sinus tarsi (Figure 2.3). The anterior process of the calcaneum was osteotomised (Figure 2.4). The anterior facet of the subtalar joint, head of the talus and the talonavicular joint were identified. An elevator was passed deep to the peroneal tendons and the tendons retracted posteriorly, exposing the capsule over the posterior facet of the subtalar joint. The capsule was removed using a rongeur. The calcaneocuboid joint and the talonavicular joint were exposed and their capsules excised (Figure 2.5).
Calcaneal fractures
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Devendra Mahadevan, Adam Sykes
The anterior process of the calcaneum projects forward into the foot from the body until it forms the calcaneocuboid joint. The bifurcate ligament connects the superior part of the anterior process to the cuboid and the navicular. On the superomedial surface of the anterior process sits the anterior facet of the subtalar joint which is widened by a fibrocartilaginous plate. It provides further support to the head of the talus and creates the ball and socket appearance of the talocalcaneonavicular (TCN) joint.
The Anatomy of Joints Related to Function
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
The articulating surfaces of the calcaneocuboid joint are highly evolved for human walking (Fig. 24A) (130,131). They are sinuously curved and approximate to the sellar form, the cuboid projecting medioproximally under the calcaneus and the calcaneus dorsally over the cuboid. This greatly enhances congruity and the location of the cuboid on the calcaneus and brings the average plane of the joint much more perpendicular to the course of the tendon of peroneus longus as it wraps around the cuboid (Fig. 24B). In the propulsive phase of gait, the subtalar joints are supinated, causing supinationof the midtarsal joint about its oblique axis. Ground reaction keeps the midtarsal joint at the pronated end of its range about its other, longitudinal axis, and strong contraction of peroneus longus at this time locks the joint in this position. The cuboid is impacted against the calcaneus; the articulating surfaces are maximally congruent in this position, and the joint is stabilized against the tension in the strong plantar ligaments (72).
Arthroscopic triple arthrodesis for the patient with rheumatoid arthritis; a case report
Published in Modern Rheumatology Case Reports, 2021
Tomoyuki Nakasa, Yasunari Ikuta, Munekazu Kanemitsu, Nobuo Adachi
To approach the subtalar, talonavicular and calcaneocuboid joints arthroscopically, various portal placements have been reported, with particular focus placed on evaluating the relationship between the position of the portal replacement and complications such as nerve injury. Lui described arthroscopic triple arthrodesis using the anterolateral and middle portals for the subtalar joint; lateral and dorsolateral portals for the calcaneocuboid joint; and the dorsolateral and dorsomedial portals for the talonavicular joint [28]. This technique places the lateral portal at the planter-lateral corner of the calcaneocuboid joint, but this runs the risk of peroneal tendon and sural nerve injuries. Placement of the dorsolateral portal carries the potential risk of injuries to the long extensor tendons and the intermediate dorsal cutaneous branch of the superficial peroneal nerve. The dorsomedial portal is located at the midpoint between the medial and dorsolateral portals, and this portal placement runs the risk of extensor hallucis longus tendon and deep peroneal nerve injuries. In the report on arthroscopic triple arthrodesis by Jagodzinski et al., two lateral portals at the sinus tarsi are used for access to the subtalar, talonavicular and calcaneocuboid joints, and a dorsolateral portal is used for access to the talonavicular joint [29]. In our procedure, two portals at the sinus tarsi were used for access to the subtalar joint, as in Jagodzinski’s procedure, obtaining good visualisation. For the calcaneocuboid joint and talonavicular joint, one portal of 1.5 cm in length was used, because our case required a bone graft and sural and saphenous nerve injuries were avoid by dividing the subcutaneous tissue and penetrating the joint capsule by mosquito clamp under direct visualisation. To correct the forefoot alignment by maintaining the length of the lateral column, a bone graft into the calcaneocuboid joint was required. A bone graft into the talonavicular joint was performed, because of the high rate of non-union according to previous reports [18,19]. Using our procedure, bone union was successfully achieved with no complications. And our procedure did not require any joint distraction device. The previous report of arthroscopic debridement and microfracture for osteochondral lesion in the talonavicular joint showed a good visualisation and an access using a Weinraub Kirschner wire type distractor [30]. However, there is the concern of the excessive force for joint distraction using this device to destruct the bone in patients with a fragile bone quality such as RA. In our case, good visualisation was obtained by the manual joint opening, and there was no risk to damage the bone by the distraction device.