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Soft-Tissue Repair for Proximal and Middle Third Problems
Published in Armstrong Milton B., Lower extremity Trauma, 2006
Kreithen Joshua, Woodberry Kerri, O Seung-Jun
The flexor digitorum longus muscle originates on the posterior surface of the tibia and inserts on the base of the distal phalanges of the second, third, fourth, and fifth toes. It functions to flex the distal phalanges and is expendable if the muscle insertion is not divided and the flexor digitorum brevis muscle is left intact. The muscle is approximately 5 X 40 cm2 and is located medial to the tibia and between the soleus and tibialis posterior muscles. This small pure muscle flap has limited applications for coverage of the middle and lower third of the leg.
Venous malformation as source of a tarsal tunnel syndrome: treat the source or the cause of the complaints? A case report
Published in Acta Chirurgica Belgica, 2018
H. Mufty, G. A. Matricali, S. Thomis
On physical examination, we have a normal weight patient (body mass index of 23.37). The presence of varicosis veins was seen on the right medial lower limb and foot (Figure 1). This was accompanied by discrete edema of the foot. No other skin changes were present. His lower extremities were well perfused with bilateral normal pulses. Clinical examination did not show sensory or motor deficits. However, a positive Tinel’s sign, evoking a needle sensation by slightly tapping the tibial nerve path, was noted. Venous duplex revealed a sufficient vena saphena magna bilateral without evidence of deep vein thrombosis. The varicosis veins in the right lower limb were partially thrombosed. New LMWH was administered and compressive stockings class two were prescribed. After two weeks, a positive evolution was noticed. Subsequently, magnetic resonance imaging (MRI) was performed, which illustrated an extensive venous malformation in the whole right lower limb. The largest component was seen anteromedian subcutaneously with a deeper connection towards the fibular artery and posterior tibial artery. There were both a muscular component, with ingrowth in the posterior tibial muscle, flexor hallucis longus muscle and flexor digitorum longus muscle, and osseous component with ingrowth in the tibial diaphyse.
Sex-related differences in hip and groin injuries in adult runners: a systematic review
Published in The Physician and Sportsmedicine, 2023
Bailey J. Ross, Greg M. Lupica, Zakari R. Dymock, Cadence Miskimin, Mary K. Mulcahey
We found the prevalence of total hip and groin injuries among adult runners as a percentage of total RRI was 10.1% across the 10 included studies. This proportion is greater than the 7.1% (759/10,688) rate reported by Francis et al. [12], but comparable to the review by Kluitenberg et al. [37] which reported rates ranging from 5.7% to 10.8% for cross-country runners and track sprinters, respectively. The relatively low rates of hip/groin RRIs support the findings of prior studies suggesting that most RRIs occur at or distal to the knee [4,10–12]. As most running injuries are related to overuse, this may suggest that running-related injuries due to overuse affect the knee primarily before other locations [38]. Although direct cause-effect relationships have not been identified, the higher frequency of injuries in the distal lower extremity may be secondary to the disproportionately greater contribution of anatomical structures in this area during running. During the braking phase of the stance, the main contributor to both braking and support is the quadriceps muscle [39]. Excessive eccentric loading of the patellar tendon and patellofemoral joint may explain the high prevalence of knee injuries [40]. Conversely, during the propulsion phase of stance, soleus, and gastrocnemius are the greatest contributors to propulsion and support [39]. Repetitive contraction of the posterior tibialis, soleus and flexor digitorum longus muscles can generate excessive stress on the tibia, resulting in periosteal inflammatory response and painful stress reaction of bone [41]. These anatomical differences in biomechanical work during running may explain the higher prevalence of RRIs in the distal lower extremity though further research is needed to evaluate this hypothesis.