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Applied anatomy and surgical approaches
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Rajeev Vohra, Babaji Sitaram Thorat, Avtar Singh
The interval used for deep dissection depends upon the location of the major fracture fragments. It may be developed between posterior border of tibia and TP, or between TP and FDL, or both TP and FDL can be retracted anteriorly (Figure 2.11d,e,f) which may require direct exposure of the neurovascular bundle. The posterior tibial tendon lies on top of a layer of fibrocartilage, which may be sharply incised to expose the posteromedial fragment. The posterior ankle capsule is opened sharply and the fracture is exposed. Minimal traction should be applied while retracting the tibial neurovascular bundle. Relaxing the retractor intermittently helps to prevent neurovascular injury.
Subtalar Dislocation
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
These are not common injuries. Fortunately, persistent instability is infrequent. Complications vary and seem to be related to the degree of energy of the injury. Post-traumatic arthritis evident on radiographs is common although the symptomatic effects of these changes may vary. These may be a result of injury to the joint surface, occult fractures or persistent instability. Open fracture dislocations with associated injuries to the nerves, vessels and related tendons (tibial nerve, posterior tibial artery or posterior tibial tendon) have been associated with worse outcomes.
Foot fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Dolfi Herscovici, Julia M. Scaduto
Most fractures are managed through a dual incision approach. The anterolateral incision, or Böhler approach, begins between the bases of the third and fourth meta-tarsals and extends towards Chaput’s tubercle of the tibia. The superficial peroneal nerve is protected as it crosses the field (Figure 43.1) and the extensor retinaculum is divided exposing the extensor tendons. Retracting the tendons medially should allow one to see the tibial plafond, the dome, neck and head of the talus (Figure 43.2). The medial incision extends from the medial malleolus towards the tuberosity of the navicular, dorsal to the posterior tibial tendon (Figure 43.3). Working through both incisions allows visualization to determine whether an anatomic reduction has been obtained. Posterior and percutaneous approaches are rarely indicated because they do not allow for adequate visualization.
Lateral collapse of the tarsal navicular in patients with rheumatoid arthritis: Implications for pes planovarus deformity
Published in Modern Rheumatology, 2018
Takumi Matsumoto, Yuji Maenohara, Song Ho Chang, Jun Hirose, Takuo Juji, Katsumi Ito, Sakae Tanaka
Some limitations of our study must be acknowledged. First, the prevalence of the MWD-like structural change might be underestimated in the present study due to its cross-sectional study design, with exclusion of patients who underwent previous mid- or hindfoot surgeries. Second, we evaluated only the shape of the tarsal navicular and the destructive and ankylotic changes at the talonavicular joints, and did not address the association with the soft tissues such as with capsular laxity, and weakened tendons or ligaments. For example, posterior tibial tendon dysfunction is considered to contribute to the development of pes planovalgus in RA patients [28]. By adding the element of soft-tissue involvement, specific characteristics will be further emphasized. Third, we did not include information about bone mineral density, or lower limb alignment in the present study, which might have some influence on the occurrence of tarsal navicular collapse. Fourth, we did not evaluate the forefoot abduction/adduction which is also one of the clinically important features in RA foot. Despite these limitations, we believe that the present study is important since it demonstrates that the prevalence of the MWD-like collapse of the tarsal navicular is not negligible in patients with RA, and that the MWD-like structural change leads to unusual pes planus deformity with hindfoot varus. Because the final fate of MWD is arthritic change around the tarsal navicular, several cases might be considered as just rheumatic joint destruction unless physicians are aware of this etiology.
Towards patient-specific medializing calcaneal osteotomy for adult flatfoot: a finite element study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Zhongkui Wang, Masamitsu Kido, Kan Imai, Kazuya Ikoma, Shinichi Hirai
A healthy volunteer (Asian male, 38 years old, 178 cm, 70 kg) and a posterior tibial tendon dysfunction (PTTD) stage II patient (Asian male, 38 years old, 168 cm, 62 kg) with symptomatic flatfoot deformity were examined. Substaging of PTTD was done by Myerson’s classification (Myerson 1996). Two orthopedic foot and ankle surgeons diagnosed PTTD and flatfoot deformity based on clinical examinations and radiographs taken under loading conditions. We constructed FE models of the flatfoot and healthy foot. Both models were validated using experimental data of plantar stress during balanced standing. The healthy foot data were used as standards to compare with flatfoot data and evaluate surgical performance. Four surgical parameters of the MCO were investigated using simulations, and plantar stress distributions were quantitatively compared and discussed.
A case report: septic shock due to (tropical) pyomyositis and multiple metastatic embolisms caused by Panton Valentine Leukocidin-positive methicillin-sensitive staphylococcus aureus in a 12-year-old boy
Published in Acta Clinica Belgica, 2022
Valérie Vanbiervliet, Ignace Demeyer, Filip Claus, Kristien Van Vaerenbergh
The boy represented on two more occasions in the next 3 days due to ongoing pain. The second time he was referred to the orthopaedic surgeons. A CT scan was performed, which showed no bone lesions; however, an unclear demarcation of the distal posterior tibial tendon was described. Based on this result the left ankle was immobilised using a cast.