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Biomechanics of the foot and ankle
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Sheraz S Malik, Shahbaz S Malik
The subtalar joint receives support from components of lateral ligament complex and deltoid ligament of tibiotalar joint, as well as ligaments of sinus tarsi. The cervical ligament is the strongest of all ligaments stabilising this joint. It is located in anterior sinus tarsi and connects neck of talus to neck of calcaneus (hence the name). Kapandji,12 however, regarded the interosseous talcocalcaneal ligament as the most important ligament of talocalcaneal articulation. It consists of two thick bands which occupy the sinus tarsi centrally and resist joint eversion.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The sinus tarsi is a tunnel between the calcaneus and talus which has important roles in foot stability and proprioception. It is a complex structure associated with the subtalar joint and several ligaments. It is usually filled with fat, which would be high on T1 and T2 weighted imaging. In sinus tarsi syndrome this is replaced with scar tissue, which is low both on T1 and T2 weighted imaging. Sinus tarsi syndrome can present with tenderness, pain on walking and instability. It can come on following ankle sprains, such as in this case, but it is also associated with inflammatory arthropathies.
History taking and clinical examination in musculoskeletal disease
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Soft tissues. The posterior tibial and the dorsal pedis pulses should be identified (Figure 31.35). Palpate the tibialis anterior tendon and the long extensor tendons on the dorsum of the foot. From the back, palpate the Achilles tendon. Palpate the peroneal tendons from the lateral side and the tibialis posterior tendon from the medial side. The sinus tarsi can be assessed. This is an anatomical space bounded by the talus and calcaneus and is recognisable as a soft-tissue depression anterior to the lateral malleolus. It is filled with fat and the extensor digitorum brevis muscle. Sinus tarsi syndrome may occur. This may be caused by injury to the interosseous talocalcaneal ligament or the subtalar joint. There is pain and tenderness over the sinus tarsi with subjective hindfoot instability. The pain is characteristically relieved by local anaesthetic injection.
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.