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Valgus Deformity of the Hindfoot
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Plain radiographs of the foot and ankle were difficult to interpret on account of the severe valgus deformity (Figure 7.3). The ankle mortise was not grossly tilted in valgus, the distal tibial epiphysis was not wedge-shaped, and the lateral malleolus was not situated proximally. The absence of these features indicated that the deformity was not at the ankle. Since the subtalar joint could not be visualised clearly on the plain radiographs, CT scans were done. The CT scan clearly showed that the ankle joint was almost horizontal but the subtalar joint was abnormally inclined at about 65 degrees from the horizontal. On account of this, the calcaneum was not under the tibia but was laterally displaced (Figure 7.4a, b).
Leg Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
The ankle consists of three distinct joints: The talocrural joint is formed by the tibia, fibula, and talus. This joint is responsible for flexion and extension of the foot.The talocalcaneal joint, also known as the subtalar joint, is formed by the talus and the calcaneus. This joint is responsible for side rotation of the foot.The inferior tibiofibular joint is between the tibia and the fibula. It is a syndesmosis joint, a fibrous joint between the fibular notch of the tibia and the distal epiphysis of the tibia. It is reinforced by the anterior and posterior tibiofibular ligaments and the inferior transverse and interosseous ligament.23
Calcaneal fractures
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Devendra Mahadevan, Adam Sykes
Calcaneal fractures may result in post-traumatic arthritis of the subtalar or calcaneocuboid joints. The two factors that have been shown to correlate with the likelihood of developing arthritis are the severity of initial displacement and the accuracy of the reduction of the articular surfaces (22). Pain on walking on uneven surfaces and a stiff subtalar joint should alert to the presence of arthritis. There may also be evidence of a loss of joint space in the posterior facet of the subtalar joint on plain radiograph or CT scanning. MRI can help to confirm the diagnosis, but may be difficult to interpret if there is significant artefact created by the adjacent metalwork. Initial treatment should be through the use of anti-inflammatories, activity modification and the use of orthotics to support the foot shape and attempt to offload the subtalar joint. If this fails then a subtalar arthrodesis may be able to offer the patient relief of their symptoms.
Modelling the complexity of the foot and ankle during human locomotion: the development and validation of a multi-segment foot model using biplanar videoradiography
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Jayishni N. Maharaj, Michael J. Rainbow, Andrew G. Cresswell, Sarah Kessler, Nicolai Konow, Dominic Gehring, Glen A. Lichtwark
We created an articulated multi-segment foot and ankle model that is capable of performing musculoskeletal analyses of human walking and running. The model reported kinematics of the human foot during the stance phase of locomotion with a mean RMS difference of 2.2° across all gaits, planes and comparable joints compared to BVR, and outperformed the 6-DoF model (mean RMS difference = 3.3°). The mean errors of the JC model were also less than those comparing a 6-DoF model to bone pin data (3.3° for the same comparable joints) (Nester et al. 2007). In addition to improved accuracy, the JC foot model is capable of quantifying subtalar joint motion and yields intrinsic foot kinematics that are physiologically more realistic; tri-planar motion of combined dorsiflexion–inversion–adduction and plantarflexion–eversion–abduction rather than motion in six independent degrees of freedom. Therefore, the intrinsic foot kinematics computed from the model may be easier to interpret and compare across participants. In this study we report bone to bone kinematics to compare the models to BVR for accuracy. Output joint angles of the subtalar joint have previously been published, see Maharaj et al. (2016).
Antiresorptive treatment and talar collapse after displaced fractures of the talar neck: a long-term follow-up of 19 patients
Published in Acta Orthopaedica, 2021
Andreas Meunier, Lars Palm, Per Aspenberg, Jörg Schilcher
We found a 100% risk of post-traumatic OA in at least 1 of the examined joints (tibiotalar joint, subtalar joint, talonavicular joint). In this respect, there was no statistically significant difference between the 2 groups. This overall rate of OA is higher compared with those reported previously: 36/66 in the Vallier study (Vallier et al. 2014) and 68% in a systematic review (Halvorson et al. 2013). However, it is similar to the OA rate reported in a recent meta-analysis, in which 81% of patients showed signs of subtalar joint OA after more than 2 years of follow-up. In that study, talocrural OA was not included, and the authors noted that the majority of the included studies used only plain radiographs for the evaluation of OA. The high rate of post-traumatic OA we observed may be attributable to the long-term follow-up and thorough evaluation using CT.
An evaluation of the use of a lateral wedged insole and a valgus knee brace in combination in subjects with medial compartment knee osteoarthritis (OA)
Published in Assistive Technology, 2021
Mobina Khosravi, Mokhtar Arazpour, Arash Sharafat Vaziri
Since the human body is an integrated and complex unit and members are connected as a closed chain, the interaction reveals itself more in one extremity. The ankle and knee unit is an integral unit in the body, so changes in each member affects another member. Therefore, in the present study, interventions were given for effectiveness on knee and ankle (subtalar joint) both. On the other hand, valgus braces can effectively improve the biomechanical position of the knee joint center, whereas the lateral wedge insoles can incline the orientation of the ground reaction force in the lateral direction, thereby reducing KAM lever arm. It seems combining the use of these two interventions may result in more significant KAM reduction. Given that there are only four studies in this field that were only two studies with follow-up (2 and 4 weeks) (Fu et al., 2015; Mirzaei, Arazpour, Roodsari, Bahramizadeh, & Mardani, 2018; Moyer et al., 2013, 2011), there was also a contradiction in previous studies, high prevalence of this disorder and high economic losses. It seems that the study of combined effect of both interventions with follow-up can help us in more precise prescription and prevention of knee OA progression. In this regard, the aim of this study was to evaluate of the use of a VB and an LWI, both in isolation and combined, on the KAM, pain levels, function, and satisfaction in patients with knee OA for 6 weeks. The main hypothesis is of this study was that combining a VB and a LWI would reduce peak external adduction moments during walking when compared to the use of a VB or LWI in isolation.