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Congenital Vertical Talus
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Christopher Prior, Nicholas Peterson, Selvadurai Nayagam
Establish a pain-free, mobile, plantigrade foot by Reducing the talonavicular jointCorrecting the forefoot deformityCorrecting the hindfoot deformity
Foot and ankle radiology
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Inflammatory arthritis is a multi-systemic disorder with predominant musculoskeletal features. It is an immune mediated inflammatory response that causes bilateral inflammatory synovitis, commonly affecting the peripheral appendicular joints. MTPJs are preferentially affected. The talonavicular joint is the most frequently affected joint amongst the tarsal joints. Like other joints, there is marginal erosion caused by pannus formation with periarticular osteopaenia due to a combination of disuse and hyperaemia. This causes symmetrical, deforming arthritis with uniform joint space loss, which may eventually lead to ankylosis.
Biomechanics and Joint Replacement of the Foot and Ankle
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Rohit Madhav, Amit Amin, Deborah Eastwood, Dishan Singh
The transverse tarsal joints (Chopart’s joints) lie just anterior to the talus and calcaneum and are associated closely with the subtalar joint. They represent motion between the talus and navicular and between the calcaneum and cuboid. The talonavicular joint is key to understanding hindfoot kinematics. If the talus is considered to sit relatively free in the ankle mortise, held by ligaments from the tibia and fibula, the foot essentially moves around an instant centre of rotation at the talonavicular joint. If an isolated talonavicular fusion is performed, 80% of hindfoot motion is eliminated, in contrast to 60% if an isolated subtalar joint fusion is performed.
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
Talonavicular joint: For access to the talonavicular joint, the forefoot was kept in a position of abduction to enlarge the joint space of the talonavicular joint. After the decortication of the calcaneocuboid joint, abduction of the forefoot enabled easily the joint space enlargement of the talonavicular joint. A 1.5 cm portal was applied at the joint line of the talonavicular joint in parallel, and just medial to the anterior tibialis tendon (Figure 2(C,D)). After the skin incision, soft tissue was divided by mosquito clamps to avoid the damage of saphenous nerve and the joint was accessed. The joint capsule was penetrated by the mosquito clamps and arthroscope was introduced into the joint. Synovectomy and decortication under arthroscopy were performed (Figure 3(F,G)). Decortication arthroscopically for three joints did not require any distraction device.
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
Spontaneous collapse of the tarsal navicular in adults has been known as Müller–Weiss disease (MWD), named after the physicians who reported this during the early twentieth century in Europe [1,2]. MWD occurs mostly in middle-aged women and presents with chronic midfoot and hindfoot pain and progressive deformity. Its radiographic appearance is characterized by dorsolateral collapse and fragmentation of the tarsal navicular, leading to advanced mid-tarsal osteoarthritis and pes planus with hindfoot varus [3]. The theory that MWD results from mechanical strain that disrupts the bone’s vascular supply with subsequent osteonecrosis is generally accepted; however, its precise etiology remains unclear [4]. Similar changes in the tarsal navicular reportedly occur secondary to diseases that increase the risk of osteonecrosis such as rheumatoid arthritis (RA), systemic lupus erythematosus, renal failure, or trauma [5]. Regarding RA, there have been many studies demonstrating that the talonavicular joint is likely to be affected most often and earlier in the disease course than other joints of the midfoot [6–8]; however, few studies have focused on tarsal navicular collapse.
Destructive arthritis with cutaneous polyarteritis nodosa requiring surgical intervention: a case report and review of the literature
Published in Modern Rheumatology Case Reports, 2020
Takahiro Iwata, Hiromu Ito, Moritoshi Furu, Masahiro Ishikawa, Masayuki Azukizawa, Haruhiko Akiyama, Shuichi Matsuda
At the age of 63, she was referred to our department for further examination and treatment. Physical examination revealed marked swelling and tenderness of the right ankle and right talonavicular joint, with moderate limitation of movement at the ankle. The erythrocyte sedimentation rate (ESR) and matrix metalloproteinase (MMP)−3 level were moderately elevated (32 mm/h and 102 ng/mL, respectively), but other investigations including serology for rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP antibody) and antinuclear antibody (ANA) yielded negative results. Radiography showed cystic changes and marked joint space narrowing in the right talonavicular joint (Figure 1). The contralateral talonavicular joint and other joints showed no destructive changes. Computed tomography (CT) revealed extensive erosive changes in the right talonavicular and middle facet of the subtalar joints (Figure 2). T1-weighted magnetic resonance imaging of the right talonavicular and middle facet of the subtalar joints showed low intensity, with high signal intensity on fat-suppressed T2-weighted imaging (Figure 3). Pronounced synovitis and bone marrow oedema of the right midfoot joints were observed in the right talocrural joint (Figure 3). Although the patient was started on cyclosporine 200 mg daily in addition to prednisolone 10 mg daily, her foot pain worsened progressively, necessitating surgery. The patient was placed supine and an anteromedial and anterolateral portal to the tibiotalar joint was created. Extensive dorsal synovitis of the tibiotalar joint was demonstrated by arthroscopy. Arthroscopic synovectomy was performed first in the central portion of the joint, along the tibial crest and talus, and was completed in the medial and lateral compartment. Thorough synovectomy was achieved by switching instruments between the portals several times. The cartilage was still in relatively good condition except for a partial defect in the talus. Subsequently, a medial skin incision was made at the level of the talonavicular joint. This revealed marked synovitis and a defect in the cartilage that had expanded within the talonavicular joint (Figure 4). Once the talonavicular joint had been synovectomized, a pronounced cartilage defect was exposed. Once the degenerated cartilage had been resected from the medial section of the joint, an extensive bone defect was seen, and therefore bone grafting was considered necessary for arthrodesis of the talonavicular joint. A corticocancellous block resected from the iliac bone was inserted (Figure 4), and two cannulated cancellous 4.0-mm screws were inserted, one from the navicular to the talus bone and the other reversely, under compression following radiographic imaging. The wound was closed, and a splint was applied with the ankle in 0-degree dorsal extension. Full weight-bearing with an insole was initiated four weeks after surgery.