Surgery of the Foot
Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou in Operative Orthopaedics, 2020
Various methods of ST joint fixation have been described. Our preferred method is to place a large-diameter (8 mm) cannulated compression screw from the posterolateral aspect of the calcaneum into the talus to cross the posterior facet at 90°. This avoids possible impingement problems from a screw inserted from the talar neck. The entry point is in a line down from the lateral margin of the Achilles tendon, just above the plantar skin of the heel. Too plantarwards or central an entry point may cause painful prominence of the screw head. Usually, a single screw is sufficient. The TN joint can be fixed using a retrograde screw from the medial edge of the navicular into the talar neck. Care must be taken to ensure a good bite is obtained medially without intruding upon the NC joint. Further fixation can be obtained with a screw from the anterior surface of the navicular. Screw fixation of the CC joint, antegrade from the anterior process of the calcaneum or retrograde from the cuboid, can sometimes be difficult, in which case compression staples or a low-profile plate can be used.
Skeletal System
David Sturgeon in Introduction to Anatomy and Physiology for Healthcare Students, 2018
The bones of the proximal (near) foot are known as tarsal bones (Figure 4.6). The largest of these are the talus and the calcaneus (heel bone). Both are connected to the distal (far) end of the tibia and fibula (and to one another) by a series of ligaments. If you are unfortunate enough to twist your ankle, it is usually the talo-fibular and calcaneo-fibular ligaments that are torn or damaged. As a rule of thumb: ligaments attach bones to other bones, and tendons attach bones to muscles allowing movement. For example, the Achilles tendon is attached to the calcaneus (heel bone) at its distal end and two large calf muscles (gastrocnemius and soleus) at its proximal end. Flexing these muscles pulls the Achilles tendon attached to the heel (plantar flexion) and enables us to stand on our toes, walk, run and jump. The five remaining talus bones (navicular, cuboid and x 3 cuneiform bones) are smaller than the talus and calcaneus and articulate with the five metatarsals. These long bones of the foot are similar to the metatarsals of the hand and are frequently considered newsworthy when a famous footballer breaks one immediately prior to a major tournament. Finally, the bones of the toes are also known as phalanges and, like the hand, there are two in the big toe (also known as the hallux) and three in toes 2–5.
Podiatric Medicine and the Painful Heel
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
One method to assess for calf tightness is to apply a heel lift (on the painful foot) that does not compress to less than 1/2 to 1 in. If the plantar heel pain eases, then calf tightness must be addressed in the process of eliminating heel pain. If calf tightness is noted, it is best to stretch the Achilles tendon bilaterally. The stretch should be done with the subtalar joint of the foot in neutral position. This helps to maximize the stretch of the Achilles tendon. The stretches should be done with static holds, without bouncing. If heel lifts are needed, then the lifts should be worn in both shoes to reduce the risk of back pain until the flexibility of the gastro-soleus complex is restored. When bouncing instead of static stretching is done during exercise, shortening of the gastro-soleus muscle area is apt to occur. This shortening may cause a secondary Achilles tendonitis.
Impaired mechanical properties of Achilles tendon in spastic stroke survivors: an observational study
Published in Topics in Stroke Rehabilitation, 2019
Caroline Pieta Dias, Bruno Freire, Natália Batista Albuquerque Goulart, Camila Dias De Castro, Fernando De Aguiar Lemos, Jefferson Becker, Anton Arndt, Marco Aurélio Vaz
The gait activity requires an efficient interaction between the calf muscles and Achilles tendon. The literature reports that spasticity causes shorter fascicle length and lower fascicle excursion5, followed by muscle atrophy6, which results in weakness. However, there is no consensus in relation to Achilles tendon properties in individuals with spasticity due to stroke. Two previous studies found decreased Achilles tendon stiffness and the Young’s modulus for the affected limb compared to the contralateral limb in people with spastic calf muscles.7,8 The authors suggest that the Achilles tendon is more compliant in the impaired side.7,8 On the other side, another study found no difference in passive Achilles tendon extensibility between individuals with stroke and healthy individuals at different ankle angles.4 The changes in Achilles tendon compliance might shorten fiber lengths in calf muscles and compromise muscle excitation patterns9 which increased the gait biomechanical disorder. However, it was not possible to find studies comparing tendon morphology and material properties between individuals with spasticity and healthy people at maximal effort, which allows the knowledge extent on tendon properties in spasticity.
Free flap reconstruction of Achilles tendon and overlying skin defect using ALT and TFL fabricated chimeric flap
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Junji Ando, Minoru Sakuraba, Atsushi Sugawara, Aya Goto, Shuchi Azuma, Nobuyuki Mitsuhashi, Kousuke Sasaki, Itaru Sone
There are various Achilles tendon repair methods. The free inguinal flap with external oblique muscle fascia [2], free inferior glutaeal artery perforator flap with glutaeus maximus fascia [3], lateral arm flap with biceps brachialis muscle fascia [4], free dorsalis pedis flap extensor tendon [5], free lateral thigh flap with fascia lata [6], free TFL flap [7], and free ALT flap with fascia lata [8,9] were reported previously. A TFL flap contains enough iliotibial thick fascia to support weight at the Achilles tendon repair site. An ALT flap provides certain coverage of wide defects with thin pliable skin to support shoe wearing. We believe that combination of these two flaps can be the first choice for the reconstruction of complex Achilles tendon defects. However, other flaps can be used if the TFL or ALT flap is impossible to use because of prior injury. In this case, the skin defect was large and accompanied by an infection, so we used an ALT flap to cover the skin and used a TFL flap to reconstruct the Achilles tendon.
Higher Rate of Postoperative Complications in Delayed Achilles Tendon Repair Compared to Early Achilles Tendon Repair: A Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Shu-Kun He, Jing-Ping Liao, Fu-Guo Huang
The Achilles tendon is one of the common injured tendons, with an incidence of 31 per 100,000 per year, following the rotator cuff tears.1,2 Moreover, Achilles tendon injuries are more common in males and the young to middle aged active population.1,2 The reason of most Achilles tendon injuries is indirect trauma such as sudden stretch or contraction, and the increasing incidence of rupture maybe due to the rise in the number of older adults participating in sports.3 For acute Achilles tendon ruptures, suitable treatment is still controversial. Operative treatment could reduce the incidence of re-rupture compared with conservative treatment.4 However, operative treatment also resulted in a higher risk of other complications (such as infection) than conservative treatment.4