Common Pitfalls in Subtalar Joint Preparation for Arthrodesis via Sinus Tarsi Approach.

This cadaveric study assessed factors that could lead to nonunions in subtalar joint arthrodesis. The purpose of this study was to assist surgeons in achieving sufficient joint preparation in hopes to achieve more frequent arthrodesis of the subtalar joint. We evaluated the influence of experience in regard to cartilage preparation of the joint. We also assessed which quadrants of the subtalar joint were more likely to have unprepared cartilage. The subtalar joints in 17 cadaveric limbs were prepared by 17 participants with differing levels of experience. After the cartilage was denuded, the percentage of unprepared cartilage in each subtalar joint was calculated. The medial quadrants were more likely to have unprepared surfaces. There was also a learning curve present with subtalar joint preparation, as seen by the significantly larger percentage of unprepared cartilage in cadavers prepared by first year residents.

Technique tip: subtalar joint fusion using a parallel guide and double screw fixation.

A wide range of techniques has been described to achieve subtalar (talocalcaneal) arthrodesis using interfragmental screw fixation. In this technical report, we describe a method that enables us to accurately position 2 screws across the subtalar joint in order to achieve arthrodesis between the talus and calcaneus. Careful attention to the tips described in this report should minimize the risk of aberrant placement of the screws while expediting the process of osteosynthesis.

Pathologic conditions of the heel: tumors and arthritides.

Heel pain is one of the most common presenting complaints to the foot and ankle specialist. There are many causes for subcalcaneal heel pain, including biomechanical, traumatic, those related to several types of arthritides and tumors, and anatomic causes. This article describes pathologic conditions of the heel, concentrating on tumors and arthritides.

Peroneal tendon injuries.

Peroneal tendon pathology is a common cause of lateral ankle pain. Because of the difficulty of distinguishing peroneal tendon injuries from lateral ligament injuries in the setting of ankle trauma, early diagnosis is often missed. Failure to recognize and adequately treat these injuries can result in significant long-term disability. Focused history and physical examination are critical, as is a thorough understanding of the local anatomy and biomechanics involved. Acute injuries may be successfully treated conservatively; however, chronic injuries have demonstrated unsatisfactory response to conservative measures. When considering surgical management of peroneal tendon injuries, as much information as possible must be gathered through history, clinical exam, and diagnostic studies. The level of injury in correspondence with the myriad of possible etiologic factors dictates the ideal procedure to be performed. Surgery is highly individualized according to the pathology encountered, and to the skill and experience of the surgeon.