RESUMO
The isolated talonavicular joint arthrodesis can be beneficial to correct midfoot deformities involving the talonavicular joint, including collapsing pes planovalgus. Studies show that isolated talonavicular arthrodesis has a higher nonunion rate because of micromotion; thus, other procedures should be used in conjunction with it. We sought to determine if adding an adjunctive medial calcaneal displacement osteotomy helps to reduce the ground reactive force and, therefore, the micromotion on the talonavicular joint. We used 4 below-knee limbs to study the force placed on the joint in an isolated talonavicular arthrodesis compared with the same procedure with an adjunctive calcaneal osteotomy under weightbearing simulation. A 0.5-inch circular force sensing resistor was placed within the talonavicular and used to check the force on the joint after a 5-lb force was added to the proximal limb. The resistance was quantified with force measured as a direct inverse. This procedure was performed 3 times for each limb. The mean resistance before and after calcaneal osteotomy was analyzed with use of the paired t test. In the pre-calcaneal osteotomy sites, the mean resistance given in 200 kΩ was 388.2 ± 565.9 compared with 1016.6 ± 482.7 in the post-calcaneal osteotomy sites (pâ¯=â¯.02). Findings from this cadaver study indicate reduction in forces to the talonavicular joint with an adjunctive calcaneal osteotomy. We conclude that it can be a beneficial adjunctive procedure for patients at a high risk of nonunion, such as those with obesity or diabetes or those who smoke. These patients could benefit from the decreased micromotion that the adjunctive procedure allows.
Assuntos
Artrodese/métodos , Calcâneo/cirurgia , Osteotomia , Amplitude de Movimento Articular/fisiologia , Articulações Tarsianas/fisiopatologia , Articulações Tarsianas/cirurgia , Idoso , Cadáver , Feminino , Pé Chato/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Cuboid dislocations are rare midfoot injuries that usually occur in the setting of high-energy trauma. Diagnosis can be challenging and optimal treatment remains unknown. This case report and review aims to summarize the recent literature on this topic.
Assuntos
Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Luxações Articulares/cirurgia , Ossos do Tarso/lesões , Articulações Tarsianas/cirurgia , Acidentes de Trânsito , Pinos Ortopédicos , Placas Ósseas , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Fixação Interna de Fraturas/instrumentação , Humanos , Escala de Gravidade do Ferimento , Luxações Articulares/diagnóstico por imagem , Pessoa de Meia-Idade , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/cirurgia , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Spring ligament tear is often found in advanced adult acquired flatfoot deformity and its reconstruction in conjunction with the deltoid ligament has been proposed to restore the tibiotalar and talonavicular joint stability. The aim of the present study is to determine the effect of spring ligament injury and subsequent reconstruction on static joint reactive force using a non-invasive method of measurement. METHODS: Ten fresh-frozen human cadaveric lower legs were disarticulated at the knee joint. Static joint reactive force of the tibiotalar and talonavicular joint were measured at baseline, after spring ligament injury, and after ligament reconstruction. Reconstruction consisted of a forked semitendinosis allograft with dual limbs to reconstruct the tibionavicular and tibiocalcaneal ligaments. FINDINGS: The mean baseline joint reactive force of the tibiotalar and talonavicular joints were 37.2â¯Nâ¯+â¯8.1â¯N and 13.4â¯Nâ¯+â¯4.2â¯N, respectively. The spring ligament injury model resulted in a significant 29% decrease in tibiotalar joint reactive force. Reconstruction of the tibionavicular limb resulted in a significant increase in tibiotalar and talonavicular joint reactive force compared to those seen in the injury state. Furthermore, the addition of the tibiocalcaneal limb significantly increased tibiotalar joint reactive force compared to those results obtained from the injury state and the tibionavicular limb alone. INTERPRETATION: This is the first study to demonstrate diminished tibiotalar static joint reactive force in a spring ligament injury model with subsequent joint reactive force restoration using two-limbed reconstruction of the deltoid and spring ligament. LEVEL OF EVIDENCE: Biomechanical Study.
Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Pé Chato/cirurgia , Instabilidade Articular/diagnóstico , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Cadáver , Pé/cirurgia , Humanos , Lacerações , Doenças Musculares , Pressão , Procedimentos de Cirurgia Plástica , Estresse Mecânico , Articulações Tarsianas/fisiopatologia , Articulações Tarsianas/cirurgiaRESUMO
The single medial incision subtalar joint and talonavicular joint arthrodesis has been shown to be a useful alternative for the correction of hindfoot valgus deformity. We describe an arthroscopic method of joint preparation using this approach. The present case report included 6 consecutive patients aged 35 to 72 (mean ± standard deviation 55.8 ± 15.54) years (4 males [66.7%] and 2 females [33.3%]), who had undergone the medial approach for modified double arthrodesis of the foot. Of the 6 patients, 3 (50.0%) had undergone arthroscopic joint preparation and 3 (50.0%) traditional (manual) joint preparation. Osteobiologic agents were used in all patients. We found a shorter tourniquet time for the patients who had undergone an arthroscopic approach, with a mean of 110 ± 7.21 minutes, compared with a traditional joint preparation, with a mean of 121.3 ± 8.08 minutes. We also found a shorter time to radiographic union in the patients who had undergone an arthroscopic approach, all of whom showed signs of union at 6 weeks. Only 2 of the 3 patients in the traditional joint preparation group had achieved union at a mean of 10 ± 2.83 weeks, with 1 case resulting in nonunion. This technique could be a viable alternative to traditional methods of joint preparation by decreasing the operative time and improving the union rates.
Assuntos
Artrodese/métodos , Artroscopia/métodos , Deformidades Adquiridas do Pé/cirurgia , Articulações Tarsianas/cirurgia , Adulto , Idoso , Parafusos Ósseos , Estudos de Coortes , Terapia Combinada/métodos , Desbridamento/métodos , Feminino , Seguimentos , Deformidades Adquiridas do Pé/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Posicionamento do Paciente/métodos , Cuidados Pós-Operatórios , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Articulação Talocalcânea/diagnóstico por imagem , Articulação Talocalcânea/fisiopatologia , Articulação Talocalcânea/cirurgia , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Isolated talonavicular arthrodesis is a commonly performed surgical intervention. Nonunion is a dreaded complication. The aim of the present study was to analyze the clinical and radiologic outcome of talonavicular arthrodesis using a dual approach with 2-side screw fixation. From February 2012 to September 2014, isolated talonavicular arthrodesis was performed on 17 joints of 16 patients (mean age 59.12 years). All procedures were performed by a single surgeon. The incidence of union, visual analog scale scores, and complications were analyzed. Radiographic union was achieved in all 17 cases (100%) at a mean period of 13.12 weeks. The visual analog scale scores had improved significantly (p < .001) at a mean follow-up of 48.53 weeks. One patient (6%) had minimal wound problems, and one (6%) showed prolonged swelling postoperatively. We have concluded that the dual window approach with 2-side screw fixation for isolated talonavicular arthrodesis results in excellent clinical and radiographic results and high fusion rates.
Assuntos
Artrodese/métodos , Parafusos Ósseos , Artropatias/cirurgia , Articulações Tarsianas/cirurgia , Adulto , Idoso , Artrodese/instrumentação , Estudos de Coortes , Feminino , Seguimentos , Humanos , Artropatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Posicionamento do Paciente/métodos , Segurança do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: To describe the diagnosis and surgical management of congenital laxity of the fibularis tendon resulting in hyperextension of the tarsus in calves. STUDY DESIGN: Case series. ANIMALS: Fourteen calves (3 unilateral, 11 bilateral) diagnosed with congenital tarsal instability caused by laxity of the fibularis musculotendinous unit resulting in hyperextension of the tarsus. METHODS: Diagnosis was made by clinical and radiologic assessments. The tarsus was surgically prepared and an incision made on the dorsal surface of the tarsus after intrathecal anesthesia with the calf sedated. A locking-loop suture (4 loops) was applied to the fibularis tendon using polyglactin 910. The free ends of the suture were then tied to the shank of a cortical bone screw inserted in the proximal metatarsus. RESULTS: The calves were evaluated on postoperative days 15, 30, and 60 and were walking normally. CONCLUSION: Congenital tarsal instability because of laxity of the fibularis musculotendoninous unit is described and surgical treatment directed at shortening the tendon shows promising results.
Assuntos
Doenças dos Bovinos/diagnóstico , Doenças dos Bovinos/cirurgia , Articulações Tarsianas/cirurgia , Animais , Bovinos , Doenças dos Bovinos/congênito , Doenças dos Bovinos/diagnóstico por imagem , Feminino , Masculino , Radiografia , Articulações Tarsianas/fisiopatologia , Tendões/fisiopatologiaRESUMO
BACKGROUND: Calcium pyrophosphate deposition (CPPD) disease is a metabolic disorder characterized by soft tissue calcific deposits formed primarily in articular cartilage. What can result is a crystal-induced arthropathy often referred to as pseudogout, which is variable in both presentation and severity. A particularly destructive and deforming arthritis is an uncommon but well-recognized subtype of this disease. Radiologically resembling the neuroarthropathy described by Charcot, a pattern of joint fragmentation and structural collapse occurs in the absence of peripheral neuropathy. This pseudo-neuroarthropathy is rarely reported in the foot and ankle. METHODS: A total of 15 cases of pseudo-neuroarthropathy involving some previously unreported joints within the foot and ankle are described in this case series of 9 patients. RESULTS: All patients presented with disease involving multiple joints. Clinical deformity was apparent in each case, and extensive joint destruction was seen on plain radiographs. In 6 patients, histopathological CPPD disease was confirmed on tissue biopsy of the affected joints. In the remaining 3 patients a clinical diagnosis was made on the basis of the classic appearance of pseudo-neuroarthropathy in the foot, with additional recognized features of CPPD. Operative management with deformity correction using joint arthrodesis produced satisfactory clinical and radiological results. CONCLUSIONS: In the absence of peripheral neuropathy and systemic disease, the pseudo-neuroarthropathy of CPPD should be considered when a progressively deforming and destructive arthritis is seen in the foot and ankle. LEVEL OF EVIDENCE: Level IV, case series.
Assuntos
Artropatia Neurogênica/diagnóstico por imagem , Artropatia Neurogênica/terapia , Pirofosfato de Cálcio/metabolismo , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/terapia , Adulto , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Artropatia Neurogênica/fisiopatologia , Condrocalcinose/fisiopatologia , Estudos de Coortes , Terapia Combinada , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/fisiopatologia , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: This study assessed the hypothesis that arthrodesis of both the ankle and the hindfoot joints produces an objective improvement of function as measured by gait analysis of patients with severe ankle and hindfoot arthritis. METHODS: Twenty-one patients with severe ankle and hindfoot arthritis who underwent unilateral tibiotalocalcaneal arthrodesis with an intramedullary nail were prospectively studied with three-dimensional (3D) gait analysis at a minimum of one year postoperatively. The mean age at the time of the operation was fifty-nine years, and the mean duration of follow-up was seventeen months (range, twelve to thirty-one months). Temporospatial measurements included cadence, step length, walking velocity, and total support time. The kinematic parameters were sagittal plane motion of the ankle, knee, and hip. The kinetic parameters were sagittal plane ankle power and moment and hip power. Symmetry of gait was analyzed by comparing the step lengths on the affected and unaffected sides. RESULTS: There was significant improvement in multiple parameters of postoperative gait as compared with the patients' own preoperative function. Temporospatial data showed significant increases in cadence (p = 0.03) and walking speed (p = 0.001) and decreased total support time (p = 0.02). Kinematic results showed that sagittal plane ankle motion had decreased, from 13.2° preoperatively to 10.2° postoperatively, in the operatively treated limb (p = 0.02), and increased from 22.2° to 24.1° (p = 0.01) in the contralateral limb. Hip motion on the affected side increased from 39° to 43° (p = 0.007), and knee motion increased from 56° to 60° (p = 0.054). Kinetic results showed significant increases in ankle moment (p < 0.0001) of the operatively treated limb, ankle power of the contralateral limb (p = 0.009), and hip power on the affected side (p = 0.005) postoperatively. There was a significant improvement in gait symmetry (p = 0.01). CONCLUSIONS: There was a small loss of sagittal plane motion in the affected limb postoperatively. There were marked increases in gait velocity, ankle moment, and hip motion and power, documenting objective improvements in ambulatory function. The data showed that preoperative ankle motion was greatly diminished. This may suggest that pain is more important than stiffness in asymmetric gait.
Assuntos
Articulação do Tornozelo/cirurgia , Artrite/cirurgia , Artrodese/métodos , Marcha , Articulações Tarsianas/cirurgia , Adulto , Idoso , Articulação do Tornozelo/fisiopatologia , Artrite/fisiopatologia , Artrodese/instrumentação , Fenômenos Biomecânicos , Pinos Ortopédicos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Articulações Tarsianas/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: The balloon kyphoplasty approach to the treatment of vertebral fractures can be adapted to achieve the reduction and cement stabilisation of intra-articular compression fractures at other sites, such as the calcaneus. PATIENTS AND METHOD: We studied six patients with a median follow-up of 12 months (range, 6-30 months). Fluoroscopy guidance was used to obtain optimal balloon positioning under the joint depression site. Reduction was achieved by expanding the balloon and stabilisation by injecting the cavity with resorbable tricalcium-phosphate cement in the younger patients and polymethyl-metacrylate cement in the two elderly patients with osteoporosis. No internal fixation was used. RESULTS: No intra-operative, postoperative, or delayed complications were recorded. Median hospital stay length was 4.5 days (range, 3-7 days). All the fractures healed within the usual timeframe, without loss of reduction. Median time to full weight-bearing ambulation was 52.5 days (range, 15-75 days). The functional outcomes correlated with the good anatomic results, with a median American Orthopaedic Foot and Ankle Society score of 87.0 (range, 86-97). DISCUSSION: This preliminary study shows that balloon reduction and cement fixation of intra-articular calcaneal fractures is easy to perform, reproducible, and devoid of specific complications. Good-quality reduction and stabilisation until fracture healing were achieved, and time to recovery of self-sufficiency was short, even in elderly patients with osteoporosis. These results support the use of this minimally invasive technique. LEVEL OF EVIDENCE: Level IV, retrospective study.
Assuntos
Calcâneo/lesões , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Intra-Articulares/cirurgia , Cifoplastia/instrumentação , Articulações Tarsianas/cirurgia , Adulto , Idoso , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Desenho de Equipamento , Feminino , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/fisiopatologia , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulações Tarsianas/lesões , Articulações Tarsianas/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Lisfranc fracture dislocations cause severe tarso-metatarsal malalignment. The research question of this study was to evaluate the severity of the soft tissue injury on the final clinical outcome and compare that with the effect of various determinants on the disability in daily living activities after open reduction and internal fixation of a Lisfranc injury. METHODS: This study consisted of a retrospective analysis of patients with Lisfranc fracture dislocations who were treated by open reduction and internal fixation beween 2004 and 2009. Evaluation focused mainly on the severity of the soft tissue injury, age, fracture classification, time to operation, posttraumatic osteoarthritis, and the results were compared with American Foot and Ankle Society (AOFAS) scores, and Foot and Ankle Disability Index (FADI). Eight patients had Tscherne Grade 1, 13 had Grade 2, and 11 had Grade 3 soft tissue injuries. Myerson classification revealed 11 type A, 8 type B and 13 type C fractures. Six patients' operations were delayed beyond 8h. RESULTS: Of the 38 patients treated in the study period, 32 patients (11 female, 21 male; <30 y-old: 14, >30 y-old: 18) were available for complete follow-up (average, 55.5 months). The comparison of treatment results revealed that those patients with high grade soft tissue injuries had lower AOFAS and FADI scores (43.8±15.9, 53.7±9.4, respectively) when compared to Tscherne Grade 1 injuries (82.8±6.1, 109±13.9, respectively) (p<0.001). The overall negative impact of the severity of soft tissue injury on functional outcomes had similar significance with regard to post-traumatic osteoarthritis, and fracture type. There was also a statistically significant difference between outcome measures and post-reduction quality (p=0.002). Patient age (p=0.9) and delayed surgery (p=0.5) had no statistically significant effect on the final outcome. CONCLUSIONS: Satisfactory results can be achieved with open reduction for Lisfranc injuries. However, despite this treatment, both the severity of the soft tissue injury and non-anatomic reduction are negative prognostic factors in the treatment of Lisfranc fracture dislocations.
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Luxações Articulares/cirurgia , Ossos do Metatarso/lesões , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Articulações Tarsianas/lesões , Adulto , Parafusos Ósseos , Feminino , Seguimentos , Fraturas Ósseas/fisiopatologia , Humanos , Luxações Articulares/fisiopatologia , Masculino , Ossos do Metatarso/fisiopatologia , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Articulações Tarsianas/fisiopatologia , Articulações Tarsianas/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Plantar pressure measurements have long been used by clinicians to provide information regarding potential impairments and disorders of the foot and ankle. Elevations in peak plantar pressures or a poor distribution of these pressures can be an indication of pathomechanics in the foot. Lower extremity deficits such as sensory impairment, foot deformities, limited joint mobility, and reduced plantar tissue thickness have been associated with high plantar pressures. The total pressures, pressure distribution, and peak pressures provide useful information to evaluate the abnormal functioning of the talotarsal joint. Instability of the talotarsal joint can result in excessive forces exerted on the joints and surrounding tissues in the foot that can then lead to dysfunction of the proximal musculoskeletal kinetic chain. In the present study, we performed a retrograde analysis of the pre- and postoperative measurements of the peak plantar pressures, peak forces, and area of contact between the foot and the ground during each phase of the gait cycle for 6 patients (12 feet) who had undergone a bilateral extraosseous talotarsal stabilization procedure using a type II extraosseous talotarsal stabilization device. After the procedure, a significant reduction was seen in the peak pressures (42%) over the entire foot and a significant increase in the contact area (19.7%) between the foot and the floor. This could imply that the extraosseous talotarsal stabilization procedure was effective in stabilizing the talotarsal joint complex, thus eliminating abnormal hindfoot motion and restoring the normal biomechanics of the foot and ankle complex, as indicated by a reduction and realignment of the peak plantar pressures and forces.
Assuntos
Pé/fisiopatologia , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos/instrumentação , Articulações Tarsianas/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Desenho de Equipamento , Feminino , Seguimentos , Pé/cirurgia , Marcha , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulações Tarsianas/cirurgia , Adulto JovemRESUMO
Displacement of the articular facets of talus on the tarsal mechanism, or partial talotarsal dislocation, is a condition seen in children, adult, and geriatric populations. A characteristic of this pathologic condition is a prolonged period of and excessive amount of pronation (hyperpronation) on weightbearing. The ill effects of this condition may lead to a multitude of other foot pathologies and to pathologies associated with the proximal lower extremity musculoskeletal structures. A variety of conservative and operative treatment options have been used to eliminate or minimize hyperpronation. Extraosseous talotarsal stabilization (EOTTS) devices have been used to realign and stabilize the articular facets of the talus on the tarsal mechanism, thereby attempting to restore the normal range of hindfoot motion while eliminating hyperpronation. A multitude of such devices, which are intended for the same purpose, are available for the surgeon to choose from. However, there is no literature discussing the differences among these devices, or the benefits of one device over the other. Based on current understanding and available knowledge base, the goal of this article was to classify EOTTS devices based on their design features and biomechanical functioning. A theoretical description of how these different types of devices function is laid out in an attempt to understand the reason for their success or failure. This new classification system is intended to help researchers and surgeons appreciate the subtle yet important differences among these devices, and to thus help them design future research studies when using these devices.
Assuntos
Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Tálus/fisiopatologia , Articulações Tarsianas , Fenômenos Biomecânicos , Humanos , Equipamentos Ortopédicos , Estresse Mecânico , Ossos do Tarso/fisiopatologia , Articulações Tarsianas/fisiopatologiaRESUMO
BACKGROUND: We aimed to report our results of peri-navicular arthrodesis with autologous iliac bone graft for Stage III Müller-Weiss disease. METHODS: Nine cases of Stage III Müller-Weiss disease according to the Maceira classification (four male and five female) with average age of 48.2 (range, 41 to 58) years, had mild or severe midfoot pain with the longitudinal arch collapse. The patients, all of whom had failed conservative treatment for more than 6 months, underwent peri-navicular arthrodesis. All patients were followed up at 3, 6, 9, and 12 months, and then every 6 months with AOFAS ankle-hindfoot scores and radiographic measurements. Mean followup time for radiological and clinical evaluation was 22.4 (rangem 12 to 52) months. RESULTS: All patients were satisfied with their clinical results without pain 12 months after surgery. The mean AOFAS ankle-hindfoot scores improved from 40.1±8.3 preoperatively to 90.9±2.1 at the last followup (p<0.05). A solid fusion was found in all cases at 3 months after surgery by radiographic and clinical evaluation. The average longitudinal arch height increased from 46.1±2.1 mm preoperatively to 53.5±2.3 mm at the last followup (p<0.05) on the lateral weightbearing radiograph. CONCLUSION: The peri-navicular arthrodesis with autologous iliac bone graft resulted in a good outcome for Stage III Müller-Weiss disease with good clinical outcomes, high fusion rate, and obvious improvement of the longitudinal arch height.
Assuntos
Artrodese/métodos , Osteonecrose/cirurgia , Ossos do Tarso/patologia , Ossos do Tarso/cirurgia , Articulações Tarsianas/cirurgia , Adulto , Artrite/diagnóstico por imagem , Artrite/etiologia , Artrite/cirurgia , Feminino , Seguimentos , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/cirurgia , Humanos , Ílio/transplante , Masculino , Pessoa de Meia-Idade , Osteonecrose/classificação , Dor/etiologia , Dor/cirurgia , Radiografia , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/fisiopatologia , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/fisiopatologia , Transplante AutólogoAssuntos
Instabilidade Articular/fisiopatologia , Osteoartrite/fisiopatologia , Tálus/fisiopatologia , Articulações Tarsianas/fisiopatologia , Fenômenos Biomecânicos , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/cirurgia , Humanos , Instabilidade Articular/classificação , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Ligamentos Articulares/fisiopatologia , Ligamentos Articulares/cirurgia , Procedimentos Ortopédicos , Osteoartrite/diagnóstico por imagem , Radiografia , Tálus/diagnóstico por imagem , Tálus/cirurgia , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/cirurgiaRESUMO
Posterior tibial tendon dysfunction is considered one of the most common causes of progressive adult acquired flatfoot deformity. The etiology leading to the dysfunction of posterior tibial tendon remains controversial. The purpose of this study was to quantify strain on the posterior tibial tendon in cadaver feet exhibiting hyperpronation caused by flexible instability of the talotarsal joint complex. We hypothesized that posterior tibial tendon strain would decrease after a minimally invasive extra-osseous talotarsal stabilization procedure. A miniature differential variable reluctance transducer was used to measure the elongation of posterior tibial tendon in 9 fresh-frozen cadaver specimens. The elongation was measured as the foot was moved from its neutral to maximally pronated position, before and after intervention with the HyProCure(®) extra-osseous talotarsal stabilization device. The mean elongation of the posterior tibial tendon (with respect to a fixed reference point) was found to be 6.23 ± 2.07 mm and 3.04 ± 1.85 mm, before and after intervention, respectively (N = 27; variation is ± 1 SD). The average elongation reduced by 51% and was statistically significant with p < .001. Strain on the posterior tibial tendon is significantly higher in hyperpronating feet. An extra-osseous talotarsal stabilization procedure reduces excessive abnormal elongation of the posterior tibial tendon by minimizing excessive abnormal pronation. This minimally invasive procedure may thus provide a possible treatment option to prevent or cure posterior tibial tendon dysfunction in patients exhibiting flexible instability of the talotarsal joint complex.
Assuntos
Instabilidade Articular/cirurgia , Procedimentos Ortopédicos/métodos , Disfunção do Tendão Tibial Posterior/cirurgia , Amplitude de Movimento Articular/fisiologia , Adulto , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Fenômenos Biomecânicos , Cadáver , Intervalos de Confiança , Feminino , Pé Chato/etiologia , Pé Chato/cirurgia , Humanos , Disfunção do Tendão Tibial Posterior/complicações , Pronação/fisiologia , Entorses e Distensões , Estresse Mecânico , Articulações Tarsianas/fisiopatologia , Articulações Tarsianas/cirurgia , Tendões/fisiopatologia , Tendões/cirurgiaRESUMO
Excessive abnormal strain or tension on the posterior tibial nerve in feet exhibiting talotarsal instability has been considered one of the possible etiologic factors of tarsal tunnel syndrome. The suggested treatment options in such cases include stabilization of the talotarsal joint complex in a corrected position, which might help minimize the abnormal forces placed on the posterior tibial nerve due to over stretching. The primary goal of this study was to quantify strain on the posterior tibial nerve in feet exhibiting hyperpronation caused by talotarsal instability, before and after an extra-osseous talotarsal stabilization (EOTTS) procedure. We hypothesized that the excessive strain placed on the posterior tibial nerve in hyperpronating cadaveric feet would be reduced significantly after intervention using the HyProCure(®) EOTTS device. Posterior tibial nerve strain was quantified in 9 fresh-frozen cadaver specimens. A miniature differential variable reluctance transducer was used to measure nerve elongation as the foot was moved from its neutral to a maximally pronated position, before and after intervention. The mean elongation of the posterior tibial nerve (with respect to a fixed reference point) decreased by 43% after the EOTTS procedure (i.e., from 5.91 ± 0.91 mm to 3.38 ± 1.20 mm; N = 27). The reduction was statistically significant at p < .001. HyProCure(®) was effective in stabilizing the talotarsal joint complex, thus reducing the excessive amount of strain placed on the posterior tibial nerve. Clinical implications of this study suggest the use of EOTTS devices in the treatment of tarsal tunnel syndrome.
Assuntos
Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Articulações Tarsianas/cirurgia , Síndrome do Túnel do Tarso/etiologia , Nervo Tibial/fisiopatologia , Fenômenos Biomecânicos , Cadáver , Feminino , Humanos , Masculino , Pronação/fisiologia , Amplitude de Movimento Articular/fisiologia , Sensibilidade e Especificidade , Entorses e Distensões/fisiopatologia , Entorses e Distensões/cirurgia , Estresse Mecânico , Articulações Tarsianas/fisiopatologia , Síndrome do Túnel do Tarso/fisiopatologia , Síndrome do Túnel do Tarso/prevenção & controle , Nervo Tibial/cirurgiaRESUMO
The navicular drop in the sagittal plane on weight-bearing is a valid indicator of foot pronation. Dislocation of the talus on the tarsal mechanism results in hyperpronation, which can lead to excessive navicular drop. The purpose of the present study was to radiographically determine the efficacy of HyProCure(®) in realigning the navicular bone in hyperpronating feet. We hypothesized that following the placement of HyProCure(®), the navicular height would increase significantly compared to its preoperative value. Radiographs of 61 adult patients (86 feet) who received HyProCure(®) without adjunctive hindfoot or midfoot soft tissue or osseous procedures were analyzed. The distance of the navicular with respect to the cuboid was measured from the pre- and postoperative weight-bearing lateral radiographs. Additionally, we measured foot length to normalize the navicular to cuboid distance. The postoperative radiographs were taken at an average follow-up of 17 days. The mean preoperative true navicular to cuboid distance was 19 ± 6 mm as compared to a mean postoperative value of 24 ± 5 mm. The mean pre- and postoperative normalized navicular to cuboid distances were 0.098 ± 0.029 and 0.125 ± 0.027, respectively (± 1 SD). The postoperative increase in the true and normalized navicular to cuboid distance was statistically significant (p < .001). HyProCure(®) was effective in improving the anatomic alignment of the talonavicular joint by reducing excessive navicular drop. This indicates reduction of excessive abnormal pronation and stabilization of the medial column of the foot, which can also lead to reduction in the excessive forces placed on the supporting soft tissue structures.
Assuntos
Instabilidade Articular/cirurgia , Pronação/fisiologia , Próteses e Implantes , Ossos do Tarso/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Luxações Articulares/cirurgia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia , Ossos do Tarso/fisiopatologia , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/fisiopatologia , Articulações Tarsianas/cirurgia , Adulto JovemRESUMO
In cases of adult acquired flatfoot associated with peritalar destabilisation, special reference is made to the plantar calcaneo-navicular (spring) ligament's degenerative disease (degenerative glenopathy) and to the presence of the accessory navicular bone as a possible pathogenic cause. Peritalar destabilization syndrome is proposed for the articular (subtalar and talo-navicular joints) or tendinosis (tibialis posterior tendon) separately or in association with degenerative glenopathy of the coxa pedis. In degenerative glenopathy surgical reconstruction of the glenoid also makes use of a posterior tibial split to create a new tibial-navicular ligament. The concept of pronatory syndrome deemed as the root the pathological subtalar pronation, which is an entirely secondary factor in peritalar destabilisation, must be questioned. We must keep in mind that subtalar pronation and supination are respectively subsequent to opening and closing of the coxa pedis (talo-calcaneo-navicular joint) kinetic chain.
Assuntos
Pé Chato/etiologia , Deformidades Adquiridas do Pé/etiologia , Artropatias/fisiopatologia , Ligamentos Articulares/fisiopatologia , Articulações Tarsianas/fisiopatologia , Adulto , Pé Chato/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Humanos , Artropatias/cirurgia , Ligamentos Articulares/cirurgia , Ossos do Tarso/fisiopatologia , Ossos do Tarso/cirurgia , Articulações Tarsianas/cirurgiaRESUMO
BACKGROUND: Today the most frequently used operative procedures in advanced arthritis of the hindfoot joints are isolated talonavicular arthrodesis and double arthrodesis (involving the talonavicular and calcaneocuboid joints, i.e. the Chopart joint). This in vitro study investigates whether the fusion of the talonavicular joint alone can provide the hindfoot, as well as a midfoot, with comparable biomechanical stability as the double arthrodesis does. Hence with the less-invasive intervention the same benefit in terms of pain reduction and better functionality could be achieved. METHODS: In a series of ten fresh cadaver feet without any radiological pathologies, we measured the range of motion of different tarsal bones in three planes under axial stress. Every foot was loaded without arthrodesis, after talonavicular and after double arthrodesis, by charging tibia and fibula with a force of 350 N using a calibrated Instron® load frame. Each tarsal bone was marked with a K-wire and its motion was measured by registering the movement of the wire's shade that was projected onto the surrounding walls of the trial box. RESULTS: Both operative procedures led to a considerable reduction of the motion of every marked bone to a mean of 18% of the preoperative value. In direct comparison of the two simulated arthrodeses we found for every bone and in every plane only minimal differences of the mean excursions of 1.0 mm on average. Both fusions lead to equal residual tarsal bone motion postoperatively, and provide the midtarsal joint as well as the subtalar joint with comparable biomechanical stability. CONCLUSIONS: Isolated talonavicular arthrodesis is a useful and effective alternative to double arthrodesis. It is the less complicated, less-invasive and functionally equivalent operative option for arthritic alterations of the hindfoot and transverse tarsal joint.
Assuntos
Artrodese/métodos , Osteoartrite/cirurgia , Articulação Talocalcânea/cirurgia , Ossos do Tarso/cirurgia , Articulações Tarsianas/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Osteoartrite/fisiopatologia , Amplitude de Movimento Articular , Estresse Mecânico , Articulação Talocalcânea/fisiopatologia , Ossos do Tarso/fisiopatologia , Articulações Tarsianas/fisiopatologiaRESUMO
Open surgical resection of calcaneonavicular coalition is indicated after the failure of conservative treatment. Our objectives are to develop the arthroscopic surgical technique and to check the feasibility of the arthroscopic resection of the calcaneonavicular coalition. We designed and performed endoscopic resection of the calcaneonavicular ligament and part of the anterior process of calcaneus as a simulation of the coalition resection on four cadaver specimens. After this procedure, we successfully performed the first resection in a 12-year-old girl, without any soft tissue interposition. American Orthopaedic Foot and Ankle Society Hindfoot Scale was 55 before surgery, 98 after 10 weeks, and 100 after 2 years without recurrence.