Ruptured Pseudoaneurysm of the Lateral Plantar Artery After Tibiotalocalcaneal Fusion With Retrograde Nail-A Rare Complication.

We report a rare presentation of a ruptured pseudoaneurysm of the lateral plantar artery following tibiotalocalcaneal fusion with a retrograde nail at 1 month after the index surgery. Although case reports of pseudoaneurysms of larger arteries such as the anterior tibial artery and posterior tibial artery after ankle surgery (e.g., ankle arthroscopy, implant removal, Ilizarov application) have been reported, we report a rare complication of a pseudoaneurysm of the lateral plantar artery. We discuss the anatomic considerations of the lateral plantar artery in the foot and the entry point of the retrograde nail to avoid this unusual complication.

Normal sonoanatomy of the paediatric entheses including echostructure and vascularisation changes during growth.

OBJECTIVES: To describe the sonoanatomy of paediatric lower-limb entheses according to age and gender. We studied sites that most commonly involved entheses in spondyloarthritis. METHODS: We studied 41 consecutive healthy children (20 girls, 21 boys; age 2-15 years) divided into four age groups: 2-4 years (n = 9), 5-7 years (n = 11), 8-12 years (n = 12) and 13-15 years (n = 9). Ultrasound was used to obtain both transverse and longitudinal views of each enthesis. We assessed the echostructural components of the lower limb entheses and the vascularisation of the entheses and cartilage according to the different anatomical sites and age and gender. RESULTS: At all sites on B-mode, cartilage and tendon thicknesses showed positive or negative correlations with age (P < 0.0001). Side-to-side correlations were good (P < 0.0001 overall) and stronger for cartilage (r, 0.77-0.97) than for tendon thickness (r, 0.58-0.63). Agreement between the two sides for discrete data was very good to excellent (kappa, 0.77-1). Cartilage thickness at the various sites was significantly greater in boys than in girls (P ≤ 0.05). Tendon thickness was not significantly influenced by gender. Blood vessels were seen within the cartilage with differences across age groups. CONCLUSIONS: This study provides the first data on normal entheseal sonoanatomy and vascularisation in children. KEY POINTS: • The tendons of children exhibit the same fibrillar structure as adults • Tendon thickness at enthesis insertion in children is not influenced by gender • Cartilage thickness in children decreases with advancing age and varies with gender.

Effect of Local Vibrations on Plantar Skin Blood Flow Responses During Weight-bearing Standing in Healthy Volunteers.

Plantar foot pressure is a risk factor for the development of foot ulcers in persons with diabetes mellitus. PURPOSE: The objective of this study was to examine the effects of local vibrations on plantar skin blood flow (SBF) responses during weight-bearing standing. Wavelet analysis of plantar SBF was used to analyze microvascular regulation in response to standing with and without local vibrations. METHODS: Fifteen (15) healthy participants (26.5 ± 5.7 years; 4 male and 11 female) received a local vibration intervention (35 Hz, 1 mm, 2 g vibration) and a sham vibration to the skin of the right first metatarsal head during 10-minute standing. Laser Doppler flowmetry was used to measure SBF before and after 10 minutes of standing. SBF after standing was expressed as a ratio of SBF before standing to minimize blood flow variations. The use of wavelet analysis allowed the authors to examine the frequency bands corresponding to the physiological controls in the vibration and sham areas of the foot, including metabolic (0.0095-0.02 Hz), neurogenic (0.02-0.05 Hz), myogenic (0.05-0.15 Hz), respiratory (0.15-0.4 Hz), and cardiac (0.4-2.0 Hz) regulations. RESULTS: Plantar SBF ratio changes in the vibration protocol (1.83 ± 0.27) were significantly higher compared with the sham protocol (0.97 ± 0.08) (P < .01). SBF before and after the 35 Hz vibrations were 41.96 ± 14.02 perfusion units (range 6.68-208.9 perfusion units) and 61.16 ± 14.74 perfusion units (range 7.76-155.37 perfusion units), respectively. SBF before and after the sham vibration were 37.32 ± 9.29 perfusion units (range 5.74-120.44 perfusion units) and 33.97 ± 8.11 perfusion units (range 6.95-108.44 perfusion units), respectively. Wavelet analysis of SBF oscillations showed a significant difference in all regulations: metabolic (P < .05), neurogenic (P < .05), myogenic (P < .05), respiratory (P < .05), and cardiac (P < .05) in response to 35 Hz local vibrations compared with the sham vibration. CONCLUSIONS: Local vibrations (35 Hz frequency, 1 mm amplitude) to the plantar tissues during 10 minutes of weight-bearing standing resulted in a significant increase in after-standing plantar SBF compared with sham vibration. The control mechanisms contributing to this increase in SBF were metabolic, neurogenic, myogenic, respiratory, and cardiac regulations. These findings confirm results of preclinical studies and support the need for additional research to examine the potential protective effects of local vibration to decrease the risk of plantar ulcers.

Microvasculature of the Plantar Plate Using Nano-Computed Tomography.

BACKGROUND:: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano-computed tomography (nano-CT) imaging. METHODS:: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. RESULTS:: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. CONCLUSION:: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. CLINICAL RELEVANCE:: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.