About the pathogenesis of the so-called adult acquired pes planus.

Even overlooking the scarcely significance nature of the term "flat", in the pathogenesis of the adult acquired flat foot deformity, we must consider also the spring ligament degenerative pathology, that I called "degenerative glenopathy", due to its reference to the glenoid, without a primitive posterior tibial tendon disease. The glenoid structure intervenes in the cotyloid structure (acetabulum) of the "coxa pedis". In many cases the aetiological moment must be clarified finding of the accessory navicular bone. Its position between the posterior tibial tendon and glenoid explains a possible direct microtraumatic lesional mechanism.

Peritalar destabilisation syndrome (adult flatfoot with degenerative glenopathy).

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.

Some words about lower limb torsion and rotation problems.

The notions of torsion and rotation of the lower limb, loading and the progression of segmentary torsions are defined. It is shown that, while proximal dysmorphisms (anteversion of the hip) may lead to distal dysmorphisms, the latter, such as cavovalgus foot, may be implicated in the progression of dysmorphisms of both the knee (femoropatellar impingement syndromes) and the hip (residual anteversion).

Sinus tarsi syndrome and subtalar joint instability.

Sinus tarsi syndrome is a poorly understood term in the orthopedic world. It is thought of as a painful condition of the sinus tarsi that often responds to corticosteroid injection and is associated with a feeling of instability in the hindfoot. Despite references in the literature, there is no agreement on pathognomonic history, clinical tests, or imaging studies that could help in confirming the diagnosis or establishing the etiology. Some authors relate the clinical condition of sinus tarsi syndrome with instability of the subtalar joint.

Segmental analysis of motor conduction velocity in distal tracts of tibial nerve: a coaxial needle electrode study.

OBJECTIVE: To describe a new method of segmental analysis of motor nerve conduction velocity (mCV) in the tibial nerve (Tn) tract distal to the upper margin of the tarsal tunnel (TT). METHODS: Compound muscle action potentials (CMAPs) were recorded with a coaxial needle electrode from the flexor hallucis brevis muscle (FHB), to test the medial plantar nerve (MPn), and from the flexor digiti quinti brevis (FDQB) and the first dorsal interosseous (FDI) muscles, to test the superficial and deep branches of the lateral plantar nerve (sLPn and dLPn, respectively). CMAPs were elicited by stimulating at three sites located above (S1) and below (S2) the TT and at the sole of the foot (S3 for MPn and S4 for LPn). RESULTS: In 20 normal subjects the mean mCV in the proximal (S1 to S2) tract was 44.5+/-4.7, 43.5+/-5.9 and 42.6+/-4.2m/s for the MPn, sLPn and dLPn, respectively. The corresponding values in the intermediate tract (S1 to S3/S4) were 40.7+/-5.6, 39.4+/-5.6 and 40.9+/-5.8m/s. CONCLUSIONS: Segmental analysis of mCV in distal Tn can be performed when CMAPs are recorded using a coaxial needle electrode, which prevents simultaneous recording of activity from nearby muscles groups. SIGNIFICANCE: Conventional neurophysiological examination for suspected entrapments in distal Tn usually can not discriminate between a lesion inside the TT or distal to it. The proposed technique, as suggested by the reported results in clinical application, may help to better define the lesion site.