Augmented Periosteal Flap Repair of the Chronically Unstable Calcaneocuboid Joint

Abstract

Isolated calcaneocuboid instability is a rarely described clinical entity, but it has been speculated that the number of patients in whom the condition has been unrecognized or misdiagnosed is high1. Up to the present time, the cases of only eight operatively treated ankles have been reported1-5 (Table I). The authors of those reports agreed that initial treatment should be conservative. Besides calcaneocuboid arthrodesis2, a plantaris tendon graft to reconstruct the calcaneocuboid ligament3 has been proposed as operative treatment. Recently, an anatomic repair has been described by one of us (H.L.)5. View this table: TABLE I Review of the Literature on Operative Treatment of Isolated Dorsal Calcaneocuboid Ligament Instability Clear diagnostic criteria for this condition have not been reported. A specific stress radiographic technique for the calcaneocuboid joint has been developed2, and serial sectioning of the calcaneocuboid ligament followed by stress radiography has been performed in five cadaver specimens4. The purpose of the present report was to focus clinical attention on isolated lesions of the dorsal calcaneocuboid ligament, and a diagnostic algorithm was developed. The outcome in a consecutive group of five adolescent female patients (six ankles) who were treated with an augmented anatomic repair is described. ### Diagnostic Procedure Several studies have served to establish the diagnosis of calcaneocuboid instability1,4,5. The patient's history reveals an initial inversion-plantar flexion, supination, or twisting injury with subsequent swelling and pain in the lateral aspect of the foot and ankle region distal and inferior to the tip of the fibula. A hematoma is not necessarily present. Most patients report that a minor injury of the lateral ankle ligaments was initially assumed. Subsequently, recurrent giving-way or fear of giving-way develops. Sports and leisure time activities therefore are restricted and painful. Physical examination should …