Calcaneal Bone Research Articles

Calcaneal Bone Quality and Physique in Elite Hungarian Male Athletes.

Abstract Regular physical activity has favourable influence on the bone status. The purpose of this study was to analyze the relationships between the bone quality index (BQI) in the calcaneus and anthropometric variables in male elite athletes. Participants were Hungarian elite male athletes: kayak-canoe (KC, n=43); triathlon (T, n=16); track & field (TF, n=46); water-polo (WP, n=19). Their physique was characterised by Heath-Carter somatotype. Calcaneal Quantitative Ultrasound (QUS) parameters were registered by Sonost3000 densitometer. Differences in bone quality between the groups and correlation patterns between QUS and physique were analysed (p<0.05). There were significant differences in QUS parameters. T and TF had significantly higher SOS (speed of sound, m/s) values than WP. KC had lower SOS values than T athletes (TF: 1519.3±16.0; T: 1512.9±20.8; KC: 1505.6±12.4; W: 1495.1±10.8. BUA (broadband ultrasound attenuation, dB/MHz) was the largestest in TF but this only differed significantly from WP (TF: 106.5±14.8; T: 98.9±11.5; KC: 98.7±16.5; WP: 92.2±8.8). BQI (αSOS+βBUA) was higher in TF (92.0±16.7) than in KC (79.2±13.1), WP (69.3±10.0); it was higher in T (84.8±19.6) than WP. Muscle percentage correlated positively, while absolute bone measurements correlated inversely with bone parameters. Higher QUS values were associated with lower endomorphy and mesomorphy, while more linear physiques correlated with better bone parameters. Physique and type of exercise training appear to be associated with bone status. Both weight-bearing and non-weight bearing exercise improve calcaneus bone parameters such as BQI to different extents. It might be preferable to combine some weight-bearing exercise during the sessions, and it is also highly recommended after a competitive period and during recreational sport activities.

Arthroscopic-Assisted Lower Trapezius Tendon Transfer for Massive Irreparable Posterosuperior Rotator Cuff Tears Using an Achilles Tendon-Bone Allograft

The lower trapezius tendon (LTT) transfer has been described for the management of irreparable posterosuperior rotator cuff tears. Here we describe our technique of an arthroscopic-assisted LTT transfer using an Achilles tendon-bone allograft. This technique allows for augmentation of the tendon transfer using an Achilles tendon allograft while also keeping the calcaneal bone insertion, which allows for added bony fixation into the humerus and also minimizing the risk of the "killer turn" phenomenon at the aperture of fixation.

Association between handgrip strength and maximum expiratory flow with site-specific bone mineral density of healthy young adults.

To explore the association of handgrip strength and peak expiratory flow rate with site-specific bone mineral density T scores, and to study the correlation of body mass index and physical activity with the three parameters. The cross-sectional study was conducted in November 2018 at the Combined Military Hospital, Lahore Medical College and Institute of Dentistry, Lahore, Pakistan, and comprised healthy young adults. Data was collected using the international physical activity questionnaire. The subjects were grouped into low, moderate and high categories. Handgrip strength, peak expiratory flow rate, bone mineral density T scores and body mass index were measured for each subject. Data was analysed using SPSS 24. Of the 102 subjects, 52(50.9%) were males and 50(49%) were females. There was a significant difference between the median values for all parameters of males and females (p<0.05). Bone mineral density and physical activity were moderately associated with handgrip strength and peak expiratory flow rate (p<0.05). Body mass index showed a moderate association with bone mineral density (p<0.05). Healthy young adults with better respiratory function and handgrip strength were found to have higher values of site-specific calcaneal bone mineral density. Subjects with higher reported levels of physical activity and a higher body mass index within a healthy range presented with improved values of bone mineral density, handgrip strength and peak expiratory flow rate.

Intraosseous lipomas originating from simple bone cysts

Fatty or part-fatty intraosseous lesions are occasionally encountered while imaging the skeletal system. A number of case reports have proposed involution of calcaneal bone cysts to intraosseous lipomas, but this has never been proven. This paper sets out to prove that simple bone cysts (SBCs) can involute to fatty lesions indistinguishable from intraosseous lipomas. The pathology and PACS databases at 2 specialist orthopedic hospitals were retrospectively interrogated for all cases of intraosseous lipomas or SBCs with cross-sectional imaging follow-up for SBCs and precursor or follow-up imaging for intraosseous lipomas, in the time period from August 2007 to December 2016. For intraosseous lipoma cases, these were only included if change in imaging appearances was observed. There was no case of change in the appearance in intraosseous lipomas. Six cases of SBC with cross-sectional imaging follow-up were identified in one participating hospital and none in the other. The 6 cases were comprised of 4 male and 2 female patients. Two were located in the proximal humerus, one in the proximal tibia, and 3 in the os calcis. All cases demonstrated filling in of the cystic lesion with fat from the periphery, in 2 cases complete filling in, and in 4 cases partial fatty conversion. SBCs can heal with fatty conversion of the cystic cavity, with partly cystic remnants. It is proposed that at least part of the so-called intraosseous lipomas are healed simple bone cysts.

Surgical Technique for Management of Severe Calcaneofibular Impingement: Case Series.

Background:Calcaneofibular impingement is characterized by lateral hindfoot pain and is commonly resulting from calcaneal fracture malunion or severe flatfoot deformity. Lateral calcaneal wall decompression has been used successfully to relieve pain in patients who have calcaneofibular impingement. However, in cases of severe impingement and hindfoot valgus, lateral wall excision may leave only a small remnant of calcaneal bone for weightbearing and can lead to chronic heel pain. We describe a surgical technique using a medial displacement calcaneal osteotomy (MDCO) combined with a lateral wall exostectomy and report on the outcomes from our series of patients.Methods:Retrospective study of a single surgeon’s patients was done from 2010 to 2020 who underwent medial slide calcaneal osteotomy and lateral wall exostectomy for calcaneofibular impingement. Descriptive statistics were used to summarize patient characteristics. Our study included 9 patients, 6 females and 3 males, with a mean age of 59 years (range: 19-77) and a mean follow-up of 62 weeks (range: 6-184).Results:Five had an Achilles split approach, 2 had an oblique lateral approach, and 1 had an extensile lateral approach. Patients achieved radiographic relief of impingement and improvement in pain. Minor skin and soft tissue complications occurred in 3 patients, all of which were associated with laterally based incisions, and all resolved after a 10-day course of oral antibiotics. No major complications, emergency department visits, or readmissions occurred.Conclusions:MDCO and lateral wall exostectomy was a safe and effective treatment for severe calcaneofibular impingement.Level of Evidence:Level IV, retrospective case series.

Autogenous Bone Graft as a Surgical Method for Treatment of Simple Bone Cyst in Calcaneus

Background: Simple bone cysts are benign lesions with fluid content, commonly occur in the proximal femur and humerus and rarely occur in the calcaneus. Calcaneal bone cysts are usually asymptomatic, diagnosed incidentally on radiographs and rarely susceptible to pathological fractures, but it may present with heel pain. The site of the cysts is usually the neutral triangle of the calcaneus. Plain radiograph, CT, MRI and histopathology examinations are the diagnostic tools for simple bone cyst (SBC) in calcaneus. Objective: To evaluate the results of using autogenous bone graft in surgical treatment of simple bone cysts in calcaneus. Patients and Method: A prospective study held between February 2019 and February 2020, where 12 patients included with simple bone cyst in the calcaneus managed by curettage and autogenous bone graft were admitted to Orthopedic Department at Zagazig University Hospitals and followed up for 6 to 12 months. Results: Age of the patients ranged from 5 to 30 years with mean age of 15.8 years. 8 [66.7%] patients were male and 4 [33.3%] patients were female. All of the patients had heel pain and two of them [16.7%] had pathological fractures. 10 patients [83.3%] had complete healing of the cyst while 2 patients [16.7%] of them healed with defect and all of the studied cases [100%] had complete clinical resolution. The observed complications during the follow-up period were superficial infection on one [8.3%] patient and delayed wound healing on another [8.3%] patient. Conclusion: Curettage and autogenous bone graft is an effective successful method for treating SBC in the calcaneus.

Calcaneal Bone Bruise After Surgery for Insertional Achilles Tendinopathy.

Excision of the posterosuperior corner of the calcaneus (EPCC) is routinely undertaken in athletes after failure of conservative management of insertional Achilles tendinopathy. Some patients can experience sharp calcaneal pain during postoperative rehabilitation, a sign of a calcaneal bone bruise (CBB). Case series, level of evidence IV. University teaching hospital. This study reports 8 patients who developed postoperative CBB after having started impact training too early. Patients in whom a diagnosis of CBB had been formulated were followed to return-to-play and resolution of bone edema by MRI. Detection of CBB after EPCC. After routine EPCC for insertional Achilles tendinopathy, 8 patients presented with sharp pain for a mean 7.1 weeks (median 6 weeks, range 5-11 weeks) before clinical suspicion of CBB. At that stage, MRI showed clear evidence of a bone bruise, with a diagnosis of CBB formulated at an average of 10.8 postoperative weeks (range 6-16 weeks). Calcaneal bone bruise resolved with modified symptom-free loading. Patients returned to play at average on 5.6 months (range 2-9 months) after the diagnosis of postoperative CBB. We describe 8 athletes who developed painful CBB following routine EPCC for insertional Achilles tendinopathy after having increased their level of activities too soon after the index procedure. In these patients, the diagnosis of postoperative CBB can be formulated by MRI and more cautious rehabilitation implemented.

Rearfoot disorders and conservative treatment: a narrative review.

Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe modification and the application of insoles or orthoses. Achilles tendinopathy is caused by excessive mechanical loads on the gastrocnemius and soleus muscles. Heel lifts, rocker shoes, and the AirHeel Brace can be used to reduce symptoms. Haglund's deformity is an osseous prominence of the posterosuperior part of the calcaneus bone, the pain from which can be alleviated by reducing pressure on the affected area by appropriately modifying the back of the shoe to prevent contact with the lesion. The pain from retrocalcaneal bursitis can be controlled by lifting the heel and loosening the shoe counter. Plantar fasciitis causes plantar heel pain, and its orthotic treatments include the application of a heel cup, heel pad, heel wedge, Thomas heel, and night splint. Calcaneal stress fractures are generally caused by repetitive loads and occur mainly in sporting activities. Patellar tendon-bearing (PTB) orthoses are helpful in reducing the load on the calcaneal bone. Heel fat pad atrophy refers to the loss of the fat pad that absorbs shock in the heel. To reduce pain caused by heel fat pad atrophy, rocker soles, heel pads, and solid ankle cushion heels (SACHs) may be used. Tarsal tunnel syndrome is caused by compression of the tibial nerve within the tarsal tunnel and its symptoms can be managed by rocker soles, supporting medial arches, Thomas heels, and SACHs. Shoe modification or application of orthoses can be helpful for managing rearfoot pain. However, for the active and wide application of these conservative treatment methods, more clinical studies should be conducted.

Consensus on Indications for Isolated Subtalar Joint Fusion and Naviculocuneiform Fusions for Progressive Collapsing Foot Deformity

Peritalar subluxation represents an important hindfoot component of progressive collapsing foot deformity, which can be associated with a breakdown of the medial longitudinal arch. It results in a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and pronation. Loss of peritalar stability allows the talus to rotate and translate on the calcaneal and navicular bone surfaces, typically moving medially and anteriorly, which may result in sinus tarsi and subfibular impingement. The onset of degenerative disease can manifest with stiffening of the subtalar (ST) joint and subsequent fixed and possibly arthritic deformity. While ST joint fusion may permit repositioning and stabilization of the talus on top of the calcaneus, it may not fully correct forefoot abduction and it does not correct forefoot varus. Such varus may be addressed by a talonavicular (TN) fusion or a plantar flexion osteotomy of the first ray, but, if too pronounced, it may be more effectively corrected with a naviculocuneiform (NC) fusion. The NC joint has a curvature in the sagittal plane. Thus, preserving the shape of the joint is the key to permitting plantarflexion correction by rotating the midfoot along the debrided surfaces and to fix it. Intraoperatively, care must be also taken to not overcorrect the talocalcaneal angle in the horizontal plane during the ST fusion (eg, to exceed the external rotation of the talus and inadvertently put the midfoot in a supinated position). Such overcorrection can lead to lateral column overload with persistent lateral midfoot pain and discomfort. A contraindication for an isolated ST fusion may be a rupture of posterior tibial tendon because of the resultant loss of the internal rotation force at the TN joint. In these cases, a flexor digitorum longus tendon transfer is added to the procedure. Level V, consensus, expert opinion.

Sodium-Glucose Co-Transporter 2 Inhibitors Increase Serum Level of Total Procollagen Type 1 Amino-Terminal Propeptide and Bone Strength in Japanese Patients With Type 2 Diabetes Mellitus

Background: Diabetes mellitus is known to be associated with an increased risk of bone fracture. We investigated the effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on bone strength and density in type 2 diabetic patients. Methods: Nineteen Japanese patients with type 2 diabetes mellitus were administered 2.5 mg/day of luseogliflozin or 5 mg/day of dapagliflozin for 6 months. Serum levels of tartrate-resistant acid phosphatase 5b (TRACP-5b), an osteoclastic marker, and total procollagen type 1 amino-terminal propeptide (P1NP), a bone formation marker, were measured and compared with those before the treatment. Bone strength was measured by quantitative ultrasound (QUS), and bone density was evaluated by dual-energy X-ray absorptiometry (DEXA). Results: SGLT2 inhibitors significantly increased the calcaneal bone strength as measured by QUS compared to that in young adult mean. However, there was no effect in the lumbar spine density as measured by DEXA after administration. The drug treatment had no effect on serum TRACP-5b, but significantly increased serum P1NP. Conclusions: The results imply that the SGLT2 inhibitors improve bone strength while the inhibitors had no effect on bone density. These results suggest that the increase in bone strength was due to improved bone quality through an increase in serum P1NP level. J Endocrinol Metab. 2020;10(3-4):89-93 doi: https://doi.org/10.14740/jem683

Timing of Antimicrobial Prophylaxis and Tourniquet Inflation: A Randomized Controlled Microdialysis Study.

Tourniquets are widely used during extremity surgery. In order to prevent surgical site infection, correct timing of antimicrobial prophylaxis and tourniquet inflation is important. We aimed to evaluate the time for which the free drug concentration of cefuroxime is maintained above the minimum inhibitory concentration (t > MIC) in porcine subcutaneous adipose tissue and calcaneal cancellous bone during 3 clinically relevant tourniquet application scenarios. Twenty-four female Danish Landrace pigs were included. Microdialysis catheters were placed bilaterally for sampling of cefuroxime concentrations in calcaneal cancellous bone and subcutaneous adipose tissue, and a tourniquet was applied to a randomly picked leg of each pig. Subsequently, the pigs were randomized into 3 groups to receive 1.5 g of cefuroxime by intravenous injection 15 minutes prior to tourniquet inflation (Group A), 45 minutes prior to tourniquet inflation (Group B), and at the time of tourniquet release (Group C). The tourniquet duration was 90 minutes in all groups. Dialysates and venous blood samples were collected for 8 hours after cefuroxime administration. Cefuroxime and various ischemic marker concentrations were quantified. Cefuroxime concentrations were maintained above the clinical breakpoint MIC for Staphylococcus aureus (4 µg/mL) in calcaneal cancellous bone and subcutaneous adipose tissue throughout the 90-minute tourniquet duration in Groups A and B. Cefuroxime administration at the time of tourniquet release (Group C) resulted in concentrations of >4 µg/mL for approximately of 3.5 hours in the tissues on the tourniquet side. Furthermore, tourniquet application induced ischemia (increased lactate:pyruvate ratio) and cell damage (increased glycerol) in subcutaneous adipose tissue and calcaneal cancellous bone. Tissue ischemia was sustained for 2.5 hours after tourniquet release in calcaneal cancellous bone. Administration of cefuroxime (1.5 g) in the 15 to 45-minute window prior to tourniquet inflation resulted in sufficient concentrations in calcaneal cancellous bone and subcutaneous adipose tissue throughout the 90-minute tourniquet application. Furthermore, tourniquet-induced tissue ischemia fully resolved 2.5 hours after tourniquet release. Cefuroxime administration 15 to 45 minutes prior to tourniquet inflation seems to be a safe window. If the goal is to maintain postoperative cefuroxime concentrations above relevant MIC values, our results suggest that a second dose of cefuroxime should be administered at the time of tourniquet release.

Genetic Predictions Of Bone Mineral Density In Ultramarathon Runners: For Men, But Not For Women

BACKGROUND: Various genetic markers have been identified as influencing bone mineral density (BMD). In a prior study in the UK Biobank, 22,866 SNPs were selected using LASSO based on ability to predict calcaneal bone mineral density. Kim in PLoS ONE 2018 tested this genetic risk score against other models and found it to have the best correlation with BMD. PURPOSE: Given the prevalence of low BMD and low energy availability in female and male endurance runners, this study investigated the correlation between this genetic risk score and BMD of runners at the Western States endurance race. METHODS: 51 runners at a 100-mile race underwent a genetic evaluation using an Affymetrix PMRA array including approximately 800,000 SNPs, which includes all those required for the Kim BMD genetic risk score. These runners also underwent dual-energy x-ray absorptiometry. We calculated Pearson’s correlation coefficients between the genetic risk score and spine, hip, femoral, and forearm BMD. RESULTS: 17 female and 34 male participants had a mean age, respectively, of 41.8 and 46.8 years (range 26.4-76.2). BMI ranged from 17.2-25.2 kg/m2 (female) and 19.3-39.4 kg/m2 (male). For the male runners, the genetic risk score significantly correlated with z-scores of the lumbar spine, total hip, femoral neck, forearm, and total body (r=0.52-0.58, p<0.005). For female athletes, all correlations were 0 or negative and non-significant (r=0.0 to -0.30, p=0.24-0.99). See Table 1. CONCLUSIONS: The BMD genetic risk score was significantly correlated with BMD in the male, but not female ultramarathon runners in this study. The sample size for women (n=17) is too small to draw robust conclusions, but we speculate that for female athletes, environmental and hormonal factors, such as low energy availability or menstrual irregularities, may decrease the influence of genetic factors.

Lateral ankle stabilization with a polyester fiber construct implant as a revision for failed primary lateral ligament reconstruction

Objective: The aim of this study is to demonstrate an original technique in which a stable construct is made by fibular and calcaneal bone tunnels producing a figure of 8 with a Polyester implant as revision for failed primary ligament reconstruction. Methods: This is a retrospective study of 19 patients with persistent lateral ankle instability diagnosis after a primary ligament repair treated between 2011 and 2019. The surgical technique is described in detail in which stabilization of the lateral ankle is performed. 11 men and 8 women with a mean age of 30.94 years (15-53). Follow up was 29.05 months (6-109). Pre and postoperative AOFAS ankle score were used as well as an AVS and a satisfaction questionnaire. Results: There was a significant improvement in AOFAS score, 76.31 to 91.47 (&lt;0.001). All the patients except one, stated to have a stable ankle and be Very satisfied (16) or satisfied (2) with the procedure. No infection was presented in any patient. Conclusion: This technique is a reliable alternative in patients in which primary ankle ligaments have failed and no autograft or allograft are wanted to be used. Level of Evidence V; Therapeutic Study; Expert Opinion.

Bone Graft Harvesting From the Calcaneus Using Lateral Wall Corticotomy Technique by an Osteotome.

Background: The aim of this study was to evaluate the complications following calcaneal autologous bone graft harvesting using an osteotome in patients who underwent foot and ankle surgery with follow-up of at least 1 year. Methods: In a cohort study, all consecutive patients underwent forefoot or midfoot surgeries in conjunction with harvesting bone graft from the calcaneus using lateral wall corticotomy technique by an osteotome from 2015 till 2018 were asked to follow. The outcome and morbidity were assessed by visual analogue scale (VAS) pain, numbness in territory of the sural nerve, surgical site numbness or tenderness, infection, hematoma formation, or pathologic fracture. Also any possible restrictions on wearing desired shoes were asked. Results: Totally, 50 patients (11 males, 39 females; 29 right foot, 21 left foot) with the mean age of 48.2 ± 13.8 years (range 8-66 years) were assessed. There were no major complications on donor site such as infection, hematoma formation, or pathologic fracture. The following results were seen; 90% without any pain (VAS 0/10), 96% without numbness at the incision site, 96% without point tenderness on lateral of heel, 98% without paresthesia or numbness in the sural nerve territory, and 84% were able to wear their favorite shoes. Forty-one (82%) cases said if they need another foot surgery, they would permit to harvest bone graft from their heel. Conclusions: Autologous bone graft harvesting from the calcaneus using lateral wall corticotomy technique by an osteotome could be a useful method with very low complications.Levels of Evidence: Therapeutic, level IV: cohort, case series.

Anatomical calcaneal external fixator self-designed according to the morphology of heel

The anatomical calcaneal external fixator was designed by measuring and calculating the morphological data of the heel. A total of 100 normal people were randomly selected to obtain 200 hind foot data, including 45 males and 55 females, with an average age of 43.9 years (range, 19-67 years). According to the principles of human engineering and local anatomy, the morphological data of the heel in the weight-bearing standing position and supine position were measured with the direct measurement mode. The heel length, heel width, heel height, medial ankle height, lateral ankle height, and calcaneal pitch angle (CPA) were measured by vernier calipers and ulnar markers in weight-bearing standing position, and the gender groups and left and right foot groups were compared; the shape of the hind foot in the supine position was measured by three-dimensional (3D) dot matrix inverse model method. According to the stereoscopic data of the comprehensive anatomical morphology of the heel, the anatomical calcaneal external fixator was designed with AutoCAD 2019 and other 3D industrial design softwares. The measurements of shoe size, heel length, heel width, heel height, medial ankle height, lateral ankle height, and CPA in male were significantly higher than those in female ( P<0.05). There was no significant difference between the left and right feet in the other indexes except that the height of the medial malleolus of the left foot was significantly lower than that of the right foot ( t=-2.827, P=0.005). The measurement of 3D dot matrix inverse model in supine position showed that the heel part was non-circular arc edge, and many groups of arc edges fluctuate in a limited range. Based on the above data, an anatomical calcaneal external fixator was designed, which could fit the anatomic radian in theory, so as to be flexible in configuration. On this basis, the ordinary configuration, compression configuration, and orthodontic configuration were designed to meet the treatment needs of calcaneal fractures in different degrees. The ordinary configuration was suitable for patients with Sanders Ⅰ, ⅡA, and ⅡB calcaneal fractures with no or slight displacement of intra-articular fractures; the ordinary configuration was mainly used for simple fixing. The compression configuration was suitable for patients with Sanders ⅡC, ⅢA, and ⅢB, tongue fractures, and avulsion fractures with severe displacement of intra-articular fractures; the compression configuration used obliquely drawn console wires to fix the displaced bones. The orthodontic configuration was suitable for patients with Sanders ⅢC and Ⅳ calcaneal fractures with severe displacement of intra-articular fractures or severe calcaneal bone defects; the orthodontic configuration was a multi-module design, which took into account the stable fixation of the fracture and the arbitrary adjustment of the joint fixation angle. The hind foot is special for morphology, so the external fixator designed based on the vernier caliper measurement method and 3D dot matrix measuring plate measurement method is an anatomical type and its configuration can theoretically meet stable and flexible clinical needs.

Tarsal fractures: part 2

Both calcaneal and central tarsal bone fractures are commonly encountered in the racing greyhound. While isolated fractures of the numbered tarsal bones are uncommon, malleolar fractures are encountered frequently in small animal practice. Fractures of the central tarsal bone or calcaneal fractures in both dogs and cats may be either fatigue or stress fractures, or associated with Knees and Teeth Syndrome, which may alter the typically expected presentation and prompt assessment for additional fractures, both in the tarsus and elsewhere. Surgical stabilisation is often the treatment of choice, particularly for fractures with an articular component. In many cases, surgical stabilisation leads to a positive outcome, with Greyhounds often being able to return to racing. However, it is important to be aware that fractures in non-racing dogs tend to be more complex and that this good prognosis may not be appropriate to extrapolate. Depending on the nature and severity of injuries, joint preservation may not always be a realistic goal. If the joint cannot be preserved, arthrodesis may become necessary.

Heel Reconstruction With Bipedicled Flap: A Salvage Procedure.

Reconstruction of the heel region poses great challenge to plastic surgeons not only due to calcaneal bone lying just deep to the subdermal fat pad but also due to easily exposed Achilles tendon. In order to achieve permanent closure of the heel defect, exposed bone or tendon-or both-should be covered with durable, preferably sensate, well-vascularized, thin skin flaps. Even though fasciocutaneous free flaps remain the gold standard in the reconstruction of heel defects with exposed bone or tendon, a significant number of these patients are older individuals with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 6 patients (1 female, 5 males), we present a new technique of reconstruction with a bipedicled flap as a safe, reliable, and efficient reconstructive modality in the treatment of heel defects in cases where free flaps and other more sophisticated reconstructive options are either not feasible or have failed. Achieving complete reconstruction of defects in all 6 patients, this technique proves to be successful as a salvage procedure in reconstruction of heel defects.

A Radiographic Study of Biomechanical Relationship between the Achilles Tendon and Plantar Fascia

Background Previously, scholars have concluded that the Achilles tendon and the plantar fascia were closely biomechanically related, although there is little clinical evidence of the relationship between the two. To investigate the biomechanical relationship between the Achilles tendon and the plantar fascia, the author used standing lateral ankle radiographs of patients with insertional Achilles tendonitis to determine the biomechanical relationship between the Achilles tendon and plantar fascia. Methods The author collected standing lateral ankle radiographs from patients with insertional Achilles tendonitis who accepted surgical treatment in the author's hospital from March 2009 to July 2018. According to whether there were bone spurs on the posterior side of the calcaneus, patients were divided into group A (spur present on the posterior side) and group B (spur not present on the posterior side). The positive rates of spurs on the plantar side of the calcaneus were determined in group A and group B. The chi-square test was used to compare the measurement results between the two groups. Results In group A, 13 heels were positive for calcaneal bone spurs, and the positive rate was 65.0%. In group B, 3 heels were positive for plantar calcaneal spurs, and the positive rate was 12%. Among all 16 patients with positive plantar calcaneal spurs, 13 had posterior calcaneal spurs (accounting for 81.3%), and 3 had negative results, accounting for 18.7%. There was a significant difference between the results in groups A and B (P < 0.05). Conclusion There is a relationship between posterior calcaneal spurs and plantar calcaneal spurs in patients with insertional Achilles tendonitis, which can be inferred as resulting from the increasing tension in the biomechanically complex relationship between the Achilles tendon and the plantar fascia.

Creatinine to Cystatin C Ratio as a Marker of Bone Property in Older Adults: The J-SHIPP Study.

To clarify whether serum creatinine to cystatin C ratio (CCR), a marker of muscle mass and muscle function may be used as a simple marker of bone property. A cross-sectional analysis. A general population-based observation study. 1,606 middle-aged to elderly (≥50 years, mean age: 66.9 ± 7.5 years old) men (n = 642) and post-menopausal women (n = 964). Speed of sound (SOS) at the calcaneal bone was used as a surrogate marker of bone mineral density. The cross-sectional area of the muscle at the mid-thigh was measured using computed tomography. There was significant linear correlation between the quartiles of CCR and SOS (Q1: 1,495 ± 25, Q2: 1,499 ± 24, Q3: 1,507 ± 26, Q4: 1,511 ± 25 m/sec; P < 0.001) even in a sex-separated analysis. This association was independent of major covariates (Q1: β = -0.126, P < 0.001; Q2: β = -0.096, P = 0.001; Q3: β = -0.022; P = 0.412, Q4: reference) and the mid-thigh muscle mass, while creatinine alone or eGFR did not show clear association with SOS. The CCR may be used as a simple marker of bone property independently of muscle mass in a general population with preserved renal function.

Bilateral unicameral bone cyst of the calcaneum with unilateral symptoms: An unusual cause for heel pain

Foot is an uncommon location for unicameral bone cyst, and it is widely believed that calcaneal cysts are typically asymptomatic. We report a case of a bilateral calcaneal cyst in a 65-year-old man which produced unilateral symptoms where open curettage and autogenous bone grafting provided a significant symptomatic relief. Our patient had complete symptomatic relief following surgical curettage without any perioperative complications. Calcaneal bone cyst, although rare, forms an important differential diagnosis in patients presenting with heel pain where surgical management can be a viable option in cases refractory to conservative treatment.