Lateral Wall Of Calcaneus Research Articles

New aspect of morphometric study of the superior peroneal retinaculum: pertinent data for surgical repair and reconstruction.

This study was conducted to investigate characteristics, attachments and morphometric parameters of the superior peroneal retinaculum (SPR). Morphology and morphometric details including width, length, thickness and angle of alignment of SPR in 109 embalmed cadaveric legs were investigated. The occurrence of peroneal tendon tear was also noted. Most of SPR originated from the fibrocartilaginous ridge of the lateral malleolus. The SPR might be a single band or split into proximal and distal bands inserted on the posterior intermuscular septum and lateral wall of calcaneus, respectively. Based on the characteristics and insertion patterns, the SPR could be divided into 3 types: type I (double band with subtype Ia and Ib), type II (single band) and type III (single band) with the prevalence of 56.88% (12.84%, 44.04%), 1.83%, and 41.28%, respectively. The average coordinate (X, Y axis) of the midpoint of width at origin measured from the tip of fibula in all types was 7.26±3.15 and 10.45±4.52 mm. The average coordinate of the midpoint at insertion on the posterior intermuscular septum was 24.06±4.94 and 13.35±5.18, and those inserted on the lateral wall of calcaneus was 21.45±7.88 and 13.59±6.73 mm. Prevalence of peroneus brevis (PB) tendon tear was 12.84% (14 cases) and was associated with SPR type Ib with statistical significance. Precise information of the characteristics, morphometric data and coordinates of attachment sites of SPR are essential for surgical procedures and reconstruction.

Correction of foot malalignment after old talar neck fracture

Category: Hindfoot Introduction/Purpose: Posttraumatic talar neck mal-union often results in varus hindfoot and adducted forefoot. That leads to a deformed stiff foot and peri-talar osteoarthritis, causing pain, altered gait and dysfunctions. This study analyzed the adopted corrective methods and their clinical and radiographic outcomes. Methods: This study retrospectively reviewed 18 cases of symptomatic malaligned foot as a result of old talar neck fracture, who undertook corrective surgeries during the period from Sept.2009 to Oct. 2016. The average time interval between the injury and the corrective surgery was 23.8±33.5 months. Procedures including ORIF of talus, lateralizing calcaneal osteotomy, subtalar arthrodesis and opening osteotomy of medial talus were selected for the correction and reconstruction of foot deformity. The follow-up time after surgery was 29.5±18.5months. The angle of first metatarsal axis and talar axis (FMT) was measured on the A-P view of foot. The distance between the lowest point of calcaneus and the tibial axis (Moment Arm, MoA) and the angle between the lateral wall of calcaneus and tibial axis (hindfoot alignment angle, HAA) were measured on the hindfoot alignment view of foot. VAS score, AOFAS-AH score and SF-36 scores were compared before and after surgery. Results: The FMT angle increased from -6.8±5.7 degrees before surgery to +1.8±2.6 degrees after surgery (p<0.05); The MoA increased from -3.1±2.4 cm before surgery to +0.5±1.0 cm after surgery (p<0.05); The HAA increased from -19.6±8.3 degrees before surgery to -3.8±4.1 degrees after surgery (p<0.05) 。 The VAS score decreased from 6.5±2.3 before surgery to 1.0±1.2 after surgery (p<0.05). The AOFAS-AH score increased from 54.5±16.2 before surgery to 88.6±12.3 after surgery (p<0.05). The SF-36 score increased from 48.7±10.5 before surgery to 85.4±9.2 after surgery (p<0.05). The osteotomy and arthrodesis sites were healing well judging from the X-ray and CT images. Conclusion: The correction and reconstruction of deformed foot resulted from old mal-united talar fracture poses a difficult clinical problem. The major principle is to correct the varus hindfoot and adducted forefoot. Selected Combined procedures including ORIF of talus, calcaneal lateralizing osteotomy, subtalar arthrodesis and medial talar opening osteotomy are recommended to restore normal alignments and functions.

Anatomy of anterior talofibular ligament and calcaneofibular ligament for minimally invasive surgery: a systematic review

To gain a better understanding of the precise anatomy of the lateral ligaments of the ankle through a systematic review of published cadaveric studies in order to improve anatomical minimally invasive surgery (MIS) for treatment of chronic ankle instability (CAI). A systematic review of the literature was performed using the PubMed, EMBASE, Cochrane databases and Web of Science on June 2015 with the two search concepts: "lateral ligament of the ankle" and "anatomy". Anatomical studies that reported gross anatomy of the anterior talar fibular ligament (ATFL) and calcaneal fibular ligament (CFL) in English were included to assess the morphology and origins and insertions of the ligaments. All records found in the literature search were screened by title and abstract. Potentially relevant articles were selected for full-text review. Each of the identified articles was reviewed and included in qualitative synthesis. The following data were abstracted from the included articles: authors, date of publication, sample size, mean age, the length and the width of the each ligament, number of bundle of the ATFL and the location and the footprint of the origins and insertions for the ATFL and CFL. Sixteen studies were identified indicating the length of the ATFL and CFL was 12-24.8 and 18.5-35.8mm, respectively, while the width was 5-11.1 and 4.6-7.6mm, respectively. Fibular origins of the ATFL and CFL were located on the anterior border of distal fibula at a distance of 10-13.8 and 5.3-8.5mm proximal to the tip of the fibula, respectively. The talar insertion of the ATFL was located 14.2-18.1mm to the subtalar joint or 11.3-14.8mm to the anterolateral corner of the talar body. The calcaneal insertion of the CFL was located 12.1-13mm to the subtalar joint or 13.2-27.1mm to the peroneal tubercle on the lateral wall of calcaneus. Systematic review of the literature of the research for the ATFL and CFL has identified the morphology of the ligaments and their location of origins and insertions. This is the best available data about the ATFL and CFL which will facilitate more precise anatomical MIS for treatment of CAI. Systematic review, Level IV.

Foundation and static analysis of calcaneal three-dimensional finite element model.

Objective To establish a more rapid and precise calcaneal three-dimensional (3D) finite element model based on the healthy human foot, to analyze the internal biomechanical properties of calcaneus, and to explore the relationship between caleaneal fracture pain with the stress imbalance factors in medial and lateral side of calcaneus. Methods One healthy male volunteer (28 years old, 64 kg) was selected. Input DICOM 3.0 standard CT sectional images into MIMICS10.1 software, set the threshold of 226-3071 Houfield unit, generate foot 3D model, extract caleaneus, optimize it into surface mesh model, and use ANSYS10.0 to develop grid mesh. According to CT sectional images of the gray value, the model materials were added, and the final 3D finite element model of ealeaneus was generated. The static standing posture was simulates using the static finite element analysis. Subtalar joint surface in the whole analysis process was fully constrained during the study period. The forces of 320 N and 160 N were loaded in perpendicular direction on heel and attachment point of Achilles tendon respectively to detect the Vonmises stress distribution of the calcaneus. Results MIMICS software can quickly establish a more accurate finite element model. When the vertical load acting on the calcaneus, there is a clear imbalance of factors about the calcaneal lateral and medial stress. The lateral calcaneal structure is a clearly weak area. The increased stress applied on the lateral wall of calcaneus, lead to secondary lateral deformity, which pressed the long and short muscle tendon of fibula and calcaneocubeid articulation, and generated pain. Conclusion The calcaneal finite element model is proved to be a correct and reliable model, which can help to understand the stress dispersion of calcaneal inner part. Key words: Finite element analysis; Calcaneus; Models, theoretical