Medial Calcaneus Research Articles

Quantitative Analysis for Effect of Orthodontic Treatment on Body Posture and Its Correlation With Cervical Posture in Skeletal Class II Malocclusion – A Clinical Study

AIM: To quantitatively evaluate and compare the body posture and its correlation with cervical posture and plantar pressure in subjects with skeletal class II malocclusion, before and after camouflage orthodontic treatment. MATERIALS AND METHODS: 18 subjects were considered for the study and subjected to lateral cephalograms and body posture analysis before and after camouflage orthodontic treatment. Cranio-cervical angles were compared before and after treatment using paired T test. A force platform was designed to accommodate the feet with pressure sensors placed at hallux, first metatarsal and medial calcaneus regions to record the loading pressure. The plantar pressure distribution values were correlated with the cranio-cervical angles. RESULTS: There is statistically significant difference (p value <0.05) in the ANB angle, GoGn/OPT angle between pre and post camouflage orthodontic therapy indicating over extension of the head over the spinal column. Post treatment Pearson correlation coefficient indicates that the cervical curvature (OPT/CVT angle) has a negative correlation with the plantar pressure at medial calcaneus region. However, high statistical significance was found in the plantar pressure distribution before and after orthodontic treatment at all three regions. CONCLUSION: Cervical curvature increased after camouflage orthodontic therapy, indicating over extension of the cervical spine. Plantar pressure reduced in the hallux, first metatarsal and medial calcaneus regions. The recorded value at the hallux region elicited considerable reduction indicating a shift in the plantar pressure from the most anterior region to the central region.

The effect of texture under distinct regions of the foot sole on human locomotion.

Sensory feedback from the foot sole plays an important role in shaping human locomotion. While net muscle activity and kinematic changes have been correlated with electrical stimulation to five topographical regions of the foot, it remains unknown if these responses are similar with tactile stimulation. The purpose of this study was to use texture in foot orthosis design, applied to five distinct regions under the foot sole, and measure joint kinematics, location of center of pressure, and muscle activity of eight lower leg muscles during level and incline walking. Fifty-five healthy adults completed 48 walking trials in textured and non-textured foot orthoses. Study results confirm that tactile stimulation is stimulation-site and gait-phase specific in modulating lower leg muscle activity during walking. For example, texture under the lateral forefoot consistently generated a suppression of EMG and texture under the lateral midfoot always generated a facilitation. In early stance, adding texture under the medial midfoot or calcaneus facilitated extensor muscle activity and suppressed flexor muscle activity. Texture under the lateral midfoot or medial forefoot facilitated tibialis posterior activation. These results support the topographical organization of cutaneous mechanoreceptors in foot sole skin while considering how texture can be used in foot orthosis design to target lower leg muscular changes during locomotion.

Assessment of Stability of MIMU Probes to Skin-Marker-Based Anatomical Reference Frames During Locomotion Tasks: Effect of Different Locations on the Lower Limb.

Soft tissue artefacts (STAs) undermine the validity of skin-mounted approaches to measure skeletal kinematics. Magneto-inertial measurement units (MIMU) gained popularity due to their low cost and ease of use. Although the reliability of different protocols for marker-based joint kinematics estimation has been widely reported, there are still no indications on where to place MIMU to minimize STA. This study aims to find the most stable positions for MIMU placement, among four positions on the thigh, four on the shank, and three on the foot. Stability was investigated by measuring MIMU movements against an anatomical reference frame, defined according to a standard marker-based approach. To this aim, markers were attached both on the case of each MIMU (technical frame) and on bony landmarks (anatomical frame). For each MIMU, the nine angles between each versor of the technical frame with each versor of the corresponding anatomical frame were computed. The maximum standard deviation of these angles was assumed as the instability index of MIMU-body coupling. Six healthy subjects were asked to perform barefoot gait, step negotiation, and sit-to-stand. Results showed that (1) in the thigh, the frontal position was the most stable in all tasks, especially in gait; (2) in the shank, the proximal position is the least stable, (3) lateral or medial calcaneus and foot dorsum positions showed equivalent stability performances. Further studies should be done before generalizing these conclusions to different motor tasks and MIMU-body fixation methods. The above results are of interest for both MIMU-based gait analysis and rehabilitation approaches using wearable sensors-based biofeedback.

Plantar fascia release and decompression of the first branch of the lateral plantar nerve (Baxter's nerve)

Treatment of chronic plantar fasciitis and release of the first calcaneal branch of the lateral plantar nerve (Baxter's nerve). Chronic plantar fasciitis, compression of the first calcaneal branch of the lateral plantar nerve (Baxter's nerve). General medical contraindications to surgical interventions, infection. Longitudinal incision at the medial heel. Exposure of the plantar fascia at its origin on the medial plantar calcaneus. Medial incision of the plantar fascia preserving the lateral portion. Resection of aheel spur, if present. Exposure of the abductor hallucis muscle. Incision of the superficial fascia of the muscle. Retraction of the muscle belly und incision of the deep portion of the fascia, decompression of the nerve. Two weeks partial weight bearing 20 kg in ahealing shoe. Progressively weight bearing using ashoe with astiff sole for another 4weeks. Atotal of 32feet of 27patients with chronic plantar fasciitis and compression of the first branch of the lateral plantar nerve were treated with medial incision of the fascia and anerve decompression. In 24feet acalcaneal spur was resected. Mean follow-up was 25.6 months (12-35months). Preoperative Manchester-Oxford Foot Questionnaire (MOXFQ) score was 52.5 (±9.0), postoperative MOXFQ score was 31.3 (±4.1). Six (18,8%) patients had same or more pain 6weeks postoperatively.;8(25%) patients stated minor complications like swelling, delayed wound healing, temporary hypoesthesia or pain while walking.

Plantaris tendon and association with mid-portion Achilles tendinopathy. Is the plantaris tendon a contributing factor in mid-portion Achilles tendinopathy?

Plantaris tendon is implicated in some cases of load-resistant Achilles tendinopathy. The tendon courses close to the medial Achilles tendon mid-portion prior to insertion onto the medial calcaneus, although there is variation in course and insertion. Clinical suspicion of plantaris involvement includes persistent medial Achilles pain unresponsive to a rehabilitation programme and imaging revealing a thickened plantaris tendon and/or focal medial Achilles tendinosis. Potential mechanisms include compression or shearing forces between the plantaris and Achilles tendons. Initial treatment should consist of a modified loading programme avoiding end-range loading. Resistant cases may be amenable to surgical excision of the plantaris demonstrating good clinical outcomes in the short and long term, although the evidence is limited to case series. Percutaneous methods show promise but require further evaluation.

Topographic anatomy of the neurovascular bundle at the tarsal tunnel and its applied significance

BACKGROUND: There are different surgical procedures and treatment modalities dealing with medial ankle region such as placement of percutaneous pins in the calcaneus, decompression in tarsal tunnel syndrome, and nerve block. This requires detailed anatomical knowledge about the neurovascular bundle to avoid iatrogenic injury. AIM OF THE WORK: To study the topography of nerves and vessels at the tarsal tunnel in relation to surface anatomical landmarks. MATERIALS AND METHODS: The medial calcaneal region of 20 lower limbs of formalin preserved specimens was dissected. The neurovascular structures were identified within a quadrangle named ABCD, formed by four palpable bony landmarks, respectively: inferior tip of medial malleolus, posterior superior tip of calcaneal tuberosity, posteroinferior aspect of medial calcaneus, and tuberosity of navicular bone. A regression analysis was done to correlate the lengths of the four imaginary lines connecting the four bony landmarks with the location of the neurovascular structures. RESULTS: The posterior tibial artery was located medial to the tibial nerve in 50% of cases. The bifurcation of the artery was found to be proximal to that of the nerve in only one case. The number of the medial calcaneal nerves (MCNs) varied from 1 to 3 branches; the most common was one branch (50%). In two cases, there was high origin of the MCN at a distance of 15.4 and 23.5 cm proximal to the ankle region. CONCLUSION: The location of the neurovascular bundle at the tarsal tunnel could be predicted by measuring the distances between the anatomical bony landmarks.

Changes in Dynamic Pedobarography after Extensive Plantarmedial Release for Paralytic Pes Cavovarus

PurposePlantarmedial release and first ray extension osteotomy are often combined to treat paralytic cavovarus foot deformity. The purpose of this study is to evaluate the effect of additional first ray extension osteotomy in terms of dynamic pedobarography.Materials and MethodsWe reviewed findings of pre- and postoperative plain radiography and dynamic pedobarography for 25 patients in whom the flexibility of the hindfoot was confirmed by the Coleman block test. The results of treatment by extensive plantar medial release with first ray osteotomy (group I) were compared with the results of treatment by extensive plantar medial release alone (group II).ResultsPlain radiographs obtained pre- and postoperatively showed no statistically significant improvement in each group. Only in group I, peak forces at the 1st metatarsal head, 2nd metatarsal head and medial calcaneus were increased after operation.ConclusionIn paralytic hindfoot flexible cavovarus, extensive plantarmedial release with first ray osteotomy improve foot pressure distribution more than extensive plantarmedial release alone.

The fibulocalcaneus (peroneocalcaneus) internus muscle of MacAlister: Clinical and surgical implications

A fibulocalcaneus (peroneocalcaneus) internus (PCI) muscle (of MacAlister) was identified and photographed in the left leg of a 78-year-old Caucasian female cadaver. This case study provides the first gross anatomical photo of this anomalous leg muscle and represents the first gross anatomical dissection of this muscle since 1914. The PCI muscle arose from the distal third of the fibula, posterior intermuscular septum of the leg, and flexor hallucis longus muscle. The PCI muscle inserted into the inferior surface of the medial calcaneus distal to the coronoid fossa, a small depression between the anterior tuberosity and the anterior apex of the sustentaculum tali. This insertion point differs from the historical literature, which commonly refers to the muscle inserting into the inferior surface of the sustentaculum tali of the calcaneus or simply distal to the sustentaculum tali into the medial aspect of the calcaneus. The PCI muscle is one of the least common muscular variants associated with the ankle joint, and it has been implicated in posterior ankle pain and impingement, as well as involvement in tarsal tunnel syndrome. This muscle is often confused with the flexor digitorum accessorius longus (FDAL) muscle. Additionally, this study describes ways to differentiate between the PCI and FDAL muscles in the lower leg. Radiologists and clinicians should be aware of this anomalous muscle when considering various diagnoses, interpreting radiographs, and pursuing surgical intervention to relieve posterior ankle symptoms.

Safe zones at the medial and lateral calcaneus for percutaneous pin placement: an anatomical study

Objective To determine safe zones at the medial and lateral calcaneus for percutaneous pin placement in Chinese patients.Methods Fourteen cadaveric specimens of normal Chinese adult foot and ankle joints were dissected in this study.At the medial calcaneus of each foot, the most medial and posteroinferior point, the most inferior medial malleolus and the navicular tuberosity were identified and labeled as points A, B and C respectively.The medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve, the posterior tibial artery, the lateral plantar artery and the medial plantar artery were carefully dissected and identified.A relative safe zone at the medial calcaneus was marked off according to where the neurovascular structures crossed lines AB and AC.At the lateral calcaneus, the most lateral and posteroinferior point and the inferior lateral malleolus were identified and labeled as points D and E respectively.The lateral calcaneal nerve, the sural nerve and the trunk of the small saphenous vein were carefully dissected and identified.A relative safe zone at the lateral calcaneus was marked off in the same way as that at the medial calcaneus.Results At the medial calcaneus, the medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve and the posterior tibial artery crossed line AB respectively at posteroinferiorly 22%, 50%,56%, 64% and 58% of the line.The medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve, the lateral plantar artery and the medial plantar artery crossed line AC respectively at posteroinferiorly 14%, 39%, 49%, 63%, 41% and 57% of the line.At the lateral calcaneus, the lateral calcaneal nerve, the sural nerve and the trunk of the small saphenous vein crossed line DE respectively at posteroinferiorly 19%, 65% and 61% of the line.Conclusions At the medial calcaneus, the circular region posterior to the 1/2 of line AB and to the 1/3 of line AC may be considered as a relative safe zone for percutaneous pin placement; at the lateral calcaneus, the region posterior to the perpendicular at the midpoint of line DE may be considered as a relative safe zone for percutaneous pin placement. Key words: Calcaneus; Medial plantar merve; Dissection

Dissecting the accessory soleus muscle: A literature review, cadaveric study, and imaging study

The accessory soleus muscle (ASM) has been an unusual anatomical variant since its first recordings in Guy's Hospital Reports of the early nineteenth century. Individuals with an ASM may present with symptoms of pain and/or swelling and were often misdiagnosed as soft-tissue tumors such as hemangioma, sarcoma, or lipoma. The aim of our study was threefold: (1) to review the cadaveric and clinical literature to determine the reported prevalence of ASM; (2) to conduct a cadaveric study investigating the prevalence and attachment sites of the ASM; (3) to conduct a retrospective analysis of magnetic resonance imaging (MRI) of patients presenting with ankle symptoms to determine prevalence and attachment sites of the ASM. Our findings demonstrated that the prevalence of the muscle (3%) was as stated in the literature (0.7-5.5%), but with males more likely to possess unilateral ASM and females more likely to possess bilateral ASM. Three common attachment types were reported in the literature: (i) a distal attachment to the medial aspect of the calcaneus by a separate tendon (26.1% of ASM subjects), (ii) a distal tendinous attachment to the calcaneal tendon (3.5%), and (iii) a distal fleshy attachment to the medial surface of the calcaneus (4.3%), with the remaining 66.1% of ASM subjects from previous studies with unidentified attachment types. Our cadaveric specimens were found to possess each attachment type, whereas imaging patients all possessed distal attachments to the medial calcaneus via a separate tendon. Furthermore, a rare cadaveric specimen with two distal attachments was also found. We believe it is important to recognize the prevalence of this condition and be aware of its morphology in order to understand its clinical presentation, accurately diagnose the condition, and pursue effective forms of management.

Identification of ankle sprain motion from common sporting activities by dorsal foot kinematics data

This study presented a method to identify ankle sprain motion from common sporting activities by dorsal foot kinematics data. Six male subjects performed 300 simulated supination sprain trials and 300 non-sprain trials in a laboratory. Eight motion sensors were attached to the right dorsal foot to collect three-dimensional linear acceleration and angular velocity kinematics data, which were used to train up a support vector machine (SVM) model for the identification purpose. Results suggested that the best identification method required only one motion sensor located at the medial calcaneus, and the method was verified on another group of six subjects performing 300 simulated supination sprain trials and 300 non-sprain trials. The accuracy of this method was 91.3%, and the method could help developing a mobile motion sensor system for ankle sprain detection.

Complications Associated with Autogenous Bone Marrow Aspirate Harvest from the Lower Extremity: An Observational Cohort Study

The purpose of this article is to report the complications associated with autogenous bone marrow aspirate harvested from the lower extremity (ie, tibia and/or calcaneus) for soft tissue and/or osseous healing augmentation. This is a multisite, multisurgeon, observational cohort study involving retrospective review of prospectively collected data of 548 autogenous bone marrow aspirate harvests from the lower extremity of 530 consecutive patients between August 2000 and March 2009. Each patient underwent autogenous bone marrow aspirate harvest from the proximal medial tibial metaphysis, distal medial tibial metaphysis, medial malleolus, lateral calcaneus, medial calcaneus, or a combination of both the proximal tibial metaphysis and lateral calcaneus for application to split-thickness skin graft application sites or for mixture with allogeneic bone graft material for osseous defects or arthrodesis. Patients were kept non-weight bearing based on the index procedure and followed until clinical healing occurred or failure was declared. There were 324 female and 206 male patients with a mean age of 54.7 +/- 14.1 years (range: 14 to 84 years). There were 276 left feet/ankles and 272 right feet/ankles undergoing operative interventions with 18 harvests occurring from the proximal medial tibial metaphysis, 183 from the distal medial tibial metaphysis, 11 from the medial malleolus, 325 from the lateral calcaneus, 3 from the medial calcaneus, and 8 from both the proximal tibial metaphysis and lateral calcaneus. All procedures were deemed successful with no nerve-related injury, infection, wound-healing complications, or iatrogenic fracture occurring. When properly performed, autogenous bone marrow aspirate harvest from various locations about the lower extremity as described here represent safe and minimally invasive techniques useful for soft tissue and osseous healing augmentation. 4 (Case Series; Therapeutic Study).

Distally Based Saphenous Nerve-Great Saphenous Veno-Fasciocutaneous Compound Flap With Nutrient Vessels

Improvements were made by us in several distally based pedicled flaps of the nutrient vessels of the saphenous nerve with lower rotation points. However, these flaps are still insufficient for trauma complicated by bone defects. Accordingly, we conducted a systematic study of the anatomic theory on distally based pedicled compound flaps of the nutrient vessels of the saphenous nerve and great saphenous vein with 30 lower limbs of adult cadavers injected with red gelatin through the femoral artery. It is found that the nutrient vessels of the saphenous nerve-great saphenous vein consist of arteria saphena, fascial cutaneous branches of the inferior medial genicular artery intermuscular spatium branches of the posterior tibial artery, osteocutaneous perforators, superior ankle perforators, medial anterior malleolus perforators, and fascial perforators of the ankle tunnel region. Musculocutaneous perforators of the interior gastrocnemius muscle also enter the nutrient vessels of cutaneous nerve-superficial vein. From May 2004 to February 2007, 23 cases of skin flaps for treating defective and infectious wound, 10 cases of musculocutaneous flaps for treating ulcus in the lower segment of the leg, medullitis, and exposure of bone, 3 cases for medial calcaneus medullitis, 7 cases of skeletal flaps for treating tibial defects and nonunion of calcaneal bone. In 2-15-month follow-ups all cases presented with survived flaps, and healed surfaces of the wound and the osteomyelitis. For cases of bone nonunion, it showed that the nonunion healed after 18 weeks, with recovery of work ability after year. Three types of the distally based pedicled flaps or compound flaps of vessels of different perforating branches can be designed for repairing tissue defects caused by trauma, such as bone defects in the distal leg, nonunion, large necrotic space as well as traumatic surface of the foot and ankle.

Distally Based Sural Neuro-Lesser Saphenous Veno-Fasciocutaneous Compound Flap With a Low Rotation Point

A distally based flap pedicled with the nutrient vessel of the sural nerve has been widely applied in the clinic. An attempt was carried out to modify the distally based flap pedicled with the nutrient vessel of the lower rotation point sural nerve to reconstruct the soft-tissue defects in foreleg. For cases with complex bone defects, this flap was unsatisfactory for the reconstruction. A compound flap pedicled with the sural nerve and the lesser saphenous veins was investigated in the lower extremities of 30 human cadavers arterially infused with red gelatin. The results showed that the sural nerve and the lesser saphenous vein had the identical source of blood supply as the nutrient vessel of muscle, fibula, and skin. The sural lateral artery, the peroneal artery, the lateral posterior malleolus artery, the perforating branches of the heel lateral artery, and the musculocutaneous perforators from the gastrocnemius formed a vascular chain for the sural nerve and lesser saphenous vein. The distally based compound flaps of sural nerve and lesser saphenous vein were applied for the reconstruction of 20 patients in the present study, from January 2004 to January 2007. The musculocutaneous flaps were applied for the repair of lower leg ulcers, osteomyelitis, or bone exposures in 10 cases and for medial calcaneus osteomyelitis in 3 cases. The osteocutaneous flaps and the myo-osteocutaneous flaps were used for tibial bone defects in 7 patients. In the 5- to 18-month follow-ups, all cases presented with survived flaps, healed wound surfaces, and with osteomyelitis. The musculocutaneous flaps were satisfactory and the appearance and movement of the donor site was normal. The transplanted fibulas of the patients with bone defects were healed after 3 to 4 months on average with a recovery of the ability for movement and support. The distally based compound flap pedicled with the nutrient vessel of sural nerve and lesser saphenous vein was convenient and reliable to employ due to its advantages of infection control, high percentage survival, and rapid healing. It was satisfactorily adapted for reconstruction of leg bone defects, missing skin, and foot and ankle defects.

The “safe zone” in medial percutaneous calcaneal pin placement

Percutaneous pin insertion into the medial calcaneus places a number of structures at risk. Evidence suggests that the greatest risk is to the medial calcaneal nerve (MCN). The medial calcaneal region of 24 cadavers was dissected to determine the major structures at risk. By using four palpable anatomical landmarks, the inferior tip of the medial malleolus (point A), the posterior superior portion of the calcaneal tuberosity (point B), the navicular tuberosity (point C), and the medial process of the calcaneal tuberosity (point D), we attempted to define the safe zone taking into account all possible variables in our dissections including ankle position, side, gender, and possible anatomical variations of the MCN. The commonest arrangement of the MCN was two MCNs that arose independently, one arising before the bifurcation of the tibial nerve and the other arising from the medial plantar nerve. A zone could be defined posterior to 75% of the distance along the lines AB, CD, AD, and CB which would avoid most structures. The posterior branches of the MCN, however, would still be at risk and placing the pin too far posteriorly risks an avulsion fracture. This is the first study to employ four palpable anatomical landmarks to identify a zone to minimize damage to neurovascular structures. It may not be possible, however, to avoid injury of the MCN and consequent sensory loss to the sole of the foot.

Foot Pain - Marathon Runner

HISTORY: A 46-year-old male runner was out for a two mile run 1 ½ weeks prior to office visit, and experienced pain in medial plantar left foot. It was of sudden onset, and there was no precipitating trauma. That night he had difficulty just walking. Since onset he has continued having a difficult time walking at all. He denies swelling and bruising. Currently he is also experiencing patellar tendonitis. He had plantar fasciitis in the past. Current symptoms are different. PHYSICAL EXAMINATION: Exam shows antalgic gait. Tenderness is present to palpation in plantar rear-foot slightly anterior and medial to plantar fascia origin. Inspection of left ankle shows no swelling and no bruising. No pain to palpation at medial or lateral malleolus, 5th metatarsal, proximal fibula, distal tibia/fibula joint, talar dome or posterior tibial tendon. Pulses are intact. Ankle exam including tib/fib squeeze test, anterior drawer, and external rotation were all negative for pain. Foot exam: No deformity of left foot noted. ROM at the ankle, subtalar joint, mid-metarsal, and MTP joint all within normal limits. Strength is 5/5 with dorsiflexion, plantarflexion, eversion and inversion. On follow-up visit: There is exquisite tenderness on the medial midfoot - talar head, plantar navicular. Pain not provoked with great toe dorsiflexion. DIFFERENTIAL DIAGNOSIS: 1) Plantar fasciitis 2) Stress fracture to tarsal bone 3) Plantar fascial nodules 4) Flexor Tendonitis 5) Knot of Henry tenosynovitis TEST AND RESULTS: MRI of left foot with gadolinium. Enhancing bone lesion within the anteromedial calcaneus. Eccentrically positioned with irregular erosion of cortex. Somewhat aggressive features are present. Ligaments and tendons intact. Lesion measures 1.5x1x1.4. Reactive change within muscular soft tissue. Surgical intervention: Needle biopsy - lateral cortex of calcaneus. Frozen section consistent with benign osteoblastoma. FINAL WORKING DIAGNOSIS: Left foot benign aneurismal bone cyst TREATMENT AND OUTCOMES: 1) Curettage and allograft bone grafting of left medial calcaneus - biopsy and visual inspection consistent with benign aneurismal bone cyst. 2) Await wound healing before return to activity. Anticipate return to long distance running.

Vascularized Bone Graft from the Medial Calcaneus for Treatment of Large Osteochondral Lesions of the Medial Talus

Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome. The purpose of this study was to evaluate the results of a vascularized bone graft transfer from the medial calcaneus to the large osteochondral lesion. Four ankles in four patients with medial osteochondral lesions were treated through a medial transmalleolar approach. Vascularized bone graft was harvested from the medial calcaneus using the calcaneal branch of the posterior tibial artery and was placed through a fenestration of the medial aspect of the talar dome. The mean duration of postoperative followup was 34 (range 24 to 48) months. Clinical and radiographic evaluations were made before surgery and at final followup. According to the AOFAS ankle-hindfoot scale, mean pain and function scores improved from 20 to 33 points and 30 to 43 points, respectively. The mean total score improved from 60 to 83 points. Plain radiography at followup showed slight osteosclerosis in all patients, but joint space narrowing was not seen in any patient. Cysts seen preoperatively on MRI or CT resolved after 12 months postoperatively, and MRI or CT did not reveal any findings indicative of osteonecrosis. Clinical and radiographic results were satisfactory. Vascularized bone grafts harvested from the calcaneus were successful for the treatment of large osteochondral lesions of the medial talus.

Isolated Rupture of the Plantaris Tendon in a High School Track Athlete

P lantaris muscle or tendon injuries, although rare, have been discussed for over a century. The plantaris is a rudimentary muscle located in the superficial posterior compartment of the leg and varies in its size and development. It originates at the inferior aspect of the lateral supracondylar line of the femur and consists of a small fusiform fleshy muscle belly with a long, slender tendon that crosses obliquely between the gastrocnemius and soleus before inserting into the medial posterior calcaneus, sometimes via the Achilles tendon or occasionally fusing with the flexor retinaculum or leg fascia. Reports of isolated ruptures of the plantaris muscle or tendon are rare, but this is probably related more to misdiagnosis as Achilles tendon pathology, and that they heal quickly, than the paucity of the injury. Plantaris tendon ruptures rarely are isolated, often involving the gastrocnemius or the Achilles tendon. The term coup de fouet, or snap of the whip, was coined in 1597 to describe an Achilles tendon rupture; some authors have used the term, inappropriately, to describe plantaris tendon ruptures. Tennis leg was used to describe plantaris tendon and muscle ruptures, causing more confusion and debate. Few cases of isolated plantaris tendon rupture have been reported. These ruptures occurred at the insertion on the calcaneus or at the proximal musculotendinous junction. To our knowledge, no case has been reported regarding the rupture of the mid-plantaris tendon in isolation, making our patient’s case unique. CASE REPORT A 16-year-old male high school track athlete (6’3’’, 158 lbs) presented to the office complaining of pain in the right Achilles tendon region. He was in his mid-season training, performing modest speed work twice weekly coupled with distance running of roughly 30–40 miles weekly; he performed no plyometric training. On the previous day (weather was sunny, approximately 501F), while performing an afternoon speed workout, he was nearing the end of his fourth 200-meter sprint and felt a ‘‘pop’’ in his right posterior lower-leg region, causing him to fall. He was able to walk, stiffly, afterwards, but incurred mild swelling and pain that evening. The patient denied numbness, tingling, weakness, joint pain, and previous injuries and was otherwise in excellent health, with no allergies and no present or recent medication or supplement use. Standing exam revealed normal foot structure. Strong, equal pulses were palpated bilaterally at his distal lower extremities and capillary refill was less than 2 seconds. No motor or sensory deficits were identified, and excellent plantar

Foot pressure distribution during walking in young and old adults

BackgroundMeasurement of foot pressure distribution (FPD) is clinically useful for evaluation of foot and gait pathologies. The effects of healthy aging on FPD during walking are not well known. This study evaluated FPD during normal walking in healthy young and elderly subjects.MethodsWe studied 9 young (30 ± 5.2 years), and 6 elderly subjects (68.7 ± 4.8 years). FPD was measured during normal walking speed using shoe insoles with 99 capacitive sensors. Measured parameters included gait phase characteristics, mean and maximum pressure and force, and relative load.Time-series measurements of each variable for all sensors were grouped into 9 anatomical masks.ResultsElderly subjects had lower normalized maximum pressure for the medial and lateral calcaneal masks, and for all medial masks combined. In the medial calcaneus mask, the elderly group also had a lower absolute maximum and lower mean and normalized mean pressures and forces, compared to young subjects. Elderly subjects had lower maximum force and normalized maximum force and lower mean force and normalized mean forces in the medial masks as well.ConclusionFPD differences between the young and elderly groups were confined to the calcaneus and hallux regions and to the medial side of the foot. In elderly subjects, weight bearing on the lateral side of the foot during heel touch and toe-off phases may affect stability during walking.

Anatomical consideration of vascularized bone graft transfer from the medial calcaneus to the talus

To investigate the possibility of use of the calcaneal branches of the posterior tibial artery as the pedicle for the vascularized bone graft to the talus, a detailed anatomical study was carried out on 30 fresh cadaver feet. Although there are several branches from the posterior tibial artery to the calcaneus, the largest posterior branch was defined as the main calcaneal branch. We recognized frequently a large branch nourishing the superior part of the calcaneus and named it the superior calcaneal branch. Twenty feet had the superior calcaneal branches. Pedicled bone grafts using the superior calcaneal branch to the postero-medial portion of the talar body were possible in 18 of 20 feet. Pedicled bone grafts using the main calcaneal branches were possible in 9 of 12 feet in which the superior calcaneal branches were not available. Finally, vascularized bone grafts were judged to be feasible in 27 feet (90%).