Subtalar Joint Movement Research Articles

Hindfoot joint kinematics analysis after the resection of talocalcaneal coalition

BackgroundThe subtalar joint movement between the talus and calcaneus is restricted in patients with talocalcaneal coalition (TCC). When the motion of the subtalar joint is restricted, shock absorption in the foot decreases, leading to pain during walking. Resection methods to maintain subtalar motion by removing abnormal unions have been proposed. The purpose of this study was to analyze the joint kinematics of patients who underwent TCC resection and to quantitatively evaluate the results of the surgery based on the measured kinematics. MethodsJoint kinematics of five patients with TCC were obtained using a biplane fluoroscopic imaging system and an intensity-based two-/three-dimensional registration method. The joint kinematics of the tibiotalar and subtalar joints and the tibiocalcaneal motion during the stance phase of walking were obtained. From the kinematics of the hindfoot joints, the inversion/eversion range of motion (ROM) of the patients before and after resection was statistically analyzed using the Wilcoxon signed-rank test to test whether TCC resection improved the ROM. ResultsDuring the loading response period, the eversion ROM of the subtalar joint and tibiocalcaneal motion significantly increased postoperatively. In addition, a significant postoperative increase was observed in the subtalar and tibiocalcaneal inversion ROM during the pre-swing period. SignificanceTCC resection surgery increased the ROM of the subtalar joint, which in turn contributed to the increase in tibiocalcaneal ROM. Increased subtalar and tibiocalcaneal ROM could result in increased shock attenuation and may be a contributing factor to pain relief during walking.

Hindfoot Motion Analysis by Subtalar Compensation and Ankle Osteoarthritis Stage using a 3D Multi- Segment Foot Model

Category: Hindfoot Introduction/Purpose: Biomechanics of the hindfoot in ankle osteoarthritis (OA) have not yet fully understood. We aimed to identify hindfoot motions by gait analysis using multi-segment foot model (MFM) according to the stage of ankle OA or hindfoot alignment determined by the presence of subtalar compensation. Methods: We retrospectively reviewed the medical records, simple radiographs, and gait MFM data from 54 ankles which admitted to our hospital for the treatment of advanced ankle OA. Spatiotemporal gait parameters and 3-dimensional motions of hindfoot segment were analyzed according to sex, age, body mass index, the Takakura classification, and the presence of subtalar compensation. Results: As a result, all spatiotemporal gait parameters showed no significant difference according to the presence of subtalar compensation and the stage of ankle OA. With regard to the relationship between hindfoot segmental motion and the stage of ankle OA, only normalized step width was significantly different from each other (p value=0.028). Average motion of hindfoot (decompensation versus compensation) showed no significant difference in sagittal and transverse plane. In coronal movement of hindfoot, there were collapsed curves in both groups, which had constant significant difference. In comparison of 3a, 3b, and 4 stages of Takakura, more advanced 3b stages of ankle OA had the smaller sagittal range of motion compared to 3a (p value=0.028). Coronal movement of hindfoot in Takakura 3a/3b/4 all showed relatively flat pattern. Conclusion: In conclusion, spatiotemporal parameters were not affected by the alignment state of the heel resulted from subtalar compensation. Sagittal range of hindfoot motion decreased in the advanced ankle OA. Coronal movement of subtalar joint in ankle OA, once it was disrupted, showed no change regardless of the stage of ankle OA or compensation state of the hindfoot.

Subtle Activities of Specific Plain Subtalar Joint May Account for Non-injured Ankle Pain: A Case Report

Current clinical practice focuses on discovering injuries and then formulating treatment plans. But some injuries have nothing to do with symptoms, including pain, let alone those situations where there is no injury. The ankle, especially the subtalar joint, has a high rate of variation, so the subtle activities of subtalar joint are exactly important in patients who have biomechanical issues, especially in the condition that all check-ups are normal. This paper presented a case report of a 16-year-old teenager who was a professional basketball player in local senior high school. The pain appeared in both of his soles and ankles as long as he played basketball and disappeared immediately after the exercise since his childhood. All the routine tests involving MRI and ultrasound were normal. No impingement condition was found. 3D dynamic reconstruction combined with 3D continuum model was performed. The specific plain subtalar articular surfaces were revealed. The treatment involving dynamic fixation via rigid tape and training lasted for 4 weeks. Before the treatment, the right talus was more stable than the left one (Δ(norm)=0.5126), and the calcaneus was the other way around (Δ(norm)=0.6280). The differences of degrees of freedom between two sides decreased significantly (Δ(norm)=0.0833, 0.000) after treatment. Besides, the steep and tone of both sides of talus and calcaneus revealed relative rotation and translation which indicated that the movement of subtalar joint trended to the balance of stability and mobility. This patient improved his athletic ability and got pain free immediately after the first treatment. Moreover, the pain didn’t appear during the 12-month follow-up. Therefore, we conclude that based on our treatment which focused on the reduction of the subtle activities of subtalar joint, we support that the subtle activities of variable subtalar joint may influence the athletic abilities and cause some symptoms. Therefore, the importance of bone shape which is the chief culprit of abnormal mobility shall be taken seriously. Moreover, in the case calculation based on the mathematical model, stable calcaneus and flexible talus make the better balance of stability and mobility and are necessary for available exercises.

Excision of a Middle Facet Tarsal Coalition.

The incision is marked from 1 cm inferior to the medial malleolus, extending distally to the navicular tuberosity and inferior to the level of the posterior tibial tendon. The coalition is first located by retracting the flexor tendons and the neurovascular bundle. The bone on the surface of the coalition is gradually removed to expose the middle facet. A 2-mm guide pin and a cannulated dilator probe inserted through the sinus tarsi into the tarsal canal that exits anterior to the posterior facet help with identifying the margins of the coalition. The middle facet is then removed either partially or totally, depending on the size, shape, and location of the coalition, until the posterior facet is visualized. Following excision, bone wax is used on the exposed surfaces or fat is inserted to prevent adhesion and recurrent bone formation. If there is an associated flatfoot deformity, additional surgeries, including a medial translational osteotomy or a lateral column lengthening of the calcaneus, a Cotton osteotomy, an arthroereisis, or a calcaneus stop procedure, may be necessary. The alternative treatment for managing a middle facet coalition is immobilization of the foot in a boot or cast for 6 to 8 weeks to decrease pain. This will not improve the function of the hindfoot, which remains stiff, but may alleviate pain temporarily. Excision of the coalition in combination with other procedures for correction of the flatfoot is an alternative to an arthrodesis of the subtalar joint and works well in children and adolescents, particularly in those with reasonable subtalar joint flexibility. A triple arthrodesis is rarely performed for an isolated middle facet coalition, even in adults, unless there is peritalar arthritis and more severe abduction of the talonavicular joint with associated stiffness. The rationale for excision of a middle facet tarsal coalition is to maximize the mobility of the hindfoot, in particular, the subtalar joint. The success of excision of the coalition is associated with the rigidity of the hindfoot and the presence of a flatfoot deformity. The stiffer the hindfoot and the flatter the foot, the less likely is excision of the coalition to be successful. Since the alternative to resection of a middle facet coalition is arthrodesis of the subtalar joint, one must distinguish between feet in which there is mobility, and excision is more likely to be successful, and those that are rigid, for which arthrodesis is preferable. In many feet, however, the size of the coalition is not associated with the flexibility of the hindfoot, and in an extremely rigid hindfoot, we recommend an arthrodesis, even in an adolescent patient. Rigidity increases with increasing age, and it is uncommon to excise the middle facet coalition in adult patients or in a patient in whom subtalar arthritis is evident.

Subtalar Arthroereisis for Correction of Flexible Flatfoot in Children: A Retrospective Comparative 5- Year Follow-Up Study

Category:HindfootIntroduction/Purpose:Subtalar arthroereisis for the treatment of flexible flatfoot in children is controversial. Self-locking implants are utilised worldwide aiming to limit subtalar joint movement and foot pronation. Recently two reviews have focused on the lack of comparative studies in literature and the poor-quality evidence available regarding these devices. In this study, performed on children diagnosed with flexible flatfoot and treated with subtalar arthroereisis, the two aims were: 1) to compare pre and postoperative radiographic measurements in order to assess the efficacy of arthroereisis in the correction of flatfoot; 2) to compare clinical outcomes between patients operated and normal controls at mid-term follow-up. Our hypothesis was that subtalar arthroereisis achieves flatfoot correction and that at the longest follow-up patients operated do not differ from normal controls.Methods:This is a single-centre single-surgeon retrospective comparative study, ethics committee approved. Fortysix feet from 24 continuous patients (5 females; 22 left and 24 right) treated at mean age of 11 years (range 8 to 15) with subtalar arthroereisis for flexible flatfoot were reviewed at a follow up of 51 months (range, 25 to 73) and compared with 23 feet from 13 controls (ratio 2:1, matched by age and body mass index). Radiographically, the following measurements were recorded and compared on pre and postoperative films: talonavicular coverage angle and talocalcaneal divergence angle on dorsoplantar view; Dijan-Annonier angle, Méary line, calcaneal pitch and talocalcaneal divergence angle on lateral views. Clinically, a goniometric assessment of ankle and hindfoot range of motion, AOFAS score and VAS-FA score were utilised in patients operated and normal controls (mean values ± standard deviation). Paired 2-tailed Student t tests were used to assess differences.Results:All radiographic measurements demonstrated improvement after surgery (p .001), except for the talonavicular coverage angle (p .812). At longest follow-up, patients and controls had 35.8° ± 3.8 vs 44.1° ± 2.8 of plantarflexion (p .092), 13° ± 1.7 vs 14.5° ± 2 of dorsiflexion (p .312), 16.5° ± 2 vs 18.7° ± 1.6 of inversion (p .124) and 10.6° ± 1.6 vs 11.8° ± 1.3 of eversion (p .073). AOFAS values were similar at 94.7 points ± 3.9 (patients) and 99.3 points ± 1.3 (controls) (p .083). All the items from VAS-FA showed no differences in two groups, except for frequency and intensity of pain during physical activity (p .053 and p .032, respectively) and ability to stand on leg for long time (p .004).Conclusion:Our study showed that subtalar arthroereisis significantly improves flexible flatfoot deformity, with a satisfactory correction of hindfoot alignment and longitudinal arch but no significant amelioration of the foot abduction. Although at 4 years of time patients do clinically well, they may still experience some limitations compared to normal individuals. It is therefore crucial to consider these anatomical and functional elements when counseling young patients and family about surgery, in order to address preoperatively and realistically their expectations.

Evaluation Of Reliability And Validity Of A New Device To Measure Knee Rotation

Rotational laxity of knee is known as the one of the intrinsic risk factors of anterior cruciate ligament (ACL) injury. However, there is no simple device to measure knee rotation. The “RotorMeter” is a newly developed, simple, non-invasive, external device that is specifically designed to measure the lower leg rotation relative to the femur in vivo. PURPOSE: To determine the reliability and validity of the RotorMeter. METHODS: Two measurements were made with the RotorMeter at 90° of knee flexion and 90° of hip flexion applying 8 Nm torque by 2 independent examiners in 14 healthy female subjects (21.1±1.2 yrs, 28 knees). Image analysis to obtain the rotation of the right lower leg was simultaneously carried out. Statistical analysis was performed using intra-class correlation coefficients (ICC, intra-examiner and inter-examiner) and Pearson’s correlation coefficient between the 2 methods. RESULTS: Total (internal + external) knee rotation ranged from 100.0° to 105.7° (standard error of measurement ranged from 2.3° to 3.7°) by the RotorMeter and was 62.2±8.24° by the image analysis. Intra-examiner ICC(1,1) results were 0.705 and 0.721, and inter-examiner ICC(2,2) was 0.828. The correlation coefficient between the results of RoterMeter and image analysis was 0.875 (significant at P < 0.05). CONCLUSIONS: The RoterMeter was found to be a reliable and valid measurement instrument concerning knee rotation. It is easy to perform and might be used in a wide field to measure knee rotation. But the deformation of soft tissue and the movement of subtalar joint should be considered. This study was supported by a Grant-in Aid Exploratory Research from NUHW (2013-A-30).

English

BACKGROUND: Surgical correction of congenital talipes equino varus (ctev) is to address adequately all aspects of this complex foot deformity. Various exposures have been elucidated with varying results and complications. This prospective study discusses the cincinnati approach advocated by Mackay to address the various aspects of clubfoot correction. Objective: To study the adequacy of exposure, wound healing and problems related to Cincinnati approach. To study the effectiveness of primary surgical correction. METHODS: The present prospective study includes treatment of 24 feet in 21 patients with clubfoot treated with posteromedial and lateral soft tissue release by Cincinnati approach and followed up with an average follow up of 6.9 months. 3 (12.5%) were followed up for 1 year and 3 (12.5%) lost for the follow up. 18 (75%) were followed up to 6 months. All were resistant to correction by conservative method. Age at operation averaged 1.6 year, ranged from 9 months to 3 years. RESULTS: Results were evaluated using Laaveg and Ponseti functional rating system of clubfoot. Postoperatively the average arc of movement in ankle joint was 370, which was 50% of normal limb. Inversion, eversion movement of subtalar joint was 230, bimalleolar angle was 770.The functional results were excellent in 6 feet (25%), good in 12 feet (50%), fair in 5 feet (20.83%) and poor in 1 foot (4.17%). In our series complications encountered were post-operative focal necrosis in 3 feet (12.5%) and marginal necrosis in 3 feet (12.5%). CONCLUSION: Cincinnati incision provides an adequate exposure for extensive surgical release under direct vision, there by bony realignment of talus over calcaneus was restored and hence the restoration of normal bimalleolar angle. Skin closure is not found to be a problem in achieving a primary closure. Wound healing leaves only a thin and cosmetically acceptable scar.

The In Vitro Reliability of the CODA MPX30 as the Basis for a Method of Assessing the In Vivo Motion of the Subtalar Joint

The considerable variation in subtalar joint structure and function shown by studies indicates the importance of developing a noninvasive in vivo technique for assessing subtalar joint movement. This article reports the in vitro testing of the CODA MPX30, an active infrared marker motion analysis system. This work represents the first stage in the development of a noninvasive in vivo method for measuring subtalar joint motion during walking. The in vitro repeatability of the CODA MPX30 system's measurements of marker position, simple and intermarker set angles, was tested. Angular orientations of markers representing the position of the talus and the calcaneus were measured using a purpose-designed marker placement model. Marker location measurements were shown to vary by less than 1.0 mm in all of the planes. The measurement of a 90° angle was also found to be repeatable in all of the planes, although measurements made in the yz plane were shown to be consistently inaccurate (mean, 92.47°). Estimation of segmental orientation was found to be repeatable. Estimations of marker set orientations were shown to increase in variability after a coordinate transform was performed (maximum SD, 1.14°). The CODA MPX30 was shown to produce repeatable estimations of marker position. Levels of variation in segmental orientation estimates were shown to increase subsequent to coordinate transforms. The combination of the CODA MPX30 and an appropriate marker placement model offers the basis of an in vivo measurement strategy of subtalar joint movement, an important development in the understanding of the function of the joint during gait.

The development of a non-invasive, in vivo method of measuring subtalar joint movement during the contact phase of walking

The development of a non-invasive, in vivo method of measuring subtalar joint movement during the contact phase of walking

Langzeitergebnisse nach zementiert und zementfrei verankerter S.T.A.R.-Prothese beim Rheumapatienten

We report the clinical and radiological results of 65 S.T.A.R. prosthesis that were performed be-tween 1993 and July 2000 in our two institutions. Cementless fixation was used in 38 prosthesis and cement fixation in 27. Rheumatoid arthritis was the main diagnosis, with females dominating. The average follow-up was 9.3 years for cemented S.T.A.R. prostheses and 11.3 years for cementless S.T.A.R. prostheses. The follow-up was based on the Kofoed ankle score, which consists of three tests, one subjective dealing with pain and two objective parts about ankle function and mobility. 23 patients (77.4%) with cementless fix-ation achieved good and excellent results. The Kofoed ankle score improved from preoperatively 44.7 to an average of 80.7 points at final examination. The cemented S.T.A.R. prosthesis gained an average score of 76,3 postoperatively, representing 16 (64%) implants with good and excellent result. The mobility score showed a moderate rise in range of motion for extension and flexion (+8.5°), while a decrease in subtalar joint movement has been noted. This is due to additional subtalar and talonavikular arthrodesis. For cemented S.T.A.R.-prosthesis we had to recognise progressive radiolucent lines of the tibial component in 11 (44%) patients and talar subsidence in eight (32%). We had three tibial exchange arthroplasties and six arthrodesis due to prosthesis loosening. The radiographic analysis showed radiolucent lines of the flat tibial component in seven cases (22.5%) of the cementless prosthesis. Five (16%) times we had to recognise talar subsidence. We had to perform six (19.3%) revisions because of meniscal breakage or insufficient meniscal height. An exchange of the talar component was necessary twice. Three prosthesis had to be revised with arthrodesis due to symp-tomatic loosening. In conclusion, cementless ankle arthroplasty using the cementless S.T.A.R.-prosthesis proved excellent clinical and radiological long-term results, especially for rheumatoid patients. The success of ankle arthroplasty depends on careful indication, cementless fixation of a second generation total ankle arthroplasty and appropriate rehabilitation. Cement fixation in total ankle arthroplasty should be abandoned.

Reliability of clinical measurement of subtalar joint movement.

This study was designed to evaluate the intra- and interexaminer reliability during repeated clinical measurements of subtalar movement. The study was a blinded experimental model in which 11 Royal College certified orthopaedic surgeons measured the subtalar movement of the 10 lower extremities of five normal subjects. The measurements were performed in accordance with previously published recommendations. Measurements of both inversion and eversion were recorded in degrees. Employing a variance component analysis, a coefficient of agreement between examiner measures was established. The coefficient of agreements were 0.107 for right lower extremities and 0.0656 for left lower extremities. An evaluation of means and ranges of individual examiner measures demonstrated a potential average loss of range of motion of 20% simply because of variability in measurement. It was also determined that a learning curve did not exist within examiners in this study. The reliability of clinical estimates of subtalar movement by this method is extremely poor. Both inter- and intraexaminer reliability are so poor as to suggest that this method of examination no longer be used to determine or document the measurement of subtalar movement.

Posterolateral release for resistant club foot

We treated 37 infants with 53 idiopathic club feet by posterolateral release alone at a mean age of 2.4 months. They were reviewed after a mean follow-up of 10 years 7 months. Both function and appearance were studied. Seventeen feet had required further surgery, at an average of four years after posterolateral release. In all cases hindfoot equinus had been well corrected; the mean ankle dorsiflexion at review was 15 degrees. Most feet showed subtalar joint movement of between 50% and 75% of normal. Four feet showed poor results: one had a stiff subtalar joint, two feet in one child showed fixed forefoot varus, and one foot had required a Dillwyn-Evans operation at 5.5 years. The overall reoperation rate of 32% at ten years suggests that a radical release operation is not necessary in all patients. Of 59 patients who had only a simple posterolateral release 27 (46%) have satisfactory results.

Clinical determination of the linear equation for the subtalar joint axis

The authors present a methodology to measure the frontal plane angular and linear displacement and the transverse plane angular displacement of subtalar joint movement. This method is combined with a modification of the Kirby method for determining the transverse plane projection of the subtalar joint axis onto the plantar foot. A mathematical model is then used to construct the subtalar joint axis into a three-dimensional linear equation. Data are obtained from an in vivo series of 62 feet that indicates that within acceptable clinical errors of measurement the subtalar joint is a ginglymus type of joint that moves around a single fixed axis. Results also indicate that the subtalar joint axis is more superior and lateral to the neutral foot than any previous studies on cadaver feet have shown. Finally, the authors show that once the subtalar joint axis can be accurately located, the torque on the joint axis produced by ground reactive forces and muscular forces can be computed.

Clinical determination of the linear equation for the subtalar joint axis.

The authors present a methodology to measure the frontal plane angular and linear displacement and the transverse plane angular displacement of subtalar joint movement. This method is combined with a modification of the Kirby method for determining the transverse plane projection of the subtalar joint axis onto the plantar foot. A mathematical model is then used to construct the subtalar joint axis into a three-dimensional linear equation. Data are obtained from an in vivo series of 62 feet that indicates that within acceptable clinical errors of measurement the subtalar joint is a ginglymus type of joint that moves around a single fixed axis. Results also indicate that the subtalar joint axis is more superior and lateral to the neutral foot than any previous studies on cadaver feet have shown. Finally, the authors show that once the subtalar joint axis can be accurately located, the torque on the joint axis produced by ground reactive forces and muscular forces can be computed.

Operative treatment of intraarticular fractures of the os calcis--the role of rigid internal fixation and primary bone grafting: preliminary results.

The treatment of intraarticular fractures of the os calcis remains controversial. Yet it seems illogical that the subtalar joints should be treated differently from other weight-bearing joints. In this paper, we report the results of treating 64 intraarticular fractures of the os calcis by open reduction, rigid internal fixation with primary bone graft, and early mobilization. Of the 64 fractures, 23.43% were tongue-type fractures, 48.43% were joint depression, and 28.12% were comminuted. All the fractures were operated on with lateral incisions. The average period of follow-up was 10.6 months. The results showed that all the patients had minimal pain, swelling, and deformity. Subtalar joint movement was retained (67.8% of active and 80.7% of passive). Eighty percent of normal Bohler angles and 93.5% of normal crucial angles were regained. Over 80% of patients resumed working within 6 months after the injuries. We therefore concluded that the present method of treating intraarticular fractures of os calcis gives very good results.