Socket Ankle Research Articles

Case of incomplete fibular hemimelia with tarsal coalition, pes planus, ball and socket ankle

Fibular hemimelia (FH) is a congenital disease with a clinical spectrum ranging from mild fibular hypoplasia to fibular aplasia. There is no proven genetic factor. Some anomalies can accompany FH such as tarsal coalition, ulnar hemimelia, amelia, syndactyly, several extremity anomalies, renal anomalies and cardiac anomalies. Our case is about unilateral and incomplete type of right-side FH in a 14 years old female patient. Tibia was curved (bowing) and short. Disparity of measure with left lower extremity was monitored. Tarsal coalition in osseous form, tibial curve anomaly and small bone part placed in fibula distal region compatible with FH, were visualized. There was curved joint form in the same ankle with hemimelia compatible with ball and socket ankle deformity. Calcaneal inclination angle was 120. The findings were compatible with pes planus.

Ball and Socket Ankle: Mechanism and Computational Evidence of Concept

The ball and socket ankle joint is a morphologically abnormal joint characterized by rounding of the articular surface of the talus. Other than anecdotal observation, little evidence has been presented to describe the development of this deformity. The purpose of the present study was to review ankle and subtalar joint mechanics and to kinematically examine the functional combination of these joints as a mechanism of the ball and socket ankle deformity. We reviewed functional representations of the ankle joint, subtalar joint, and ball and socket ankle deformity. A computational study of joint kinematics was then performed using a 3-dimensional model derived from a computed tomography scan of a ball and socket deformity. The joint kinematics were captured by creating a “virtual map” of the combined kinematics of the ankle and subtalar joints in the respective models. The ball and socket ankle deformity produces functionally similar kinematics to a combination of the ankle and subtalar joints. The findings of the present study support the notion that a possible cause of the ball and socket deformity is bony adaptation that compensates for a functional deficit of the ankle and subtalar joints.

Three cases of congenital bilateral ball and socket ankle joints in the same family – a case series

A 40-year-old lady presented with a 10-year-history of left ankle and foot pain. Clinically the pain was thought to be due to instability of the lateral ligament complex. Bilateral ankle radiographs showed a ball and socket ankle joints. Magnetic Resonance Imaging (MRI) scan of the left ankle in addition showed a chronic tear of the lateral ankle ligaments and subluxation of the peroneal tendons. Subsequently, she underwent an examination under anaesthesia of the left ankle which demonstrated no significant difference in stability between the two sides. Interestingly, because of the daughter’s peculiar ankle radiograph appearances, her mother’s and son's radiographs of the ankle were reviewed and they also showed similar appearance of bilateral ball and socket joints, favouring congenital aetiology.

Ankle Fusion Combined With Calcaneal Sliding Osteotomy for Severe Arthritic Ball and Socket Ankle Deformity

Although a ball and socket ankle deformity is usually congenital and asymptomatic, abnormal inversion and eversion mobility can result in recurrent ankle sprain and osteoarthritis. This retrospective study was performed to evaluate the clinical and radiologic outcomes of ankle fusion combined with calcaneal sliding osteotomy for severe arthritic ball and socket ankle deformity. Fourteen patients with severe arthritic ball and socket ankle deformity were followed for more than 3 years after operation. The clinical evaluation consisted of American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS) for pain, and subjective satisfaction score. The period to fusion and union of osteotomy, the change of hindfoot alignment angle, and complications were evaluated radiologically. AOFAS and FAAM scores were significantly improved from an average of 37.4 and 34.5 points to 74.6 and 78.5 points, respectively. VAS for pain with walking over 20 minutes was significantly improved from an average of 8.4 points to 1.9 points. The average satisfaction score of patients was 88.9 points. The difference in heel alignment angle (compared to contralateral side) was significantly improved from an average of 34.8 to 5.4 degrees. There were 2 cases of progressive arthritis in an adjacent joint and 1 case of failed fusion. Ankle fusion combined with calcaneal sliding osteotomy can be an effective operative option for ball and socket ankle deformity with advanced arthritis. In spite of increased complication rate, reliable pain relief, and restoration of gait ability through correcting hindfoot malalignment could improve the quality of life. Level IV, retrospective case series.

Surgical Correction of the Ball and Socket Ankle Joint in the Adult Associated With a Talonavicular Tarsal Coalition

Ball and socket ankle (BASA) deformity is a rare condition. Little is known about outcomes and treatments in the adult population. Retrospective comparative review was performed of 13 patients treated for BASA with a minimum follow-up of 2.5 years. Evaluation included clinical and radiographic review, outcome scores, a questionnaire, and a subjective satisfaction survey. Nine patients with correctable valgus deformity not associated with arthritis of the ankle joint underwent a supramalleolar osteotomy (SMO). Four patients underwent arthrodesis-2 a tibiotalocalcaneal (TTC) arthrodesis and 2 a pantalar arthrodesis. AOFAS scores improved from 30.1 to 77.6 (range, 16-82) (P < .05) in the SMO group. AOFAS scores improved from 24 to 60.5 (range, 16-66) (P < .05) in the arthrodesis group. Arthritis grade in the SMO patients was unchanged in 4 patients at final follow-up and worsened in 5 patients by only 1 grade. Nine patients reported good results (all 4 arthrodesis patients, 5 SMO patients) and 4 reported fair results (all SMO patients). BASA deformity and dysfunction can be improved with corrective surgery. Level III, prospective comparative study.

Limb length discrepancy and congenital limb anomalies in fibular hemimelia

The aim of this study was to determine the prevalence of ipsilateral congenital musculoskeletal anomalies associated with fibular hemimelia. We also attempted to determine the corelation between the eventual limb length discrepancy at maturity and these associated anomalies, as well as the Achterman-Kalamchi class of these patients. The records and roentgenograms of 45 patients with fibular hemimelia were reviewed retrospectively. All patients were classified into three groups (types I-A, I-B, and II) according to the Achterman-Kalamchi system. The prevalence of congenital limb anomalies, lower extremity discrepancy percentage, and ultimate limb length discrepancy at skeletal maturity were evaluated. There was no significant statistical association between the number of congenital limb anomalies and severity of the limb length discrepancy, but patients included in the mildly affected group (type I-A) had a higher average prevalence of congenital limb anomalies than those classified as types I-B and II. There was a substantial correlation between congenital short femur as well as the Achterman-Kalamchi classification system and the predicted limb length discrepancy. A similar percentage of limb length discrepancy in types I-B and II was seen. In conclusion, the numbers of associated congenital limb anomalies are not predictive of the eventual limb length discrepancy. Presence of a congenital short femur and ball and socket ankle are predictive of a higher limb length discrepancy. Achterman-Kalamchi types I-B and II show a similar percentage of limb length discrepancy and this is significantly higher than that seen in type I-A.

A rare pentad of foot and ankle deformities in hyperlax children

The aim of this paper is to describe the clinical features and radiological appearance of a rare and complex lower leg and foot deformity in hyperlax children. Four children were included in the study; of these, two had bilateral feet involvement. All deformities were present since birth, comprising a pentad of conditions: (1) pathologic external tibia and fibula torsion, (2) ball and socket ankle joint with medial subluxation and talus medial subluxation, (3) excessive hindfoot valgus, (4) peroneal and Achilles tendon displacement anterior to the lateral malleolus and (5) generalized ligament laxity. All children had failed cast manipulation. Only two had undergone a minimal soft tissue procedure, but there had been no improvement. All patients were ambulatory and pain free at the mean age of 6.5 years. Conservative or minimal soft tissue procedures are not effective in restoring the anatomy of such feet.

Ball and socket ankle joint in connection with bilateral tarsal synostosis in a boy with congenital absence of the portal vain: a novel malformation complex

BackgroundContracted valgus flat foot in the adolescent is frequently caused by tarsal synostosis or synchondrosis. These synostoses are prevalently symptomatic during adolescence, when by ossifying they block the subtalar joint in valgus. Careful and detailed examinations might reveal additional abnormalities.Case presentationA 16-year-old boy of Austrian origin presented with contracted valgus foot associated with tarsal hypomobility and pain. Talonavicular synostosis with ball and socket ankle joint was detected via lateral radiographs and 3 DCT scan. Preoperative laboratory investigations revealed leucocytopenia, and thrombopenia. Computerised abdominal tomography showed portal vein atresia and portopulmonary hypertension.ConclusionClinical research is the corner stone to elucidate the aetiological understandings in patients with malformation complex. The latter is a critical task for the development of scientific bases for preventive strategies. Careful examination for these abnormalities should lead the clinician to earlier referral of patients for additional examination by a specialised medical team. This often enables more focused care for the individual and better characterisation/documentation of the malformation complex. The association of tarsal synostosis and the previously unreported associated occurrences of congenital absence of the portal vein, portopulmonary hypertension, cardiomegaly and splenomegaly have been encountered. We stress that our present patient illustrates and supports the pathophysiological hypotheses that have previously proposed for the concurrent existence of absent portal vein, hepatic nodular hyperplasia and portopulmonary hypertension. Nevertheless, no previous single report signifies the existence of tarsal synostosis in connection with the above-mentioned abnormalities.

Terminal hemimelia of the lower extremity: absent lateral ray and a normal fibula

Congenital lateral ray deficiency is considered to be a manifestation of fibular hemimelia. However, we have noted patients with absent lateral ray but stable knee and ankle joints, and named this condition terminal hemimelia of the lower extremity. This study was undertaken to further define this group of patients and to compare these patients with fibular hemimelia patients. Four boys and one girl of mean age six years two months were in the terminal hemimelic group and four boys and three girls of mean age eight years seven months in the fibular hemimelic group at the final evaluation. Clinical features commonly observed in the fibular hemimelia such as knee valgus, knee instability, tibial bowing, ball and socket ankle, ankle instability, tarsal coalition, leg length inequality were compared between both groups. Terminal hemimelia of the lower extremity was the same as fibular hemimelia in clinical features below the ankle joint. However, terminal hemimela was found to be milder than fibular hemimelia in terms of limb shortening. The clinical features above the ankle joint were different between both groups. Knees and ankles were stable, and gait disturbance were rarely noticed in patients with terminal hemimelia of the lower extremity.

3-D-Computertomographie einer seltenen Fehlbildung: Das talokrurale Kugelgelenk

Background We report on a very rare anomaly of the ankle joint with a spherical deformity of the talus and associated anomalies of the lower limbs, which may appear as part of a hemimelia syndrome. Case report 3D-reconstructed computer tomography shows anatomic details of the ball and socket ankle joint of a 16-year-old patient, who had consulted us with unilateral shortening of leg length and oligodactylia. Conclusion In opposition to conventional X-ray CT-reconstruction illustrates the complex anomalies of the foot and ankle joint three dimensionally and serves for further comprehension of anatomy and biomechanics of the ball and socket ankle joint.

Findings of fibular hemimelia syndrome with radiographically normal fibulae

We have noted a number of patients with features of fibular hemimelia with radiographically normal fibulae. This study was undertaken to further define this group. A review of hospital records and radiographs over a 72-year period identified 149 limbs in 123 patients with features of fibular hemimelia syndrome. Sixteen limbs in fourteen patients had findings of fibular hemimelia with radiographically normal fibulae. Thirteen of 16 had absent lateral rays with either ball and socket ankle joint, tarsal coalition or both. Six of the 13 had limb shortening. Three limbs in three patients did not have absent lateral rays, but had at least two other features of fibular hemimelia syndrome. All of these three limbs had ball and socket ankles and tarsal coalitions and two had shortening. These patients represent a mild subset of fibular hemimelia syndrome and we propose that they be classified as type 0 fibular hemimelia.

Findings of fibular hemimelia syndrome with radiographically normal fibulae.

We have noted a number of patients with features of fibular hemimelia with radiographically normal fibulae. This study was undertaken to further define this group. A review of hospital records and radiographs over a 72-year period identified 149 limbs in 123 patients with features of fibular hemimelia syndrome. Sixteen limbs in fourteen patients had findings of fibular hemimelia with radiographically normal fibulae. Thirteen of 16 had absent lateral rays with either ball and socket ankle joint, tarsal coalition or both. Six of the 13 had limb shortening. Three limbs in three patients did not have absent lateral rays, but had at least two other features of fibular hemimelia syndrome. All of these three limbs had ball and socket ankles and tarsal coalitions and two had shortening. These patients represent a mild subset of fibular hemimelia syndrome and we propose that they be classified as type 0 fibular hemimelia.

An unusual cause of ankle pain: stress fracture in a ball and socket ankle joint

Summary This paper illustrates an unusual case of ball and socket joint of the ankle. Although ball and socket ankle joint has been described before, we have not found any literature describing it in association with stress fracture of the medial malleolus as identified in this patient.

The Correction of Complex Foot Deformities Using Ilizarov??s Distraction Osteotomies

Twenty-five very complex foot deformities were treated by Ilizarov distraction osteotomies. The osteotomy types included supramalleolar, U, V, posterior calcaneal, talocalcaneal neck, midfoot, and metatarsal osteotomies. In addition, the leg was lengthened and widened in most cases. The mean treatment time was 6.4 months. There were 20 minor or major complications related to the foot osteotomies in 18 feet, including deep pin-tract infection in three, failure of osteotomy separation in nine, acute postoperative tarsal tunnel syndrome in two, toe contractures in three, wire breakage or cutout in two, and buckle fracture in one. Nineteen secondary procedures were required in 13 patients to treat these complications. The final result was a plantigrade foot in 22 in late follow-up evaluation. The three nonplantigrade feet were attributable to unrecognized heel varus in one, ball and socket ankle joint in one, and partial growth arrest progressive deformity in one. Gait was improved in all cases. Pain was eliminated in all but two patients. Based on these criteria, the results were judged to be satisfactory in 22 and unsatisfactory in three. The Ilizarov method can successfully correct complex foot deformities despite complications.

Congenital Ball - and - Socket Ankle Joint: A Case Report

Congenital Ball - and - Socket Ankle Joint: A Case Report

The ball and socket ankle joint

This paper reports fifteen cases of ball and socket articulation at the ankle followed up for an average of twelve years. All patients showed inequality of leg length. Ten patients showed coalitions of the bones of the hindfoot and nine patients had a reduction in the number of bony elements of the forefoot. Other associated anomalies are described. The abnormality seems to be part of a congenital short-limb malformation, perhaps modified by adaptive change associated with rigidity of the hindfoot. Surgical intervention was not required in any patient in the series.

BALL AND SOCKET ANKLE JOINT IN METATARSUS ADDUCTUS VARUS

1. Three children with metatarsus adductus varus have been found to have ball and socket ankle joints. 2. The effect of this finding on treatment is discussed.

Ball and Socket Ankle Joints

Ball and Socket Ankle Joints

Congenital ball and socket ankle joint.

In 1958 Lamb described five cases with a ball and socket ankle joint. Brahme (1961) reported a further case with a bilateral ankle joint involvement in a paper entitled “Upper Talar Enarthrosis”. In some of the cases presented the affected limb was shorter than the normal limb. Fusion of the tarsal bones was noted in some cases. Jacobs (1962) has collected three more cases, the reports of which are in the press at present.