Tarsal Scaphoid Research Articles

Translated article] Aetiopathogenic factors and treatment of Müller-Weiss disease

Background and aimMüller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. Materials and methodsRetrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. ResultsSixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. ConclusionsAs in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.

Factores etiopatogénicos y tratamiento de la enfermedad de Müller-Weiss

Background and aimMüller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. Materials and methodsRetrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. ResultsSixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. ConclusionsAs in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.

Coalición calcáneo-navicular asociada a pie plano rígido infantil. A propósito de un caso

Tarsal coalition (a congenital fibrous, cartilaginous or bony connection between two bones) often leads to a flatfoot deformity in children. Usually it presents with recurrent ankle sprains or insidious onset of a painful rigid flatfoot and movement limitation of midtarsal and subtalar joints. Clinical diagnosis is confirmed by X-rays, computed axial tomography and nuclear magnetic resonance. The anteater nose sign is caused by a tubular elongation of the anterior process of the calcaneus that approaches or overlaps the tarsal scaphoid (navicular) and resembles the nose of an anteater on a lateral foot or ankle radiograph. The treatment of this union is primarily symptomatic but if the pain persists must be surgical .

Destructive arthritis in Behçet’s disease: a report of eight cases and literature review

Behçet's disease (BD) is a multisystemic disease with typically non-erosive and non-deforming joint manifestations. The occurrence of destructive arthritis in Behçet's disease has rarely been reported. Here we attempt to define the epidemiological, clinical and radiological features of this unusual type of osteoarticular manifestation of BD. We retrospectively reviewed the medical records of 553 patients with Behçet's disease seen over 25-year period in our department of Internal Medicine (Sfax-Tunisia). All the patients fulfilled The International Study Group of Behçet's Disease criteria. Patients with destructive arthritis (defined by radiological changes: erosions and/or geodes and/or global narrowing of the joint space and/or ankylosis) were included in this study. Rheumatologic manifestations were observed in 71.1% patients. Eight patients (1.4% overall, 2% among patients with rheumatologic manifestations) had presented with destructive arthritis. The joint symptoms involved the knee in two cases, the wrist in one case, the elbow (one case), the sternoclavicular joint in two cases, the foot in one case and the tarsal scaphoïd in one case. There was recurrent arthritis at the same joint in the majority of cases. X-ray examinations revealed radiological changes: global narrowing of the joint in one case (knee), narrowing of the joint with geodes in three cases (knee, sternoclavicular), isolated geodes in two cases (tarsal scaphoid, foot) and severe lesions with ankylosis in two cases (two elbows, right wrist). Joint manifestations are common in patients with BD, but destructive arthritis is rare.

The bipartite tarsal scaphoid.

Brailsford introduced the descriptive term “listhesis of the tarsal scaphoid” to describe the cinicopathological changes associated with congenital bipartition ofthis bone. This uncommon condition involves the separation and displacement oftwo scaphoid fragments, producing a fixed flat foot deformity, which eventually becomes symptomatic. Six cases are described, the lesion being bilateral in three. No particular definitive treatment is advocated, other than symptomatic management. Brailsford (1953) used the descriptive term “listhesis of the tarsal scaphoid” to describe an uncommon clinical entity associated with a flat foot. This lesion which is also called bipartite scaphoid was first described by Muller (1927, 1928) and was initially thought to be the end-result of childhood K#{246}hler’s disease. The lesion was eventually shown to be a distinct entity (Brailsford 1935; Zimmer 1937). After his initial report of five cases, Brailsford subsequently included some 20 cases of the lesion in his textbook (Brailsford 1953). The purpose of this paper is to reiterate the features of this entity and add a further six cases to the reported literature.

Evaluation of the Kidner Procedure in Treatment of Symptomatic Accessory Tarsal Scaphoid

The Kidner operation is a successful method of treatment for symptomatic feet with Type II and Type III accessory tarsal scaphoids that do not respond to conservative methods of treatment. The success of this operation is related more to the elimination of the bony prominence on the medial aspect of the foot and its mechanical irritation than to the correction of the pronated foot by means of posterior tibial tendon transfer. The age of occurrence of symptoms can be correlated with the level of physical activity and ossification or growth of this accessory bone. Symptoms in older patients develop after injury. The pronated foot or mechanically insufficient foot increases the stress on the bony prominence of the accessory tarsal scaphoid bone and precipitates in symptoms.

Aplastic anemia in siblings with multiple congenital anomalies (The Fanconi type)

Summary Two cases of aplastic anemia are described in siblings. The first is a classic example of the Fanconi type. The association of pancytopenia and multiple congenital defects supports this contention. In addition to the aplastic anemia, other aberrations were evident in the skin, ears, eyes, skeletal system, kidney, and adrenal. Papilledema, due to anoxemia of the optic nerve, was demonstrated clinically and at necropsy. The second case is of special interest in connection with the first, since the onset of the aplastic anemia occurred at the same chronological age in this sibling. This child had abnormalities, including pigmentation, vitiligo, microphthalmia, strabismus, and papilledema. Skeletal malformations observed were microcephaly, a delay in the appearance of the carpal centers, and a double nucleus in the tarsal scaphoid. While this boy did not present as many of the typical features of the Fanconi type as his brother, he had sufficient abnormalities to be included in this syndrome. The occurrence of aplastic anemia with congenital malformations in two brothers suggests that the congenital aberrations were probably the result of defective germ plasm or consanguinity. The onset of the aplastic anemia was observed in both children at the age of 6 years. This coincidence may be due to an exhaustion phenomenon, incurred by a familial congenital constitutional defect of the marrow germ plasm. Normal hematopoietic function continued for six years until this inadequacy became manifest. Splenectomy in the treatment of aplastic anemia has proved of limited value.

LUMBAR VERTEBRAL EPIPHYSITIS

For a number of years physicians have recognized the existence in adolescent youths of a disturbance in the epiphyseal rings of the vertebral bodies due to nutritional inadequacy and rapid growth. The condition has been designated, for convenience, vertebral epiphysitis; its clinical appearance and the roentgenographic evidence of pathologic changes are similar to the syndrome occurring in other epiphyses, notably in the head of the femur, the tibial tubercle, the tarsal scaphoid and other similar structures. Vertebral epiphysitis, described by Scheuerman, Buchman and others, has a clinical syndrome which is readily recognized. In brief, the patient, a boy or girl in the early teens, usually without any apparent cause or at times after a seemingly minor trauma, experiences pain in the middorsal area of the back and tires easily. Objectively he presents an abnormal degree of rounding of the back and tenderness to pressure over the dorsal portion of the

Osteochondritis

Until the beginning of the present century, all localised rarefying conditions of bone were regarded as due to tuberculous infections. Many of them were undoubtedly of this nature, but it was noted that in a considerable percentage of such cases the clinical course of the condition was not such as would be expected if it was due to tuberculous infections. With the routine use of X-ray investigation it was now possible to follow these cases, and to study the living pathology. Gradually doubt has given way to certainty that many of the localised rarefying changes in bone, affecting the primary and secondary centres of ossification, are definitely non-tuberculous in origin. Such localised rarefying bone changes have now been described in many centres, e.g., Kümmell (1895) has written on the spine, Osgood (1903) and Schlatter (1908) on the tubercle of the tibia, Köhler (1908) on the tarsal scaphoid and patella. Legg, Calvé, Perthes and Waldenström (1910) on the epiphysis of the head of the femur, Kienböck (1910) on the semilunar, Preiser (1910) on the carpal scaphoid, Sever (1912) on the os calcis, Freiberg (1914) on the head of the second metatarsal, Scheuermann (1921) on the spine, Renander (1924) on the medial sesamoid of the big toe, Van Neck (1924) on the pubis, Buchman (1925) on the iliac crests, Voltancoli (1925) on the ischio-pubic junction, Calvé (1925) on the spine, Friedrich (1924) on the clavicle, Lewin (1927) on the shoulder, Mauclaire (1927) on the heads of the metacarpal bones, Mouchet (1928) on the astragalus, Wagner (1930) on the epiphysis of the first metatarsal, Burns (1931) on the lower ulnar epiphysis.

BILATERAL DISEASE OF THE INTERNAL CUNEIFORM BONE WITH AN ASSOCIATED DISEASE OF THE RIGHT SCAPHOID BONE (KÖHLER'S)

In recent years considerable interest has centered around a certain group of closely related disorders of bone. These are Legg-Perthes' disease of the femoral capital epiphysis, Kohler's disease of the tarsal scaphoid, Osgood-Schlatter's disease involving the epiphysis of the tibial tubercle, Kienboch's disease affecting the semilunar bone in the wrist, and Freiberg's infraction of the second metatarsal head. Most authors are of the opinion that the underlying pathologic condition in these bone disorders is microscopically an aseptic necrosis. Some authorities have observed an infiltration of the bone with fibrous tissue extending from the periosteum. Others have found cystic formation with fibrous tissue infiltration, and some report the changes of an osteochondritis. I believe that the condition which I present has heretofore been undescribed, as a careful search of the literature has failed to reveal any case with similar pathologic changes. This is a case of bilateral disease of the internal

INORGANIC BLOOD CHEMISTRY IN THE OSTEOCHONDRITIDES

The search for the etiology of the various forms of osteochondritis has led some authors to believe that rickets is a causative factor. Clinical and roentgenologic studies,¹however, have failed to substantiate this assumption. A review of the literature shows that the few desultory studies on the inorganic blood chemistry, based on a limited number of cases, have given conflicting results. Seldowitz and Zimtbaum²concluded that their study of the inorganic composition of the blood, that the efficacy of antirachitic therapy in their single case of Koehler's disease of the tarsal scaphoid and that the histologic evidence of osteoid tissue and irregular calcification gleaned from the literature pointed toward the rachitic nature of the disease. Durham and Outland,³in a study of six cases of Perthes' disease and one case each of apophysitis of the os calcis and of Osgood-Schlatter's disease, concluded: (1) that Perthes' disease is

Isolated Disease of the Tarsal Scaphoid (Koehler's Disease): End-results in Treated and Untreated Cases

Many have reported cases of isolated disease of the tarsal scaphoid, but, apparently, none have considered their cases from a viewpoint of functional end-results. We wish to report one case from its incipiency to its termination, careful, painstaking treatment being carried out during the interim. Two other cases of undoubted Köhler's disease, which were untreated, are reported in order to demonstrate the function of the scaphoid, its shaping after untreated recovery, and the consequent end-results. The function of the scaphoid is that of a multiple keystone, supporting the weight distributed between the distal ends of the metatarsals, the os calcis and the cuboid. This bone is, therefore, subjected to stress from all sides (except from the superior aspects) when weight is placed upon the foot. We know that any bone, according to an interpretation of Wolff's Law, assumes a shape compensatory to its added function and changes its minute structure to conform, after a definite change in its normalcy. The tarsal scaphoid ossifies from two centers. Frequently the two portions of the scaphoid do not unite. A divided scaphoid is afterwards discovered inadvertently by means of the roentgen ray, and consequently not a great deal of significance is placed upon it. Now comes our theory of the condition first described by Köhler and interpreted by many as due to pyogenic infection. Wolff first explained bone changes following injury to the cartilage between the epiphysis and the diaphysis. We believe—and our belief is substantiated by the following case reports—that an injury to the center of ossification of the scaphoid produces a definite change in the shape of the bone and definite abnormality in its ossification. The accompanying radiograph (Fig. 1) of Case 1 demonstrates that the bony scaphoid is much flattened, but that there is marked space between the scaphoid and the astragalus, and the scaphoid and the internal cuneiform. It demonstrates also that the density of the bony portion is decreased, indicating a lack of normal function of the ossification centers. Therefore the spaces are occupied by cartilages lacking the bone-forming function because of injury to the centers of ossification. The injury to the centers is due not to pyogenesis, but to violence. The pain, local swelling, and redness are easily explained without the consideration of infection. Again, the process occurs only in childhood and would therefore be classed as mechanical rather than infectious. Also, the tarsal scaphoid is the only small bone ever involved in a process of this nature, and when its function is remembered the explanation is simple. Case No. 1. J. C, age five, appeared for examination in July, 1919. Complaint: pain in right foot when active. Examination revealed slight redness and swelling over dorsum of right foot. Temperature normal. Blood count normal. No evidence of any systemic trouble. Family history negative.

KÖHLER'S DISEASE OF THE TARSAL SCAPHOID OR OS NAVICULARE PEDIS RETARDATUM

There are two distinct pathologic entities to which the name of Kohler's disease has been given. One of these occurs in the head of the second metatarsal, and the other in the scaphoid of the tarsus. A similar condition has been described by Kienbock as occurring in the carpus. In this paper, we shall deal only with the condition as seen in the tarsal scaphoid. We suggest as an accurate descriptive name the term os naviculare pedis retardatum. To correspond with this term, we suggest for the other two conditions the names metatarsus planus and os lunatum retardatum. We are presenting this paper because we recently had an opportunity to study a typical case of os naviculare pedis retardatum from both the clinical and the pathologic points of view. REPORT OF CASE A. B., a boy, aged 8 years came to the hospital clinic complaining of pain in the left

COMPLETE DISLOCATION OF TARSAL SCAPHOID

Complete dislocation of the tarsal scaphoid is very uncommon; therefore, a report of a case may be of interest. REPORT OF CASE J. C., a youth, aged 17, a milk man, was riding horseback, Nov. 3, 1922, when the horse tripped over a car track, fell, and landed on the patient's right foot. His foot was caught in the track, and when the horse struck it he felt something in his foot give. He was unable to walk, and was brought at once to the hospital. On admission, the entire foot was considerably swollen, and along the inner surface, from the base of the first metatarsal to the internal malleolus, there was marked ecchymosis. The pain was intense. All active motions were absent, and on passive motion no crepitus could be felt. On the inner aspect, alongside the head of the astragalus, a distinct protuberance was noted. The swelling obliterated

Disability associated with a congenitally separate tuberosity of the tarsal scaphoid

Disability associated with a congenitally separate tuberosity of the tarsal scaphoid

Isolated Disease of Tarsal Scaphoid—Köhler's Disease.

Isolated Disease of Tarsal Scaphoid—Köhler's Disease.

Köhler's Disease of the Tarsal Scaphoid in Children

Köhler's Disease of the Tarsal Scaphoid in Children