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1. Tarsal bone disintegration is a progressive disorder that affects a high proportion of leprosy patients. 2. Early detection and treatment by immobilisation permit healing with minimal deformity or disability. 3. Feet with advanced lesions can be similarly treated with a satisfactory outcome and amputation is not needed.

Fracture of the tibial tarsal bone was encountered in two dogs. In one case, coaptation in flexion resulted in joint stiffness and persistent lameness. In the other, open reduction and transverse pinning of each fragment to the adjacent fibular tarsal bone was followed by uncomplicated healing and normal function of the tarsus. Resume. On a rencontre, chez deux chiens, un cas de fracture de l'os tibiotarsien. Dans un cas, la coaptation de flexion a resulte en raidure de l'articulation et en claudication persistante. Dans l'autre cas, une reduction ouverte et un epinglage transversal de chaque fragment a l'os adjacent peroneotarsien e ete suivi d'une guerison sans complications et d'un fonctionnement normal du tarse. Zusammenfassung. Bruch des Schienbien-Fusswurzel Knochens kamen in zwei Hunden vor. In einem Fall hatte das Aufeinanderpassen in Biegung Gelenksteifheit und anhaltende Lahmheit zur Folge. In dem anderen folgte blutigem Knochenbruchreposition und querlaufencer Nage-lung von jedem Fragment an den benachbarten Wadenbein-Fusswurzel Knochen, eine unkom-plizierte Heilung und Normale Funktion des Tarsus.

An ununited fracture of the fibular tarsal bone, of 14 weeks' duration, was successfully repaired. Five surgical procedures were attempted in order to maintain reduction of the fracture. Resume. On a traite avec succes une fracture avec deplacement du calcaneum, ayant persiste depuis 14 semaines. Il a fallu pratiquer cinq interventions chirurgicales pour obtenir le maintien de la reduction de la fracture. Zusammenfassung. Ein unvereinigter Bruch des Fusswurzelknochens wurde nach 14 Wochen erfolgreich operativ vereinigt. Es wurden funf chirurgische Eingriffe unternommen, urn die Reduktion der Fraktur zu bewerkstelligen.

Charcot like change in leprosy appears only on foot and ankle but not another joint. We found 3 cases of the destruction all over the tarsus, 23 cases on ankle joint, 8 cases on Chopart joint, 4 cases on Lisfranc joint and 7 cases on subtalar joint of 45 joints in totals.Charcot like change in tarsal bone and ankle joint may be caused by repeated distorsion. Clinical finding shows lateral instability. The sclerosis and deformity of the tarsal bone and the loose bodies in ankle joint are reviewed roentgenologically, but there is rare the proliferation of bone.In Chopart joint, Lisfranc joint and subtalar joint, a warm swollen ankle is developed without existing cause, and the stability of foot is good.There are the destruction of the navicular, cuneiforme and calcaneal bones roentgenologically, and these findings show the feature of the leprous osteous osteomyelitis in early stages.

X-ray and γ-radiation techniques for evaluating bone density under field conditions in cattle and sheep were investigated. The best results were obtained from measurements of the density of radiographs of tibial tarsal bones of sheep and from the absorption of γ-radiation of the tibial tarsal bones of sheep and the fibular tarsal bones of cattle. The γ-radiation techniques may be carried out rapidly under field conditions (up to 30 animals an hour) and bone density can be estimated with a standard error of 0.042–0.046 SG units.

The unusual occurrence of mitral insufficiency, conductive deafness, short stature,and skeletal anomalies in 3 members of one family is reported and appears to represent a new syndrome. The skeletal anomalies appear as bony fusion, involving the cervical vertebrae, ossicles, and carpal and tarsal bones. Except for deafness related to ossicular anomalies, no functional loss has resulted from the bone malformations. The basic defect involves only mesodermal structures and appears to be genetically transmitted as simple dominant.

Summary Attention has been called to the fact that delay in ossification of the tarsal bones may be an important factor in those cases of clubfoot which have been found to relapse after routine treatment for the usual length of time. An analysis of a series of x-ray pictures from actual case records has been tabulated and comparisons have been made by the use of a proposed ossification index for the foot. The facts thus obtained indicate that delayed ossification is actually present in an appreciable number of those children whose treatment has not been successful by the present conservative methods. Medication with thyroid in order to accelerate bone formation has been suggested as an adjunct to the usual routine of surgical treatment. The continued use of the ossification index during treatment has been advocated as a means of determining the need for medication, the progress under treatment, and the ultimate prognosis.

Fractures of the calcaneus comprise approximately 2 per cent of all fractures and 90 per cent of those occurring in the tarsal bones. The relatively poor overall results in these injuries have been mentioned by many authorities (1–8, 12, 13, 15, 17). In this brief presentation, we shall endeavor to remind radiologists of some of the more pertinent and significant aspects of calcaneal fractures and suggest more comprehensive x-ray studies and detailed interpretations. Our orthopedic confreres often feel that we contribute little to the situation when we merely report “a comminuted fracture of the calcaneus,” and rightly so. Actually, the radiologist should play an important role in determination of the prognosis and treatment, as well as in the roentgen diagnosis. The calcaneus is primarily cancellous in structure, its spongy character providing elasticity in weight-bearing. Architecturally, its trabeculae conform to the major lines of compression and traction stress to which the bone is normally subjected...

1 . Two cases of chronic progressive dislocation of the talo-navicular joints are discussed. 2. Radiographs are presented showing the development of the lesions over a period of eighteen years. 3. It is thought that the lesion is caused by laxity of ligaments and subsequent osteoarthritic changes.

It has been known for well over a century that the corresponding ossification centres of the hand tend to appear before those of the foot (Mall 1906), although even now the range of variability remains poorly defined. Presumably a similar asynchrony also obtains for chondrification, although precise timing is more difficult here than for ossification. Accordingly, it is tempting with respect to this syndrome to relate fusions restricted to the phalanges of the hand and to the tarsal bones to the action of a gene which during a very limited period of development exerts an effect on those small bones of the hand and foot which are in a very specific stage of development. But since there are other inherited abnormalities of the skeleton, such as brachydactyly, where homologous bones are involved, it is clear that at the descriptive level gene action can either appear to be "stage-specific" or "homologue-specific." There are also mutations affecting the axial skeleton such as the type of polydactyly of the foot described by Neel and Rusk (1963) which appear to be neither "stage" nor "homologue" specific, involving only the foot. Finally then, there are syndromes, such as Lawrence-Moon-Biedl-Bardot, in which involvement of the hands and feet (polydactyly) is associated with such other apparently completely unrelated defects as retinitis pigmentosa and hypogonadism. While it is tempting to try to construct theoretical patterns and systems of developmental processes on the basis of results such as these, it is clear that the ultimate understanding of how genes can appear to act in so many ways almost certainly depends on the identification of a genetically controlled, qualitative or quantitative biochemical lesion. With the current parallel developments in biochemical and developmental genetics, new insights into these enigmas will surely be forthcoming in the relatively near future.

The clinical features which distinguish hypermobile flat-foot with short tendo achillis are: 1. A prolonged history of some degree of foot disability extending back into childhood, the degree of disability tending to increase. There is often an hereditary tendency. 2. Flat-foot deformity which is mobile. It disappears when the feet are freed of weight-bearing, and appears when the patient stands. It can be corrected by muscular effort. 3. A short tendo achillis, which limits dorsiflexion at the ankle joint. 4. Hypermobility of the mid-tarsal and subtalar joints. 5. A deformity which is often severe and of characteristic appearance. Evidence from anatomical and roentgenographic studies shows that hypermobile flat-foot with short tendo achillis results from unstable architecture of the tarsal bones, especially their configuration and position in relation to each other. This results in imperfect support of the head of the talus by the calcaneus.

Es wird uber ein 6jahriges Madchen berichtet, das bei der Geburt unauffallig war und sich im 1. Lebensjahr gut entwickelte. Seit dem 8. Lebensmonat hatte es Beschwerden in den Handen und seit dem 3. Jahr Gangstorungen. Die Rontgenaufnahmen zeigen eine fortschreitende Osteolyse der Hand-und Fuswurzelknochen, die spater auch auf die Metacarpalia, Metatarsalia, Unterarm-und Unterschenkelknochen ubergriffen.

Ankle fusion may be accomplished in a satisfactory fashion by a number of standard techniques. There is still a place for the choice of technique, depending on the situation. The Gallie ankle fusion with or without modifications is a useful addition and yielded a minimum of complications in twenty patients. An analysis of fifty ankle fusions revealed sufficient postoperative complaints to emphasize the need for careful patient selection.

The factors relating to pseudarthrosis after triple arthrodesis were analyzed in 301 feet. The primary factors associated with pseudarthrosis were poor contact of the joint surfaces being fused and early weight-bearing. Unrelated factors were age, anatomical deformity, disease entity, infection, total time in a plaster cast, and tendon transplantation in the early postoperative period. Most of the pseudarthroses occurred at the talonavicular joint and in patients who had simultaneous bilateral procedures.

The various forms of treatment for fractures of the carpal navicular have been briefly reviewed, and ninety-one such fractures have been analyzed in detail. Thirty-eight were acute, three were subacute, and fifty were old when first seen.From this study the following conclusions were reached: 1. Acute fractures of the navicular should be completely immobilized until union has occurred, even though this may require many months. 2. Concomitant injuries, such as dislocation of one or more carpal bones, should be appropriately treated. 3. Gross displacement of fragments should be reduced, by open surgery if necessary. 4. Fractures of the carpal navicular a year old or more have a good chance of uniting if immobilized for many months provided the fragments are not grossly displaced, sclerosis is not present at the fracture line, and there are no arthritic changes visible by roentgenogram. 5. Excision of part or all of the navicular often results in a painful wrist with limited function. 6. Styloidectomy is not recommended for general use. It was effective in relieving pain in only two of eleven cases of old non-union. 7. Styloidectomy combined with a bone graft of the Murray type was the most effective means of securing union of the fracture and relieving wrist pain in the surgically treated cases in this series. The Murray bone graft alone was not nearly so effective. 8. Wrist fusion relieves pain but eliminates wrist motion. It may salvage a comparatively useless wrist. 9. Active treatment of every non-union is not necessary. Persons who do not do manual work are often able to live useful happy lives with some limitation of wrist motion and occasional discomfort, despite an old ununited fracture.

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Operative management of serious injury to the fibular collateral ligament of the ankle is satisfactory. Reconstruction of the late injury is best accomplished by the tenodesis of Watson-Jones, utilizing the peroneus brevis tendon as replacement tissue. Improvement in the early treatment of the severe injury can be assured by primary repair.

Recently, an extremely interesting case of melorheostosis was encountered at the Kagoshima prefectual Hospital for crippled children.A review of the world literature failed to disclose similar marked progression of the disease.Therefore this case is of sufficient interest to warrant a report.The diagnosis is made from its characteristic roentgen appearance.The charcteristic appearance resembling was flowing down the side of a candle is present in the streaked, sclerotic thickening on one side of the long bones of the limb.The condition was first described in 1922 by Leni and joanny.The patient was a boy of seven years old.He was first seen in May 1968, at the age of seven, because of Pes calcaneus in the left limb, and the condition was found incidentally on roentgengrams.Roentgenograms showed that in the left ilium, extending from the acetabulum upward, there was an irregular area of markedly increased density. The head of the femur the tibia, the fibula, and the tarsal bones, demonstrated similar sclerotic areas.Abnormalities of the soft tissues of the affected limb, was found, including scleroderma.Etiology and pathogenesis of Melorheostosis are unknown.

1. In congenital absence of the fibula, the fibrous strip that replaces the bone, abnormal insertions of fibular muscles, and disturbances in the formation and growth of the tarsal bones all go to cause the valgus deformity of the foot and the complete or partial dislocation of the talo-tibial joint. 2. Conservative treatment is justified only for children less than a year old and then only as preparation for operation. 3. Between the second and seventh year of life operations upon the soft tissues are indicated, to eliminate the contractures occurring on the posterior and lateral sides, to restore the proper position of the foot in line with the axis of the tibia, and to restore the normal shape of the foot and muscular equilibrium. At the same time favourable conditions are created for operative reconstruction of the lateral malleolus. 4. Arthrodesis of the talo-tibial joint or reconstruction of the lateral malleolus by a bone graft with the aim of stabilising the foot in the axis of tibia is not advisable in the growing limb. 5. The results obtained in three cases described support the conclusion that the bifurcation operation recommended by Gruca produces a new lateral malleolus with an epiphysis that grows at the same rate as the remainder of the lower epiphysis of the tibia, does not affect the rate of growth of the tibial epiphysis, prevents the recurrence of the deformity, and preserves the mobility of the talo-tibial joint. 6. In early cases this reconstructive operation may be done at the same time as soft-tissue deformities are corrected and subluxation reduced. 7. It is probable that the bifurcation operation should be done on children aged between two and seven years in order to give the limb the best chance to develop normally.

1. The syndrome here described in six Bulgarian subjects is characterised by partial duplication of the foot or diplopodia, combined with either hyperplasia or aplasia of the tibia. The accessory elements are located along the medial border of the "normal" foot and consist of two or three toes with related metatarsal and tarsal bones. The fibula is not directly involved. 2. No evidence of familial inheritance was found in these cases. 3. Various reconstructive measures and the place of amputation of the whole foot are discussed in the course of the six case reports.

Es wird an Hand eines Falles von Fuswurzelsynostose in Verbindung mit 2 vorher veroffentlichten Fallen behauptet, das die Entstehung von Synostosen der Hand- und Fuswurzel an eine Storung der Gelenkdifferenzierung gebunden ist und bei einer erheblichen Intensitat des Storungsfaktors nicht nur benachbarte Gelenksysteme, sondern auch die knochernen Anteile der Gelenkkorper Reduktionen erleiden. Postnatal brauchen Synostosen rontgenologisch noch nicht sichtbar zu sein, lediglich die Form der Knochenkerne kann einen Hinweis fur das pathologische Geschehen geben.

THE calcaneum, or os calcis, enjoys the distinction of being more frequently fractured than any of the other tarsal bones, and even comparatively the lesion is not rare. Strauss states that it comprises 2 per cent of all fractures, while Cahill, in an analysis of seventy-two cases ranging in age from fourteen to seventy-three years, places the percentage at between two and four. It is commonly the result of direct violence induced by a fall in which the victim alights upon the feet. The superimposed body weight exerts a crushing force producing impactions occasionally, but more frequently explosive comminution. Rarely a separation of the attachment of the tendon Achilles results from muscular activity. Invariably the treatment presents difficulties which must be intelligently surmounted unless more or less incapacitating and permanent deformities are to result. Structurally, the os calcis, by reason of the absence of a shaft and because of its spheroidal shape, offers very evident restrictions to manipula...

The surgical removal of the radial styloid process is presented as an aid in tile treatment of malunited and ununited fractures of the carpal navicular. It is believed to simplify the surgical approach, and ensures better visualization and immobilization of the fracture fragments, as well as less likelihood of secondary degenerative arthritic changes. By employing the excised styloid fragment for grafting material, the whole operative procedure can be confined to a single operative field.

1. A case of osteochondritis of the cuboid, with co-existing tuberculosis of the third cuneiform bone, is reported. 2. The possible relationship between osteochondritis and tuberculosis is discussed.

For some time we have been using a position for examining the tarsal bones, which has certain advantages over the standard dorso-plantar and lateral positions. Inasmuch as this does not appear to be standardized, we have felt that a brief description of the position as we use it will be worth while. In this position, the foot is inverted, with the outside elevated to a thirty-degree angle with the film holder (Fig. 1). The central ray is directed perpendicularly to the film and centered over the tarsal bones. We have found that if the angle which the foot makes with the film is increased more than thirty degrees, the external cuneiform tends to be thrown over the other cuneiform bones so that it is not clearly shown. This angle is easily obtained by making a wooden angle board for insertion under the sole of the foot. The resultant film (Fig. 2) is quite different from that obtained by allowing the foot to remain flat and only tilting the tube. This position is of particular value in the demonstration of ...

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.

The developmental abnormalities of the tarsal navicular are discussed, with special reference to the existence of calcaneo-navicular coalition. Five cases of this condition are reported, together with an example of bilateral talo-navicular synostosis. These cases are associated with spasmodic flat feet, particularly with peroneal spasm, and such cases warrant full radiological investigation. The importance of additional projections is stressed, with the adoption of an oblique view as a routine procedure. This is particularly urged in the presence of lipping on the dorsal surface of the talo-navicular joint. More examples of calcaneo-navicular coalition and other rare conditions would then be seen.