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For lengthening irregular bones, such as calcaneus, there are few reports in the literature. This study aimed to introduce the treatment strategy and preliminary outcomes for calcaneus shortening using calcaneal body lengthening. From January 2017 to January 2022, calcaneal lengthening was conducted for three patients (two males and one female) who suffered from traumatic calcaneal shortening. The Achilles tendon was lengthened in one patient. After osteotomy of the calcaneus, an Ilizarov frame was used to gradually (1 mm/day) distract the calcaneal fragment. The lengthening procedure was stopped when the calcaneal height and length were restored based on radiography. The fixator was removed after bone union. The average follow‐up length was 18 months (range, 14–24 months). X‐ray was used for radiological assessments. Patients reported satisfaction using the 100‐mm visual analog scale (VAS). Clinical outcome was evaluated following the American Orthopedic Foot and Ankle score. All data were assessed by two physicians blind to clinical assessments. The wound healed primarily in three cases. The bone got solid union without refracture and malunion. The distraction time was 30 days (range, 25–45 days). The fixation time was 113.3 days (average, 80–150 days). Calcaneal lengthening was 26 mm (range, 15–43 mm). The height and length of the calcaneus were restored nearly to the same as the opposite foot. The mean preoperative calcaneal pitch angle increased from 2.6 degrees to an average of 19.0 degrees after the surgery. The AOFAS score increased from 60.0 to 86.0. One patient experienced pin infection. The infection healed after changing the dressing. Calcaneal lengthening using an Ilizarov external fixator is a preferable technique to restore the length and height of the calcaneus and can achieve satisfactory foot function. [ABSTRACT FROM AUTHOR]

Background: Despite known disparities in pediatric perioperative outcomes, few studies have examined factors associated with the use of regional anesthesia for pediatric orthopedic surgery. Aims: This investigation aimed to determine if minority and developmental disability status were associated with the allocation of peripheral nerve blocks in calcaneal osteotomy. Methods: We conducted a single‐center, retrospective study of records of patients <18 years who underwent calcaneal osteotomy from 2013 to 2023. Regional technique was classified into three groups: popliteal‐sciatic single‐shot block, popliteal‐sciatic catheter, and no block. Patients were classified as either nonminority (white, non‐Hispanic) or minority. Developmental disability status was defined based on medical history and classified as binary. Anesthesiologists were classified as "regional" or "nonregional" based on clinical expertise. A Bayesian hierarchical multinomial model with random intercepts for patients and surgeons was used to investigate the association of minority status, developmental disability, and anesthesiologist expertise with block selection. Results: We analyzed 287 cases in 225 patients; of these, 55% occurred in minority patients and 28% occurred in patients with developmental disability. Catheters were placed in 45% of cases, single shot blocks in 41%, and no block in 14%. Minority and nonminority patients had a similar likelihood of receiving of any block. Patients with developmental disability had a −22% absolute difference of receiving any block (95% credible interval [−38%, −7%]) compared to those without developmental disability (55% vs. 77%), an effect primarily driven by a lower rate of catheter placement in these children. Regional anesthesiologists were more likely to place catheters (23% absolute increase; 36% vs. 13%) and more likely to perform any block in children with developmental disability (30% absolute increase; 67% vs. 37%) than nonregional anesthesiologists. Conclusions: Decision‐making surrounding the placement of regional anesthesia techniques is complex. In this study, developmental disability status and anesthesiologist experience were associated with a difference in the use of regional anesthesia in patients undergoing calcaneal osteotomy. [ABSTRACT FROM AUTHOR]

Objectives: Calcaneus defect remains challenging with limited strategies for reconstruction. Current methods, including graft transplantation, substitution, and distraction osteogenesis, showed limited advantages with certain shortcomings. Current calcaneus lengthening for partial calcaneus loss reconstruction requires bone loss of less than 35%. We introduced our combination of tarsal bone fusion and gradual lengthening method in treating massive calcaneus loss. Methods: From January 2015 to December 2021, tarsal bone fusion and calcaneus gradual lengthening were performed in six patients with unilateral massive traumatic loss of the calcaneal tuberosity. A retrospective study was held to evaluate the outcomes of this novel technique. Clinical outcomes were assessed based on the American Orthopedic Foot and Ankle Score (AOFAS). Radiological data were assessed, which included tibio‐calcaneal angle (TCA), calcaneal interface angle (CIA), metatarsal declination angle (MDA), angle of longitudinal arch (ALA), and the amount of calcaneus axial lengthening (CAL). Results: The mean calcaneal axial lengthening was 43.8 ± 3.1 mm (range, 39–49.5 mm), and the mean proportion of the lengthened calcaneus was 47.8% ± 3.7% (range, 42.8–55.3%). The mean external fixation time was 104.8 ± 67.5 days (range, 69 to 242 days), and the mean external fixation index was 2.4 ± 1.6 days/cm. All patients stuck to the postoperative follow‐up plan with an average follow‐up time (FT) of 35.0 ± 6.7 months (range, 26–40 months). Deformities of the injured limbs were all corrected according to radiography. Based on the AOFAS, three excellent and three good results were achieved. Conclusion: The Ilizarov technique remains an option for calcaneus reconstruction with a great amount of loss once combined with tarsal bone fusion. The function of the injured foot and ankle can be satisfactorily restored using these techniques in our study. Apart from calcaneus elongation, tarsal bone fusion is somehow necessary to reinforce the proximal segment of the distracted calcaneus for creating a larger distraction callus, correcting concomitant foot deformities, and enhancing hindfoot stability. It is necessary to choose flexibly when tarsal bones should be fused. [ABSTRACT FROM AUTHOR]

Objective: Heel fractures need extensive surgical incisions and are challenging to successfully reposition using traditional prying. The goal of this study is to evaluate the clinical effectiveness of using a Kirschner pin‐guided distractor to treat inversion shortening calcaneal fractures in the "out‐in" position. Methods: A total of 40 data from 37 patients with inversion shortened calcaneal fractures from January 2018 to March 2020 were reviewed. Preoperative lateral and axial X‐rays and 3D CT were taken to assess the fracture type, and minimally invasive internal fixation was performed in the "out‐in" position with distractor repositioning, and intraoperative and postoperative images were taken to assess fracture repositioning and fixation. During the follow‐up period, the postoperative functional recovery status was assessed using the VAS score, AOFAS score, and FAOS score. Paired‐samples t‐test was used for all data comparisons. Results: All cases received a mean follow‐up of 28.49 ± 3.25 months, and the mean fracture healing time was 7.84 ± 0.71 weeks. The postoperative images showed well‐fixed fracture repositioning, and calcaneal height, length, width, and inversion angles were significantly improved. At the final follow‐up, the calcaneal height, length, and width recovered from 39.35 ± 4.44mm, 79.35 ± 2.7mm, and 45.75 ± 2.87mm preoperatively to 50.93 ± 3.18mm, 82.23 ± 1.90mm, and 39.67 ± 1.58mm postoperatively (p < 0.001; p < 0.001; p < 0.001). The calcaneus inversion angle restored from 7.73° ± 2.26° to 3.80° ± 1.80° (p < 0.001). Böhler's angle and Gissane's angle improved from 13.13° ± 3.02° and 105.15° ± 8.94° to 27.95° ± 3.41° and 122.85° ± 5.54° (p < 0.001; p < 0.001). No non‐healing fractures, osteomyelitis, or traumatic arthritis were observed. Conclusion: Minimally invasive internal fixation with distractor repositioning in the "out‐in" position is effective in the treatment of inversion shortening calcaneal fractures while restoring the anatomy and protecting the soft tissue. [ABSTRACT FROM AUTHOR]

In 3D‐analysis of the calcaneus, a consistent coordinate system aligned with the original anatomical directions is crucial for pre‐ and postoperative analysis. This importance stems from the calcaneus's key role in weight‐bearing and biomechanical alignment. However, defining a reliable coordinate system based solely on fractured or surgically reconstructed calcanei presents significant challenges. Given its anatomical prominence and consistent orientation, the talus offers a potential solution to this challenge. Our work explores the feasibility of talus‐derived coordinate systems for 3D‐modeling of the calcaneus across its various conditions. Four methods were tested on nonfractured, fractured and surgically reconstructed calcanei, utilizing Principal Component Analysis, anatomical landmarks, bounding box, and an atlas‐based approach. The methods were compared with a self‐defined calcaneus reference coordinate system. Additionally, the impact of deviation of the coordinate system on morphological measurements was investigated. Among methods for constructing nonfractured calcanei coordinate systems, the atlas‐based method displayed the lowest Root Mean Square value in comparison with the reference coordinate system. For morphological measures like Böhler's Angle and the Critical angle of Gissane, the atlas talus‐based system closely aligned with ground truth, yielding differences of 0.6° and 1.2°, respectively, compared to larger deviations seen in other talus‐based coordinate systems. In conclusion, all tested methods were feasible for creating a talus derived coordinate system. A talus derived coordinate system showed potential, offering benefits for morphological measurements and clinical scenarios involving fractured and surgically reconstructed calcanei. Further research is recommended to assess the impact of these coordinate systems on surgical planning and outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Gorillas are diverse behaviorally and ecologically with higher frequencies of arboreality and frugivory observed in populations living at lower altitudes compared to those living at higher altitudes. Previous studies have shown that the more arboreal western lowland gorilla has hallucial tarsometatarsal and talocrural joint morphologies associated with enhanced hallucial abduction and foot inversion capabilities whereas the more terrestrial eastern gorilla does not. Here we examine how known ecological and behavioral differences among gorillas relate to variation in calcaneal and cuboid morphology. Specifically, we test whether gorillas that climb more frequently (i.e., western lowland and lowland grauer gorillas) have cuboid‐metatarsal and calcaneocuboid morphologies that facilitate increased foot mobility compared to those that climb less often (i.e., mountain and highland grauer gorillas). Methods: We quantify the relative areas of articular and nonarticular surfaces, angles between articular surfaces, articular surface curvatures, the relative length and depth of the calcaneocuboid joint, and the relative size of the calcaneal tuber using three‐dimensional models of gorilla calcanei and cuboids (n = 90 and 81, respectively). Results: Our results, based on univariate and multivariate analyses, show that western and eastern gorillas follow our predicted arboreal‐terrestrial morphocline in terms of their calcaneal and cuboid morphology; however, highland and lowland grauer gorilla populations do not. Conclusions: This study has implications for understanding gorilla foot function and the evolutionary processes responsible for producing the morphological patterns among living gorilla populations. Future studies of gorilla morphological diversity may provide a useful comparative model for studies of locomotor evolution in extinct clades. [ABSTRACT FROM AUTHOR]

Objectives: The positional repertoire of the human‐chimpanzee last common ancestor is critical for reconstructing the evolution of bipedalism. African apes and humans share a heel strike plantigrade foot posture associated with terrestriality. Previous research has established that modern humans have a relatively large and intrinsically robust calcaneal tuber equipped to withstand heel strike forces associated with bipedal walking and running. However, it is unclear whether African apes have a relatively larger calcaneal tuber than non‐heel‐striking primates, and how this trait might have evolved among anthropoids. Here, I test the hypothesis that heel‐striking primates have a relatively larger calcaneal tuber than non‐heel‐striking primates. Methods: The comparative sample includes 331 individuals and 53 taxa representing hominoids, cercopithecoids, and platyrrhines. Evolutionary modeling was used to test for the effect of foot posture on the relative size of the calcaneal tuber in a phylogenetic framework that accounts for adaptation and inertia. Bayesian evolutionary modeling was used to identify selective regime shifts in the relative size of the calcaneal tuber among anthropoids. Results: The best fitting evolutionary model was a Brownian motion model with regime‐dependent trends characterized by relatively large calcaneal tubers among African apes and humans. Evolutionary modeling provided support for an evolutionary shift toward a larger calcaneal tuber at the base of the African ape and human clade. Conclusions: The results of this study support the view that African apes and humans share derived traits related to heel strike plantigrady, which implies that humans evolved from a semi‐terrestrial quadrupedal ancestor. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive reduction and fixation of intra‐articular calcaneal fractures poses great challenges for orthopaedic surgeons. The aim of the present study was to report the technical points, evaluate the efficacy of minimally invasive reduction and internal fixation assisted by the temporary limb reconstruction system (LRS) external fixator for intra‐articular calcaneal fractures, and propose the indications of our protocol. Methods: In this retrospective study, a series of 34 consecutive closed and displaced intra‐articular calcaneal fractures involving the articular surface were treated by this technology between June 2016 and April 2018. X‐ray and computed tomography (CT) scans were performed before and after surgery to measure Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot. Postoperative complications were recorded. Imaging and clinical outcomes were comprehensively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot‐ankle scoring system. After testing the normality of the data, Bohler's angle and the length of calcaneus were compared using the Wilcoxon signed‐rank test. The height, width of the calcaneus, and the mechanical axis of the hindfoot were compared using the Paired‐Samples t‐test. Results: Thirty‐two fractures were followed up for an average of 20.66 months (from 12 to 32 months). All fractures achieved stable reduction and bony union. The articular surface was reduced and fixed with direct vision through the sinus tarsi incision. No failure of internal fixation or loss of reduction was detected during follow‐up. There were no soft tissue complications. Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot improved significantly. The AOFAS scores averaged 84.12 points; seven cases were rated excellent, 20 good, four fair, and one poor. Conclusions: For intra‐articular calcaneal fractures, minimally invasive surgery assisted with temporary LRS external fixation can reconstruct the calcaneal shape and the sub‐talar articular surface. This simple surgical modality with limited complications may be helpful in the surgical treatment of most type II and III calcaneal fractures except comminuted fractures of the calcaneal tuberosity. [ABSTRACT FROM AUTHOR]

Objective: Accurate placement of the screws is challenging in percutaneous cannulated screw fixation of calcaneal fractures, and robot‐assisted (RA) surgery enhances the accuracy. We investigated the outcome of percutaneous cannulated screw fixation of Sander's type II and III calcaneal fractures. Methods: This retrospective study analyzed clinical data of 26 patients with fresh closed calcaneal fractures (28 fractures) who were admitted to our center from January 2022 to July 2022. All fractures were divided into the RA group and the open reduction and internal fixation (ORIF) group according to the surgeries performed. RA surgery was performed by closed reduction or open reduction combined with a tarsal sinus approach. Age, sex, operation time, preoperative waiting time, length of postoperative hospital stay, wound complications, and American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS) at 3 months postoperatively were compared. Preoperative and postoperative radiographic parameters (calcaneal length, width, height, Böhler angle, and fixation rate of the sustentaculum tali) were documented. The chi‐square test, one‐way analysis of variance, and Wilcoxon test were used for the comparison of categorical, normally distributed, and nonnormally distributed continuous variables, respectively. Results: The calcaneal width, height, and Böhler angle were significantly corrected postoperatively in both groups. The postoperative calcaneal lengths in both groups were also corrected. However, no significant difference was found. No significant differences in calcaneal length, width, height, and Böhler angle were observed between the two groups. The operation time (p < 0.001), preoperative waiting time (p < 0.001), and length of postoperative hospital stay (p = 0.003) in the RA surgery group were significantly shorter than those in the ORIF group. The fixation rate of the sustentaculum tali (p < 0.001) in the RA surgery group was significantly superior to that in the ORIF group. All wound complications occurred in the ORIF group. All fractures healed within 3 months. The AOFAS scores at 3 months postoperatively were not significantly different. Conclusion: RA percutaneous screw fixation of the calcaneal fracture is a safe, effective, rapid, and minimally invasive surgical option for surgeons. [ABSTRACT FROM AUTHOR]

Objective: Various surgical techniques have been reported in treating calcaneal malunions over the decades, while the operations on single plane were accompanied by respective limitations. The purpose of this study is to evaluate the efficacy of a novel multiple reconstructive osteotomy for treating malunited calcaneal fractures without subtalar joint fusion. Methods: From March 12, 2010, to August 17, 2017, 10 patients (10 feet) with malunited calcaneal fractures were treated with multiple reconstructive osteotomy with subtalar joint‐preserving operations. All patients were treated with a corrective osteotomy, joint realignment, soft tissue balancing, and secondary internal fixation at a mean of 5.6 ± 2.41 months since the initial injury. With the utilization of the multiple reconstructive osteotomy, the posterior facet was restored to preserve the subtalar joint. All patients were evaluated clinically and radiographically at a mean follow‐up of 3.04 ± 1.21 years. Results: All patients were subjectively satisfied with the treatment. The average time to union was 12.2 ± 1.11 weeks. The American Orthopedic Foot and Ankle (AOFAS) ankle and hind foot score was 86.3 ± 4.45 (t = 27.64, P < 0.0001, paired t‐test), which was significantly higher than the preoperative assessment. Postoperative radiographic assessment revealed great improvement in Böhler's angle (from 25.4° to 86.3°), talocalcaneal height (65.15–72.68 mm) and Calcaneus‐talus angle (from 34.46° to 39.7°). One patient had mild discomfort after a 1‐h brisk walk. One patient was suspected to have early posttraumatic arthritis of the subtalar joint based upon radiographic evidence during the follow‐up, but the patients could walk normally for a long time without pain. Conclusion: Multiple reconstructive osteotomy is an effective way to restore the calcaneal morphology and preserve the subtalar joint for selected calcaneal malunion. [ABSTRACT FROM AUTHOR]

Summary: A 9‐year‐old 390 kg games pony presented with acute onset of grade 5/5 (AAEP) right hindlimb (RH) lameness. During clinical examination, the source of lameness was localised to the tarsal region. Radiographic examination identified a closed, simple, nondisplaced, incomplete fracture of the calcaneal shaft. The pony was initially treated with box rest; however, despite an initial good response, the horse re‐presented with a grade 5/5 (AAEP) RH lameness, 2 weeks after initial presentation. The decision was made to treat the fracture using a tarsal sleeve cast extending from mid‐third of the tibia/crus to the level of distal metatarsus. The cast was replaced every 2 weeks and maintained for a total of 8 weeks. After cast removal, the horse was kept on strict box rest for 3 weeks. After discharge from the hospital, in‐hand walking exercise from the stable was commenced and gradually increased over a 4‐week period. The horse was then gradually reintroduced to small paddock turnout exercise for eight further weeks. The horse was able to return to full athletic function. Conservative treatment using a tarsal sleeve cast should be considered only in horses presenting an incomplete nondisplaced fracture of the calcaneal shaft. [ABSTRACT FROM AUTHOR]

Background: Calcaneal apophysitis is a common condition in childhood. Parents often seek online information for children's' health care concerns prior to seeking care. Therefore, we aimed to evaluate the credibility, readability, and accuracy of calcaneal apophysitis advertising on popular websites in three countries. Methods: We used content analysis of publicly accessible data. This involved identifying the top 50 websites in each country from their hit rates. We used elements of validated tools to audit and determine frequencies relevant to credibility (e.g. publisher), readability (e.g. literacy score) and accuracy (e.g. alignment with evidence). Data were analysed quantitatively and reported against each element. Results: Websites were predominantly hosted by private health services (n = 118, 79%). The mean (SD) SMOG (readability) score was 9.3 (4.5). The majority of websites (n = 140, 93%) provided at least one treatment recommendation, and less than 10% (n = 11) of websites advertised treatments fully aligned with evidence. Use of treatment modalities without evidence and with high risk to children were also found including surgery, extracorporeal shock wave therapy and laser. Conclusions: Calcaneal apophysitis online advertising is mostly curated by clinicians. Clinicians should consider revising online advertising to increase understandability and accuracy to reduce health care wastage, risk, and low value care. [ABSTRACT FROM AUTHOR]

Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical assessment and management of both paediatric and sub‐adult patients presenting with heel pain. Despite this, the current understanding of calcaneal apophyseal development is constrained by the limitations of the imaging modalities used to examine the apophysis, with no current literature reporting the development of the medial and lateral processes. This study aimed to overcome these limitations by investigating the ossification and fusion of the calcaneal apophysis using three‐dimensional computed tomography analysis, and statistically predicting the apophyseal developmental stage in contemporary Australian children. The development and fusion status of the apophysis was scored using a novel 11‐stage scoring system on 568 multi‐slice computed tomography scans (295 females; 274 males) and 266 lateral radiographic scans (119 females; 147 males) from the Queensland Children's Hospital. Multinomial logistic regression along with classification tables and predictive probabilities were then utilised to assess developmental stage likelihood from known age and sex. The apophysis commenced ossification at a mean age of 5.2 years for females and 7.2 years for males, and then elongated to form the apophyseal cap around 10 years for females and 12.4 years for males. Fusion of the apophysis commenced at a mean age of 11.18 years for females and 13.3 years for males, with the earliest age of complete fusion observed at 10 years for females and 14 years for males. The results demonstrate significant sexual dimorphism in ossification and fusion with females developing and fusing significantly earlier. Furthermore, the use of computed tomography in this study allowed for the first time evaluation of the ossification and fusion of the medial and lateral processes of the calcaneus. The medial process formed at a mean age of 9.5 years for females and 10.9 years for males while the lateral process formed at around 9.8 years for females and 11.7 years for males. The medial process demonstrated slower rates of fusion compared to the lateral process. The present study provides Queensland specific standards for assessing the calcaneal apophyseal developmental stage as well as novel predictive regression models for apophyseal stage estimation using known age and sex to aid in the diagnosis of heel pain conditions such as apophysitis or screen for developmental delays in children and subadults. [ABSTRACT FROM AUTHOR]

Objective: Traditional internal fixation of calcaneus fractures, involving lateral L‐shaped incisions and plate fixation, has disadvantages such as increased operative exposure, eccentric plate fixation, and complications. The aim of this study was to design a Spatial Weaving Intra‐calcaneal Fixator System (SWIFS) for the treatment of complex calcaneal fractures and to compare its biomechanical properties with those of traditional calcaneal plates. Methods: The computed tomography (CT) data of the normal adult calcaneus was used for modeling, and the largest trapezoidal column structure was cut and separated from the model and related parameters were measured. The SWIFS was designed within the target trapezoid, according to the characteristics of the fracture of the calcaneus. The Sanders model classification type IV calcaneal fracture was established in finite element software, and fixation with calcaneal plate and the SWIFS examined. Overall structural strength distribution and displacement in the two groups were compared. Results: The maximum 3D trapezoidal column in the calcaneus was constructed, and the dimensions were measured. The SWIFS and the corresponding guide device were successfully designed. In the one‐legged erect position state, the SWIFS group exhibited a peak von Mises equivalent stress of 96.00 MPa, a maximum displacement of 0.31 mm, and a structural stiffness of 2258.06 N/mm. The conventional calcaneal plate showed a peak von Mises equivalent stress of 228.66 Mpa, a maximum displacement of 1.26 mm, and a structural stiffness of 555.56 N/mm. The SWIFS group exhibited a 75.40% decrease in displacement and a 306.45% increase in stiffness. Conclusion: Compared with fixation by conventional calcaneal plate, the SWIFS provides better structural stability and effective stress distribution. [ABSTRACT FROM AUTHOR]

Calcaneal osteotomy is a commonly established method used to correct various foot malalignment surgery problems that produce varus and valgus hindfoot abnormality as well as Haglund's deformity, cavovarus foot reconstruction, flatfoot deformity, plantar fasciitis, posterior tibial tendon insufficiency and planovalgus foot. After decades, several procedures in orthopaedic foot surgery have been suggested for reducing the risk of wound and neurovascular complications. The goal of this Prisma statement guidelines compliant systematic review was to establish the effectiveness and safety of calcaneal osteotomy in foot surgery. We have performed a novel systematic review of the current published literature in order to evaluate the scientific evidence now available on this association, assigning predefined exclusion and inclusion criteria. Eight investigations were selected which had 191 cases. The adult flatfoot, tibialis posterior reconstruction and cavovarus foot deformity were treated with different procedures of calcaneal osteotomy techniques. The adequate level of effectiveness of calcaneal osteotomy is associated with the kind and location of the incision, with or without screw application, in each specific foot condition. There is a limited number of scientific investigations of the effectiveness and safety of the different kinds of calcaneal osteotomy in foot surgery, and there is the need to enhance outcome knowledge on this foot surgery technique. [ABSTRACT FROM AUTHOR]

The calcaneal tuberosity, due to its superficial location and prominent positioning, is predisposed to traumatic injury and synovial infection. Frequently, injury also involves the superficial digital flexor tendon either directly or through inflammation, swelling, adhesions and proliferative osteitis resulting in increased tension and persistent pain. This case report describes permanent superficial digital flexor tendon luxation to improve surgical access to the calcaneal tuber and alleviate pain associated with tension of the superficial digital flexor tendon following chronic septic calcaneal osteomyelitis and bursitis. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy of percutaneous minimally invasive reduction combined with external fixation and a tarsal sinus approach to treat Sanders type II and III intra‐articular calcaneal fractures. Methods: The clinical data of 64 patients with Sanders type II and III calcaneal fractures admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed; data includedage, sex, body mass index. According to the surgical method, they were divided into the percutaneous minimally invasive reduction with internal and external fixation group (30 cases) and the tarsal sinus approach group (34 cases).The two groups of patients were compared in terms of the time tosurgery, length of hospital stay, intraoperative blood loss, operative duration, complications, radiographic features, including the heel bone length, width, height, Bohlerangle, Gissane angle, and calcaneal varus angle, and clinical efficacy indicators, including the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS) pain score, health survey profile (SF‐36) score and Maryland ankle function score. Results: Patients in both groups were followed up for 12 to 50 months, with an average of 24.8 months.Bony union was achieved in all cases. The time to surgery, length of hospitalstay, intraoperative blood loss and incidence of incision‐related complications were significantly lower in the percutaneous minimally invasive medial external fixation group than in the tarsal sinus group (P < 0.01). At the last follow‐up, the calcaneal length, width, and height, Bohler angle, Gissane angle, and varus angle were significantly increased in both groups (P < 0.01), the calcaneal width was significantly lower after than before surgery (P < 0.01), and there were no statistically significant differences between the two groups (P > 0.05). As measures of clinical efficacy, the AOFAS, VAS, SF‐36 and Maryland scores were 85.28 ± 8.21, 0.84 ± 1.21, 82.95 ± 3.25 and 83.56 ± 3.32, respectively, at the last follow‐up in the percutaneous minimally invasive medial external fixation group and 83.32 ± 7.69, 1.85 ± 1.32, 80.71 ± 5.42, and 81.85 ± 2.41 in the tarsal sinus group, respectively, with no significant differences between the two groups (P > 0.05). Conclusion: Under the condition of a good command of surgical indications and surgical skills, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with medial external fixation for the treatment of Sanders type II and III intra‐articular calcaneal fractures can achieve similar clinical effects as the tarsal sinus approach. However, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages, such as fewer complications, less bloodloss, and a shorter operation, and thus has good safety and is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to introduce a novel method of simultaneous in situ decompression of lateral calcaneal bulge and subtalar arthrodesis via a single incision for malunion after calcaneal fractures and evaluate the feasibility of this method. Methods: From September 2010 to October 2011, six patients (five males and one female) with malunion and delayed heel pain after conservative treatment of displaced intra‐articular calcaneal fractures were included in our study. The mean age of the six patients was 32.9 years (range, 25–71 years). Patients were treated with this novel technique at our department and the functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scores during follow‐up. Information of the six patients including surgical data and pre/postoperative function scores were retrospectively analyzed using SPSS 19.0 statistical software. Results: The average operation time between wire insertion and incision suture was 42.2 ± 11.5 min (range, 25–56 min). The blood loss in all patients was all less than 50 ml each. The average fluoroscopy time was 25.7 ± 11.6 s (range, 11–43 s). No wound‐related and other short‐term complications were recorded. Six patients who were included in our study were followed for an average period of 66.2 ± 4.7 months (range, 60–73 months). There was no patient lost to follow up. Heel pain was observed to be greatly improved preoperatively in all of the six patients. All patients restored to normal activity of life after surgery. Radiological evidence of fusion was observed in five patients. The average fusion time of these five patients was 3.5 months (range, 2–4 months). The remaining one failed to achieve fusion and the hardware removal was performed due to screw tail irritation. This patient was satisfied with the final outcomes subjectively after removal of hardware. The mean AOFAS scores at 24 months postoperative were 82.0 ± 7.0, which was greatly improved compared to preoperative (44.8 ± 10.7) (P < 0.05). The preoperative VAS pain scores were decreased from 5.8 ± 1.5 to 2.6 ± 1.4 at 24 months postoperative (P < 0.05) and slightly decreased to 2.0 ± 1.7 at 48 months postoperative (P < 0.05). No surgery‐related complications were observed in any of the patients. Conclusions: The novel technique can effectively relieve the heel pain, prompt functional recovery, decrease the incidence of complications, simplify the surgical procedure, and shorten the learning curve. Therefore, the technique is a feasible and worthwhile alternative in treating malunion after calcaneal fractures. [ABSTRACT FROM AUTHOR]

The purpose of our study was to determine the risk factors for post‐operative wound complications (PWCs) after open reduction and internal fixation (ORIF) for calcaneal fracture and establish a nomogram prediction model. We retrospectively analysed the clinical data of patients who suffered from calcaneal fractures and had been surgically treated for ORIF in our institution between January 2010 and January 2020. Perioperative information was obtained through the electronic medical record system, univariate and multivariate analyses were performed to determine the risk factors of PWCs, and a nomogram model was constructed to predict the risk of PWCs. The predictive performance and consistency of the model were evaluated by the Hosmer –Lemeshow (H‐L) test and the calibration curve. In total, 444 patients were enrolled in our study. Multivariate analysis results showed that smoking, limb swelling, angle of incision, and CRP were independent risk factors for skin necrosis. The AUC value for skin necrosis risk was 0.982 (95%CI 0.97‐0.99). The H‐L test revealed that the normogram prediction model had good calibration ability (P =.957). Finally, we found a correlation between PWCs and smoking, limb swelling, angle of incision, and CRP after ORIF for calcaneal fracture patients. Our nomogram prediction model might be helpful for clinicians to identify high‐risk patients, as interventions could be taken early to reduce the incidence of PWCs. [ABSTRACT FROM AUTHOR]

Purpose. To explore the comparison of the reduction of the subtalar articular surface and other postoperative effects of the minimally invasive tarsal sinus approach and lateral L-shaped incision conventional approach for the treatment of calcaneal fracture with 3D printing technology. Methods. Patients who received surgical treatment for calcaneal fractures in the First Affiliated Hospital of Henan University of Science and Technology from June 2019 to December 2020 were collected. 3D printing equipment produced the affected side reduction heel bone fracture model and navigation template model. The tarsal sinus approach was used in the experimental group, and the lateral L-shaped incision approach was used in the control group. Patients were followed up 3 days, 1 month, 3 months, 6 months, and 12 months after the operation. Imaging indicators were measured 12 months after surgery, and scores from American Foot and Ankle Orthopaedic Society (AOFAS) and MSF were performed. Results. Operation time was 70.52 ± 13.16 in the control group and 55.24 ± 12.25 minutes in the experimental group (P < 0.001). Intraoperative blood loss was 98.77 ± 18.65 in the control group and 89.56 + 17.54 in the experimental group (P > 0.05). The duration of antibiotic use was 5.53 ± 3.24 days in the control group and 5.48 ± 4.18 days in the experimental group (P > 0.05). The frequency of fluoroscopy was 6.56 ± 1.72 in the control group and 3.88 ± 1.05 in the experimental group (P < 0.001). Fracture healing time was 3.24 ± 0.52 months in the control group and 3.08 ± 0.58 months in the experimental group (P > 0.05). The postoperative Böhler angle was 28.31 ± 3.14 in the control group and 29.24 ± 2.76 in the experimental group (P > 0.05). Postoperative subtalar articular displacement (step > 2 mm) was observed in 4 patients in the control group and 1 in the experimental group (P < 0.05). MSF score was 90.12 ± 4.85 in the control group and 91.36 ± 2.58 in the experimental group (P > 0.05). Conclusion. The study found that the experimental group was significantly better than the control group in terms of the operation time, intraoperative fluoroscopy times, and success rate of reduction of the subtalar articular surface. 3D printing technology can shorten the operation time, accurately reduce the fracture block, and reduce the secondary trauma, which is conducive to the functional recovery of the affected foot. [ABSTRACT FROM AUTHOR]

Objective To assess the clinical outcomes of open calcaneal fractures with medial wounds treated with one‐stage management, including early modern wound care, sequential reduction, and frame structure fixation using percutaneous Kirschner wires. Methods: A total of 19 patients with open calcaneal fractures admitted to our hospital from May 2016 to March 2019 were selected in this study. Twelve type‐II and seven type‐IIIA medial open injuries were identified according to the classification of Gustilo and Anderson. Fractures were stratified by Sanders classification, including nine type‐II fractures, seven type‐III fractures, and three type‐IV fractures. All patients accepted one‐stage irrigation and debridement, sequential reduction of calcaneal fractures through the open medial wound, percutaneous Kirschner wire fixation, and primary closure of wounds covered with vacuum‐assisted closure (VAC) device. The Bohler angle, the Gissane angle, and the width of the calcaneus were compared before and after surgery. The functional results were evaluated according to the Paley and Hall score system, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Maryland Foot Score, and related complications. Results: The follow‐up duration for all patients ranged from 14 to 28 months (mean, 22.7 months). The angle of Bohler and Giasane was increased from (−7.6° ± 15.0°) and (96.6° ± 7.6°) before surgery to (23.7° ± 6.1°) and (124.1° ± 7.1°) postoperatively (P < 0.05), respectively. Three cases of superficial infection and two cases of wound dehiscence were observed in our study, which were then successfully treated with wound debridement, VAC replacement, appropriate use of antibiotics, and delayed closure. The last follow‐up revealed three cases of lateral wall expansion and six cases of mild‐to‐moderate subtalar arthritis based on the Paley and Hall scoring system. According to the AOFAS ankle and hindfoot score, one case showed excellent results, 14 cases exhibited good results, and four cases displayed fair results, with the mean of 80.7 ± 6.7 points (range, 70–90). The Maryland Foot Score revealed one case of excellent outcomes, nine cases of good outcomes, and nine cases of fair outcomes with an average of 76.8 ± 8.6 points (range, 62–90). The mean VAS for pain was 1.8 ± 1.5 (range, 0–5), and a total of 14 patients complained of mild‐to‐moderate pain when walking for a more extended period. Severe complications, such as deep infection, osteomyelitis, and soft tissue necrosis, were not observed during follow‐up. Conclusions: Collectively, one‐stage management allowed the direct restoration of calcaneal morphology with a minimal invasion of soft tissues in most open calcaneal fractures with medial wounds, and the functional outcomes were comparable to previous data. [ABSTRACT FROM AUTHOR]

Dwyer (lateral calcaneal closing wedge) osteotomy is commonly used in surgical correction of heel varus deformity. The purpose of this study was to determine the effect of wedge size and angle of osteotomy on deformity correction using preoperative imaging analysis with three‐dimensional (3D) printed modeling. Seven patients diagnosed with pes cavovarus deformity who underwent Dwyer calcaneal osteotomy were identified retrospectively. Preoperative computed tomogrphy scans were used to create 3D printed models of the foot. After18 variations of osteotomy and fixation performed for each foot, Harris heel and Saltzman images were obtained. The angle between the tibia‐talus axis and calcaneal‐tuber axis was measured and compared to pre‐osteotomy state. Change in the calcaneal lengths was also analyzed. The average degree correction of deformity per mm of bone resected was 3.8 ± 0.2 degrees in the Harris Heel view and 2.7 ± 0.8 degrees in the Saltzman view. A significant increase in correction was obtained with 10 mm compared with 5 mm wide wedges (P <.001). The difference in correction was not statistically significant between 30 and 45 degree cuts or osteotomy distance from the posterior calcaneal tuberosity, but a 45 degree sagittal angle resulted in less calcaneal shortening compared to 30 degrees (P =.02). A clinically driven method using patient‐specific 3D models for determining effects of calcaneal osteotomy variables in correcting hindfoot alignment was developed. In summary, the amount of wedge resected impacts hindfoot alignment more than location and sagittal angle of the cut. Calcaneal shortening depends on sagittal angle of the cut. [ABSTRACT FROM AUTHOR]

Objectives: The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the alignment of foot. The purpose of this study was to explore whether the subtalar alignment would influence the configuration of foot. Methods: From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary's angle, calcaneal pitch angle, and talar pitch angle reflected the alignment of foot. They were measured in the weightbearing foot X‐rays. The angles in different groups were compared via Mann–Whitney U test. We calculated the correlation between the sagittal alignment of subtalar joint and the alignment of foot using Spearman's correlation analysis. Interobserver and intraobserver reliability were calculated. Results: The Gissane angle, calcaneal posterior articular surface inclination angle, Meary's angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary's angle (r = 0.850, p < 0.0001), and the talar pitch angle (r = −0.825, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = 0.638, p < 0.0001). The calcaneal posterior articular surface inclination angle had an excellent correlation with the Meary's angle (r = −0.902, p < 0.001), and the talar pitch angle (r = 0.887, p < 0.0001), and a good correlation with the calcaneal pitch angle (r = −0.702, p < 0.0001). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent. Conclusion: A subtalar joint with a larger Gissane angle and a more horizontal calcaneal posterior articular surface angle tended to have a higher foot arch and vice versa. The inspiration from this study was that the deformities of flatfoot and cavus foot may relate to the subtalar deformity. [ABSTRACT FROM AUTHOR]

Summary: Sepsis of the calcaneal bursae (CB) presents significant treatment challenges with limited clinical data available in the literature. The objective of this retrospective cohort study was to assess the clinical outcomes associated with CB lavage using either a through‐and‐through needle or bursoscopic technique. Clinical records of 29 horses treated for septic calcaneal bursitis using either technique between 2005 and 2019 were reviewed. Fisher's exact test was used to assess statistical significance between first surgical technique and success at first surgery (i.e. not requiring >1 lavage), survival to discharge and return to work (RTW). Bursoscopy was performed in 13/29 (44.8%) cases, and needle lavage in 16/29 (55.2%). In the needle group, 12 (75%) horses were discharged following the first surgery. Four had repeat interventions; two (12.5%) had needle lavage and two (12.5%) had bursoscopy. Of the two horses to have repeat needle lavage, one was subjected to euthanasia and one discharged, and of the two that underwent bursoscopy, one was discharged and one received a third bursoscopy prior to discharge. In the bursoscopy group, seven (53.8%) were discharged and three (23.1%) were subjected to euthanasia following the first surgery. Three (23.1%) received a second bursoscopic lavage with one discharged, one subjected to euthanasia and one having a third bursoscopic lavage prior to discharge. Overall, 18/24 (75%) followed up cases RTW, 10 (55.5%) from the needle group, eight (44.4%) the bursoscopy group. No statistically significant differences between first surgical technique used and success at first surgery (no subsequent lavage(s) required), survival to discharge or return to work were detected. The main limitations of this study are that it is a retrospective study, has a small population with limited statistical power and potential selection bias. No statistically significant differences existed between the outcomes of the two techniques, contrary to the belief that bursoscopic lavage is superior. Larger, multicentred studies, with greater statistical power are required to further assess this relationship. [ABSTRACT FROM AUTHOR]

Objective: To assess the long‐term outcomes after percutaneous reduction (PR) and screw fixation versus plate fixation via the sinus tarsi approach (STA) for displaced intra‐articular calcaneal fractures (DIACF). Methods: This retrospective study included a total of 150 patients (June 2008–August 2011), comprising 85 men and 65 women (mean age, 38.4 years), who were assigned to the PR group or the STA group. The inclusion criteria were DIACF (>2 mm) including Sanders type II and III, closed fracture, unilateral fracture, no history of smoking or no smoking during hospitalization and 3 months after surgery, and follow‐up time not less than 8 years. The exclusion criteria were clear surgical contraindications (severe cardiovascular and cerebrovascular diseases), local or systemic infection symptoms, diagnosis with diabetes or lower extremity vascular disease, and Sanders type IV or open fractures. Outcomes were assessed by means of the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores, radiographic images, and postoperative complications. Results: The mean follow‐up period was 8.7 years (range, 8.0–10.0 years). The AOFAS scores in the PR group during the follow‐up period were 54.2 ± 5.1, 85.8 ± 4.0, 88.1 ± 3.8, 87.9 ± 3.6, 87.8 ± 3.9, 86.9 ± 3.9, respectively, and in the STA group were 55.0 ± 5.6, 84.5 ± 5.2, 87.1 ± 3.8, 86.9 ± 3.8, 87.7 ± 3.3, and 87.6 ± 2.8, respectively. There was no significant difference in AOFAS scores, Bohler's angle, Gissane's angle, calcaneal length, and height between the two groups (P > 0.05). The good to excellent rate of the PR group (80.8%) was less than that of the STA group (91.7%) (P = 0.055). For Sanders III fractures, the good to excellent rate of the PR group (33.3%) was less than that of the STA group (76.9%) (P = 0.029). For calcaneal width recovery, the STA group performed better than the PR group (P < 0.05). The incidence of postoperative complications in the PR group (12.8%) was lower than that in the STA group (27.8%) (P = 0.026), of which the incidence of wound complications was 3.8% in the PR group and 13.9% in the STA group (P = 0.041). In addition, there was no significant difference in other postoperative complications such as sural nerve injury, peroneus longus and brevis muscle injury, calcaneal valgus symptoms, lateral impingement symptoms, and subtalar arthritis (P > 0.05). Conclusion: From the 8–10‐year follow‐up results of PR and STA as surgical procedures for the treatment of DIACF, it was found that there was no significant difference in the overall efficacy between them. STA was found to be superior to the PR in terms of the recovery of calcaneal width, providing more stable fixation for Sanders III fractures. PR was found to be more effective in reducing wound complications. [ABSTRACT FROM AUTHOR]

A 9‐month‐old male entire Dobermann weighing 30 kg presented to our hospital for complications following previous fixation of a comminuted fracture of the proximal left femoral diaphysis. On presentation, the dog had a marked thickening of the calcaneus and hyperflexion of tarsi bilaterally; however, no discomfort was elicited on manipulation of the joint. Radiographs showed evidence of calcaneal epiphysiolysis. The femoral fracture was treated with revision surgery. The dog had an excellent recovery and the femoral fracture healed without further complications. Calcaneal epiphysiolysis is an infrequently reported orthopedic condition of growing dogs, affecting the physis of tuber calcis in the Dobermann and Rottweiler. There are very few reported cases of calcaneal epiphysiolysis in dogs, with none as yet being reported in the United Kingdom. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the computational biomechanical analysis of intra‐articular calcaneal fractures with different fixation status of the sustentaculum plate screw, when the finite element modeling of calcaneal fractures were fixed by the lateral locking plate. Methods: The normal right foot of a male (age: 36 years; height: 174 cm; body weight: 65 kg) was scanned by the CT scanner. As the computational biomechanical study, the three‐dimensional finite element model of the simplified Sanders type‐II calcaneal fracture was built. Fixation with the lateral calcaneal locking plate and screws was simulated using a finite element software package according to clinical operation. According to the different placement of the sustentaculum plate screw, the models were categorized as the accurate fixation group, marginal fixation group, and non‐fixation group. The loading of 650 N with the vertical axial compression was applied to simulate the standing phase with single foot. The Von Mises stress distribution, maximal displacement, and contact area of the subtalar joint were analyzed among three groups. Results: The pressure distribution of the subtalar joint facet was inhomogeneous. The stress concentration of the calcaneus was located at the medial zone of the posterior subtalar joint facet. The peak Von Mises stress distribution in three groups was similar at the subtalar joint facet of 4.9 MPa, 5.1 MPa, and 5.4 MPa. In the accurate fixation group, the contact area on the posterior articular facet was 277.1 mm2; the maximal displacement was 0.18 mm. The contact area of the marginal fixation group was 265.3 mm2 on the posterior facet, where the maximal displacement was 0.23 mm. In the non‐fixation group, the contact area was 253.8 mm2; the maximal displacement was 0.25 mm. There was a slight change in the contact area of the subtalar joint and no prominent displacement of the calcaneus could be detected among the three groups. Conclusions: The biomechanical results, including the peak stress distribution, contact area, and maximal displacement of subtalar joint, were similar whether the screw is placed exactly within the sustentaculum tali or not, when the calcaneal fractures were fixed by the lateral locking plate. The sustentaculum plate screw had less effect on the biomechanical performance of the calcaneus. [ABSTRACT FROM AUTHOR]

Objectives: The primate foot has been extensively investigated because of its role in weight-bearing; however, the calcaneus has been relatively understudied. Here we examine entire gorilla calcaneal external shape to understand its relationship with locomotor behavior., Materials and Methods: Calcanei of Gorilla gorilla gorilla (n = 43), Gorilla beringei graueri (n = 20), and Gorilla beringei beringei (n = 15) were surface or micro-CT scanned. External shape was analyzed through a three-dimensional geometric morphometric sliding semilandmark analysis. Semilandmarks were slid relative to an updated Procrustes average in order to minimize the bending energy of the thin plate spline interpolation function. Shape variation was summarized using principal components analysis of shape coordinates. Procrustes distances between taxa averages were calculated and resampling statistics run to test pairwise differences. Linear measures were collected and regressed against estimated body mass., Results: All three taxa exhibit statistically different morphologies (p < .001 for pairwise comparisons). G. g. gorilla demonstrates an anteroposteriorly elongated calcaneus with a deeper cuboid pivot region and mediolaterally flatter posterior talar facet. G. b. beringei possesses the flattest cuboid and most medially-angled posterior talar facets. G. b. graueri demonstrates intermediate articular facet morphology, a medially-angled tuberosity, and an elongated peroneal trochlea., Discussion: Articular facet differences separate gorillas along a locomotor gradient. G. g. gorilla is adapted for arboreality with greater joint mobility, while G. b. beringei is adapted for more stereotypical loads associated with terrestriality. G. b. graueri's unique posterolateral morphology may be due to a secondary transition to greater arboreality from a more terrestrial ancestor., (© 2020 Wiley Periodicals LLC.)

Calcaneal fractures are a challenging clinical problem. Management of this type of injury remains controversial, especially in the context of intra-articular fractures. Surgical treatment with open reduction and internal synthesis (ORIF) is considered the standard treatment for CF, but it is associated with many complications. Several minimally invasive techniques such as balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation have been proposed to avoid the frequent and recurrent postoperative problems related to these fractures. We retrospectively examined 20 patients (mean age was 54.5), all undergoing minimally invasive calcaneoplasty surgery at our Department of Orthopaedics and Traumatology between 2012 and 2016. X-ray and CT scan were performed preoperatively and at 5 years of follow-up (57.9 ± 6 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for clinical examination, and the Short-Form (36) Health Survey (SF-36) score and Visual Analogue Scale (VAS) were used to assess the Health-Related Quality of Life (HRQoL). All 20 patients were available at the final follow-up. The mean AOFAS score was 82.25/100. The VAS results attest an overall average of 2.7/10 (0–9). The average of the parameters "Physical Health" and "Mental Health" was, respectively, 81.25 and 83.55. In terms of postoperative complications, we observed no cases of superficial or deep infections. Clinical response after balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation has shown a comparable or better outcome according to the AOFAS and VAS score. Quality-of-life scores, obtained according to the SF-36 questionnaire, are considered high. From both a clinical and quality-of-life point of view, our study highlights that there is not gender distinction. Further comparative studies with a higher number of patients are needed which assess the quality of life in the various techniques used to treat calcaneal fractures. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to summarize the clinical efficacy of three‐dimensional (3D) printing technology combined with the Masquelet technique in the treatment of calcaneal defects. Methods: From January 2018 to April 2019, 3D printing combined with induced masquelet technology was used to treat four patients with calcaneal defects, including two men and two women. The patients were aged 22–52 years old, with an average age of 36 years. There were two cases of traffic accident injuries, there was one case of a fall from height, and there was one case of crush injury. CT scans were used to reconstruct the bilateral calcaneus, mirror technology was used to construct the bone defect area, and Materialise 3‐matic software was used to design the calcaneus shaper mold and 3D print the mold. During the operation, the mold was used to shape the bone cement and fill the bone defect. In the second stage, the bone cement was removed and autologous bone was implanted to repair the bone defect. All patients were followed up to observe the effect. Results: All four patients were followed up for 14 months (range, 10–18 months). There were three cases of infectious bone defects: two cases of Escherichia coli and one case of Pseudomonas aeruginosa. The 3D printed mold was used to shape the bone cement. During the operation, it was found to have a high degree of matching with the defect area of calcaneus. There is no need to adjust it again, and the wound healed well after the first stage. In the second stage of surgery, it was found that the induced membrane formed was complete and of appropriate size; the bone cement was easily removed during the operation. The fracture healing time was 3–6 months, with an average of 4 months. At the last follow up, there was no pain and the patients walked with full weight bearing. The Maryland score was 94 points (range, 88–98 points); three cases were excellent and one case was good. The AOFAS score ranged from 86 to 98, with an average of 92.8 points; three cases were excellent and one case was good. Conclusion: Three‐dimensional printing technology combined with induced membrane technology is an effective approach for treating calcaneal bone defects. [ABSTRACT FROM AUTHOR]

This study aimed to evaluated ischemic metabolites in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone before, during, and after tourniquet application in a simultaneous paired comparison of tourniquet‐exposed and non‐tourniquet‐exposed legs. Ten patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed to simultaneously and continuously sample the metabolites glucose, lactate, pyruvate, and glycerol bilaterally for 12 h in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the leg planned for surgery (inflation time: 15 min, mean tourniquet duration time (range): 65 (58;77) min). During tourniquet inflation, a 2‐ to 3‐fold increase of the mean lactate/pyruvate ratio was found for all investigated tissues in the tourniquet‐exposed leg compared with the non‐tourniquet‐exposed leg. The lactate/pyruvate ratio recovery time after tourniquet release was within 30 min for skeletal muscle, 60 min for subcutaneous tissue, and 130 min for calcaneal cancellous bone. Only the tourniquet‐exposed skeletal muscles were found to be ischemic during tourniquet inflation, defined by a significant increase of the lactate/pyruvate ratio exceeding the ischemic cutoff level of 25; however, this level decreased below 25 immediately after tourniquet release. The glycerol ratio increased instantly after inflation in the tourniquet‐exposed leg in skeletal muscle and subcutaneous tissue, and recovered within 60 (skeletal muscle) and 130 min (subcutaneous tissue) after tourniquet release. These findings suggest that applying tourniquet for approximately 1 h results in limited tissue ischemia and cell damage in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. [ABSTRACT FROM AUTHOR]

Objectives: Small-bodied vertical clinging and leaping primates have elongated calcanei which enhance leap performance by optimizing leap velocity, distance, and acceleration, but at the expense of experiencing relatively large forces during takeoff and landing. This study tests the hypothesis that the elongated calcaneus of leaping galagids is adapted to resist larger and more stereotyped bending loads compared to more quadrupedal galagids., Materials and Methods: The calcanei of 14 individuals of Otolemur and 14 individuals of Galago (three species of each genus) were μCT scanned. Calcaneal cross-sectional properties (maximum and minimum second moments of area and polar section modulus) were obtained from a slice representing the 50% position of bone segment length and dimensionless ratios were created for each variable using calcaneal cuboid facet area as a proxy for body mass., Results: There were no significant differences in size-adjusted bending strength between Galago and Otolemur. Galago exhibited more elliptically shaped calcaneal cross sections, however, suggesting that its calcanei are more adapted to stereotyped loading regimes than those of Otolemur., Discussion: The results suggest that the calcaneus of specialized leapers is adapted to more stereotyped loading patterns. The lack of predicted bone strength differences between Galago and Otolemur may be related to body size differences between these taxa, or it may indicate that loads encountered by Galago during naturalistic leaping are not reflected in the available experimental force data., (© 2019 Wiley Periodicals, Inc.)

Summary: The objective of this study was to report the outcome of horses treated either conservatively or surgically for luxation of the superficial digital flexor tendon (SDFT) from the calcaneal tuber. Medical records of horses with diagnosed SDFT luxations from the calcaneal tuber were reviewed (1993–2015) and long‐term follow‐up examinations and owner questionnaires performed. Survival to hospital discharge, complications, final SDFT position, soundness and return to intended use were compared between conservatively or surgically treated horses. Following conservative treatment all horses (n = 8) survived to hospital discharge. At long‐term follow‐up 71.4% (5/7) had returned to intended use. The SDFT was unstable in all of them resulting in a mild mechanical lameness. Nine horses underwent surgical treatment. The SDFT was reduced and maintained in position with a synthetic mesh and sutures (n = 2), with a synthetic mesh, sutures and suture screws (n = 6) or with sutures and suture screws (n = 1). Only 66.7% (6/9) of the horses survived to hospital discharge. Fatal complications including support limb laminitis (1/9), implant infection (1/9), and support limb laminitis plus infection (1/9) occurred. All horses available for long‐term follow‐up (n = 5) were clinically sound and 80% (4/5) had returned to intended use. Following conservative treatment, a mild mechanical lameness will persist but will not prevent the horses from returning to their intended use. Surgical repair can result in a stable fixation of the SDFT with long‐term soundness and return to intended use; however, fatal complications (support limb laminitis, infection) can occur leading to the euthanasia of the horse in the immediate post‐operative period. [ABSTRACT FROM AUTHOR]

Aim: To investigate the utility of calcaneal quantitative ultrasound compared with bone densitometry (DXA) in predicting incident low‐trauma fracture in type 2 diabetes. Methods: This retrospective cohort study included a subset of participants in the Dubbo Osteoporosis Epidemiology Study who had concurrent calcaneal quantitative ultrasound and DXA measurement, comprising 809 people without type 2 diabetes and 96 with type 2 diabetes. Fracture data had been collected prospectively. Cox proportional hazard models and receiver operating curves (ROC) were used to compare calcaneal quantitative ultrasound and DXA parameters as predictors for any low‐trauma fracture. Results: The median age of participants was 71 years (IQR 68–76, 50% men) for those without type 2 diabetes and 70 years (IQR 68–76, 55% men) for those with type 2 diabetes. There was no difference in low‐trauma fracture incidence between groups when stratified by sex. In those without type 2 diabetes, the hazard ratio for fracture per 1 sd decrease in broadband ultrasound attenuation and femoral neck bone mineral density (BMD) was 1.47 [95% confidence interval (CI) 1.26–1.71] and 1.39 (95% CI 1.17–1.64), respectively. The corresponding figures in type 2 diabetes were 1.81 (95% CI 1.03–3.19) for broadband ultrasound attenuation and 2.55 (95% CI 1.28–5.08) for femoral neck BMD. Conclusion: Broadband ultrasound attenuation is comparable with femoral neck BMD as a predictor for low trauma incident fracture in type 2 diabetes. Calcaneal quantitative ultrasound offers several advantages over DXA and should be considered in further studies of bone health screening or in clinical practice where DXA is unavailable. What's new?: Type 2 diabetes is generally associated with greater fracture risk and paradoxically higher bone mineral density.Calcaneal quantitative ultrasound has practical advantages over bone densitometry (DXA) and incorporates assessment of bone quality.The association of type 2 diabetes with greater fracture risk may not be generalizable to all populations.Calcaneal quantitative ultrasound parameter broadband ultrasound attenuation independently predicts low‐trauma incident fracture in type 2 diabetes.Calcaneal quantitative ultrasound could be used to assess fracture risk in type 2 diabetes when DXA is not available.Further studies should investigate the benefit of calcaneal quantitative ultrasound in screening bone health to direct early intervention in type 2 diabetes. [ABSTRACT FROM AUTHOR]

Plantar heel pain is a common disease with a high incidence in different races. It significantly reduced the quality of life of patients. However, the cause of PHP is still controversial and there were varieties of physiological factors associated with PHP. The most common pathological factor in the population was plantar fasciitis. Some existing research studies had found a correlation between calcaneal spurs and plantar fasciitis, and this study had found the correlation in Chinese population. It is invaluable not only to understand the relationship between different types of plantar calcaneal spurs and plantar fasciitis but also to identify the most appropriate treatment strategies. A total of 71 patients with calcaneal spurs were chosen from the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. All 71 patients had completed X-rays and MRI scans; then, surgeons had removed their plantar calcaneal spurs. After surgery, all patients were followed up for 12 months; their prognosis was tested by the VAS and AOFAS scores. Type II (29, 40.8%) had the highest incidence in Chinese population, followed with type I (24, 33.8%) and type III (18, 25.4%). Preoperative VAS scores showed that type II (7.72 ± 1.10) was significantly higher than the other two types (P < 0.001). Postoperative VAS scores of type II were higher than those of type I and type III (P < 0.001). Postoperative AOFAS scores of type II were the lowest (P < 0.001). Researchers had proved that type II was more likely to cause PF. [ABSTRACT FROM AUTHOR]

The plantar calcaneal spur ( PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain. [ABSTRACT FROM AUTHOR]

It is well established that the postoperative results were affected by the surgeon volume in a variety of elective and emergent orthopaedic surgeries; however, by far, no evidences have been available as for surgically treated displaced intra‐articular calcaneal fractures (DIACFs). We aimed at investigating the relationship between surgeon volume and deep surgical site infection (DSSI) following open reduction and internal fixation (ORIF) of DIACFs. This was a further analysis of prospectively collected data from a validated database. Patients with DIACFs stabilised by ORIF between 2016 and 2019 were identified. Surgeon volume was defined as the number of surgically treated calcaneal fractures within one calendar year and was dichotomised based on the optimal cut‐off value. The outcome measure was DSSI within 1 year postoperatively. Multivariate logistics regression analyses were performed to examine the relationship, adjusting for confounders. Among 883 patients, 19 (2.2%) were found to have a DSSI. The DSSI incidence was 6.5% in surgeons with a low volume (<6/year), 5.5 times as that in those with a high volume (≥6/year) (incidence rate, 1.2%; P < 0.001). The multivariate analyses showed a low volume <6/year was associated with a 5.8‐fold increased risk of DSSI (95% confidence interval, 2.2‐16.5, P < 0.001). This value slightly increased after multiple sensitivity analyses, with statistical significances still unchanged (OR range, 6.6‐6.9; P ≤ 0.001). The inverse relationship indicates a need for at least six cases/year for a surgeon to substantially reduce the DSSIs following the ORIF of DIACFs. [ABSTRACT FROM AUTHOR]

Trabecular bone structure in adulthood is a product of a process of modelling during ontogeny and remodelling throughout life. Insight into ontogeny is essential to understand the functional significance of trabecular bone structural variation observed in adults. The complex shape and loading of the human calcaneus provides a natural experiment to test the relationship between trabecular morphology and locomotor development. We investigated the relationship between calcaneal trabecular bone structure and predicted changes in loading related to development of gait and body size in growing children. We sampled three main trabecular regions of the calcanei using micro‐computed tomography scans of 35 individuals aged between neonate to adult from the Norris Farms #36 site (1300 AD, USA) and from Cambridge (1200–1500 AD, UK). Trabecular properties were calculated in volumes of interest placed beneath the calcaneocuboid joint, plantar ligaments, and posterior talar facet. At birth, thin trabecular struts are arranged in a dense and relatively isotropic structure. Bone volume fraction strongly decreases in the first year of life, whereas anisotropy and mean trabecular thickness increase. Dorsal compressive trabecular bands appear around the onset of bipedal walking, although plantar tensile bands develop prior to predicted propulsive toe‐off. Bone volume fraction and anisotropy increase until the age of 8, when gait has largely matured. Connectivity density gradually reduces, whereas trabeculae gradually thicken from birth until adulthood. This study demonstrates that three different regions of the calcaneus develop into distinct adult morphologies through varying developmental trajectories. These results are similar to previous reports of ontogeny in human long bones and are suggestive of a relationship between the mechanical environment and trabecular bone architecture in the human calcaneus during growth. However, controlled experiments combined with more detailed biomechanical models of gait maturation are necessary to establish skeletal markers linking growth to loading. This has the potential to be a novel source of information for understanding loading levels, activity patterns, and perhaps life history in the fossil record. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to quantify isolated coupling mechanisms of calcaneal adduction/abduction and calcaneal eversion/inversion to proximal bones in vitro. The in vitro approach is necessary because in vivo both movements appear together, making it impossible to determine the extent of their individual contribution to overall ankle joint coupling. Eight fresh frozen foot‐leg specimens were tested. Data describing bone orientation and coupling mechanisms between segments were obtained using bone pin marker triads. The bone movement was described in a global coordinate system to examine the coupling between the calcaneus, talus and tibia. The strength of coupling was determined by means of the slope of a linear least squares fit to an angle–angle plot. The coupling coefficients in the present study indicate that not only calcaneal eversion/inversion (coupling coefficient: 0.68 ± 0.15) but to an even greater extent calcaneal adduction/abduction (coupling coefficient: 0.99 ± 0.10) was transferred into talus and tibial rotation, highlighting the relevance of calcaneal adduction for the overall ankle joint coupling. The results of this study present the possibility that controlling calcaneal adduction/abduction can affect talus and tibial rotation and therefore the possible genesis of overuse knee injuries. [ABSTRACT FROM AUTHOR]

Objective: To determine associations between chronic plantar heel pain (CPHP) and imaging biomarkers derived from magnetic resonance imaging (MRI) and ultrasonography. Methods: We compared 218 participants with CPHP with 100 age‐ and sex‐matched population controls. We assessed imaging biomarkers on MRI (calcaneal bone marrow lesions [BMLs], plantar fascia [PF] signal and thickness, spurs, and fat pad signal) and B‐mode/power Doppler ultrasound (PF thickness, echogenicity, and vascularity). Covariate data collected included demographic characteristics, disease history, clinical measures, and physical activity by accelerometry. Data were analyzed using multivariable conditional logistic regression. Results: Plantar calcaneal BML size (mm2, odds ratio [OR] 1.03 [95% confidence interval (95% CI) 1.02–1.05]), larger plantar spurs (OR for spurs >5 mm 2.15 [95% CI 1.13–4.10]), PF signal (OR for signal penetrating >50% of the dorsoplantar width 12.12 [95% CI 5.36–27.42]), PF thickness (mm, OR for MRI 3.23 [95% CI 2.36–4.43] and ultrasound OR 3.78 [95% CI 2.69–5.32]), and echogenicity (diffusely hypoechoic OR 7.89 [95% CI 4.02–15.48] and focally hypoechoic OR 24.92 [95% CI 9.60–64.69]) were independently associated with CPHP. PF vascularity was uncommon, occurring exclusively in cases (cases with signal n = 47 [22%]). Combining imaging biomarkers into 1 model, plantar BMLs and PF imaging biomarkers, but not fat pad signal or heel spurs, were independently associated with CPHP. Conclusion: Calcaneal BMLs and PF imaging biomarkers are associated with CPHP. Further research is required to understand whether these different markers represent distinct phenotypes of heel pain, and if so, whether there are specific treatment implications. [ABSTRACT FROM AUTHOR]

Pseudoaneurysm of the medial plantar artery following low-energy closed calcaneal fracture Plain radiographs and computed tomography (CT) revealed a minimally displaced calcaneal fracture with largely preserved congruency of the subtalar joint (Fig. Due to the ongoing pain, and persistent soft-tissue changes which seemed disproportionate to the fracture displacement and mechanism of injury, CT angiography was performed. [Extracted from the article]

Due to the calcaneal osteoarthritis, patients had a lower quality of life. This research was to study which type of calcaneus was more likely to cause osteoarthritis and then to guide the clinical prevention and treatment in Chinese population. All 505 intact Chinese calcaneus facets were reconstructed by CT-3D reconstruction scanner and classified into five types based on the calcaneal talar facet (CTF) configuration. CTF's morphology parameters (osteophyte, cortical thickness of calcaneus, GIssane's and Bohler's angle, and long and short axis) were measured and recorded by PACS CT system. Researchers used the length of long and short axis to calculate the CTF area. By comparing the morphology parameters of five types of calcaneus, the differences among different types of calcaneus in Chinese people were statistically different. The study showed that Type II and Type IV had the highest percentage of osteophytes. After being compared and analyzed, the CTF pressure and the subtalar joint stability were closely related to the occurrence of osteoarthritis. Based on the measurement and comparison of morphological parameters in this study, Types II and IV were the most likely to develop osteoarthritis in Chinese population. [ABSTRACT FROM AUTHOR]

Deep surgical site infection (DSSI) is a serious complication affecting the surgical outcome of displaced intra‐articular calcaneal fracture, and a risk prediction model based on the identifiable risk factors will provide great clinical value in prevention and prompt interventions. This study retrospectively identified patients operated for calcaneal fracture between January 2014 and December 2019, with a follow‐up ≥1 year. The data were extracted from electronic medical records, with regard to demographics, comorbidities, injury, surgery and laboratory biomarkers at admission. Univariate and multivariate logistics regression analyses were used to identify the independent factors for DSSI, thereby the risk prediction model was developed. Among 900 patients included, 2.7% developed a DSSI. The multivariate analyses identified five factors independently associated with DSSI, including current smoking (OR, 2.8; 95% confidence interval [CI], 1.3‐6.4; P =.021), BMI ≥ 26.4 kg/m2 (OR, 3.1; 95% CI, 1.6‐8.4; P =.003), ASA ≥II (OR, 1.3; 95% CI, 1.0‐5.1; P =.043), incision level of II (OR, 3.8; 95% CI, 1.3‐12.6; P =.018) and NLR ≥6.4 (OR, 3.2; 95% CI, 1.3‐7.5; P =.008). A score of 14 as the optimal cut‐off value was corresponding to sensitivity of 0.542 and specificity of 0.872 (area, 0.766; P <.001); ≥14 was associated with 8.1‐times increased risk of DSSI; a score of 7 was corresponding sensitivity of 100% and 10 corresponding to sensitivity of 0.875. The risk prediction model exhibited excellent performance in distinguishing the risk of DSSI and could be considered in practice for improvement of wound management, but its validity requires to be verified by better‐design studies. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between calcaneal enthesophytes and osteoarthritis (OA) in the hands and feet, and to provide insights into the role of biomechanical and systemic processes in the development of OA.Methods: Adults ages ≥50 years who were registered with 4 general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months underwent a detailed assessment, including hand and foot radiographs. Calcaneal enthesophytes (plantar and posterior) and OA features (osteophytes and joint space narrowing) were documented. Associations between enthesophytes and hand and foot OA (including OA phenotypes and OA features at individual joints) were explored using generalized estimating equations, adjusting for age, sex, and body mass index.Results: Data were available from 532 participants (298 women, mean ± SD age 64.9 ± 8.4 years). Calcaneal enthesophytes were not associated with hand OA phenotypes or OA at individual hand joints. In contrast, plantar calcaneal enthesophytes were positively associated with polyarticular foot OA (odds ratio [OR] 1.80 [95% confidence interval (95% CI) 1.02-3.17]). When individual foot joints were examined, posterior enthesophytes were associated with talonavicular joint OA (OR 1.58 [95% CI 1.02-2.44]) and plantar enthesophytes were associated with first metatarsophalangeal joint OA (OR 0.67 [95% CI 0.49-0.98]) and navicular-cuneiform joint OA (OR 2.30 [95% CI 1.40-3.79]). Patterns of association were similar for osteophytes and joint space narrowing.Conclusion: Calcaneal enthesophytes are associated with foot OA but not hand OA. The pattern of association is indicative of a local, biomechanical rather than systemic bone-forming process. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the sensitivity and specificity of calcaneal quantitative ultrasound (QUS) measurements for identifying osteoporosis determined by dual-energy x-ray absorptiometry (DXA) at the hip in a spinal cord injury (SCI) population. Design: Cross-sectional retrospective review of data collected in the bone health registry of persons with a disability. Setting: Inpatients and outpatients at a single acute rehabilitation hospital. Participants: A convenience sample of 66 participants, both inpatients and outpatients, with a spinal cord injury. Methods: Calcaneal T scores were determined by ultrasound, and bone density of the lumbar spine, total hip, and femoral neck were determined by DXA. Main Outcome Measurements: Right and left calcaneal QUS T scores and right and left hip and femoral neck DXA T scores. Results: Right and left hip DXA T scores were strongly associated with corresponding right and left calcaneal QUS T scores (right: r = .72, P < .001; left: r = .70, P < .001). Similar associations were found when we evaluated femoral neck T scores and calcaneal QUS T scores. Receiver operating characteristic analysis for evaluating QUS to identify DXA-defined osteoporosis demonstrated an area under the curve of 0.81 for all participants (acute and chronic injury) and 0.68 for those with a chronic SCI. Conclusions: A strong association exists between calcaneal QUS T scores and bone density T scores at the hip measured by DXA. QUS may have a place in the screening of people with SCI 1 year or more after their injury to evaluate their bone status. [ABSTRACT FROM AUTHOR]

Findings on the twisting structure and insertional location of the AT on the calcaneal tuberosity are inconsistent. Therefore, to obtain a better understanding of the mechanisms underlying insertional Achilles tendinopathy, clarification of the anatomy of the twisting structure and location of the AT insertion onto the calcaneal tuberosity is important. The purpose of this study was to reveal the twisted structure of the AT and the location of its insertion onto the calcaneal tuberosity using Japanese cadavers. The study was conducted using 132 legs from 74 cadavers (mean age at death, 78.3 ± 11.1 years; 87 sides from men, 45 from women). Only soleus (Sol) attached to the deep layer of the calcaneal tuberosity was classified as least twist (Type I), both the lateral head of the gastrocnemius ( LG) and Sol attached to the deep layer of the calcaneal tuberosity were classified as moderate twist (Type II), and only LG attached to the deep layer of the calcaneal tuberosity was classified as extreme twist (Type III). The Achilles tendon insertion onto the calcaneal tuberosity was classified as a superior, middle or inferior facet. Twist structure was Type I (least) in 31 legs (24%), Type II (moderate) in 87 legs (67%), and Type III (extreme) in 12 legs (9%). A comparison between males and females revealed that among men, 20 legs (24%) were Type I, 57 legs (67%) Type II, and eight legs (9%) Type III. Among women, 11 legs (24%) were Type I, 30 legs (67%) Type II, and four legs (9%) Type III. No significant differences were apparent between sexes. The fascicles of the Achilles tendon attach mainly in the middle facet. Anterior fibers of the Achilles tendon, where insertional Achilles tendinopathy is most likely, are Sol in Type I, LG and Sol in Type II, and LG only in Type III. This suggests the possibility that a different strain is produced in the anterior fibers of the Achilles tendon (calcaneal side) where insertional Achilles tendinopathy is most likely to occur in each type. We look forward to elucidating the mechanisms generating insertional Achilles tendinopathy in future biomedical studies based on the present results. [ABSTRACT FROM AUTHOR]

Background. Both percutaneous and arthroscopic techniques have been introduced in anatomic ankle lateral ligaments reconstruction. The purpose of this study was to compare these two techniques in identifying the calcaneal insertion of the calcaneofibular ligament (CFL). Methods. Fifteen fresh-frozen human ankle cadaver specimens were used in this study. Each specimen was tested in three stages. For stage 1, each specimen was evaluated under arthroscopy. After debridement was performed, the insertion of the CFL on the calcaneus was identified, and a 1.5mm Kirschner wire was drilled at the center of the insertion. For stage 2, a percutaneous technique was used to identify the center of the insertion of the CFL. A second 1.5 mm Kirschner wire was drilled through the skin marker. For stage 3, the ankle was dissected, the footprint of the CFL was identified under direct vision, and the distances between the center of the CFL insertion on the calcaneus and the two Kirschner wires were measured, respectively. Results. In the arthroscopic technique group, the mean distance from the Kirschner wire to the center of the CFL insertion in the calcaneus was 3.4 ± 1.3 mm. In the percutaneous technique group, the mean distance from the Kirschner wire to the center of the CFL insertion was 3.2 ± 1.4 mm. No significant difference was found between the two groups. Conclusion. No difference in identifying the calcaneal insertion of the CFL was found between the percutaneous and the arthroscopic ankle lateral ligaments reconstruction technique. Both techniques can be used during anatomic ligaments reconstruction in treatment of chronic ankle instability. [ABSTRACT FROM AUTHOR]