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BackgroundThe calcaneal enthesis, an osseous footprint where the Achilles tendon seamlessly integrates with the bone, represents a complex interface crucial for effective force transmission. Bone adapts to mechanical stress and remodels based on the applied internal and external forces. This study explores the relationship between the elasticity of the Achilles tendon enthesis and the bone microstructure in the calcaneal crescent.MethodsIn total, 19 calcaneal-enthesis sections, harvested from 10 fresh-frozen human cadaveric foot-ankle specimens (73.8 ± 6.0 years old, seven female), were used in this study. Indentation tests were performed at the enthesis region, and Hayes' elastic modulus was calculated for each specimen. Micro-CT scanning was performed at 50-micron voxel size to assess trabecular bone microstructure within six regions of interest (ROIs) and the cortical bone thickness along the calcaneal crescent.ResultsSignificant Spearman correlations were observed between the enthesis elastic modulus and trabecular bone thickness in the distal entheseal (ROI 3) and proximal plantar (ROI 4) regions (R = 0.786 and 0.518, respectively).ConclusionThis study highlights the potential impacts of Achilles tendon enthesis on calcaneal bone microstructure, which was pronounced in the distal calcaneal enthesis, suggesting regional differences in load transfer mechanism that require further investigation.

The human calcaneus is robust and provides a prominent heel for effective bipedal locomotion, although the adjacent talus has no muscle attachments. However, there is incomplete information about the morphological changes in these prominent bones during embryo development. We examined serial histological sections of 23 human embryos and early‐term fetuses (approximately 5–10 weeks' gestational age [GA]). At a GA of 5 weeks, the precartilage talus was parallel to and on the medial side of the calcaneus, which had a prolate spheroid shape and consisted of three masses. At a GA of 6 weeks, the cartilaginous talus extended along the proximodistal axis, and the tuber calcanei became long and bulky, with a small sustentaculum talus at the "distal" side. At a GA of 6 to 8 weeks, the sustentaculum had a medial extension below the talus so that the talus "rode over" the calcaneus. In contrast, the talus had a more complex shape, depending on the growth of adjacent bones. At a GA of 9 to 10 weeks, the talus was above the calcaneus, but the medial part still faced the plantar subcutaneous tissue because of the relatively small sustentaculum. Therefore, the final morphology appeared after an additional several weeks. Muscle activity seemed to facilitate growth of the tuber calcanei, but growth of the other parts of calcaneus, including the sustentaculum, seemed to depend on active proliferation at the different sites of cartilage. Multiple tendons and ligaments seemed to fix the talus so that it remained close to the calcaneus. [ABSTRACT FROM AUTHOR]

Bacground: Morphologic measurements such as body lenght, wither height, heart girth, chest width, body leght, cannon‐bone circumference is used to predict carcass weight. For this purpose, estimating carcass weight with measurements of key bones such as ankle bones, which play a significant role in the balance distribution of body weight, seems possible. Objectives: The aim of this study is to create new regression models for effective carcass weight estimation by using the morphometric data of the talus and calcaneus bones of hair goats. Methods: Study materials consisted of talus and calcaneus bones obtained from abattoir products of hair goat kids (12–18 months old, 20 female and 20 male) and adult hair goats (36–48 months old, 20 female and 20 male). Morphometric measurements of the talus and calcaneus of each animal were taken by a digital caliper. Using the morphometric measurements, an index and a factor were calculated for each bone. Regression analysis and correlations were examined in IBM SPSS 21 programme. Results: As a result, statistical analysis of GLc, GLt, Bd, Calfactor and Talfactor were statistically significant on predicting carcass weight. Conclusion: Specific anatomical structures, such as certain bone measurements, such as talus and calnaneus could serve as indicators of growth performance and also carcass weight performance. In addition new anatomical factors and indices may be produced and new regression methods may be applied with these new parameters to predict carcass weight. [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.

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]

The calcaneal morphology changed considerably during human evolution to enable efficient bipedal locomotion. However, little information exists regarding its adaptation to changes in habitual activities following the transition to a sedentary lifestyle. We aimed to examine changes in calcaneal morphology during the Pleistocene-Holocene Levant in light of sexual dimorphism. We studied three archaic Homo sapiens calcanei dated to the Middle and Upper Paleolithic, 23 Natufian hunter-gatherers, 12 Pre-Pottery Neolithic early farmers, and 31 Chalcolithic farmers. The calcanei were scanned via a surface scanner and measured, and bone proportions were calculated. Measurements included the height, length, and width of various calcaneal elements. The sex of each individual was determined using methods based on calcaneal morphology. The validity of these methods was tested in those individuals who had the pelvis (92.3% agreement rate). Accordingly, the sample included 59.4% males and 40.6% females. Most calcaneal indices were sex-independent, except for the relative width, relative anterior length, and the cuboid index. Temporal trends between the Natufian and Chalcolithic periods were more pronounced among males than females. While in the proximal calcaneus, the temporal trend was similar between males and females, it differed in the distal part and articular facets. The calcanei of archaic H. sapiens exceeded the average of the Natufian hunter-gatherer for most variables, though the trend varied. To conclude, males and females were affected differently by the changing environment. The calcanei of archaic H. sapiens were better adapted for activity involving high mobility, independent of sex. During the transition to a sedentary way of life, different factors probably designed the male and female calcaneus. These could include factors related to the sexual division of labor, adaptation to lengthy standing, and changes in footwear. [ABSTRACT FROM AUTHOR]

Introduction: Flatfoot is a condition commonly seen in children; however, there is general disagreement over its incidence, characterization and correction. Painful flatfoot accompanied with musculoskeletal and soft tissue problems requires surgery to avoid arthritis in adulthood, the most common surgical approach being two osteotomies to the calcaneus and medial cuneiform bones of the foot. Objectives: This study focuses on the parametrization of these two bones to understand their bone morphology differences in a population sample among 23 normal subjects. Population differences could help in understanding whether bone shape may be an important factor in aiding surgical planning and outcomes. Methods: A total of 45 sets of CT scans of these subjects were used to generate surface meshes of the two bones and converted to be iso-topological meshes, simplifying the application of Generalized Procrustes Analysis and Principal Component Analysis, allowing the main sources of variation between the subjects to be quantified. Results: For the calcaneus, 16 Principal Components (PCs) and, for the medial cuneiform, 12 PCs were sufficient to describe 90% of the dataset variability. The quantitative and qualitative analyses confirm that for the calcaneus PC1 describes the Achilles attachment location and PC2 largely describes the anterior part of the bone. For the medial cuneiform, PC1 describes the medial part of the bone, while PC2 mainly describes the superior part. Conclusion: Most importantly, the PCs did not seem to describe the osteotomy sites for both bones, suggesting low population variability at the bone cutting points. Further studies are needed to evaluate how shape variability impacts surgical outcomes. Future implications could include better surgical planning and may pave the way for complex robotic surgeries to become a reality. [ABSTRACT FROM AUTHOR]

Objectives: Identify the effectiveness of neurokinetic therapy on pain and plantar fascia thickness in patients with plantar fasciitis. Method: An experimental study was performed on 80 patients with plantar fasciitis after screening based on selection criteria. The patients were randomly allocated into two groups: the neurokinetic therapy group (n = 40) and the foot core exercises group (n = 40). In both groups, the treatments were given for two weeks, five days each week. The pre-and post-test results were assessed. A statistical analysis was performed on the gathered data. Result: A significant statistical difference was observed between the groups; the post-test mean value of the Foot Function Index scale in the neurokinetic therapy group was 129.12, while in the foot core exercises group was 141.42. Additionally, the post-test mean value of the therapeutic ultrasound in the neurokinetic therapy group was 3, whereas in the foot core exercises group was 3.38. These values yielded a p-value of less than 0.001. Conclusion: This study demonstrated an improvement in both groups. However, the neurokinetic therapy group showed a significant improvement in pain, functionality, and plantar fascia thickness compared to the foot core exercises group. Level of evidence IV; Experimental study.

Abstract Bacground Morphologic measurements such as body lenght, wither height, heart girth, chest width, body leght, cannon‐bone circumference is used to predict carcass weight. For this purpose, estimating carcass weight with measurements of key bones such as ankle bones, which play a significant role in the balance distribution of body weight, seems possible. Objectives The aim of this study is to create new regression models for effective carcass weight estimation by using the morphometric data of the talus and calcaneus bones of hair goats. Methods Study materials consisted of talus and calcaneus bones obtained from abattoir products of hair goat kids (12–18 months old, 20 female and 20 male) and adult hair goats (36–48 months old, 20 female and 20 male). Morphometric measurements of the talus and calcaneus of each animal were taken by a digital caliper. Using the morphometric measurements, an index and a factor were calculated for each bone. Regression analysis and correlations were examined in IBM SPSS 21 programme. Results As a result, statistical analysis of GLc, GLt, Bd, Calfactor and Talfactor were statistically significant on predicting carcass weight. Conclusion Specific anatomical structures, such as certain bone measurements, such as talus and calnaneus could serve as indicators of growth performance and also carcass weight performance. In addition new anatomical factors and indices may be produced and new regression methods may be applied with these new parameters to predict carcass weight.

Purpose: This retrospective study aimed to investigate whether the standard radiographic indicators for Haglund's syndrome are applicable to insertional Achilles tendinopathy. Methods: Patients who underwent surgery for insertional Achilles tendinopathy in one heel and experienced no pain in the other heel were enrolled in this study. Preoperative calibrated radiographs of the lateral view of the calcaneus were assessed using (1) calcaneal pitch angle, (2) Fowler-Phillip angle, (3) posterior calcaneal angle, (4) Chauveau-Liet angle, (5) X/Y ratio, (6) Haglund’s deformity height, (7) Haglund’s deformity peak angle, (8) calcification length, (9) calcification width, (10) parallel pitch test, and (11) presence of free body. The Wilcoxon signed rank test and McNemar’s test were used for statistical analyses. Results: Seventy-one patients (52 males; mean age, 57.2; mean body mass index, 27.1) were included. Mean values for each index in the symptomatic and asymptomatic heels were as follows, respectively: (1) 23.5, 23.0 (p = 0.30); (2) 58.9, 57.8 (p

Background and Aim: Captivity alters the locomotor behavior of wild artiodactyls and affects the mechanical loading of the calcaneus; however, the resulting adaptive changes in calcaneus morphology have not been sufficiently studied to date. This study aimed to investigate the morphological and mechanical adaptive variations in the calcaneus of Saiga tatarica to understand further the functional adaptation of the calcaneus in wild artiodactyl to captivity. Materials and Methods: Paired calcanei from autopsy samples of six captive wild artiodactyls (S. tatarica) and six domesticated artiodactyls (Ovis aries) were divided into skeletally immature and mature groups using X-ray evaluation of growth plate closure. High-resolution microcomputed tomography revealed a calcaneal diaphyseal cross-section. The mechanical and nanomorphological characteristics of the trabecular bone were determined by atomic force microscopy. Results: The percent cortical bone area (%CA), cortical thickness ratio (CTR), and Young’s modulus (E) differed between species in the immature groups but not in the mature groups. S. tatarica had significantly higher growth rates for %CA, CTR, and E in the mid-shaft than O. aries (p < 0.05). Conclusion: The calcaneus morphology of S. tatarica converges with that of domesticated O. aries during ontogeny. These results indicate that the calcaneus of wild artiodactyls can undergo potentially transitional changes during the short-term adaptation to captivity. The above parameters can be preliminarily identified as morphological signs of functional bone adaptation in artiodactyls.

Introduction. Calcaneus fractures are rare but potentially debilitating injuries. Most of them are displaced intraarticular fractures, whose management is among controversial issues. There is no consensus on whether to operate or not. The most often chosen surgical treatment is open reduction and internal fixation as the primary method. Failure of this surgery often needs secondary subtalar arthrodesis as definitive management, so primary subtalar arthrodesis in cases with severe comminution represents definitive treatment in one stage with good functional results. Case outline. We present a case of a 54-year-old male patient with a severely comminuted (Sanders type IV) bilateral calcaneus fracture. After the withdrawal of local swelling and disappearance of fracture blisters, the patient was operated on using one-stage bilateral subtalar arthrodesis with percutaneous screw fixation and bone grafting performed through a mini-open sinus tarsi approach. The early postoperative period was uneventful. The patient did not walk for the first seven postoperative weeks, after which rehabilitation was continued with partial weight bearing with a gradual increase of weight-bearing to full over the next five weeks, after which walking aids were completely phased out. Three years after surgery, the patient has no symptoms and has a close-to-normal gait. Conclusion. Although this type of injury has traditionally been treated with open reduction and internal fixation, we believe that primary subtalar arthrodesis with bone grafting through a mini-open sinus tarsi approach can benefit patients with severe comminution of calcaneus, allowing good functional results and patient satisfaction, with fewer postoperative complications and faster definitive recovery.

Purpose. Plantar fasciitis (PF) is a degeneration of the plantar fascia. There are different forms of treatment for PF. Conservative treatment stands out as the main method of choice. The aim was to review in the literature the effectiveness of therapeutic exercise (TE) on pain and functionality in PF. Methods. The search was carried out in the databases: PubMed, Web of Science, Embase and Lilacs, and in the gray literature: Google Scholar, Open Grey, LIVIVO and Brazilian Library of Theses and Dissertations. A Cochrane tool was used to assess the quality of the studies. The primary outcome was pain, and the secondary outcomes were range of motion (ROM) and functionality. The assessments were performed by two reviewers and a third reviewer resolved conflicts. Randomized controlled trials using therapeutic exercise compared with placebo, no treatment, phototherapy, thermotherapy, and electrotherapy. There was no restriction on time or language. Results. The references of 2,984 studies were identified, 2,832 from major databases and 152 from gray literature. A total of 10 articles were included in this review. Nine studies assessed pain, and all had positive results in decreasing pain levels. All 10 studies used to stretch exercises, but only one used strengthening exercises. Conclusions. It is concluded that TE, mainly through plantar fascia and triceps sural stretching, is effective in reducing pain and functionality when associated with other therapies in PF. Study registration. The study is registered with the International Prospective Register of Systematic Review (PROSPERO) under protocol CRD42021296710. [ABSTRACT FROM AUTHOR]

Intraosseous lipoma of calcaneum is a rare cause of heel pain. Calcaneum is a typical site of involvement of IOL. There are only a few published articles regarding calcaneal intraosseous lipoma and one has been reported from Nepal. We report a case of 35 years female who presented with left heel pain for 1 year. The pain was gradually increasing in intensity and was severe enough to refrain her from activities of daily living. She was surgically operated with curettage and filling the defect with bone cement. There is no residual pain at 2.5 years follow up. We briefly review the postulated pathogenesis, clinical manifestations, diagnosis and various modalities of treatment of intraosseous lipoma. An orthopedic surgeon should have high degree of suspicion regarding the uncommon cause of heel pain and its possible management. When conservative methods do not relieve symptoms, surgical excision and filling the defect with bone cement provides long term relief.

Background: The flexible flatfoot is characterized by a flattening of the foot arch due to excessive bodyweight. The use of shoe insoles or taping methods has been identified as effective in realigning the navicular or calcaneus bones and addressing supination in pronated feet. Objects: This study aimed to analyze the difference between the arch taping attachment method, introduced in a previous study, and a novel taping method designed to provide support to the inner aspect of the heel bone in cases of flexible flatfoot. Methods: A navicular drop test was performed to discriminate flexible flatfoot. To analyze the differences in pressure distribution during walking for each taping method, the subjects underwent testing in the barefoot state with no attachments. The procedure included a sequence of arch taping and heel taping. Subsequent analysis of pressure distribution during walking utilized the GaitRite® system (GAITRite Gold, CIR Systems Inc.). Results: Arch taping and calcaneus taping significantly reduced the integrated pressure over time and peak pressure on the medial side of the midfoot for both feet compared to the barefoot state. Conclusion: The findings of this study suggest that supporting the inside of the heel through calcaneus taping, without direct stimulation to the longitudinal arch and navicular bone, is an effective intervention for flexible flatfoot.

Abstract The foot is an uncommon location for osseous tumors, comprising ~ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Aims: This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis. Methods: We included adult patients with limb osteomyelitis who received debridement and ALCS insertion into the bone defect as definitive management between 2013 and 2020 in our clinical centre. The follow-up time was at least two years. Data on patients’ demographics, clinical characteristics, and infection recurrence were retrospectively collected and analyzed. Results: In total, 314 patients with a mean age of 52.1 years (SD 12.1) were enrolled. After a mean of 50 months’ (24 to 96) follow-up, 53 (16.9%) patients had infection recurrence including 32 tibiae, ten femora, ten calcanea, and one humerus. Of all patients with recurrence, 30 (9.6%) occurred within one year and 39 (12.4%) within two years. Among them, 41 patients needed reoperation, five received antibiotics treatment only, and seven ultimately required amputations. Following multivariable analysis, we found that patients infected with Gram-negative bacilli were more likely to have a recurrence (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.20 to 6.94; p = 0.046) compared to Staphylococcus aureus; segmental bone defects (OR 5.25, 95% CI 1.80 to 15.26; p = 0.002) and smoking (OR 3.00, 95% CI 1.39 to 6.50; p = 0.005) were also independent risk factors for recurrence after treatment. Conclusion: Permanent ALCS might be an alternative strategy for definitive bone defect management in selected osteomyelitis cases. However, the overall high recurrence found suggests that it should be cautiously treated. Additionally, segmental defects, Gram-negative infections, and smoking were associated with an increased risk of infection recurrence. Cite this article: Bone Joint Res 2023;12(8):467–475.

The calcaneal morphology changed considerably during human evolution to enable efficient bipedal locomotion. However, little information exists regarding its adaptation to changes in habitual activities following the transition to a sedentary lifestyle. We aimed to examine changes in calcaneal morphology during the Pleistocene-Holocene Levant in light of sexual dimorphism. We studied three archaic Homo sapiens calcanei dated to the Middle and Upper Paleolithic, 23 Natufian hunter-gatherers, 12 Pre-Pottery Neolithic early farmers, and 31 Chalcolithic farmers. The calcanei were scanned via a surface scanner and measured, and bone proportions were calculated. Measurements included the height, length, and width of various calcaneal elements. The sex of each individual was determined using methods based on calcaneal morphology. The validity of these methods was tested in those individuals who had the pelvis (92.3% agreement rate). Accordingly, the sample included 59.4% males and 40.6% females. Most calcaneal indices were sex-independent, except for the relative width, relative anterior length, and the cuboid index. Temporal trends between the Natufian and Chalcolithic periods were more pronounced among males than females. While in the proximal calcaneus, the temporal trend was similar between males and females, it differed in the distal part and articular facets. The calcanei of archaic H. sapiens exceeded the average of the Natufian hunter-gatherer for most variables, though the trend varied. To conclude, males and females were affected differently by the changing environment. The calcanei of archaic H. sapiens were better adapted for activity involving high mobility, independent of sex. During the transition to a sedentary way of life, different factors probably designed the male and female calcaneus. These could include factors related to the sexual division of labor, adaptation to lengthy standing, and changes in footwear.

The treatment of displaced intra-articular calcaneal fractures is not standardized, as many surgeons prefer not to perform surgery, considering a high rate of cutaneous complications associated with the usual extensile lateral approach. The Calcanail® represents a percutaneous osteosynthesis device that is biomechanically more stable than multiple screws or locking plates. While it effectively restores the height and axis of the hindfoot, it appears to be less reliable in achieving articular reduction of the thalamic surface in cases of mixed fractures. Therefore, we developed a new technique suitable for comminuted mixed fractures, using the Calcanail® device with an arthroscopically guided closed reduction internal fixation of the thalamic surface.

Background: Primary subtalar arthrodesis (PSTA) is a valid option in treating Sanders IV calcaneal fractures with few studies to assess its outcomes. Methods: Seventeen patients with Sanders IV calcaneal fractures were managed by open reduction and primary subtalar arthrodesis. Functional outcomes were measured by AOFAS-AHS and FAAM-ADL. We also documented time to return to work, union rate, wound complications and the need for second surgeries. Results: Fourteen patients were followed for two years. At final follow-up, the mean AOFAS-AHS score was 74.42 ± 1.95, while the mean FAAM- ADL score was 59.21 ± 1.6. Conclusion: PSTA is a valid option in treating these severe fractures. It may reduce the overall disability time.

Background: The fracture of the calcaneus is the most common traumatic lesion of the hindfoot and can cause severe disability with social and economic sequelae. Since 1980, an increasing number of studies and new technologies have led to an improvement in the management of calcaneal fractures, but treatment is still controversial. The purpose of this review was to investigate the secondary scientific literature to detect the optimal management of calcaneal fracture. Methods: A MEDLINE search via PubMed was conducted. A total of 4856 articles were identified, and only meta-analyses and systematic reviews were included. Results: 59 articles with more than 10,000 calcaneus fractures were examined, and the results were divided into various topics. Most articles agree on the superiority of surgical treatments compared to conservative ones. Moreover, minimally invasive access to the sinus tarsi showed better results and fewer complications than traditional extended lateral access. Also, reduction and osteosynthesis with percutaneous and/or minimally invasive techniques seem to provide better outcomes when compared to open treatments. Conclusions: The management of calcaneal fractures requires an individualized treatment plan based on the functional demands of the patient, the type of fracture, and associated injuries. New technologies and further studies can lead to an improvement in the management of calcaneal fractures. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Extended lateral approach to calcaneus fractures is associated with a high risk of infection. Such risk can be reduced by using mini-invasive approaches. The sinus tarsiapproach provides a good overview of the posterior joint facet of the calcaneus and can also be done as a mini-invasive procedure. The authors present their first experience with osteosynthesis of joint depression calcaneal fractures using the anterolateral locking plate inserted through the sinus tarsiapproach. MATERIAL AND METHODS During the period from 1 February 2020 to 31 January 2022, 18 patients were treated by the anterolateral locking plate in the authors‘ department (3 women, 15 men). Eleven fractures were classified according to Sanders as IInd grade, five as IIIrd grade and two fractures were classified as tongue-type (as described by Essex-Lopresti). The fractures were treated by open reduction through the sinus tarsiapproach and osteosynthesis by the anterolateral locking plate combined with headless screws. The following factors were examined: time from injury, duration of surgery, quality of reduction (post-op control with multiplanar CT scans), wound and technical complications, loss of reduction after treatment, substance abuse and comorbidities. The follow-up was 12–36 months (median 17). At one year after surgery, the functional outcomes were evaluated using the AOFAS Hindfoot score. RESULTS The most common negative predispositions for successful healing were smoking (9 cases), alcohol abuse, drug abuse, mild mental retardation, personality disorder, insulin-dependent diabetes and epilepsy (1 case each), hypothyreodism and bronchial asthma (2 cases each). The time from injury to surgery and duration of surgery surgery were measured. The quality of reduction was excellent in 12 patients (dislocation less than 1 mm), good in 6 patients (dislocation less than 2 mm), dislocation more than 2 mm was not present in the group. In one case, a revision surgery was performed because of screw malposition into the subtalar joint, delayed wound healing was observed in two cases. There was no case of deep surgical site infection or loss of reduction. The mean AOFAS score after one year was 85 points. The most common complaints were scar pain or discomfort. DISCUSSION The current studies on osteosynthesis of calcaneal fractures favor the sinus tarsiapproach for its lower risk of wound-related complications compared to the extended lateral approach. The sinus tarsiapproach requires the use of different osteosynthetic material than the conventional calcaneal plate. If a conventional locking plate is to be used, the surgical approach has to be modified. In 2021, Wang et al. published an intermediate step leading to the reduction of early complications and the use of conventional locking calcaneal plate inserted through the sinus tarsiapproach, with an additional incision. The sinus tarsiapproach is used also when intramedullary nailing is performed, which is preferred by biomechanical studies evaluating the rigidity of osteosynthesis. However, when comparing nails and locking plates, the differences are insignificant. The use of anterolateral locking plates was presented by Xie et al., with results similar to those of our own group of patients. CONCLUSIONS The results of the followed-up group of patients confirm low complication rate of the sinus tarsiapproach as reported by current literature. At the same time, it provides good options for reduction even in complicated fractures. For successful osteosynthesis, the anterolateral locking plate with headless screws may be used. The incidence of post-operative complications is low even in high-risk patients. Adhesions of peroneal tendons can be treated with material removal and tissue release. They could be prevented by good physiotherapy. [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

Background: Only one article described ankle varus as a typical symptom in the late stage of the intra-articular osteoid osteoma of the calcaneus. And the red-brown color of synovial fluid in the affected joint hasn't been reported. This report shows a patient with intra-articular osteoid osteoma of the calcaneus who had the 2 above symptoms. Case presentation: A 39-year-old man had left ankle pain and the diagnosis was delayed for 20 months. At the late stage, the ankle was gradually varus. In our hospital, the withdrawal of the subtalar joint gave a red-brown synovial fluid. Together with the typical lesion on MRI, the diagnosis of intra-articular osteoid osteoma of the calcaneus was made. An open operation was performed for treatment. In the procedure, the red-brown synovial fluid was exuded. A specimen was harvested for biopsy confirming osteoid osteoma. Conclusions: It is still essential that intra-articular calcaneal osteoid osteoma should be considered in patients with prolonged pain and varus of the ankle. The red-brown synovial may be used as a finding for diagnosis. [ABSTRACT FROM AUTHOR]

Gelatinous transformation of bone marrow (GTBM) is a complication of various diseases, one of which is anorexia nervosa (AN). We describe a rare case of a 20-year-old man who presented to our clinic with a 3-month history of heel pain without trauma. At presentation, he was noted to have a low body mass index (BMI) of 16.2 kg/m2 and pancytopenia. On magnetic resonance imaging, the left calcaneus showed low intensity on T1-weighted and high intensity on T2-weighted images. Open biopsy was done because we suspected that the lesion was either a lymphoproliferative tumor or a trabeculartype bone metastatic tumor. However, tissue histology of bone samples showed atrophy of fat cells with deposition of gelatinous material and a decreased hematopoietic cell population. Therefore, we made a diagnosis of GTBM, most likely caused by AN. We started treatment with nutritional support, and 6 months later, the hematological parameters returned to normal and BMI improved to 19.4 kg/m2. He was able to return to work and had no left heel pain. This case indicates that foot and ankle surgeons need to be aware of this rare pathology, although it might be difficult to diagnose without biopsy. To our knowledge, very few descriptions of GTBM in the calcaneus have been reported to date. [ABSTRACT FROM AUTHOR]

Background: Bone marrow aspirate (BMA) is used with the putative goal of enhancing healing of injured tissue. The most common sites to harvest BMA are the iliac crest, the tibia, and the calcaneus. Investigators have found that the tibia and calcaneus have fewer progenitor cells than the iliac crest. This retrospective review evaluates the efficacy and safety profile of harvesting BMA from the calcaneus bone. We hypothesized that harvesting BMA from the calcaneus will have high efficacy and safety profile with low complication rates. Methods: A retrospective chart review of patients undergoing bone marrow aspiration from the calcaneus bone from January 2019 to October 2022 was performed. The main data points evaluated were patient satisfaction and pain level, followup times, quantity of BMA harvested, fusion rates, and complications including nerve damage, infections, and nonunions. Results: There were 45 (34 female and 11 male) patients who underwent 45 procedures. The average age, BMI, and amount of BMA were 45.1 years (range 23-79), 33.1 (range 19.2-61.3), and 10.3 mL (range 2-40), respectively. There was no pain reported at the final follow-up in 32 patients (71.1%), and there was minimal to no pain in the area of surgery in the remaining 13 patients (28.9%). The 10 cases of fusion successfully healed with combined use of allograft and BMA. The average follow-up time was 12.3 months (range 2.4-33.7). There were no infections, wound complications, or nerve injuries. Conclusion: Harvesting BMA from the calcaneus bone is a safe procedure. In this heterogenous series where BMA augmented other surgical strategies, patients had little to no pain and there were no cases of wound complication or iatrogenic neuropraxia after undergoing bone marrow harvest from the calcaneus. [ABSTRACT FROM AUTHOR]

Background The association of sedentary behavior and physical activity with bone mineral density (BMD) in Chinese population has been rarely studied in China, and also seldom studied in Asian populations (mainly limited in young children) by foreign countries. Considering there are great discrepancies between foreign populations and Chinese populations in genetics, dietary habits and other aspects, it is necessary to carry out relevant research in China. Objective To assess the association of sedentary behavior and physical activity with calcaneal BMD in college students, offering a reference for understanding the bone health status of college students, and for preventing osteoporosis in middle-aged and old people. Methods By use of stratified cluster sampling, 781 college students aged 19-25 years (including 518 females and 263 males) of different grades were selected from a medical university in Guangzhou from January 2021 to March 2022. Demographic and anthropometric characteristics (including sex, age, height, weight, fat mass index and fat free mass index) and lifestyle information (including daily sedentary time, time spent on physical activity in one week, frequency of dairy products, carbonated drinks and tea consumption, calcium supplement, smoking status, alcohol use status) were collected. Calcaneal BMD was measured, and compared across college students by physique and lifestyle. Multiple linear regression and binary Logistic regression were used to investigate the association of sedentary behaviors and physical activity with calcaneal BMD. Results The prevalence of normal and abnormal calcaneal BMD in all students was 50.3% and 49.7%, respectively. The prevalence of abnormal calcaneal BMD in female college students (59.4%) is higher than that in male college students (30.4%) (χ2=58.849, P8 hours per day〔OR=0.17, 95%CI (0.04, 0.68), P

Introduction/Objective. Heel deformity accompanied by pain at the attachment of the Achilles tendon is generally known as Haglund’s syndrome. The prominence of the posterosuperior part of the heel bone generates pressure on the retrocalcaneal bursa and Achilles tendon, causing swelling and pain. The condition itself can be treated using surgical or non-surgical methods. The aim was to present our first experiences in the endoscopic treatment of Haglund’s syndrome, employing the three-portal technique. Methods. This study includes ten patients whose surgeries were performed during the period between January 2019, and May 2020. All interventions were endoscopic with the three-portal technique used. The diagnosis was made based on the anamnesis, clinical examination, X-rays, and magnetic resonance imaging diagnostics. For the evaluation of results, the AOFAS (American Orthopedic Foot and Ankle Society) score was used. Results. The endoscopic findings in all patients revealed a hypertrophic retrocalcaneal bursa and prominence at the posterosuperior part of the calcaneus, generating pressure on the Achilles tendon. By employing the three-portal technique, considerably better visualization is obtained, enabling easy removal of the degenerated tissue. The radiographic control image was satisfactory. The result of the AOFAS score showed a significant improvement after the surgery. Conclusion. The endoscopic approach and the use of the three-portal technique in resolving Haglund’s syndrome is a secure procedure that produces good results. It enables faster recovery and fewer complications compared to open surgery.

Background: Luxation of the superficial digital flexor (SDF) tendon involves the dislocation of the tendon from the groove of the calcaneal tuberosity. Although it is common in Shetland sheepdogs and collies presenting with acute, severe, and non-weight-bearing lameness, it is a rare orthopedic disease in golden retrievers. Case Description: A 13- month-old neutered male golden retriever (32.2 kg) with acute right hind lameness and pain, was diagnosed with SDF luxation based on physiological, radiographic, and ultrasound examinations. The surgical procedure used was capsulorrhaphy of the tarsal joint and fixation with Kirschner wire. Postoperatively, the tarsal joint was stretched and externally fixed to prevent tension. The patient showed good gait without pain after pin removal on postoperative day 88. Conclusion: In clinical practice, the possibility of this condition should be considered in golden retrievers presenting with lameness. [Open Vet J 2022; 12(6.000): 851-854]

Abstract Objective To compare the clinical efficacy of minimally invasive percutaneous treatment by ligamentotaxis with traditional open reduction and internal fixation in the treatment of Essex-Lopresti joint depression-type displaced intra-articular calcaneal fractures (DIACFs). Methods The medical records of patients with calcaneal fractures admitted to our department from January 2016 to December 2020 were retrospectively analyzed, and patients who met the inclusion criteria were finally included for analysis. Twenty-one patients underwent minimally invasive percutaneous treatment by ligamentotaxis (Group A), while eighteen patients were treated by traditional open reduction and internal fixation through an extended lateral approach (Group B). The preoperative waiting time, operative time, hospital stay, radiologic parameters (calcaneal height, width, length, Böhler angle and Gissane angle), American Foot and Ankle Surgery Association (AOFAS) hindfoot scores, Maryland Foot Score (MFS), visual analogue scale (VAS), and incidence of complications of the included patients were all recorded and analysed. Results Thirty-nine patients with Essex-Lopresti joint depression type DIACFs were finally included. According to the Sanders classification, 22 were type II, 12 were type III and 5 were type IV. The preoperative waiting time and the hospital stay of Group A were 3.7 ± 1.6 d and 7.2 ± 1.7 d, respectively, which were significantly shorter than those of Group B (6.9 ± 2.0 d and 12.4 ± 1.5 d) (P 0.05). No significant differences were shown in the radiological parameters (calcaneal height, width, length, Böhler angle and Gissane angle) or the satisfactory rate of joint surface reduction (SRJSR) of the two groups immediately postoperatively. All patients were followed up for 14 to 56 months [(30.2 ± 10.4) months]. All fractures healed. At the final follow-up, there were no significant differences in the radiological parameters or the SRJSR between the two groups (P > 0.05). No significant differences were shown in the AOFAS scores, MFS or VAS scores between the two groups [(89.5 ± 8.2) vs. (89.4 ± 9.0), P > 0.05; (87.5 ± 8.3) vs. (86.3 ± 8.9), P > 0.05; and (2.1 ± 1.2) vs. (2.2 ± 1.2), P > 0.05]. The excellent and good rates of the AOFAS scores and MFS were 90.5% and 85.7%, respectively, in Group A and 88.9% and 88.9%, respectively, in Group B (P > 0.05). Four patients experienced wound complications, including 1 superficial incision infection, 2 skin necrosis around the incision edge and 1 deep infection in Group B, while there were no wound complications in Group A (P 0.05). Conclusions In the assessment of Essex-Lopresti joint depression type DIACFs, minimally invasive percutaneous treatment by ligamentotaxis has similar clinical outcomes to traditional open reduction and internal fixation through an extended lateral approach. However, the former has the advantages of shorter preoperative waiting time and hospital stay, and lower incidence of incision complications.

Abstract Background Resection of tarsal coalitions provides good patient satisfaction scores, reduced pain, and improved long-term function in both athletic and non-athletic populations. This study aimed to determine when athletic patients undergoing resection of a tarsal coalition were able to return to their desired activity, and whether they experienced a decreased desired activity level (DDA). Methods Data on a total of 78 patients who underwent 97 tarsal coalition resections (49 talocalcaneal coalitions, 47 calcaneo-navicular, 14 cuboid-navicular, and three cuneo-navicular; some patients had more than one coalition) operated between January 2001 and June 2020 were prospectively collected. To subjectively assess outcomes, the Roles and Maudsley score (RM) was utilized. Results At an average follow-up from the index procedure of 33.6 ± 41.5 months, return to activity for the entire cohort was 18.3 ± 9.6 weeks. Post-RM was 1.3 ± 0.6. Conclusion Surgical excision of tarsal coalitions produced favorable results, with most patients able to return to their desired activity level. Level of evidence IV.

Objectives: To use the computed tomography (CT) attenuation of the foot and ankle bones for opportunistic screening for osteoporosis. Methods: Retrospective study of 163 consecutive patients from a tertiary care academic center who underwent CT scans of the foot or ankle and dual-energy X-ray absorptiometry (DXA) within 1 year of each other. Volumetric segmentation of each bone of the foot and ankle was done in 3D Slicer to obtain the mean CT attenuation. Pearson's correlations were used to correlate the CT attenuations with each other and with DXA measurements. Support vector machines (SVM) with various kernels and principal components analysis (PCA) were used to predict osteoporosis and osteopenia/osteoporosis in training/validation and test datasets. Results: CT attenuation measurements at the talus, calcaneus, navicular, cuboid, and cuneiforms were correlated with each other and positively correlated with BMD T-scores at the L1-4 lumbar spine, hip, and femoral neck; however, there was no significant correlation with the L1-4 trabecular bone scores. A CT attenuation threshold of 143.2 Hounsfield units (HU) of the calcaneus was best for detection of osteoporosis in the training/validation dataset. SVMs with radial basis function (RBF) kernels were significantly better than the PCA model and the calcaneus for predicting osteoporosis in the test dataset. Conclusions: Opportunistic screening for osteoporosis is possible using the CT attenuation of the foot and ankle bones. SVMs with RBF using all bones is more accurate than the CT attenuation of the calcaneus.

Abstract This study examined whether radiographic images measurements of the calcaneus in cats are determinative of sex and breed. For this purpose, radiographic images of 70 cats (37 male and 33 females) of different ages (from one to 18 years) and different breeds (41 mix‐breed, 18 Scottish Fold and 11 British Shorthair cats) without orthopaedic problems were used. Right tarsal joint radiographs of these orthopaedically healthy cats were taken. Four linear measurements and two angle values of the calcaneus were obtained from the radiographic images. The MANOVA result showed that the most determining factor between the three groups was the greatest width (p value = 0.001). Calcaneal body length, calcaneal greatest length and calcaneal shortest depth were higher in mix‐breed cats. Calcaneal tuber length was higher in Scottish Fold cats. The only statistically significant difference between Scottish Fold and British Shorthair was in the calcaneal tuber length (p value = 0.04). In the comparison made between the sexes regardless of species, the linear measurements in males were higher than in females. It was determined that these parameters are statistically significant in terms of sex differentiation in cats. Dorsal and plantar calcaneal angles are not sex determinants in cats. The effect of age on other measurements was analysed by correlation test. However, the effect of age on the measurements was not statistically significant. Mix‐breed cats were examined in four groups according to their colour (grey, black‐white, yellow, tri‐colour). No statistically significant difference was found between calcaneal measurements of cats with different skin colour genotypes. In this study, calcaneus measurements were both determinative between breeds and sexes in cats.

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]

Introduction: Flatfoot is a condition commonly seen in children; however, there is general disagreement over its incidence, characterization and correction. Painful flatfoot accompanied with musculoskeletal and soft tissue problems requires surgery to avoid arthritis in adulthood, the most common surgical approach being two osteotomies to the calcaneus and medial cuneiform bones of the foot. Objectives: This study focuses on the parametrization of these two bones to understand their bone morphology differences in a population sample among 23 normal subjects. Population differences could help in understanding whether bone shape may be an important factor in aiding surgical planning and outcomes. Methods: A total of 45 sets of CT scans of these subjects were used to generate surface meshes of the two bones and converted to be iso-topological meshes, simplifying the application of Generalized Procrustes Analysis and Principal Component Analysis, allowing the main sources of variation between the subjects to be quantified. Results: For the calcaneus, 16 Principal Components (PCs) and, for the medial cuneiform, 12 PCs were sufficient to describe 90% of the dataset variability. The quantitative and qualitative analyses confirm that for the calcaneus PC1 describes the Achilles attachment location and PC2 largely describes the anterior part of the bone. For the medial cuneiform, PC1 describes the medial part of the bone, while PC2 mainly describes the superior part. Conclusion: Most importantly, the PCs did not seem to describe the osteotomy sites for both bones, suggesting low population variability at the bone cutting points. Further studies are needed to evaluate how shape variability impacts surgical outcomes. Future implications could include better surgical planning and may pave the way for complex robotic surgeries to become a reality.

This paper describes the morphology of the feet of a population of elite women from the Ming dynasty (1368-1644 CE) in Shaanxi province. This is a social stratum, time, and place in which foot binding was practiced. Among a group of 31 skeletons exhumed from the cemetery, eight were women with well-preserved foot bones. Macroscopic examination revealed that half these women (4/8) had clearly altered foot bones: the metatarsal bones, and the few observable phalanges, were gracile and small, while the tarsal bones exhibited a slight reduction in size but no dramatic change in morphology. The other half of the women (4/8) had apparently unmodified metatarsal bones. T-tests comparing linear measurements of the foot bones between the two groups revealed that metatarsal bones were the most affected by binding, and among the tarsal bones, the talar trochlea and calcaneal dimensions were most impacted. This small group of skeletons reveals that some elite women in Shaanxi apparently still did not practice foot binding in the late Ming dynasty, or practiced a much milder form of foot binding, and that there was considerable variation even among those who did practice it.

Osteomyelitis of the calcaneus is a complex disease that is difficult to treat, as it is based on a lesion of the spongy bone, that is poorly capable of regeneration, especially in the purulent-inflammatory process. There are also a number of factors that aggravate the course of the disease: impaired blood supply, in particular obliterating atherosclerosis of the lower extremities, decreased body reactivity and the presence of diabetes mellitus. Currently, the treatment of osteomyelitis is complex. The key role is played by radical surgical treatment aimed at eliminating the purulent focus with subsequent replacement of the defect with a patient’s own tissues or artificial materials. This clinical observation presents a comprehensive approach to the treatment of calcaneal osteomyelitis, which includes sanitation of the osteomyelitis focus, grafting of a bone tissue defect with an automyelo-fibrinous-platelet clot and wound vacuum therapy using the first domestic device Impulse KM-1. As a result of the provided treatment, a positive clinical result has been achieved.

Abstract Background Complete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury. Case presentation A 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint. Conclusion Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.

An aneurysmal bone cyst (ABC) is a rare bone tumor usually observed in long bones. The surgical treatment of this pathology is often related to high recurrence rates, so novel biological techniques can help to enhance tissue regeneration and bone consolidation. We present a case of a patient with ABC of the calcaneus treated with an endoscopic resection followed by grafting with an autologous-based matrix composed of allograft bone chips and autologous platelet-rich plasma (PRP) in semisolid and liquid states. Patient demonstrated excellent defect filling in both magnetic resonance imaging and radiologic exams and returned to pre-injury activity with no recurrence at 2 years follow-up. Endoscopic curettage together with allograft bone and autologous PRP is effective in treating ABC patients and could be a good adjuvant treatment to prevent reinjury and enhance consolidation.

Background: In people with diabetes (DM) and peripheral neuropathy (PN), loss of bone mineral density (BMD) in the tarsals and metatarsals contribute to foot complications; however, changes in BMD of the calcaneal bone is most commonly reported. This study reports rate of change in BMD of all the individual bones in the foot, in participants with DM and PN. Our aim was to investigate whether the rate of BMD change is similar across all the bones of the foot. Methods: Participants with DM and PN (n = 60) were included in this longitudinal cohort study. Rate of BMD change of individual bones was monitored using computed tomography at baseline and 6 months, 18 months, and 3–4 years from baseline. Personal factors (age, sex, medication use, step count, sedentary time, and PN severity) were assessed. A random coefficient model estimated rate of change of BMD in all bones and Pearson correlation tested relationships between personal factor variables and rate of BMD change. Results: Mean and calcaneal BMD decreased over the study period (p < 0.05). Individual tarsal and metatarsal bones present a range of rate of BMD change (-0.3 to -0.9%/year) but were not significantly different than calcaneal BMD change. Only age showed significant correlation with BMD and rate of BMD change. Conclusion: The rate of BMD change did not significantly differ across different foot bones at the group level in people with DM and PN without foot deformity. Asymmetric BMD loss between individual bones of the foot and aging may be indicators of pathologic changes and require further investigation. Trial registration: Metatarsal Phalangeal Joint Deformity Progression—R01. Registered 25 November 2015, https://clinicaltrials.gov/ct2/show/NCT02616263 [ABSTRACT FROM AUTHOR]

Sex estimation is an important aspect of skeletal identification. In addition, previous studies have found that the sex estimation of each race is different. Thus, it is necessary to develop discriminant function equations for the estimation of sex for the Thai population. This study aims to investigate the relationship between width, length and height of the calcaneus and talus with regards to sex and compare the effectiveness of sex estimation between the calcaneus alone, the talus alone, and between both the calcaneus and talus. A total of 200 individuals (100 males and 100 females) were used in this study; ages ranged from 19 to 94 years. Thirteen variables of calcaneus and ten variables of talus were measured. The authors created discriminant function equations for the estimation of sex and tested the efficiency of the equations obtained by using a test group of 40 individuals (20 males and 20 females). By analyzing the mean values of the variables in the calcaneus and the talus, it was shown that males were significantly different from females (p<0.05). Except for the Minimum Inferior Interarticular Distance (MinIID) variable in the left and right talus, the mean of the male and female variables was not significantly different (p>0.05). A stepwise method was used to create 6 equations for sex estimation. The equations were categorized from between the calcaneus alone, the talus alone, and between both the calcaneus and the talus, providing a sex estimation accuracy of between 88.5 and 93.0 %. Using the test group, it was shown that discriminant function equations from the calcaneus alone, the talus alone, and the calcaneus and the talus together, can estimate sex at a high level of accuracy. Sex estimation accuracy was greater than 85 % in all equations. Therefore, the discriminant function equations from the calcaneus alone, the talus alone, and between both the calcaneus and the talus, from this study can be applied to the Thai population. [ABSTRACT FROM AUTHOR]

Bone autografts are frequently harvested for use in foot and ankle surgery. A commonly used harvest site is the iliac crest; however, because of known morbidity with this site, the tibia and calcaneus are attractive alternatives. There remains limited understanding regarding the osteogenic potential of autografts from each of these locations. In this review, we provided an update of the known data on bone autografts from the iliac crest, tibia, and calcaneus, focusing on the total cells harvested from each site as well as the presence of osteogenic osteoprogenitor cells. Level of Evidence: Level V, expert opinion. [ABSTRACT FROM AUTHOR]

Background: The Malerba calcaneal Z-osteotomy is an operative procedure to treat the hindfoot varus component of adult cavovarus deformity. Basic science studies support the corrective ability of this osteotomy. However, there have been no published midterm clinical and radiographic results. The purpose of this article is to describe the radiographic and clinical improvement in a series of patients treated with this osteotomy. Methods: A retrospective chart review identified 14 feet in 12 patients from January 2013 to August 2018 who met minimal follow-up criteria. Preoperative visual analog scale (VAS) scores, Foot Function Index (FFI) scores, and American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared with postoperative scores. Preoperative Meary angle, calcaneal pitch, and hindfoot alignment were also compared with postoperative measurements. Complications and radiographic union were recorded. Results: At a mean of 80 months, VAS, FFI, and AOFAS scores improved from 7.86 to 1.64, 57.78% to 18.11%, and 39.57 to 80.71, respectively (all P <.001). At a mean of 15 months, Meary angle, calcaneal pitch, and hindfoot alignment improved from 11.14 to 6.64 degrees (P <.001), 30.93 to 27.43 degrees (P =.005), and 19.83 degrees varus to 8.50 degrees varus (P <.001). There was 1 nonunion and 1 postoperative sural nerve neuralgia, but both patients ultimately did well clinically. There were no instances of postoperative tarsal tunnel syndrome. All patients stated that they would have the procedure done again. Conclusion: The calcaneal Z-osteotomy is an effective method to treat adult hindfoot cavovarus deformity. All patients had good clinical outcomes with minimal complications. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Background: Luxation of the superficial digital flexor (SDF) tendon involves the dislocation of the tendon from the groove of the calcaneal tuberosity. Although it is common in Shetland sheepdogs and collies presenting with acute, severe, and non-weight-bearing lameness, it is a rare orthopedic disease in Golden Retrievers. Case Description: A 13-month-old neutered male Golden Retriever (32.2 kg) with acute right hind lameness and pain, was diagnosed with SDF luxation based on physiological, radiographic, and ultrasound examinations. The surgical procedure used was capsulorrhaphy of the tarsal joint and fixation with Kirschner wire. Postoperatively, the tarsal joint was stretched and externally fixed to prevent tension. The patient showed good gait without pain after pin removal on postoperative day 88. Conclusion: In clinical practice, the possibility of this condition should be considered in Golden Retrievers presenting with lameness. [ABSTRACT FROM AUTHOR]

Background: The fracture of the calcaneus is the most common traumatic lesion of the hindfoot and can cause severe disability with social and economic sequelae. Since 1980, an increasing number of studies and new technologies have led to an improvement in the management of calcaneal fractures, but treatment is still controversial. The purpose of this review was to investigate the secondary scientific literature to detect the optimal management of calcaneal fracture. Methods: A MEDLINE search via PubMed was conducted. A total of 4856 articles were identified, and only meta-analyses and systematic reviews were included. Results: 59 articles with more than 10,000 calcaneus fractures were examined, and the results were divided into various topics. Most articles agree on the superiority of surgical treatments compared to conservative ones. Moreover, minimally invasive access to the sinus tarsi showed better results and fewer complications than traditional extended lateral access. Also, reduction and osteosynthesis with percutaneous and/or minimally invasive techniques seem to provide better outcomes when compared to open treatments. Conclusions: The management of calcaneal fractures requires an individualized treatment plan based on the functional demands of the patient, the type of fracture, and associated injuries. New technologies and further studies can lead to an improvement in the management of calcaneal fractures.

Background/Aim. Determining the value of Gissane’s angle (GA) plays a role in the diagnosis and prognosis of heel fractures, determining treatment methods, and assessing the outcome of surgical treatment. Normal values of the GA vary in relation to ethnicity, age, and gender of the examined group, which indicates its anthropometric significance. The aim of this study was to determine the range of normal GA values in the population of Central Serbia. Methods. GA was determined on lateral radiography of the foot of 145 subjects of both sexes (67 women and 78 men), with subjects divided into 6 age groups. The patients included in the study did not have a calcaneus fracture. The obtained results were processed in the Graph Pad program. Results. The average value of GA in Central Serbia was 110.8° ± 8.1°, ranging from 93° to 132.9°. The mean value of GA decreased with age, and no difference was observed between women and men, except in the youngest age group, where women had higher GA values than men. Conclusion. The results of the study showed a wide range of normal GA values, as well as the existence of a difference in subjects of different ages and sex.

Background: Reduction of calcaneal fractures using the sinus tarsi approach can be challenging due to limited visualization of the fragment fragments and lack of direct access for reduction instrumentation. The present study introduces a modified reduction technique using a percutaneously placed two pin joint distractor along the medial wall of the calcaneus to assist with reduction. Case Study: We present the treatment of a 44-year-old male with Sanders IV calcaneus fracture. Multiple reduction techniques were attempted through a sinus tarsi approach including use of a traction pin through the calcaneal tuberosity. Adequate reduction was then attained using a two-pin joint distractor inserted percutaneously along the medial aspect of the calcaneus at the sustentaculum tali and tubor. Adequate reduction with this method provided adequate reduction for definitive fixation. This technique has been reproducible at our institution. Conclusions: The technique described in the present study may assist surgeons in the reduction of difficult calcaneus fractures with minimal invasiveness. The technique can be used to realign the calcaneus with minimal soft tissue dissection and can be performed immediately following injury in instances of extensive soft tissue swelling. Percutaneous reduction avoids the risk of wound complications and infection that is common with the lateral extensile approach. Minimally invasive reduction and fixation of the calcaneus as described is technically demanding, and hindfoot osteology and surface anatomy should be understood.

Abstract Background In people with diabetes (DM) and peripheral neuropathy (PN), loss of bone mineral density (BMD) in the tarsals and metatarsals contribute to foot complications; however, changes in BMD of the calcaneal bone is most commonly reported. This study reports rate of change in BMD of all the individual bones in the foot, in participants with DM and PN. Our aim was to investigate whether the rate of BMD change is similar across all the bones of the foot. Methods Participants with DM and PN (n = 60) were included in this longitudinal cohort study. Rate of BMD change of individual bones was monitored using computed tomography at baseline and 6 months, 18 months, and 3–4 years from baseline. Personal factors (age, sex, medication use, step count, sedentary time, and PN severity) were assessed. A random coefficient model estimated rate of change of BMD in all bones and Pearson correlation tested relationships between personal factor variables and rate of BMD change. Results Mean and calcaneal BMD decreased over the study period (p

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 0.05). 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.