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The in vivo kinematic characteristics of the tarsal joints during gait stance phase were still unclear in adult-acquired foot deformity (AAFD). This study included seven healthy subjects (14 feet) and 12 stage II AAFD patients (14 feet). The 3D models of tarsal bones were reconstructed based on CT scan. Each subject took standard gait on the single fluoroscopy system. Continuous lateral fluoroscopic images were collected. The key postures during the stance phase were selected. The 2D-3D registration technique was applied to explore the spatial motions of the tarsal joints in 6 degrees of freedom (DOF). During the whole stance phase, the AAFD talo-navicular joint (TNJ) exhibited ROM of 13 ± 6° in the sagittal plane while the normal subjects showed ROM of 7 ± 3° (p = 0.004). In AAFD, the subtalar joint (STJ) demonstrated 19 ± 8° and 7 ± 3° of motion in coronal and horizontal plane, respectively, while the normal subjects showed 14 ± 4°(p = 0.031) and 11 ± 3° (p = 0.014) of motion, respectively. Additionally STJ of AAFD patients showed significantly less dorsiflexion during the weight acceptance and showed significantly less external rotation both during the weight acceptance and single limb support of stance phase. In conclusion, for stage II AAFD patients, the talonavicular joint and the subtalar joint showed hypermobility in dorsi/planterflexion and inversion/eversion, respectively, during the gait stance phase while the internal/external rotation of the subtalar joint was reduced. The current study improves our understanding of the pathological kinematics of the tarsal complex in AAFD patients. Notice should be taken about these tarsal joints mobility in AAFD during clinical practice. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:477-482, 2019.

Purpose To point out the need to take into account the dysplastic nature of tarsal bones when treating idiopathic clubfoot (CF). Methods Review the published evidence on the developmental abnormalities of tarsal bones in idiopathic CF. Results The literature review provides abundant proof of the existence of delayed appearance and slower development of ossification centres of tarsal bones in idiopathic clubfoot. Conclusion Gentle manipulations and casting are the cornerstone of the Ponseti method. The biological response of all foot elements is critical for a successful outcome. Delayed ossification and abnormal development of tarsal bones in idiopathic CF may affect the results. Development of a personalized tailored bracing protocol based on severity assessment and response to casting treatment will improve results and quality of care in CF management. Level of Evidence V

Objective The aim of the study was to assess and compare the knowledge of fourth-year medicine, physiotherapy (PT), nursing, and podiatry students in carpal and tarsal bone anatomy. Methods A cross-sectional study was carried out. Based on a nonprobability convenience sampling, 177 fourth-year students (117 women and 60 men, mean age of 23.16 ± 3.82 years) from the podiatry (n = 39), nursing (n = 26), PT (n = 73), and medicine (n = 39) schools at a large Spanish university were included. Measurements were taken of their gross anatomy knowledge by means of the carpal and the tarsal bone tests. Students were asked to identify all carpal and tarsal bones in an illustration of the bony skeleton of both regions and were given a maximum of 5 minutes per test. Results Of a total of 15 bones to be labeled, the PT (11.07 ± 3.30) and podiatry (9.36 ± 2.93) students had the highest rate of correct answers compared with the medicine (6.13 ± 3.27) and nursing (4.04 ± 3.72) undergraduates. When assessing academic degrees and test scores, significant differences were observed between PT and podiatry participants vs those from the medicine and nursing schools ( P Conclusion Fourth-year students from the PT and podiatry programs correctly identified a higher number of carpal and tarsal bones than students from the nursing and medicine schools.

The aneurysmal bone cysts, usually found in the tibia, femur, pelvis, or humerus, are expansile pseudotumor lesions of unknown etiology. An aneurysmal bone cyst is rarely seen in the medial cuneiform. In this case report, a 43-year-old man with an aneurysmal bone cyst in the left medial cuneiform is presented. The cyst was curetted, and the defect was filled with an en bloc iliac crest graft. A screw was placed to fix the graft in the proper position. In the 2-year follow-up of the patient, recurrence was not detected radiologically.

OBJECTIVE To investigate the effects of triamcinolone acetonide (TA) and methylpredniso-lone acetate (MPA) on the viability of resident cells within the fibrocartilage on the dorsal surface of the deep digital flexor tendon (FC-DDFT) and fibrocartilage on the flexor surface of the navicular bone (FC-NB) of horses. SAMPLE 12 to 14 explants of FC-DDFT and of FC-NB from grossly normal forelimbs of 5 cadavers of horses aged 9 to 15 years without evidence of musculo-skeletal disease. PROCEDURES Explants were incubated with culture medium (control) or TA-supplemented (0.6 or 6 mg/mL) or MPA-supplemented (0.5 or 5 mg/mL) medium for 6 or 24 hours. Explant metabolic activity and percentage of dead cells were assessed with a resazurin-based assay and live-dead cell staining, respectively, at each time point. Drug effects were assessed relative to findings for the respective control group. RESULTS Application of TA (at both concentrations) did not significantly change the cell viability of FC-DDFT explants. For FC-NB explants, TA at 6 mg/mL significantly reduced the metabolic activity and increased the percentage of dead cells at both time points. With either MPA concentration, FC-DDFT and FC-NB explants had reduced metabolic activity and an increased percentage of dead cells at 24 hours, whereas only MPA at 5 mg/mL was cytotoxic at the 6-hour time point. CONCLUSIONS AND CLINICAL RELEVANCE In ex vivo explants, TA was less cytotoxic to equine FC-DDFT and FC-NB cells, compared with MPA. Further work is warranted to characterize the drugs' transcriptional and translational effects as well as investigate their cytotoxicity at lower concentrations.

Background Although lengthening of the lateral column through an osteotomy of the anterior calcaneus is an integral component of flatfoot reconstruction in younger patients with flexible planovalgus deformities, the procedure has been implicated in iatrogenic calcaneocuboid (CC) subluxation and subsequent degenerative changes at the CC articulation. The purpose of this study is to characterize alterations at the CC joint after lateral column lengthening (LCL) and determine if Steinmann pin stabilization of the CC joint before distraction maintains a normal relationship. Methods Seven matched pairs of fresh-frozen cadaveric feet underwent preprocedure plain radiography and cross-sectional computed tomography (CT) imaging. LCL by osteotomy through the anterior calcaneus was then performed. One foot of each matched pair had a single smooth Steinmann pin placed centrally across the CC joint before osteotomy distraction. Distraction across each osteotomy was then performed and maintained with a 12-mm porous titanium wedge. Repeat imaging was obtained and compared with preprocedure studies to quantify sagittal and rotational differences at the CC articulation. Results Following LCL, plain radiography demonstrated statistically significant increases in the percentage of the calcaneal articular surface dorsal to the superior aspect of the cuboid in both the pinned (8.2% vs. 17.6%, P=0.02) and unpinned (12.5% vs. 16.3%, P=0.04) specimens. No difference in the percentage of subluxation was found between the 2 groups after LCL. CT imaging demonstrated statistically significant increases in rotation between the calcaneus and cuboid after LCL in both the pinned (7.6±5.6 degrees, P=0.01) and unpinned (17±12.3 degrees, P=0.01) specimens. The degree of rotation was greater in unpinned specimens after LCL (P=0.043). Conclusions Both sagittal and rotatory subluxation seem to occur at the CC joint after LCL regardless of pin stabilization. As a single pin would be expected to limit pure translation while having little effect on rotation, it is possible that the rotational changes identified on 3-dimensional imaging are interpreted as dorsal translation when viewed 2 dimensionally using plain radiography. Consideration should therefore be given to CC stabilization with 2 pins during LCL to prevent this rotatory subluxation. Level of evidence Level V-cadaver study.

We aim to elucidate the mechanism of the foot by automated measurement of its multiple bone movement using 2D-3D registration of bi-plane x-ray video and a stationary 3D CT. Conventional analyses allowed tracking of only 3 large proximal tarsal bones due to the requirement of manual segmentation and manual initialization of 2D-3D registration. The learning-based 2D-3D registration, on the other hand, has been actively studied and demonstrating a large capture range, but the accuracy is inferior to conventional optimization-based methods. We propose a fully automated pipeline using a cost function that seamlessly incorporates the reprojection error at the landmarks in CT and x-ray detected by off-the-shelf CNNs into the conventional image similarity cost, combined with the automated bone segmentation. We experimentally demonstrated that the pipeline allowed a robust and accurate 2D-3D registration to track all 12 tarsal bones, including the metatarsals at the foot arch, which is especially important in the foot biomechanics but has been unmeasurable with previous methods. We evaluated the proposed fully automated pipeline in studies using a bone phantom and real x-ray images of human subjects. The real image study showed the registration error of 0.38 ± 1.95 mm in translation and 0.38 ± 1.20\(^\circ \) in rotation for the proximal tarsal bones.

Background Osteochondrosis occurs due to failure of the blood supply to growth cartilage. Osteochondrosis lesions have been identified in small tarsal bones and suggested to cause distal tarsal osteoarthritis, however; it has not been determined whether distal tarsal osteochondrosis lesions were the result of vascular failure. Objectives To perform post-mortem arterial perfusion and micro-computed tomography (CT) of the central (CTB) and third tarsal bones (TIII) of foetuses and foals up to 5 months old, to describe tarsal development and any lesions detected. Study design Descriptive, non-consecutive case series. Methods Twenty-three animals that died or were euthanased from 228 days of gestation to 5 months old were collected, comprising 2 foetuses and 9 foals of miscellaneous breeds and 12 Icelandic Horse foals; a breed with high prevalence of distal tarsal osteoarthritis. One hindlimb from each foal was perfused arterially with barium, and the CTB and TIII were examined with micro-CT. Results Perfusion yielded partial information from 41% of the animals. The CTB and TIII were supplied by nutrient arteries and perichondrial vessels with vertical, transverse and circumferential configurations. Fourteen of the 23 (61%) animals had focal defects in the ossification front, i.e. radiological osteochondrosis. The majority of lesions matched the configuration and development of vertical vessels. Additionally, full-thickness, cylindrical defects matched transverse vessels, and the long axes of some dorsal lesions matched circumferential vessels. Main limitations Lack of histological validation. Conclusions Post-mortem perfusion was poor for examination of the blood supply to the growth cartilage of the CTB and TIII. Radiological osteochondrosis lesions were compatible with vascular failure because they were focal, and because lesion geometry matched vessel configuration. The relationship between osteochondrosis and distal tarsal osteoarthritis warrants further investigation.

The effects of acupuncture treatment and taping therapy on a 22-year-old man who suffered from left foot pain due to Lisfranc joint injury were examined. Fractures of the first, second, and third metatarsal bones and a cuneiform bone were treated with acupuncture and taping therapy from March 24, 2017 to May 4, 2017. The patient was evaluated using the American Orthopaedic Foot & Ankle Society’s Ankle–Hindfoot Scale. His Ankle–Hindfoot Score increased from 27 points pre-treatment to 65 points post-treatment. There were no side effects. While the improvement observed in this patient is encouraging, no definitive conclusion on the effects of acupuncture treatment and taping therapy on Lisfranc joint injuries can be reached without further large-scale study.

The talus is the second most common fractured tarsal bone. While their incidence may be low, talus fractures are severe injuries that can lead to long-term disability and pain. Displaced talar body fractures are typically treated through an open approach with the aim of obtaining anatomic reduction and stable fixation. There are several case reports in the literature demonstrating successful management of talus fractures arthroscopically. An arthroscopic approach minimizes soft tissue trauma, which can help decrease postoperative wound complications and infections. In this article, the authors describe a surgical technique of an arthroscopic reduction and internal fixation of a comminuted posterior talar body fracture. Compared with an open posterior approach with or without osteotomies, an arthroscopic technique improved visualization and allowed precise reduction and fixation. Levels of Evidence: Level V: Case report

Introduction: The calcaneus is the most frequently injured tarsal bone. Many calcaneal fractures are work-related as they result from a fall from height, especially in males' age 35–45 years. These fractures frequently result in long-term disability with potentially severe economic impact on the patient. Operative treatment of displaced calcaneal fractures has been a controversial due to tissue condition and wound infection. In this study, our objective is to investigate the outcome of percutaneous fixation of displaced calcaneal fractures with cannulated cancellous screws. Materials and Methods: A retrospective review of 14 patients with 16 calcaneal fractures who had percutaneous reduction and screw fixation for displaced fracture of calcaneus was done. The patients were assessed with plain radiography. In developing countries like India, cost of medical treatment is often a concern, so computed tomography scan was not done as most of the patients were poor and did not afford the treatment. The fractures were classified according to Essex-Lopresti classification system. Functional assessment involved the use of calcaneal fracture scoring system of Kerr et al. and the Maryland foot scoring. Results: The age of the patients ranged from 23 to 62 years (mean: 34 years). Time to union averaged 13 weeks (range 11–16). The treatment outcome as measured by calcaneal fracture scoring system ranged from 63 to 94 (mean 79). The mean calcaneal fracture score was 87 (72–91/100) for the tongue-shaped group and 73 (52–83/100) for the joint depression group (P = 0.0034). The mean Maryland foot score was 73/100, with 86% of patients achieving fair to excellent results. The mean functional score was 83 (42–91/100) for the tongue-shaped group and 61 (52–73/100) for the joint depression group (P = 0.002). Conclusion: Percutaneous fixation of fracture calcaneum, offers the prospect of fewer complications and better outcome, especially in Essex-Lopresti tongue-type fracture.

Embryological differentiation of the foot is noticeable by the fifth intrauterine week. By the end of the fifth week, condensation of the mesenchymal tissue has resulted in the formation of tarsal bone anlage (earliest developmental models). Tissue differentiation to precartilage and cartilage follows and all skeletal elements of the foot have begun to chondrify by 7 weeks with the exception of the distal phalanx of the little toe. By the end of the second month, the outline of each bone is becoming distinct [1–3]. Homogenous interzones develop at the ankle and between all tarsal, tarsal-metatarsal, metatarsal-phalangeal, and interphalangeal joints with the three-layered interzone developing earliest at the ankle and metatarsal-phalangeal joints at the end of the embryonic period (8 weeks). Cavitation with vascularized synovial tissue is seen in most joints of the foot at 9–11 weeks (early fetal period). A proximodistal sequence of development unfolds. By the end of the embryonic period (8 weeks), the foot resembles that of the adult in most details. All elements of the foot destined to become bone have begun to chondrify (except the distal phalanx of the little toe) by 7 weeks of embryonic life. Anomalies of the skeletal elements (such as tarsal coalition) form very early. The articular surfaces of the ankle joint and of the other joints of the foot reach a high degree of differentiation before the resorption phase of the interzone begins around 8 weeks of age. Hesser noted that the articular surfaces of the ankle joint reach a high degree of differentiation even before joint cavitation is complete [4]. The talonavicular and calcaneocuboid joints also reach close to their final shapes very early. Straus also stated that the joints of the foot are laid down in their definitive form by the ninth intrauterine week [5]. Cavitation of the interzone to form the synovial joints begins first at the ankle and progresses distally, forming last in the interphalangeal joints. O’Rahilly et al. further reviewed the skeletal development of the foot [6]. The prenatal development of the human foot has been well studied and described by Gardner et al. who reviewed the extensive developmental literature as well as assessing 184 human embryos and fetuses.

Several studies have described the pathology of idiopathic congenital clubfoot (ICCF) in fetus. Numerous pathogenetic theories have been postulated on ICCF, but many of them lack any objective evidence. Pathologic studies in fetus together with MRI studies in patients with ICCF seem to favor the theory of a muscular imbalance of the foot activators during fetal growth as the main pathogenetic factor of ICCF. Our objectives were: (I) To support the theory of muscular imbalance as the primary pathogenetic factor of ICCF; (II) To clarify why atrophy and shortening affect the activator muscles of the foot unevenly, as reported by literature. A literature search based on MEDLINE and the COCHRANE database was performed to identify all published studies from 1929 to 2020 which report ICCF pathology in fetus, its etiopathogenesis, and imaging and biomechanical studies showing how the basic pathology may be addressed by Ponseti treatment. A manual search was also performed of the references cited in studies, reviews, and university libraries. Altered size, shape and articular relationships of the tarsal bones, and uneven atrophy and shortening of the leg muscles together with capsule and ligament abnormalities were the main pathologic findings reported in fetus with ICCF. Regarding ICCF pathogenesis, the main debate is between the advocators of a primitive blastemal defect of the tarsal bones leading to the skeletal abnormalities and those who hold that the latter are secondary to a deforming force generated by the soft tissues. Imaging studies have shown that the Ponseti method is able to address the skeletal abnormalities, the correction of which is maintained until adulthood, whereas leg muscle atrophy is not improved but tends to worsen with growth. Preliminary histochemical studies of the soleus-Achilles tendon junction have shown a decrease of the growth factors and the presence of myostatin, both down-regulators of muscle growth in patients with ICCF. The authors postulate that a defect of both the radial and the longitudinal growth unevenly affecting the leg muscles with a consequent imbalance of the foot activators might be the main pathogenetic factor of ICCF. Further studies are needed to confirm this theory.

This study aims to evaluate changes in tarsal bones relationship after the use of one week accelerated Ponseti method in the treatment of severe idiopathic clubfoot using MRI. We hypothesize that one-week accelerated Ponseti is at least as effective as standard techniques in achieving the desirable MRI parameters.This is a prospective study of 8 children with severe idiopathic clubfeet (Pirani 6) (4 unilateral and 4 bilateral) treated before the age of three months with one-week accelerated Ponseti technique, as described in a former study with minimum 2-year follow-up. The 8 corrected feet were compared with the 4 unilateral normal feet at clinical and radiological levels using a Pirani scoring system and an MRI, respectively.Clinical results showed that Pirani score was 1.1 in the last follow up in comparison to Pirani 6 pretreatment (p 0.05). MRI results indicated that the malleocalcaneal angle, axial malleocalcaneal index, coronal tibiocalcaneal angle, sagittal talocalcaneal angle, and talar head neck calcaneal rotation showed statistical difference between the two groups (p 0.05). Sagittal malleocalcaneal index, sagittal tibiocalcaneal angle, talar head neck rotation related to talar body, and posterior calcaneal rotation showed no statistical difference between normal feet and clubfeet after correction (p value0.05).One-week accelerated Ponseti technique showed to be as effective and safe as other treatment methods through clinical and MRI follow up data. MRI role was to confirm the efficiency of this innovative accelerated technique, but not used as a routine follow up.

Vascularized small-bone grafting is an efficient and often necessary surgical approach for nonunion or necrosis of several bones in particular sites of the body, including scaphoid, lunate, distal ulna, and clavicle. The medial femoral condyle is an excellent graft source that can be used in treating scaphoid, ulna, clavicle, or lower-extremity bone defects, including nonunion. Vascularized bone grafting to the small bones, particularly involving reconstruction of damaged cartilage surfaces, should enhance subchondral vascular supply and help prevent cartilage regeneration. Vascularized osteoperiosteal and corticoperiosteal flaps are useful for treating nonunion of long bones.

The giant cell tumor of tendon sheath (GCTTS) is a benign lesion most commonly attached to the tendons and bones of the fingers, hands, and wrists. The involvement of GCTTS to the foot is uncommon. The GCTTS invading tarsal bones and intertarsal joints is not described yet, and the appropriate diagnosis and treatment remain unclear. We report a case of GCTTS with the involvement of tarsal bones and intertarsal joint. Computed tomography scan and magnetic resonance imaging were used to further diagnose and evaluate the quality and range of tumor. The patient was treated with surgical excision of the tumor without application of bone graft. After adequate clearance of the tumor, the patient returned to an asymptomatic walk in 3 months. No malfunction, fracture, or tumor recurrence was found in 2-years follow-up. This report includes clinical, radiologic, histologic diagnostic, and surgical challenges in an unexpected lesion and a review of the literature.

Introduction The standard of care in the treatment of symptomatic tarsal coalitions is open surgery. However, certain limitations exist with open surgery, which include limited visualization leading to an incomplete resection and possible recurrence of the tarsal coalition. Arthroscopic tarsal coalition resection (TCR) is an alternative that is gaining traction, primarily as the safety profile of posterior ankle and subtalar arthroscopy is more well understood. This study provides a systematic review of the outcomes of arthroscopic TCR. Methods PubMed and Embase were searched independently by 2 reviewers for relevant articles based on predetermined criteria. The subject heading “tarsal coalition” and its related key terms were used. Results A total of 416 studies were revealed by the initial search, out of which only 6 met our predetermined inclusion criteria. A total of 42 patients (average age: 17.6 years) were treated with arthroscopic TCR. Thirty-three (78.6%) and 9 (21.4%) patients had talocalcaneal and calcaneonavicular coalitions, respectively. The follow-up period ranged from 6 to 60 months (mean: 26 months), and no recurrence of the tarsal coalition was detected (0.0%). Complications occurred in two (4.8%) patients only, with one developing complex regional pain syndrome (CRPS), and another patient developing hyperesthesia on the medial aspect of the calcaneus. Conclusion Arthroscopic TCR is a feasible and effective surgery for both CNC and TCC with minimal complications and no disease recurrence at an average of 26 months follow-up. Future high-level of evidence studies are needed to compare the outcomes of open versus arthroscopic TCR.

Background Upper eyelid ectropion occurs as a post-blepharoplasty complication or involution change, and it causes dry eye symptoms that cannot be resolved with conservative management. Objectives The aim of this study is to describe the authors’ surgical technique of anatomical correction of upper eyelid ectropion, including tarsal scoring incision. Methods The technique involves the following 4 steps: (1) adhesiolysis at the preaponeurotic layer; (2) undermining and redraping of the pretarsal flap in a pretarsal plane; (3) optional, partial thickness tarsal scoring incision over the central two-thirds; and (4) downward repositioning of the pretarsal flap and lower fixation to the tarsus. Outcomes were assessed based on the position of eyelid margin and the improvement of the dry eye symptoms. Results A retrospective review of 54 cases of patients who underwent ectropion correction, including tarsal scoring incision, was performed. The eyelid margin was well positioned in 51 patients (94.4%). Of the 32 patients involved in the study assessed with the 7-point Patient Global Impression of Improvement, 29 (90.6%) reported the resolution of dry eye symptoms. Furthermore, in the 22 patients assessed with the Ocular Surface Disease Index, the mean score significantly decreased from 43.2 ± 24.1 before surgery to 29.8 ± 23.3 (P = 0.006) after surgery. Conclusions The combination of partial-thickness tarsal plate scoring and lower flap redraping surgical techniques resolved the upper eyelid ectropion, reducing the dry eye symptoms. Level of Evidence: 4

Tarsal coalition refers to an abnormal fibrous, cartilaginous, or bony connection that develops between two or more tarsal bones. Talocalcaneal coalition and calcaneonavicular coalition account for more than 90% of all cases of tarsal coalition. Coalition exists early at birth, but bony connection usually develops during the patient’s late growth period. Isolated cases of talonavicular coalition have rarely been reported. We herein report a case involving an 11-year-old patient with an isolated talonavicular coalition from a soft tissue to bony connection who was treated with arthroscopy for ankle arthritis. To our knowledge, this is the first case in which the whole formation of the talonavicular coalition was observed with a series of radiographic and magnetic resonance imaging examinations. The pain caused by the talonavicular coalition was managed by nonoperative treatment, while the ankle pain caused by the arthritis was relieved after ankle arthroscopy. At 6 years postoperatively, the patient remained pain-free while walking for 30 minutes and was satisfied with the operative outcome. Continuous follow-up confirmed that after the formation of talonavicular coalition, the coalition can continue to progress, forming bony talocalcaneal coalition and calcaneocuboid coalition.

Background Multicentric carpotarsal osteolysis syndrome (MCTO) is characterized by progressive destruction and disappearance of the carpal and tarsal bones associated with nephropathy. MCTO is caused by loss-of-function mutations in the MAF bZIP transcription factor B (MAFB) gene. Case presentation This report describes three unrelated patients with MAFB mutations, including two male and one female patient. Osteolytic lesions in the carpal and tarsal bones were detected at 2 years, 12 years, and 14 months of age, respectively. Associated proteinuria was noted at 4 years, 12 years, and 3 months of age, respectively. Kidney biopsy was performed in two of them and revealed focal segmental glomerulosclerosis (FSGS). One patient showed progression to end-stage renal disease, that is by 1 year after the detection of proteinuria. The second patient had persistent proteinuria but maintained normal renal function. In the third patient, who did not undergo a kidney biopsy, the proteinuria disappeared spontaneously. The bony lesions worsened progressively in all three patients. Mutational study of MAFB revealed three different mutations, two novel mutations [c.183C > A (p.Ser61Arg) and c.211C > G (p.Pro71Ala)] and one known mutation [c.212C > T (p.Pro71Leu)]. Conclusion We report three cases with MCTO and two novel MAFB mutations. The renal phenotypes were different among the three patients, whereas progressive worsening of the bony lesions was common in all patients. We also confirmed FSGS to be an early renal pathologic finding in two cases. A diagnosis of MCTO should be considered in patients with progressive bone loss concentrated primarily in the carpal and tarsal bones and kidney involvement, such as proteinuria.

Tarsal coalitions are the result of impaired mesenchymal separation of the tarsal bones. The most common types include calcaneonavicular or talocalcaneal coalitions. Subtalar stiffness results in pathologic kinematics with increased risk of ankle sprains, planovalgus foot deformity, and progressive joint degeneration. Resection of the coalition yields good results. Tissue interposition may reduce the risk of reossification, and concomitant deformity should be addressed in the same surgical setting.

Objective Restoration of physiological alignment of the distal tibia and thereby restoration of physiological loading of the ankle joint; joint preservation in asymmetric degenerative arthritis of the ankle. Indications Congenital deformities of the distal tibia; acquired deformities of the distal tibia; asymmetric degenerative arthritis with partially preserved cartilage. Contraindications Absolute contraindications comprise severe nicotine abuse, Charcot arthropathy, peripheral polyneuropathy, relevant peripheral arterial vessel disease, poor local soft tissue condition, acute infection and extensive cartilage damage grade 3-4 in the Outerbridge classification in the complete joint. Surgical technique Medial and lateral open and closed wedge osteotomies and dome osteotomies of the distal tibia are used, and shortening, lengthening and derotating osteotomies of the fibula. Postoperative management For 6 weeks, 15-20 kg partial weight-bearing in a below knee cast or a walker orthosis; full weight-bearing depending on osseous healing after 9-12 weeks postoperatively. Results Between July 2012 and May 2017, 15 patients (10 men, 5 women) underwent a supramalleor osteotomy. Average age was 41.8 years (range 17-63 years) and the retrospective average follow-up was 28.7 months (range 3-47 months). Mean preoperative AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 54.3 (range 26-86) and postoperatively a mean of 74.2 (44-100). Preoperatively, 9 patients had varus malalignment and 6 patients valgus malalignment; overall, 4 patients developed complications requiring surgical intervention (26.7%). Osteosynthetic material was removed in 60% of the patients.

There has been growing interest in minimally invasive foot surgery due to the benefits it delivers in post-operative outcomes in comparison to conventional open methods of surgery. One of the major factors determining the protocol in minimally invasive surgery is to prevent iatrogenic thermal osteonecrosis. The aim of the study is to look at various drilling parameters in a minimally invasive surgery setting that would reduce the risk of iatrogenic thermal osteonecrosis.Sixteen fresh-frozen tarsal bones and two metatarsal bones were retrieved from three individuals and drilled using various settings. The parameters considered were drilling speed, drill diameter, and inter-individual cortical variability. Temperature measurements of heat generated at the drilling site were collected using two methods; thermocouple probe and infrared thermography. The data obtained were quantitatively analysed.There was a significant difference in the temperatures generated with different drilling speeds (p0.05). However, there was no significant difference in temperatures recorded between the bones of different individuals and in bones drilled using different drill diameters. Thermocouple showed significantly more sensitive tool in measuring temperature compared to infrared thermography.Drilling at an optimal speed significantly reduced the risk of iatrogenic thermal osteonecrosis by maintaining temperature below the threshold level. Although different drilling diameters did not produce significant differences in temperature generation, there is a need for further study on the mechanical impact of using different drill diameters.

The tarsal navicular is a critical component of the foot's medial longitudinal arch. Injuries to the navicular have significant long-term functional consequences. In addition to stress fractures, acute injuries to the navicular include acute avulsion, tuberosity, and body fractures. Nonoperative treatment is the mainstay for avulsion injuries and nondisplaced body fractures. Open reduction and internal fixation is performed to achieve anatomic reduction in the other situations. Common complications following operative intervention include pain, stiffness, post-traumatic arthritis, avascular necrosis, nonunion, and hindfoot deformity. This article provides an overview for recognition and treatment of common presentations of these injuries as described in the literature.

This study aimed to describe the radiographic anatomy and osteology and to evaluate angular radiographic measurements-Norberg angle, inclination angle and anteversion angle-of the pelvic limbs in free-ranging capybaras. Twenty cadavers of free-ranging capybaras (Hydrochoerus hydrochaeris), including five adults and 15 subadults, were studied. Ventrodorsal, craniocaudal, dorsoplantar and mediolateral radiographic views of the pelvic limbs were obtained. The radiographic features were described together with bone samples. The hip bone (os coxae), shaped like an isosceles trapezoid, was elongated and narrow with the presence of an oblong obturator foramen, sagittal ilial wing and rectilinear ilial body. The femoral shaft was relatively straight, while the greater trochanter was projected above the femoral head. No sesamoid bones of the gastrocnemius and popliteus muscles were observed radiographically or for those animals used in gross macroscopy. The fibula was located lateral and parallel to the tibia. Eight tarsal bones, four metatarsal bones and three digits were identified. The mean radiographic measurements included Norberg angle of 125.9°; respective angles of femoral inclination by the Hauptman B and Tomlinson methods of 139.9 and 141°; anteversion angle of the femoral head and neck of 29.80°. The bones of the pelvic limbs in capybaras have several anatomical characters and radiological features that are shared with members of the caviomorph superfamily Cavioidea. The radiographic angles measured in this study help characterize the functional morphology of this species.

In patients with rheumatoid arthritis (RA), the talonavicular joint is commonly involved and midfoot collapse can lead to progressive flattening of the arch. Despite a general awareness of the important structural role of the talonavicular joint in rheumatoid foot disease, details of its destructive pattern have not been elucidated.We cross-sectionally investigated 176 RA patients (342 feet) and classified their feet into the following five groups according to radiographic findings: arthritis (RA changes with normal navicular shape), Müller-Weiss Disease (MWD) (collapse of the lateral aspect of the tarsal navicular), flat (flattened navicular), ankylosis (ankylosis of the talonavicular joint), and normal. We compared medical histories and radiographic measurements among all five groups.The arthritis group comprised 91 feet, 36 in the MWD group, nine in the flat group, 12 in the ankylosis group, and 194 classified as normal. The MWD group demonstrated a trend towards pes planovarus deformity in contrast to pes planovalgus deformity in the arthritis group. Corticosteroid use and the mean daily dosage were the highest in the MWD group.This report revealed a high prevalence of MWD-like changes to the navicular in RA patients and its association with pes planovarus deformity and corticosteroid usage.

Conradi–Hunermann syndrome is a common form of chondrodysplasia punctata, inherited as X-linked dominant disorder of cholesterol metabolism due to mutation of emopamil-binding protein gene resulting in a spectrum of skeletal, cutaneous, and ocular abnormalities. One-day-old premature, cesarean-delivered female neonate admitted with xerotic, featherlike yellow-to-white hyperkeratotic scale all over the body with craniofacial defect, coarse hair, patches of cicatricial alopecia, and absent eyebrows. Baby had rhizomelic shortening of proximal limb, clinodactyly, club foot, talipes equinovarus, and bilateral congenital cataract. Radiological skeletal survey revealed punctate stippled calcification involving left femoral head epiphysis, bilateral tarsal bones, vertebral bodies of multiple thoracolumbar vertebrae, and sternum. Serum level of 8-dehydrocholesterol was elevated. Diagnosis of rare disease can be made on clinical suspicion and radiological survey in resource-limited setting.

Giant cell tumor (GCT) or Osteoclastoma of the tarsal bone is very rare as compared to that of long bones. The involvement of talus becomes unique in its presentation as it remains undiagnosed for a long time. The tumor usually occurs in younger age especially in small bones of hands and feet. We present a case of 34-years old male who presented with sprain of left foot and was finally diagnosed as giant cell tumor of the talus. This was possible with the help of various radiological modalities like plain X-ray, computerised tomography (CT) and magnetic resonance imaging (MRI). GCT of talus may be found as an incidental finding but the subsequent management depends upon the staging of the tumor as per the radiological evaluation.

An enlarged and hard right hind limb of a condemned lame pig from a local slaughterhouse was submitted to National Chung Hsing University for pathological examination on 29 May 2015. Gross examination revealed brush burn and skin abscess. The radiography of the affected foot showed enlarged hock joint, collapsed tarsal joint with bony proliferation, and a soft tissue mass extending from the lateral to the tarsal bones. After the sample was split between the third and fourth metatarsal bone longitudinally, the calcaneus, talus, and the fourth tarsal bone were shown to be broken and damaged. Histopathological findings were as follows. First, the fractured bones showed the formation of callus and multiple small bone fragments were found. Second, osteoclasts and osteogenesis with bone remodeling were discovered at the edge of the bone fragments. Third, the skin abscess showed well-encapsulated clumps of bacteria and cellular debris. Trueperella pyogenes was identified from skin abscess and bone marrow. We speculate that the neglected fractures might have been related to crush injury inflicted by a sow or possible damage caused by the floor of the crate. This case highlights the importance of maintaining a high standard of animal welfare and once a lesion has occurred in food-producing animals, medication or elimination should be considered to avoid the long-term suffering of the animals.

Background The recent classifications for posterior tibial tendon dysfunction (PTTD) stage II are based on forefoot deformity, but there is still no consensus regarding a detailed explanation of the clinical condition. The purposes of this study were to clarify the clinical condition of flatfoot deformity using three-dimensional (3D) computed tomography (CT) imaging under loading on both healthy and flat feet and to compare 3D movement of the forefoot in response to load. Methods Ten volunteers and 10 PTTD stage II patients with symptomatic flatfoot deformity were examined. CT scans of 20 healthy and 20 flat feet were performed under non-loading and full weight-bearing conditions. Images of the tibia and foot arch bones (talus, calcaneus, navicular, and first and fifth metatarsal bones) were reconstructed into 3D models. Rotations of individual tarsal bone or metatarsal bone were described by the Eulerian angles. Results Compared with healthy feet, flat feet experienced plantarflexion of the fifth metatarsal bone relative to the first metatarsal bone under loading conditions. We defined this phenomenon as synonymous with forefoot varus on the coronal plane. Conclusions The results of this study have clarified part of the clinical condition of the forefoot in flatfoot deformity and may have applications in basic research of the staging advancement and substage classification of PTTD.

For the equine veterinarian, it is often difficult to interpret degenerative radiographic changes in the small tarsal joints of clinically healthy young horses on sales or prepurchase radiographs. The aim of this study was to expand the knowledge in this area by investigating the prevalence and progression of degenerative radiographic findings of the small tarsal joints in a homogenous population of young horses. For this purpose, the first part of the study comprised the radiographic examination of 292 two-year-old, clinically healthy and untrained Warmblood stallions to determine the prevalence of radiographic degenerative changes in the small tarsal joints. The second part of the study assessed the development of such degenerative changes over five to sixteen months. This time period is relevant for the public sale or stallion approval preparation of the horses. Follow-up radiographs of 77 stallions with degenerative changes were taken and evaluated to monitor the development of these changes over time. A standardized evaluation of the radiographs was guaranteed by a detailed evaluation scheme and three experienced and specifically qualified investigators. Our hypotheses were: a. Degenerative radiologic findings in the small tarsal joints have a high prevalence even in young and clinically healthy horses, b. Such radiologic changes can be dynamic over a short period of time. In the first part of the study, 22.6% of the stallions showed radiologic changes consistent with degenerative joint disease. There were osteophytes in the distal intertarsal and/or tarsometatarsal joint in 15.4%, areas of reduced radiopacity in the central tarsal or third tarsal bone in 6.5%, narrowing of the joint space of the distal intertarsal and/or tarsometatarsal joint in 0.3%, and sclerosis at the distal intertarsal joint in 0.7% of the horses. Dorsoproximal spurs at the third metatarsal bone were observed in 27.4% of horses; this was the most common radiologic finding. However, this finding alone did not result in the radiologic diagnosis of degenerative joint disease. In part two of the study, there was a tendency for progression of the findings “spur at third metatarsal bone” and “osteophytes at distal intertarsal and/or tarsometatarsal joint” over time. The finding “areas of reduced radiopacity in the central tarsal or third tarsal bone” appeared to be regressive over time. While the progression of spurs and osteophytes was expected as described in the literature, there was an unexpected regressive dynamic of areas of reduced radiopacity in the small tarsal bones. In the literature, these changes have been interpreted as lytic areas and as a sign of degenerative joint disease. A regression of bone lysis secondary to degenerative joint disease is not described in the literature and seems not plausible. However, it is possible that such areas of reduced radiopacity in the small tarsal bones are due to a delayed increase in bone density in young horses – such areas could really be regressive due to the significant potential for bone remodelling, especially in young animals. Results of our study confirm the high prevalence of degenerative radiographic changes of the small tarsal joints even in young, untrained and clinically healthy Warmblood stallions. However, areas of reduced radiopacity in the small tarsal bones can be regressive over a short period of time and should be evaluated cautiously concerning the radiologic diagnosis of degenerative joint disease.

SummaryObjective: Describe optimal corridors for mediolateral or lateromedial implant placement in the feline tarsus and base of the metatarsus.Methods: Computed tomographic images of 20 cadaveric tarsi were used to define optimal talocalcaneal, centroquartal, distal tarsal, and metatarsal corridors characterized by medial and lateral insertion points (IP), mean height, width, length and optimal dorsomedial-plantarolateral implantation angle (OIA).Results: Talocalcaneal level: The IP were at the head of the talus and plantar to the peroneal tubercle of the calcaneus and OIA was 22.7° ± 0.3. Centroquartal level: The IP were at the centre of the medial surface of the central tarsal bone and dorsoproximal to the tuberosity of the fourth tarsal bone and OIA was 5.9° ± 0.06. Distal tarsal level: The IP were at the centre of the medial surface of the tarsal bone II and dorsodistal to the tuberosity of the fourth tarsal bone and OIA was 5.4° ± 0.14. Metatarsal level: The IP were at the dorsomedial surface of the proximal end of the metatarsal bone II and at the dorsolateral surface of metatarsal bone V and OIA was 0.5° ± 0.06. Significant positive correlation was found between body weight and the length of each corridor.Clinical significance: Most of the corridors obtained in this study had a diameter between 1.5 mm and 2 mm with a length of 15 mm to 18 mm, which stresses the importance of their accurate placement.

In this retrospective study, we aim to assess the safety and feasibility of adapting subtalar arthroereisis (SA) for type I osteogenesis imperfecta (OI) patients with symptomatic flatfoot. From December 2013 to January 2018, six type I OI patients (five girls and one boy, 12 feet) with symptomatic flexible flatfoot were treated with SA and the Vulpius procedure. All the patients were ambulatory and skeletally immature with failed conservative treatment and unsatisfactory life quality. The median age at the time of surgery was 10 years (range 5&ndash, 11), and the median follow-up period was 55 months (range 33&ndash, 83). All functional and radiographic parameters improved (p &lt, 0.05) after the procedure at the latest follow-up. The median American Orthopaedic Foot and Ankle Society ankle-hindfoot scale improved from 68 (range 38&ndash, 80) to 95 (range 71&ndash, 97). All of the patients ambulated well without significant complications. The weight-bearing radiographs showed maintained correction of the tarsal bone alignment with intact bony surfaces adjacent to implants during the post-operative follow-up period. This is the very first study on symptomatic flatfoot in pediatric patients with type I OI. Our data suggest that SA is a potentially viable approach, as functional improvements and maintained radiographic correction without significant complication were observed.

Simple bone cysts compose approximately 3% of all primary bone tumors and most commonly occur in the metaphyseal regions of the proximal humerus and femur. The percentage of the talus with suspected bone tumors is reported to be 0.003%. Therefore, talar cysts are rare but sometimes present as aggressive lesions, and they can affect any of the tarsal bones. Recently, an arthroscopic approach to these lesions has been developed that is less invasive than conventional open surgery. In the present case study, we profile a 65-year-old female patient who received arthroscopic debridement of a bone cyst from the medial aspect of the talus with the osteochondral autograft transfer system (OATS). By using the OATS core harvester, we penetrated into the tumor. After the cylindrical bone plug was pulled out, the tumor was removed and artificial bone granules were firmly packed into the cavity with intralesional arthroscopy. Then, the cylindrical bone plug previously harvested by OATS was implanted at the site with careful precision. This intervention resulted in a relative restoration of talar dome anatomy and ultimately restored the patient to activity with minimal discomfort. Therefore, arthroscopic debridement with OATS has the potential to be a useful option in dealing with debilitating osteochondral cystic lesions.

A 14-year-old boy reported with congenital deformity of the left lower limb, with gross shortening, hip and knee flexion deformities, ankle with equinus deformity, and polydactyly of the left foot. Radiologic examination showed proximal femoral focal deficiency, double fibula, and duplication of the tarsal bones, and a diagnosis of 'proximal femoral focal deficiency associated with fibular duplication and diplopodia with complete agenesis of tibia' was made. Such association of deformities is very rare and poses difficulties in rehabilitation of the case. This patient was managed with elective knee disarticulation, early prosthetic fitment, and gait training.

Introduction. Tarsal coalition is a foot bone malformation, characterized by bony, cartilaginous or fibrosis fusion between the tarsal bones. It clinically appears as decreased mobility of the tarsal joints. This feature can be predicting factor for feet injuries. Aim: This study analyzed the frequency and nature of the injuries of the feet in patients with tarsal coalitions. Materials and methods. TThe article presents data on the frequency and nature of feet injuries in patients with tarsal coalitions (22 patients (30 feet) with talocalcaneal coalitions and 28 patients (45 feet) with calcaneonavicular coalitions) aged 12 to 18 years. The control group included 50 patients (80 feet) with flatfeet without tarsal coalitions, aged 12 to 15 years. The study was a retrospective analysis of anamnestic data of feet injuries. Results. The study found patients with tarsal coalitions had a significantly higher incidence of ankle sprains (the general group – 26 patients (52%) versus the control group – 12 (24%). Conclusion. Tarsal coalition can be predicting factor to feet injuries. Patients with tarsal coalitions should consider this concern for sports activities. They can use different orthoses, tape, or choose not to engage in traumatic sports to avoid ankle sprains.

To assess the clinical and radiographic outcomes of patients with recurrent anterior shoulder instability treated with fresh distal tibia allograft (DTA) glenoid reconstruction.Consecutive patients with a minimum 15% anterior glenoid bone loss associated with recurrent anterior instability who underwent stabilization with DTA glenoid reconstruction were retrospectively reviewed. Patients were evaluated with the American Shoulder and Elbow Society score, Western Ontario shoulder instability index, and single numerical assessment evaluation score at a minimum 2 years after surgery. All patients also underwent postoperative imaging evaluation with computed tomography where graft incorporation and allograft angle were measured. Statistical analysis was performed with paired t-tests, with P.05 considered significant.A total of 27 patients (100% male) with an average age of 31 ± 5 years and an average follow-up of 45 months (range, 30-66) were included. There were significant improvements in preoperative to postoperative American Shoulder and Elbow Society score (63-91, P.01), Western Ontario shoulder instability index (46% to 11% of normal, P.01), and single numerical assessment evaluation score (50-90.5, P.01) outcomes. Analysis of computed tomography data at an average 1.4 years postoperatively (available for 25 patients) showed an allograft healing rate of 89% (range, 80% to 100%), average allograft angle of 14.9° (range, 6.6° to 29.3°), and average allograft lysis of 3% (range, 0% to 25%). Grafts with lesser allograft angles (15°) were better opposed to the anterior glenoid, showing superior healing and graft incorporation. There were no cases of recurrent instability.At an average follow-up of 45 months, fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with excellent clinical outcomes and minimal graft resorption. Optimal allograft placement resulted in superior bony incorporation with the native glenoid.Level IV, therapeutic case series.

Objective. Development of methods for orthopedic correction and evaluation of their efficacy, depending on the options of pronation foot deformities in children with cerebral palsy. Material and methods. The data obtained during the orthopedic treatment of 36 patients aged from 1 year to 7 years with pronation foot deformities on the background of cerebral palsy. Survey method involves determining the height of the longitudinal arch, plantography, deviation angle of the heel bone in the sagittal and frontal planes, X-ray examination. Results and conclusions. Correction of pronation deformities included the ankle-foot cast application for the gradual elimination of the certain elements of deformation. During the treatment of the first pronated foot type, we managed to correct the equinus foot deformity, grade I, in children under the age of 2.5 years. In other cases, we could not manage to achieve the correct heel bone position, even after the repeated serial casting. Failure of repeated serial casting had a negative impact on the formation of longitudinal arch of the foot. In the case of orthopaedic treatment of the second pronated foot type, alongside with both a flexible foot and the intact tarsal bones, we managed to achieve the correct bones shape. Under the condition of the rigid foot and the deformed tarsal bones, the prolonged plaster and splint immobilization were needed. In the course of treatment of the third deformation type, a positive effect was achieved on condition that the physiological calf muscle retraction was restored and the pathological tone of the m. tibialis anterior and musculi extensoris digitorum was eliminated. The negative factor were the gross anatomical abnormalities in the tarsal bones. However, orthopaedic treatment of the third variant of strain, grade II-III, carried out as preoperative preparation that permitted to limit the scope of surgical intervention.

One case of biplanar isolated fracture and dorsal dislocation of the tarsal navicular is reported in a 72-year-old male. We had analyzed the mechanism of injury which suggested that the dislocation of the navicular cannot occur without a fracture because of anatomical considerations. These types of injury always require anatomical reduction and stable fixation, and it is mandatory to restore the keystone function of the navicular to the longitudinal arch of the foot.

Postresection reconstruction of the navicular bone is challenging. A composite hemangioendothelioma is an intermediate malignancy characterized by an admixture of differing vascular components. In the present report, a 40-year-old male with a composite hemangioendothelioma presented with multiple soft tissue lesions of the leg and sole and a navicular bone lesion. The navicular bone was resected and reconstructed using β-tricalcium phosphate of strong compression resistance with plating. The current reconstruction method can be applied, not only for tumors, but also for trauma.

This study aimed to evaluate whether radiographic abnormalities at yearling sales were associated with the failure to start racing at 2–3 years of age. Radiographic abnormalities in the carpal (n=852), tarsal (n=976), metacarpophalangeal (n=1,055), and metatarsophalangeal joints (n=1,031) from 1,082 horses, recorded at yearling sale, were reviewed. Eighty-two horses (7.6%) failed to start racing. Radiographic abnormalities such as wedged or collapsed tarsal bones, irregular lucency of a sagittal ridge at the distal aspect of the distal third metatarsal bone, and proximal dorsal fragmentation of the first phalanx in metatarsophalangeal joints were associated with failure to start racing in these horses. In the follow-up survey of 12 horses with one or more these radiographic abnormalities, the horses failed to start racing due to reasons unrelated to these radiographic abnormalities such as pelvic fractures (2 horses), fracture of a distal phalanx (1 horse), cervical stenotic myelopathy and proximal sesamoid fracture (1 horse), superficial digital flexor tendonitis (2 horses), laryngeal hemiplegia (1 horse), economic problems (2 horses) and unknown causes (3 horses). Although radiographic abnormalities at yearling sales can be associated with failure to start racing at 2–3 years of age, these radiographically detected abnormalities might not necessarily cause that failure.

The talus secundarius is one of the rarest accessory tarsal bones, being present in 0.01% of all ankles. It is located at the lateral side of the talus, distally to the tip of the fibula. Hitherto, only five cases of a symptomatic talus secundarius have been described in literature. We presented a case of bilateral symptomatic talus secundarius in a young gymnast. There was a difference in size of the two accessory bones. The large talus secundarius in the left ankle was fixated, in the right ankle the fragment was excised. Both excision and fixation in the presented patient led to satisfactory results, both in the short and long term outcome. (C) 2017 Published by Elsevier Ltd on behalf of European Foot and Ankle Society

[Purpose] To report an adolescent male basketball player with nonhealing stress fractures of the foot and discuss the probable factors. [Subject and Methods] A 13-year-old basketball player presented with right foot pain. He had been playing basketball for three years and practicing 5 days/week. He denied any increase in daily training intensity. Magnetic resonance imaging confirmed stress fractures of the cuboid and cuneiform, with mild edema of the soft tissues between the tarsal bones and tenosynovitis of the flexor hallucis and flexor digitorum longi. The foot was immobilized for 4 weeks, with progressive weight bearing introduced at the fifth week. At the 6th week, while still restricted to partial weight bearing, he reported diffuse severe pain. The entire foot was painful with palpation, and new imaging showed stress fractures of the talus, cuboid, cuneiform, and proximal first metatarsal bones, and tenosynovitis of the flexor hallucis longus and flexor digitorum longus tendons with progression of the soft tissue edema around the tarsal bones. Acute phase reactants were elevated; vitamin K level was low. [Results] He started participating in games again at the 6th month post-injury. [Conclusion] Management of patients with stress fractures includes immobilization, physical therapy, and biomechanical arrangements. If the expected healing does not occur, a deficiency of vitamin K might be considered as a factor. Questioning on dietary habits of the patient and encouraging adequate intake of the deficient nutrient might assist in the healing process.

When one or more of the person’s metatarsal bones are unusually small is known as hypoplastic metatarsal or Brachymetatarsia. Metatarsal are 5 miniature bones which present between the tarsal bones and the phalanges of the foot. This may cause significant pain and the toes appear to be short abnormally. Incidence of brachymetatarsia is one in 2,000 people. Women are affected more. Down’s syndrome and other genetic conditions may also increase the incidence of brachymetatarsia. To treat brachymetatarsia surgeons have two choices-corrective footwear or surgery. In the present case we found shortening of fourth toe of both foot in 45 year old male without any complaints or similar familial incidence. Keywords: Brachymetatarsia, Metatarsal hypoplasia, Bilateral 4th toe shortening, Short fourth toes, Congenital brachymetatarsia.

Cleidocranial dysplasia is a rare syndrome that has as main clinical findings changes in bones of the neurocranium and viscerocranium, clavicular, and teeth, although it can affect other bones. Its etiology originates from a defect of the gene CBFA1 of chromosome 6 p21, whose function is the differentiation of osteoblasts. Evidence suggests that this gene also acts in the participation of odontoblasts differentiation. The main clinical alterations are short stature, enlarged head, prolonged retention of deciduous teeth, delayed eruption of permanents, and presence of innumerable supernumeraries. The objective of this study is to report the diagnosis of cleidocranial dysplasia in a 4-year-old female patient with light brown skin color in a family health unit. The main clinical findings were prominence of the frontal and parietal bosses, ocular hypertelorism, and depressed nasal bridge and shoulders with hypermobility. The imaging examinations showed clavicular hypoplasia and changes in tarsal bones without major abnormalities in facial radiograph.

Mueller-Weiss disease is an alteration of the tarsal navicular that is primarily due to anomalous ossification of the bone and lateral deviation of the talar head associated with screw-like movement through the axis of the subtalar joint. This syndrome tends to be associated with various degrees of flatfoot and hindfoot valgus combined with subtalar joint varus. Ancient cases of Mueller-Weiss disease have not been described in specialized literature. We present the case of an adult male from the Hellenistic period (Ptolemaic dynasty; fourth to first century BC), the skeleton for which was found inside a sarcophagus in the archaeological site of Sharuna (middle Egypt) with Mueller-Weiss disease. The specimen is, in all likelihood, the earliest case of this type of foot pathology in the archaeological record.

The bone SPECT/CT allows for precise anatomic delineation of bone activity, which can be valuable for diagnosis of nonmalignant bone diseases. We report an extremely rare case of sphenoid sinus aspergillosis, observed on bone SPECT/CT imaging, as an isolated disease in an immunocompetent individual. A 58-year-old woman with a history of plantar fasciitis was assessed for infection in the tarsal bones. Planar bone scan image revealed incidental focal lesion in skull base, which was considered to be the left sphenoid sinusitis by the bone SPECT/CT scan.

Memorising human anatomy structures remains a challenge for nursing students. Educators endeavour to make human anatomy interesting and easy to memorise. Various instructional approaches can be used to help students enhance their memory. Mnemonics, for example, are well-established educational strategies that have proven useful in the encoding, retention and retrieval of anatomical terms. The carpal and tarsal bones are some of the anatomical structures that prove challenging to nursing students’ study of anatomy. Although available online to students, most of the accessible mnemonics are in English and non-native English-speaking students (students who are native Arabic-speakers) might find them difficult to understand. Therefore, we have created two simple Arabic mnemonics that can simplify the memorisation of the carpal and tarsal bones. We believe that Arabic mnemonics effectively enhance memorisation by linking the new learning material to familiar information.Keywords: Learning; Memory; Anatomy; Nursing; Carpal bones; Tarsal Bones; Oman.

Introduction: Osteonecrosis is a disease that rarely affects foot bones. When present, it is more commonly found in the talus and navicular bones. Cases of osteonecrosis of the intermediate cuneiform bone are extremely rare, and after a literature review, we found 5 reported cases, all in pediatric patients. Objective: The objective of this study is to report a case of an adult patient with osteonecrosis of the intermediate cuneiform bone that was resistant to conservative treatment, for which we proposed a surgical approach. Results: The patient underwent surgical treatment and showed excellent clinical and radiographic progression, with significant improvements in the American Orthopedic Foot and Ankle Society (AOFAS) score and in the pain visual analog scale. He rated the outcome as excellent and reported that he would undergo the procedure again. Conclusion: The authors present a rare case of an adult patient with osteonecrosis of the intermediate cuneiform bone that was surgically treated with decompression and bone grafting and had a good outcome.

Background Ponseti method have been widely accepted as the initial treatment of congenital idiopathic clubfoot because its excellent primary result. On the other hand, relapses after Ponseti method are not uncommon and the cause of relapses have not been fully elucidated. We investigated detailed morphology and alignment of tarsal bones in clubfoot after Ponseti method using three-dimensional MRI analysis. Methods We performed MRI with 10 patients of unilateral clubfoot at three months after Achilles tenotomy. Based on the MRI volume data, we reconstructed three-dimensional bone surface model using the marching cubes method. We evaluated the volume of the talus and navicular bone, medial and planter deviation of the talar head and neck, medial deviation of the navicular bone, and internal rotation angle of the distal tibiofibular joint. Results In clubfoot, the volume of talus and navicular bone were significantly smaller compared with the contralateral side. Deviation of the talar head and neck varied from medially to almost the same as that on the contralateral side. The degree of deformity of the talus and alignment of the navicular bone and distal tibiofibular joint showed correlations. Conclusions Patients with the medial deviated talar neck might have the alignment change of navicular bone and distal tibiofibular joint. Deformity of talar neck might to be compensated by talonavicular joint and distal tibiofibular joint through the manipulation of Ponseti method.