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Accessory navicular (AN) is a developmental variation of the secondary ossification center of the navicular tuberosity. Ten percent of patients with AN will have pain symptoms that affect walking and life. As the AN changes the position of the posterior tibial tendon insertion, children with AN often have posterior tibial tendon function insufficiency and flexible flat foot. Surgical treatment is often required after failure of conservative treatment. This article reviewed the etiology, clinical manifestations, complications, and treatment methods of AN., Competing Interests: Conflict-of-interest statement: All the authors declare that they have no competing interests., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

We report the case of a 32-year-old basketball player who presented with an acute flatfoot deformity after performing a unipodal power jump. Rupture of the posterior tibial tendon within the foot was diagnosed and then treated by hamstring tendon transfer combined with application of autologous biologic preparations. The functional outcome at 18 months was good. To our knowledge, this is the first reported case of posterior tibial tendon rupture treated by hamstring tendon transfer. [ABSTRACT FROM AUTHOR]

Category: Ankle; Trauma Introduction/Purpose: The Tibialis Posterior tendon (TPT) is the only tendon to come into contact with the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle they often have been missed and present late. Aim: Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia i.e. Pilon (PLM) and posterior malleolar fractures (PMF). Methods: A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site this was denoted as a minor entrapment and if ≥50% of the tendon was present in the fracture site was denoted as major. Results: A total of 363 patients were identified for further analysis, 220 who had a PMF and posterior 143 with Pilon injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture entered the TPT sheath, there was a 45% (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath p <.001). There was no significant difference in TPT entrapment in PMF as compared to PML (p=0.353). Conclusion: In our assessment, there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider care pre-operative imaging and seek to identify the TPT intraoperatively where entrapment does occur. [ABSTRACT FROM AUTHOR]

Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot. Degenerative changes in this tendon, lead to pain and weakness and if not identified and treated will progress to deformity of the foot and degenerative changes in the surrounding joints. Patients will complain of medial foot pain, weakness, and a slowly progressive foot deformity. A "too many toes" sign may be present and patients will be unable to perform a single heal raise test. Investigations such X-ray, ultrasound and magnetic resonance imaging will help stage the disease and decide on management. The optimal manage may change based on the progression of deformity and stage of disease. Early identification and prompt initiation of treatment can halt progression of the disease. The purpose of this article is to examine the causes, signs, symptoms, examinations, investigations and treatment options for posterior tibial tendon dysfunction.

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Isolated medial malleolar fractures are a less common presentation of an ankle fracture. Treatment is not universally accepted, although many have agreed that any displacement warrants anatomic reduction and fixation. We present a case of an isolated, comminuted medial malleolar fracture that was displaced secondary to entrapment of the posterior tibial tendon between the fracture fragments requiring surgical intervention. The patient was treated with prompt open reduction and internal fixation and had an excellent functional outcome at 1 year. When open reduction and internal fixation of the medial malleolus is indicated, a thorough exploration of the zone of injury is required to identify and adequately address any surrounding pathologic features beyond just the disrupted bony anatomy. To the best of our knowledge, this specific injury has never been previously reported and emphasizes the importance of understanding the local anatomy and how restoration of the distorted anatomy is vital to optimize patient function. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: The treatment of progressive collapsing foot deformity (PCFD) typically begins with nonoperative management including physical therapy, bracing, nonsteroidal anti-inflammatory medications, and activity modifications. Surgical intervention is not typically performed until nonoperative treatment has failed. Corticosteroid injections into the posterior tibial tendon sheath (PTTS) is a burgeoning nonoperative treatment modality for PCFD. The purpose of our study was to assess the safety of ultrasound-guided corticosteroid injections into the posterior tibial tendon sheath for posterior tibialis tendon tendinopathy. Secondary outcomes include duration of pain relief, amount of pain relief, need for repeat injections and progression to surgery. Methods: We retrospectively reviewed all patients in our electronic medical record who underwent a PTTS steroid injection between 2015 to 2020 for the diagnosis of posterior tibial tendon dysfunction, and/or posterior tibialis tendon insufficiency, and/or ankle pain. Demographic information was obtained from the patient record in addition to MRI data, clinical response to injection based on follow up visits, number of total injections, and progression to surgery. Thirty-eight posterior tibial tendon sheath ultrasound-guided injections in 33 patients met criteria during the 5 year study period. Results: Thirty-three patients were included in the study with 38 injections. Two patients (6.1%) had 3 posterior tibial tendon injections, one patient (3%) had 2 injections, and the rest had only a single injection yielding a total of 38 injections included in the study. Eighteen of 38 (47%) injections yielded good or better pain relief. Seven of 33 patients (21%) progressed to surgery. There were no reported complications with the 38 performed injections. Conclusion: Ultrasound-guided corticosteroid injections into the posterior tibial tendon sheath is a safe nonoperative treatment modality for posterior tibialis tendon tendinopathy. The efficacy of the injection appears highly variable with 47% of injections yielding 'good' or better clinical results. When evaluating BMI, obese patients (BMI >= 30.0) were found to have a more sustained response to injection (P = 0.029) and more pain relief (P = 0.049) compared to non-obese patients. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Cerebral palsy (CP) provides challenges when treating congenital clubfoot (CF) due to the presence of aberrant muscle tone and motor dysfunction. Split anterior tendon transfer (SPATT) and split posterior tendon transfer (SPOTT) are two ubiquitous treatments in the surgical repair of CP CF. Kling et. al. developed a three-tier grading system for documenting SPOTT outcomes; assigning excellent, good, or poor based on postoperative ambulation and functional dorsiflexion, this system has also been applied to SPATT recovery. The purpose of this study is to elucidate any difference in the outcomes of CP CF patients who receive SPOTT vs SPATT treatment. Methods: Following PRISMA guidelines a comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science. Collected publications represent all available literature on clubfoot. Articles were then screened by two independent reviewers at the title, abstract, and full-text level; only articles that detailed tendon-transfer treatment of pediatric patients with CF, CP, and contained three or more human subjects were included. Publications were excluded from screening if found to be duplicate articles, historical reviews, professional opinions, case reports, or contained non-human subjects. Two independent reviewers verified that each article met predetermined inclusion criteria at each level of screening. SAS statistical software was used to determine the relationship between positive and negative interventions outcomes, as well as patent demographics. Results: An initial search yielded 6,469 articles; after review 17 articles remained which described surgical tendon transfer: 12 (70.59%) split posterior tendon transfer (SPOTT) articles (mean-age 9.30 +- 2.57 years, mean follow-up length 60.03 +- 37.64 months), 5 (29.41%) split anterior tendon transfer (SPATT) articles (mean-age 10.12 +- 3.40 years mean follow-up length 64.16 +- 34.35 months). SPOTT papers included a total of 391 patients and 446 feet with a post-operative excellent & good rate of 90.48% and failure rate of 8.70%. SPATT papers included a total of 136 patients and 151 feet with a post-operative excellent & good rate of 71.22% and failure rate of 9.73%. Conclusion: These results show that the publication frequency of CP CF treatment by split posterior tendon transfer is higher than that of split anterior tendon transfer. Additionally, results of this systematic review indicate that there is a greater predicted positive outcome in SPOTT vs SPATT while there is no significant difference in predicted negative outcomes between procedures. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Cerebral palsy (CP) can lead to various foot deformities, including equinovarus, or clubfoot position. Patients with CP present a challenge when treating clubfoot as there is aberrant muscle tone and motor dysfunction. Many interventions with variable outcomes are available for patients with clubfoot and cerebral palsy, however, no studies exist that compare existing treatments and outcome measures. The purpose of this study is to investigate the existing body of evidence surrounding the treatments and outcomes of clubfoot in cerebral palsy by way of a systematic review. Methods: Using PRISMA guidelines a comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science. Publications were collected which represent all available literature on clubfoot. Articles were screened at the title, abstract, and then full-text level. Only articles that detailed the treatment of pediatric patients with clubfoot, CP, and contained three or more human subjects were included. Publications were excluded from further screening if they were found to be duplicate articles, historical reviews, professional opinions, case reports, or if subjects were non-human. At each level of screening, articles were screened by two independent reviewers to verify that each paper met the predetermined inclusion criteria. Following this, data extraction from primary sources was conducted for; number of patients, age of patients, follow-up length, treatment modality applied, and outcome measures. T-tests were performed using SAS statistical software to determine the relationship between age and type of intervention. Results: An initial search yielded 6,469 articles, after review and cross selection, 32 remained as shown in Table 1. Of these, 53.13% (n=17) articles documented surgical tibial tendon transfer (TT): anterior TT (n=5) (mean-age 10.12 +-3.40yrs), posterior TT (n=12) (mean-age 9.30 +-2.57yrs). Botox & casting was referenced in 15.63% (n=5) articles (mean age 5.34 +-1.21yrs), lengthening of tendon or muscle procedures 12.50% (n=4) (mean age 6.30 +-1.69yrs), botox alone 12.50% (n=4) (mean age 6.83 +-1.72yrs), and osteotomy 6.25% (n=2) (mean age 10.94 +-1.51yrs). There was a difference in age for patients receiving TT versus those receiving botox & casting (9.54+-2.75 years old vs 5.34 +-1.21yrs years, p<.05). Conclusion: These results indicate the preferred modality of clubfoot correction in the setting of cerebral palsy is tibial transfer. The average age of patients receiving surgical treatments was higher than those with casting, Botox, or orthotics. Due to a lack of standardized outcome measurements reported across studies, we recommend further research aimed specifically at evaluating intervention selection based on patient desired functional outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the use of spring ligament to support the talar head and prevent it from falling into plantarflexion and adduction in patients with adult-acquired flatfoot deformity.

Lateral column lengthening is a common procedure for correction of pes planovalgus. A tricortical bone graft has been a standard among foot and ankle surgeons. The purpose of the present study was to compare the union rates and complications between the 2 forms of fixation for lateral column lengthening. The present study was a retrospective medical record and radiograph review of 52 patients divided into 2 equal groups, allograft (group A) and opening wedge plate (group B). The radiographic analyses compared the preoperative, postoperative and long-term measurements of cuboid abduction and talonavicular angles. The outcome measures included nonunion, hardware removal, and infection. The median follow-up duration for each group was 34.5 (range 6.3 to 89.5) months and 12.6 (range 6.5 to 56.8) months for groups A and B, respectively. Group A had 4 nonunions (15.4%) and group B had 2 nonunions (7.7%). The mean radiographic measurements of cuboid abduction and talonavicular articulation for each group improved significantly. The incidence of hardware removal was greater for group A than for group B (30.8% versus 15.4%), although the difference was not statistically significant. The median time to osseous healing for group A was 12.0 (range 8.0 to 80.0) weeks and for group B was 10.0 (range 6.0 to 36.0) weeks. The interposition plating techniques for lateral column lengthening procedures had a lower nonunion rate and incidence of hardware removal compared with the traditional use of tricortical bone grafting. The findings from the present study will aid surgeons in alternative fixation for lateral column lengthening procedures. [ABSTRACT FROM AUTHOR]