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Background Congenital talipes equinovarus (CTEV )/clubfoot is the most common congenital orthopedic condition. The success rate of Ponseti casting in the hands of the legend himself is not 100%. The prediction of difficult to correct foot and recurrences still remains a mystery to be solved. We all know that tarsal bones are dysplastic in clubfoot and considering it; we hypothesize that the amount of tarsal dysplasia can predict management duration and outcome. In literature we were not able to find studies that satisfactorily quantify the amount of tarsal dysplasia. Hence, it was considered worthwhile to quantify the amount of dysplasia in tarsal bone and to correlate these parameters with the duration and outcome of treatment by conventional method. Methods A total of 25 infants with unilateral idiopathic clubfoot that have not taken any previous treatment were included in the study. An initial ultrasonography was done before start of treatment in 3 standard planes to measure the maximum length of 3 tarsal bones (talus, calcaneus, and navicular). Ponseti method of treatment was used; pirani scoring was done at each OPD (out patient department) visit. Number of casts required for complete correction and need for any surgical intervention were taken as the outcome parameters. Results We found that there is a significant correlation between number of casts required and the dysplasia of talus (α error=0.05). We also found a significant negative correlation between relative dysplasia of talus and number of casts required (r=-0.629 sig=0.001, r=-0.552 sig=0.004). Conclusions Tarsal bone dysplasia as quantified by using ultrasonography can be used as a prognostic indicator in congenital idiopathic clubfoot. Although promising the method needs further studies and can be more useful after long-term follow-up where recurrences if any can be documented. Level of evidence Level II.

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.

OBJECTIVE To determine and compare mean standing extension and maximum flexion angles of various joints in healthy adult alpacas and llamas, and determine the reliability of goniometric data within and between 2 observers for each joint of interest. SAMPLE 6 healthy adult llamas and 6 healthy adult alpacas. PROCEDURES The shoulder joint, elbow joint, carpal, and metacarpophalangeal (MCP) joints of the forelimbs and the hip joint, stifle joint, tarsal, and metatarsophalangeal (MTP) joints of the hind limbs were investigated. Each articulation was measured with a universal goniometer by 2 observers, who each obtained 2 measurements when each joint was maintained in standing extension and in maximal passive flexion. Two sample (unpaired) t tests were performed for comparisons of mean standing extension and maximum passive flexion angles between alpacas and llamas. Intraclass correlation coefficients were calculated for each articulation to assess interobserver and intra-observer reliability of measurements. RESULTS Llamas had larger mean standing extension angles than alpacas for the tarsal and elbow joint, but there were no significant differences between species for all other joints. For all joints, flexion measurements did not differ significantly between the 2 species. For most joints, the reliability of goniometric data between observers was good to excellent (intraclass correlation coefficients, 0.6 to 0.95) CONCLUSIONS AND CLINICAL RELEVANCE Except for the elbow joint and tarsus in extension, the angle of limb articulations during flexion and extension can be considered similar for alpacas and llamas. These measurements have relevance for veterinary surgeons when assessing joint mobility and conformation and determining appropriate angles for arthrodesis.

The tarsal bones articulate with each other and demonstrate complicated kinematic characteristics. The in vivo motions of these tarsal joints during normal gait are still unclear. Seven healthy subjects were recruited and fourteen feet in total were tested in the current study. Three dimensional models of the tarsal bones were first created using CT scanning. Corresponding local 3D coordinate systems of each tarsal bone was subsequently established for 6DOF motion decompositions. The fluoroscopy system captured the lateral fluoroscopic images of the targeted tarsal region whilst the subject was walking. Seven key pose images during the stance phase were selected and 3D to 2D bone model registrations were performed on each image to determine joint positions. The 6DOF motions of each tarsal joint during gait were then obtained by connecting these positions together. The TNJ (talo-navicular joint) exhibited the largest ROMs (range of motion) on all rotational directions with 7.39±2.75°of dorsi/plantarflexion, 21.12±4.68°of inversion/eversion, and 16.11±4.44°of internal/external rotation. From heel strike to midstance, the TNJ, STJ (subtalar joint), and CCJ (calcaneao-cuboid joint) were associated with 5.97°, 5.04°, and 3.93°of dorsiflexion; 15.46°, 8.21°, and 5.82°of eversion; and 9.75°, 7.6°, and 4.99°of external rotation, respectively. Likewise, from midstance to heel off, the TNJ, STJ, and CCJ were associated with 6.39, 6.19°, and 4.47°of plantarflexion; 18.57°, 11.86°, and 6.32°of inversion and 13.95°, 9.66°, and 7.58°of internal rotation, respectively. In conclusion, among the tarsal joints, the TNJ exhibited the greatest rotational mobility. Synchronous and homodromous rotational motions were detected for TNJ, STJ, and CCJ during the stance phase.

Tarsal coalitions are an abnormal union between 2 tarsal bones. They occur most commonly between the calcaneus and talus or the calcaneus and navicular but can also arise from other joints in the foot. Isolated cases of coalitions between the medial cuneiform and navicular are extremely rare, and only a few cases have been reported. Treatment recommendations are, therefore, sparse, and no long-term follow-up data have been reported. We present the case of 2 sisters, each diagnosed with a symptomatic naviculocuneiform coalition. To our knowledge, this is the first reported case in 2 first-degree relatives. Both sisters were involved in sports and presented with pain during physical activities. After conservative treatment had failed, they were both treated successfully with surgical excision of the coalition and arthrodiastasis, followed by a progressive return to activities. At the last follow-up examination at 5 and 3 years postoperatively, they remained pain free and fully involved in college soccer, making excision of a naviculocuneiform coalition with arthrodiastasis a valid treatment in the young athletic population.

Introduction. Tarsal coalition is congenital bony, cartilaginous, or fibrous fusion between tarsal bones. The most specific clinical feature of these patients is limitation of tarsal joints mobility. Foot mobility is evaluated using a few clinical tests-tip-toe test, Jack test, and manual evaluation of passive foot inversion/eversion. However, these tests do not have high rates of sensitivity and specificity, and cannot be used to make differential diagnosis among the different types of coalitions.Aims. To improve the clinical diagnosis of calcaneonavicular coalitions.Materials and methods. We present a new clinical test-evaluation of calcaneonavicular segment mobility. To evaluate this test, we studied a group of 100 children (155 feet), which included those with talocalcaneal coalitions (22 patients/30 feet), calcaneonavicular coalitions (28 patients/45 feet), and those without tarsal coalitions (50 patients/80 feet).Results. The sensitivity of the test was 95.6%, and specificity was 93.3%. This test had good reproducibility, as evidenced by the inter-rater reliability coefficient of 0.818.Conclusions. The clinical test presented here can be used to identify patients with calcaneonavicular coalitions, which could not be identified using other clinical tests of foot mobility

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.

The longitudinal arch is a unique characteristic of the human foot, yet the timing and pattern of its evolution remain controversial, in part due to the disagreement among researchers over which skeletal traits are the best indicators of its presence or absence. The small size of the human navicular tuberosity has previously been linked to the presence of a longitudinal arch, implying that the large tuberosity of early hominins such as Australopithecus afarensis reflects a flat foot. However, this hypothesis is at odds with other evidence of pedal form and function, such as metatarsal, tarsal, and footprint morphology, which show that a longitudinal arch was probably present in A. afarensis. This study reevaluates the morphometric affinities of the A. afarensis naviculars among other Plio-Pleistocene fossil hominins and anthropoid primates (N = 170). Multivariate cluster analyses show that all fossil hominin naviculars, including those attributed to A. afarensis, are most similar to modern humans. A measure of navicular tuberosity size quantified as the ratio of the tuberosity volume to the surface area of the talar facet shows that Ateles has the largest navicular tuberosity among the anthropoid sample and that there is no difference between highly arboreal and terrestrial taxa in this metric (e.g., Hylobates and Gorilla beringei). Instead, a relatively large navicular tuberosity may reflect the development of leg musculature associated with ankle plantarflexion. The functional inferences derived from the morphology of the A. afarensis naviculars are consistent with the morphology of the Laetoli footprints.

Aims Although infrequent, a fracture of the cuboid can lead to significant disruption of the integrity of the midfoot and its function. The purpose of this study was to classify the pattern of fractures of the cuboid, relate them to the mechanism of injury and suggest methods of managing them. Patients and Methods We performed a retrospective review of patients with radiologically reported cuboid fractures. Fractures were grouped according to commonly occurring patterns of injury. A total of 192 fractures in 188 patients were included. They were classified into five patterns of injury. Results Type 1 fractures (93 fractures, 48.4%) are simple avulsion injuries involving the capsule of the calcaneo-cuboid joint. Type 2 fractures (25 fractures, 13%) are isolated extra-articular injuries involving the body of the cuboid. Type 3 injuries (13 factures, 6.8%) are intra-articular fractures solely within the body of the cuboid. Type 4 fractures (35 fractures, 18.2%) are associated with disruption of the midfoot and tarsometatarsal injuries. Type 5 fractures (26 fractures, 13.5%) occur in conjunction with disruption of the mid-tarsal joint and either crushing of the lateral column alone or of both medial and lateral columns. Fractures with significant articular disruption or with loss of length of the lateral column underwent fixation. This involved either internal fixation to restore the anatomy of the cuboid and/or restoration of the length of the columns with bridging constructs using internal or external fixation. Conclusion A classification system for fractures of the cuboid is proposed in relation to the mechanism of injury. The treatment of these fractures is described. Cite this article: Bone Joint J 2016;98-B:1003–8.

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.

We report the case of a 32-year-old Japanese female with a giant cell tumor of bone involving multiple midfoot bones. Giant cell tumors of bone account for approximately 5% of all primary bone tumors and most often arise at the ends of long bones. The small bones, such as those of the hands and feet, are rare sites for giant cell tumors. Giant cell tumors of the small bones tend to exhibit more aggressive clinical behavior than those of the long bones. The present patient underwent en bloc tumor excision involving multiple tarsals and metatarsals. We reconstructed the longitudinal arch of the foot with a free vascularized fibular graft. At the 2-year follow-up visit, bony union had been achieved, with no tumor recurrence.

Objective To evaluate the frequency of inadvertent penetration of the digital flexor tendon sheath (DFTS) and/or distal interphalangeal joint (DIPJ) when using a direct endoscopic approach to the navicular bursa, and to evaluate an alternate direct approach to the navicular bursa. Study Design Cadaveric study. Sample Population Equine cadaver limbs (n = 40 for direct; n = 12 for alternate approach). Methods Four surgeons performed the direct endoscopic approach to the navicular bursa on 10 limbs each. Frequencies of inadvertent synovial penetration and iatrogenic damage were compared between surgeons. Use of an alternate direct approach, adopting a straight parasagittal trajectory, was evaluated by 2 surgeons. Results Inadvertent synovial penetration occurred in 45% of limbs (DFTS 37.5%; DIPJ 17.5%; and both structures 10%). Successful bursa entry was achieved on the first attempt in 45% of limbs. Significant variation in frequency of inadvertent synovial penetration was observed between surgeons (range 10–80%). Inadvertent synovial penetration did not occur when using the alternate direct technique. Iatrogenic damage to navicular bone fibrocartilage and/or deep digital flexor tendon occurred in 55% of limbs using the direct endoscopic approach and in 0% of limbs using the alternate direct approach. Conclusion Because of the considerable risk of inadvertent penetration of the DFTS and/or the DIPJ when making a direct endoscopic approach to the navicular bursa, it is advisable to investigate for inadvertent penetration when treating navicular bursa sepsis using a direct approach. The alternate direct technique may reduce the risk of inadvertent penetration; however, the view within the bursa may be restricted.

Fractures of the central tarsal bone are a rarely recognized cause of acute severe hind limb lameness in nonracehorses. Diagnosis of these fractures can be challenging and little is known about their configuration or outcome. The objectives of this retrospective case series study were to describe the clinical features, imaging findings, and outcomes of fractures of the central tarsal bone in a sample of nonracehorses. Medical records from 2001 to 2014 were searched for cases of central tarsal bone fractures in nonracehorses. All available imaging findings including radiography, ultrasound, computed tomography (CT), and/or nuclear scintigraphy were reviewed. History, clinical presentation, and outcome were collected from the records. Four horses met the inclusion criteria. All had a similar configuration as a simple nondisplaced slab fracture in a dorsomedial to plantarolateral orientation. Initial radiographs failed to reveal the fracture in three of four cases. When additional plantarolateral-dorsomedial oblique radiographic views were obtained, the fracture could be identified in all cases. Fractures of the central tarsal bone seemed to occur in a consistent dorsomedial to plantarolateral orientation in this sample of nonracehorses, which is different from the configuration previously reported in racehorses. While CT can be used for detection and assessment of these fractures, authors propose that radiography can also identify these fractures with the appropriate view. Authors recommend the use of several plantarolateral to dorsomedial radiographic projections at varying degrees of obliquity for horses with a suspected central tarsal bone fracture.

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.

Background: In ice hockey players, serious bone injuries in the foot and ankle, especially those attributed to impact from the moving puck, may be radiographically occult and underrecognized. Purpose/Hypothesis: The purpose of this research was to study foot and ankle bone injuries detected with magnetic resonance imaging (MRI) that occurred in elite hockey players. The hypothesis was that these injuries predominate medially, especially when caused by the impact from the puck, and are associated with prolonged lost playing time. Study Design: Case series; Level of evidence, 4. Methods: Three independent observers, blinded to the mechanism of injury, retrospectively reviewed foot and ankle MRI examinations acquired after 31 acute injuries that occurred in 27 elite ice hockey players who had no radiographically visible fractures. Bone abnormalities were classified as fractures or varying degrees of contusion based on predetermined definitions. Interobserver agreement was analyzed with kappa statistics. The association between the injury mechanism and the bones involved was examined with the Fisher exact test. A t test was applied to determine if MRI evidence of a severe bone injury (defined as either a fracture or a high-grade bone contusion) was associated with longer recovery times, when return-to-play information was available. Results: The observers identified at least 1 bone injury in 27 of the 31 MRI examinations, including 10 with radiographically occult fractures. Agreement among the 3 observers for injury categorization was substantial (κ = 0.76). Seventeen injuries were caused by a direct blow (15 from a moving puck, 2 from an uncertain source), resulting in 6 fractures and 6 high-grade bone contusions, with 14 of the 17 involving a medial bone (medial malleolus, navicular, or first metatarsal base). Compared with other mechanisms, direct impaction was statistically more likely to result in a severe bone injury and to involve the medial foot and ankle. In 20 injuries where return-to-play information was available, players with severe bone injuries missed a mean of 10.6 games compared with 2.4 games for other players ( P = .05). Conclusion: MRI can show severe bone injuries that are not visible radiographically in ice hockey players. Most fractures and high-grade contusions involve the medial ankle and midfoot bones, can be caused by direct blows from the puck, and are associated with prolonged recovery times.

Müller-Weiss disease (MWD) is a rare condition that results in dorsolateral collapse of the navicular associated with rotation of the talar head and subtalar varus deformity. There are also varying degrees of midfoot collapse and associated loss of the medial arch in more advanced cases. The characteristic deformities and classification have been described on weightbearing radiographs. While early stage disease can be detected on magnetic resonance imaging and bone scan, there are considerable advantages to computed tomography (CT) scanning, in particular, weightbearing CT for further evaluation of this condition. We describe the imaging findings of this condition, and present 3 cases where weightbearing CT was used in the context of MWD. This is the first time the use of weightbearing CT scan has been reported for diagnosis and treatment of this condition. Levels of Evidence: Diagnostic, Level IV: Case series

Tarsal coalition is a condition described by partial union between tarsal bones. Its clinical significance is the potential cause for chronic pain in the ankle and foot. Diagnosis of this condition may be delayed until adolescence or early adulthood, and is often made incidentally on examination for other purposes. Treatments for this condition can range from conservative options to surgical approach. The calcaneonavicular and talocalcaneal subtypes make up the majority of this condition, with involvement among other tarsal bones much rarer in comparison. This report illustrates the cubonavicular subtype, which has only been described in very small number cases.

Background: The Lisfranc injury is an injury of the foot in which one or more metatarsal bones are displaced from the tarsal bones. Due to their low incidence and complexity, these injuries are often missed on initial evaluation. Prompt recognition and then anatomic reduction and stabilization gives best outcomes post treatment.Aim: The study aimed to compare short-term treatment results for tarso-metatarsal joint injuries with treatment outcomes and compare it with type of injury per classification.Methods: This was a prospective observational, analytical hospital based study. The subjects included in the study were classified according to radiological findings and treated with open reduction and K-wire fixation. Study subjects were immobilized for six weeks. Weight bearing was progressed slowly. Short term result was calculated by American orthopaedic foot and ankle society score (AOFAS) at six months. Results: Of the nine cases included in the study, low energy fall, five (55.55%) was commoner cause for injury followed by high energy road traffic accident (RTA) in four (44.44%) patients. Six fractures (66.67%) were of type A while, three (33.3%) were type B. Average day from injury to surgery was 3.11 (range 2-5). AOFAS Score calculated in six months average was 82.44(SD±12.79). In patients with type A injury mean AOFAS score was 89(SD±2.6), while in patients with type B injury had mean of 69.33(SD±15.82). The AOFAS score difference for the group A and B was statistically significant (P

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.

Introdução: O osso navicular é um dos ossos do tarso que mais raramente sofre uma fratura. Com o formato de um barco e posicionado entre a cabeça do tálus e dos três cuneiformes, desempenha um papel importante na sustentação da coluna medial do pé. Uma vez fraturado, pode ter seu diagnóstico feito através da radiografia, tomografia computadorizada, ressonância magnética ou ainda por cintilografia óssea. Objetivo: Relatar um caso incomum de fratura do osso navicular, diagnosticado apenas pela ressonância magnética. Relato do Caso: Mulher de 41 anos que após uma queda referiu dor em seu pé direito com piora ao caminhar. Apresentava dor à palpação na porção medial e dorsal do mediopé e edema. Radiografia do pé normal. A ressonância magnética apresentou traço de fratura na porção medial do osso navicular. Conclusão: Apesar de incomum, as fraturas do mediopé devem ser pesquisadas com métodos de imagem e, mesmo quando a radiografia seja normal, na continuação da sintomatologia do paciente, exames de maior acurácia devem ser realizados, tais como a TC e a RM.Palavras chave: Ossos do tarso, Fraturas ósseas, Imagem por ressonância magnéticaABSTRACT:Introduction: The navicular bone is one of the tarsal bones that most rarely suffers a fracture. Shaped like a boat and positioned between the head of the talus and the three cuneiforms, it plays an important role in supporting the medial column of the foot. Once fractured, the diagnosis can be made through radiography, computed tomography, magnetic resonance imaging, or even bone scintigraphy. Objective: To report an unusual case of fracture of the navicular bone, diagnosed only by magnetic resonance imaging. Case Report: A 41-year-old woman who, after a fall, reported pain in her right foot, which worsened when walking. He had pain on palpation in the medial and dorsal portion of the midfoot and edema. The radiograph of the foot is normal. Magnetic resonance imaging showed a fracture in the medial portion of the navicular bone. Conclusion: In spite of being uncommon, midfoot fractures should be investigated with imaging methods and, even when the radiograph is normal, in the continuation of the patient’s symptoms, more accurate tests should be performed, such as CT and MRI. Keywords: Tarsal bones, Bone fractures, Magnetic resonance imaging

Rationale Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve and its branches. Tarsal coalition is defined as a fibrous, cartilaginous, or osseous bridging of 2 or more tarsal bones. TTS with tarsal coalition is uncommon. Here, we present a rare example of successful surgical management of TTS with posterior facet talocalcaneal coalition. Patient concerns A 74-year-old woman presented with hypoesthesia, numbness, and an intermittent tingling sensation on the plantar area over the right forefoot to the middle foot area. The hypoesthesia and paresthesia of the right foot began 6 years previously and were severe along the lateral plantar aspect. The symptoms were mild at rest and increased during daily activities. Tinel sign was positive along the posteroinferior aspect of the medial malleolus. Diagnosis Lateral ankle radiography showed joint-space narrowing and sclerotic bony changes with a deformed C-sign and humpback sign. Oblique coronal and sagittal computed tomography revealed an irregular medial posterior facet, partial coalition, narrowing, and subcortical cyst formation of the posterior subtalar joint. Magnetic resonance imaging showed an abnormal posterior talocalcaneal coalition compressing the posterior tibia nerve. Electromyography and nerve conduction velocity studies were performed, and the findings indicated that there was an incomplete lesion of the right plantar nerve, especially of the lateral plantar nerve, around the ankle level. Interventions Surgical decompression was performed. Intraoperatively, the lateral plantar nerve exhibited fibrotic changes and tightening below the posterior facet talocalcaneal coalition. The coalition was excised, and the lateral plantar nerve was released with soft-tissue dissection. Outcomes The patient's symptoms of tingling sensation and hypoesthesia were almost relieved at 4 months postoperatively, but she complained of paresthesia with an itching sensation when the skin of the plantar area was touched. The paresthesia had disappeared almost completely at 8 months after surgery. She had no recurrence of symptoms at the 1-year follow-up. Lessons The TTS with tarsal coalition is rare. Supportive history and physical examination are essential for diagnosis. Plain radiographs and computed tomography or magnetic resonance imaging are helpful to determine the cause of TTS and verify the tarsal coalition. After diagnosis, surgical excision of the coalition may be appropriate for management with a good outcome.

Introdução: A coalizão tarsal representa uma comunicação anormal entre ossos do tarso e pode ser óssea, cartilaginosa ou fibrosa, se desenvolvendo de forma secundária a insuficiência da diferenciação e segmentação do mesênquima primitivo nas primeiras fases do desenvolvimento, diminuindo a mobilidade e deformando os pés, quando congênita. Quando adquirida ocorre devido à artrite inflamatória, infecção, trauma, neoplasia, entre outras causas. Relato de Caso: Relatamos o caso de uma mulher de 37 anos com queixa há um mês, desmontando a importância da investigação da causa e a necessidade de atenção por parte do radiologista para a avaliação das coalizões tarsais visto que, uma coalizão, independentemente de quais ossos envolvidos, pode levar a uma sintomatologia limitante. Palavras chave: Ossos do tarso, Coalizão tarsal, Imagem por ressonância magnética, Deformidades do péAbstractIntroduction: Tarsal coalitions represent abnormal bridging between tarsal bones and can be osseous, cartilaginous, or fibrous, developing secondary to failure of differentiation and segmentation of the primitive mesenchyme in the first stages of development, decreasing mobility and deforming the feet, when is congenital. When acquired it occurs due to inflammatory arthritis, infection, trauma, neoplasia and other causes. Case report: We report the case of a 37-year- -old woman with a complaint a month ago, dismantling the importance of investigating the cause and the need for attention by the radiologist for the evaluation of tarsal coalitions since, a coalition, regardless of which bones involved, can lead to limiting symptoms.Keywords: Tarsal bones, Tarsal coalition, Magnetic resonance imaging, Foot def

Objective: To describe the study design and baseline patient characteristics of the Asia and Latin America Fracture Observational Study (ALAFOS) to better understand the profile of patients receiving teriparatide during the course of routine clinical practice in Asia, Latin America, the Middle East and Russia. Methods: Prospective, observational, non-interventional study in postmenopausal women with osteoporosis who are prescribed teriparatide for up to 24 months, according to local medical standards, with a 12 month post-treatment follow-up. Measures: Demographics, risk factors for osteoporosis and fractures, history of fracture, prior osteoporosis medications, comorbidities, physical function, back pain and quality of life (QoL). Results: In total 3031 postmenopausal women (mean age 72.5 years) recruited at 152 sites in 20 countries were analyzed; 62.9% had a history of fragility fracture after age 40 (33.0% of patients with spinal, 14.2% with hip fractures). The mean (SD) bone mineral density T-scores at baseline were −3.06 (1.40) and −2.60 (1.05) at the lumbar spine and femoral neck, respectively. At entry, 43.7% of patients were naïve to prior osteoporosis treatments; 40.5% of patients reported ≥1 fall in the past year. The median (Q1; Q3) EuroQoL Visual Analog Scale (EQ-VAS) for perceived overall health status was 60 (50; 80). The mean (SD) worst back pain Numeric Rating Scale in the last 24 hours was 4.6 (3.3). Conclusions: Our data indicates that patients who were prescribed teriparatide in the ALAFOS participant countries had severe osteoporosis, high prevalence of fractures, disabling back pain and poor QoL. The frequency of patients receiving prior osteoporosis medications was lower than in previous observational studies conducted in other locations.

Foot-binding was a widespread custom in China for hundreds of years, though the severity and type of binding varied considerably over time and space. To examine the morphological consequences of extremely severe foot-binding, this paper uses 35 sets of bound and 33 sets of unbound foot bones, from the remains of women excavated from the Xinzhi cemetery in northern Shandong Province. Based on macroscopic observation, CT slices, and measurements of bound foot bones, multiple distinctive consequences of foot-binding were identified. Compared with normal bones, bound foot bones have severely reduced overall size and weight. The density of trabecular mesh was reduced and its structure was altered in all tarsal bones. While the talus and navicular bones of bound feet retained all major groups of trabeculae, the calcaneus experienced massive trabecular loss, suggesting that in a bound foot the calcaneus lost its weight bearing function and its role in plantarflexion. The severity of changes was greater in the laterally positioned foot bones, i.e. the lateral cuneiform, the cuboid, and 4th and 5th metatarsals, than in the medial ones, showing that most of the body weight in the bound foot was transmitted along the first ray. Degenerative osteoarthritic changes affected articular surfaces of the foot bones, even in young individuals. These changes suggest that the biomechanics of bipedal locomotion were considerably affected in all females with severely bound feet.

Objective To evaluate and differentially diagnose erosive skeletal lesions located on multiple joints of an individual archaeologically recovered in 2017. Materials Skeletal remains of a well-preserved skeleton dating to the 12th–13th centuries from the medieval church of San Biagio in Cittiglio (Varese, northern Italy). Methods Macroscopic and radiographic imaging. Results Erosive marginal symmetrical lesions are present on the metatarsophalangeal, metacarpophalangeal and interphalangeal joints of an adult male, aged 55–75 years. Osteolytic changes, in the form of pocket erosions, surface resorptions and pseudocyst formations, are also macroscopically observed on some carpal and tarsal bones and on several large peripheral joints. Conclusions A careful differential diagnosis of the lesions and their macroscopic and radiological appearance is suggestive of a case of rheumatoid arthritis-like polyarthropathy. Significance This case contributes to the debate regarding the antiquity of erosive polyarthropathies, providing additional evidence for the existence of these diseases in the Old World prior to the European discovery of the Americas. Limitations Small sample size limits discussion of the scope of the disease in antiquity. Suggestions for further research This case highlights the need for further macroscopic, radiographic, and biomolecular studies of pre-modern European skeletal samples to investigate the hypothesized pre-existence of these pathological conditions in Europe prior to 1492.

Veterinarians are required to interpret the significance of radiographic findings for sale, soundness and future racing performance of weanling and yearling Thoroughbreds. We investigated the prevalence and radiographic appearance of slab fractures of the third (T3) and central tarsal (Tc) bones.Weanling and yearling horses with complete or incomplete T3 or Tc fracture were identified by searching a database of radiographs. The prevalence and radiographic appearance at initial diagnosis and after continued pasture turnout, as well as prognosis for racing, of fractures of T3 and Tc were determined.Fractures were identified in 186 tarsi (184 T3 fracture only, 1 Tc fracture only, 1 Tc and T3 fracture) of 157 horses (126 unilateral T3, 29 bilateral T3, 1 contralateral Tc and T3, 1 unilateral Tc and T3) from 7676 examinations. The prevalence of T3 and Tc fractures was 2.40 (95% CI 2.07, 2.76) and 0.04 (95% CI 0.01, 0.11) per 100 radiographic examinations respectively. Fractures were identified on the D556-65°MPlLO view and occurred by survey examination at 11.1 ± 1.3 months in 85.7% horses. At initial diagnosis, 84.3% of T3 fractures appeared incomplete and involved the distal articular surface. Fracture score improved (P 0.001), and dorsal modelling (P 0.001) and osteoarthritis score increased in the distal intertarsal joint (P 0.001), but not the tarsometatarsal joint, between survey and repository examinations. Fractures healed by repository examination in 71.9% of tarsi if there was 6 months between examinations. There was no difference in sale price, and horses with T3 fractures had fewer trials when 2 and 3 years old (P = 0.023), yet no difference in other parameters of racing success when 2 or 3 years old compared with controls.Tarsal slab fractures can occur in juvenile Thoroughbreds and most heal with continued pasture turnout of 6 months. Further investigation is required to determine risk factors and before making firm conclusions regarding the optimal management, prognosis for racing and long-term soundness.

Ballerinas use their ankle joints more extremely and sustain injuries on the ankle joint more frequently than non-dancers. Therefore, the ankle movement of dancers is important and should be studied to prevent injuries. Measuring ankle joint range of motion (ROM) using radiographs could demonstrate the contribution to motion of each joint. The aim of this study was to analyse and compare ankle joint movements and the ratio of each joint's contribution during movement between dancers and non-dancers, using radiographic images. Dancers have lower dorsiflexion (26.7 ± 6.2°), higher plantarflexion (74.3 ± 7.1°) and higher total (101.1 ± 10.8°) ROMs than non-dancers (33.9 ± 7.0°, 57.2 ± 6.8° and 91.1 ± 9.3°, respectively) (p

BackgroundThe Windover mortuary pond dates to the Early Archaic period (6,800-5,200 years ago) and constitutes one of the earliest archaeological sites with intact and well-preserved human remains in North America. Unlike many prehistoric egalitarian hunter-gatherers, the Windover people may not have practiced a sex-based division of labor, rather they may have shared the load. We explore how mobility and subsistence, as reconstructed from archaeological data, influenced hand and foot bone morphology at Windover.MethodsWe took length and width measurements on four carpal bones, four tarsal bones, and load- bearing tarsal areas (calcaneus load arm, trochlea of the talus). We analyzed lateralization using side differences in raw length and width measurements. For other hypothesis testing, we used log transformed length-width ratios to mitigate the confounding effects of sexual dimorphism and trait size variation; we tested between-sex differences in weight-bearing (rear foot) and shock-absorbing (mid foot) tarsal bones and between-sex differences in carpal bones.ResultsWe identified no significant between-sex differences in rear and midfoot areas, suggesting similar biomechanical stresses. We identified no significant between-sex differences in carpal bones but the test was under-powered due to small sample sizes. Finally, despite widespread behavioral evidence on contemporary populations for human hand and foot lateralization, we found no evidence of either handedness or footedness.DiscussionThe lack evidence for footedness was expected due its minimal impact on walking gait but the lack of evidence for handedness was surprising given that ethnographic studies have shown strong handedness in hunter-gatherers during tool and goods manufacture. The reconstructed activity patterns suggested both sexes engaged in heavy load carrying and a shared division of labor. Our results support previous findings—both sexes had stronger weight-bearing bones. While male shock-absorbing bones exhibited a trend towards greater relative width (suggesting greater comparative biomechanical stress), this may simply some lingering hunting behavior with males walking greater distances at higher speeds than females. While there were no significant between-sex differences in carpal bones (supporting a shared work load model), females exhibited greater variation in index values, which may reflect a greater variety of and specialization in tasks compared to males. Because carpals and tarsals are so well- preserved at archaeological sites, we had surmised they might be useful proxies for activity in the absence of well-preserved long bones. Tarsals provide a stronger signal of past activity and may be useful in the absence or, or in addition to, preferred bones. Carpals, however, may not be useful as the effect size of biomechanical stress (in this study at least) is low and would require larger samples than may be possible at archaeological sites.

The location and/or type of variants in FLNB result in a spectrum of osteochondrodysplasias ranging from mild forms, like spondylocarpotarsal synostosis syndrome and Larsen syndrome, to severe perinatal lethal forms, such as atelosteogenesis I and III and Boomerang dysplasia. Spondylocarpotarsal synostosis syndrome is characterized by disproportionate short stature, vertebral anomalies and fusion of carpal and tarsal bones. Biallelic loss-of-function variants in FLNB are known to cause spondylocarpotarsal synostosis syndrome and 9 families and 9 pathogenic variants have been reported so far. We report clinical features of 10 additional patients from 7 families with spondylocarpotarsal synostosis syndrome due to 7 novel deleterious variants in FLNB, thus expanding the clinical and molecular repertoire of spondylocarpotarsal synostosis syndrome. Our report validates key clinical (fused thoracic vertebrae and carpal and tarsal coalition) and molecular (truncating variants in FLNB) characteristics of this condition.

Calcaneonavicular coalitions are an important cause of adolescent foot pain and deformity. The congenital condition is characterized by an aberrant osseous, cartilaginous, or fibrinous union of the calcaneal and navicular bones. Calcaneonavicular coalitions are the most common form of tarsal coalitions identified within epidemiologic studies. A thorough understanding of this clinically significant entity is important for restoring joint motion and preventing long-term disability.

The objective of our study was to retrospectively determine the prevalence and image findings of extraarticular talocalcaneal coalition with os sustentaculum, a type of talocalcaneal coalition that does not appear in current classification systems, in patients with an imaging diagnosis of foot coalition.This study was performed using a database query of radiology reports of ankle and foot CT or MRI examinations performed from August 2001 to November 2013. Eighty-one patients were identified through a keyword search of the database for "talocalcaneal coalition," "tarsal coalition," "coalition," or "os sustentaculum." Imaging features of CT or MRI findings were evaluated. Chart review was used to identify demographic information.Extraarticular talocalcaneal coalition with os sustentaculum was diagnosed in 13 patients (nine men, four women), which represents a prevalence of 16.0% (13/81) in all foot coalitions and 24.1% (13/54) in all talocalcaneal coalitions. Four of 13 patients underwent surgical resection, and histology was obtained in three patients. Nine patients who had no history of trauma were symptomatic and all patients with bone marrow edema at the coalition sites on MRI (n = 5) were also symptomatic. Coexisting extraarticular talocalcaneal coalition with os sustentaculum and intraarticular talocalcaneal coalition were observed in 11 of 13 patients.The os sustentaculum is a component of extraarticular talocalcaneal coalitions and as such is usually related to the presence of symptoms. If a patient with an os sustentaculum has symptoms in the medial talocalcaneal joint area, an extraarticular talocalcaneal coalition related to the os sustentaculum should be considered.

Synovitis of the navicular bursa is common in performance horses. The objective of this study was to describe an ultrasound-guided technique to inject a distended navicular bursa and to evaluate its feasibility for use by a clinician not trained in the technique. Twenty distal limbs of horses of various breeds and sizes were used. To produce synovial distension, the navicular bursa of each limb was injected with contrast medium using a lateral approach and radiography was performed to confirm that the contrast medium was distending the bursa. The digit was positioned with the distal interphalangeal joint in hyperextension. A microconvex ultrasound probe was placed in the hollow of the pastern, palmar to the middle phalanx and the region was assessed in a transverse plane slightly oblique to the horizontal plane. The ultrasound probe was rotated to visualize both the lateral and medial recesses and to select which side was more distended to inject. A 21G 0.8 × 50 mm needle was inserted abaxially to the probe in the plane of the ultrasound beam into the proximal recess of this navicular bursa and a methylene blue solution was injected. Following injection, dissection was performed to assess whether the navicular bursa had been successfully injected. This ultrasound-guided technique was reliably performed with a success rate of 68%. The success of injection is influenced by hyperextension of the foot, quality of ultrasound images and degree of distension of the bursa.

BACKGROUND The aim of this study was to investigate the relationship between accessory navicular (AN) and flat foot and to evaluate the association between flat foot and the symptoms of patients with AN. METHODS We enrolled 196 patients with painful or asymptomatic AN in this study. Patients who were older than 18 years or who had no weight-bearing radiographs of the feet were not included. Another 46 normal participants were used as a control group. The AN group was divided into 3 subgroups: a group with asymptomatic AN; a symptomatic group that had not undergone excision; and a symptomatic group that had undergone surgery. Seven radiographic indices were measured including calcaneal pitch angle, tibiocalcaneal angle, talocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, lateral talo-first metatarsal angle, and AP talo-first metatarsal angle. Groups were compared regarding age, sex, presence of pain at the time of surgery, and radiographic parameters. RESULTS The calcaneal pitch angle in the AN group was significantly smaller than that of controls (P=0.004). Naviculocuboid overlap (P=0.001), talonavicular coverage angle (P

Computed tomography (CT) data provide information for volumetric and radiographic density analysis. The present study investigated the application of virtual CT volumetry of the tarsal bones to estimation of the sex, stature, and body weight using postmortem CT (PMCT) data of forensic autopsy cases. Three-dimensional (3D) images of the bilateral foot bones of intact Japanese subjects after adolescence (age ≥ 15 years, n = 179, 100 males and 79 females) were reconstructed on an automated CT image analyzer system. Measured parameters were mass volume, mean CT value (HU), and total CT value of the talus and calcaneus. Mean CT values of these bones showed age-dependent decreases in elderly subjects over 60 years of age for both sexes, with significant sex-related differences especially in the elderly. The mass volumes and total CT values of the talus and calcaneus showed significant sex-related differences, and also moderate correlations with body height and weight for bilateral bones in all cases (r = 0.58-0.78, p < 0.0001); however, the correlations of these parameters of the female talus with body weight were insufficient (r = 0.41-0.61, p < 0.0001). These observations indicate the applicability of virtual CT morphometry of the talus and calcaneus using an automated analyzer to estimate the sex and stature in forensic identification; however, greater variations should be considered in body weight estimations of females.

REASONS FOR PERFORMING STUDY: There are no reports on the configuration of equine central tarsal bone fractures based on cross-sectional imaging and clinical and radiographic long-term outcome after internal fixation. OBJECTIVES: To report clinical, radiographic and computed tomographic findings of equine central tarsal bone fractures and to evaluate the long-term outcome of internal fixation. STUDY DESIGN: Retrospective case series. METHODS: All horses diagnosed with a central tarsal bone fracture at our institution in 2009-2013 were included. Computed tomography and internal fixation using lag screw technique was performed in all patients. Medical records and diagnostic images were reviewed retrospectively. A clinical and radiographic follow-up examination was performed at least 1 year post operatively. RESULTS: A central tarsal bone fracture was diagnosed in 6 horses. Five were Warmbloods used for showjumping and one was a Quarter Horse used for reining. All horses had sagittal slab fractures that began dorsally, ran in a plantar or plantaromedial direction and exited the plantar cortex at the plantar or plantaromedial indentation of the central tarsal bone. Marked sclerosis of the central tarsal bone was diagnosed in all patients. At long-term follow-up, 5/6 horses were sound and used as intended although mild osteophyte formation at the distal intertarsal joint was commonly observed. CONCLUSIONS: Central tarsal bone fractures in nonracehorses had a distinct configuration but radiographically subtle additional fracture lines can occur. A chronic stress related aetiology seems likely. Internal fixation of these fractures based on an accurate diagnosis of the individual fracture configuration resulted in a very good prognosis.

Osteopoikilosis (OPK) is a very rare and primarily benign autosomal dominant disorder of unknown etiology. Genetic studies showed heterozygous mutations of the LEMD3 gene. It is characterised by the occurrence of hyperostotic spots throughout the skeleton, with the most frequent localizations in the epiphyses and metaphyses of long bones, as well as in the carpal and tarsal bones. The clinical features of osteopoikilosis are poorly represented; consequently the condition is usually diagnosed incidentally on radiological examination or due to the association with other medical disorders (articular pain, fractures, joint dislocations, etc.). We report a case of osteopoikilosis in a 44 year-old man who presented with left hip joint pain and low back pain irradiated in left leg. Radiographs showed typical features of osteopoikilosis. Necessary investigations were done to exclude osteoblastic metastasis. The patient was treated with drugs and physiotherapy with significant improvement of the symptoms.

Only few procedures for Lisfranc ligaments reconstruction to treat subtle injury of the Lisfranc joint have been reported. We have developed a novel technique for Lisfranc ligaments reconstruction, which was applied to treat chronic symptomatic subtle injuries that had failed to respond to initial treatment or were misdiagnosed. This article describes the technique and its operative outcome in a small case series. Between April 2011 and October 2013, 5 (4 male and 1 female) athletes with a mean age of 19.4 (range 17–21) years were diagnosed with chronic subtle injury of the Lisfranc joint and underwent our novel reconstructive operation. In this technique, only a bone tunnel between the medial cuneiform and the second metatarsal bone is needed for near-anatomical reconstruction of the dorsal and interosseous ligaments. All patients were evaluated before and at 1 year after surgery using the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle–midfoot. In addition, the interval between surgery and return to athletic activity, defined as return to near pre-injury performance level, was investigated. Mean duration of postoperative follow-up was 18.8 (range 12–26) months. Mean AOFAS score improved significantly from 74.6 ± 2.5 (range 71–77) preoperatively to 96.0 ± 5.5 (range 90–100) at 1 year after the operation (p

INTRODUCTION: Talar fractures are difficult and rare injuries with incidence of less than 2%1, are one of the most challenging and devastating injuries with varied prognosis, posing a real time challenge to orthopedic surgeons. METHODS: The study is a prospective multicenter randomized therapeutic study initiated in December '2006 on 40 patients with talus fracture to highlight and compare the different modalities of management of talar fractures in terms of functional and clinical results and complications. RESULTS: Out of 40 patients, 32 were male and 8 were female with a male/female ratio of 4:1. Most fractures were due to RTA in 22 cases. Most fractures were in neck of talus in 20 (50%). Out of 40 talar fractures, 10 were managed conservatively, 18 operated with screw fixation, 4 were fixed with cross K-wires and 8 old cases were managed with Blair's fusion. We experienced complications in 12 cases. DISCUSSION: A high degree of suspicion is required for the diagnosis of talus/ talar processes fractures, talus being the second most common tarsal bone to fracture. The preferred surgical timing for talar neck fractures is controversial. But the scenario in the sub-continent is quite different wherein the patients report late to the hospital often due to ignorance, quack therapy and illiteracy, often presenting with complicated and neglected injuries. Also, published literature and long term prospective studies on talar fractures, its treatment and complications based on our population is lacking.

Osteosarcoma is the commonest primary malignant bone tumor in children and adolescents. Giant cell rich osteosarcoma is a rare subtype of conventional osteosarcoma. Osteosarcomas commonly involve the metaphysis and meta-diaphysis of long bones. We report a 19-year-old girl with giant cell rich osteosarcoma of the medial and intermediate cuneiform bones. Even though, giant cell rich osteosarcoma is frequently mistaken for osteoclastoma of the bone; age of onset, location of lesion, radiological features, and histological characteristics on a high power field helps to differentiate the two conditions. Appropriate and early diagnosis of this variant possibly averts severe morbidity and mortality to the patient. Nonmetastatic osteosarcomas in the foot have better prognosis and are amenable to limb salvage surgeries.

PURPOSE Magnetic resonance (MR) imaging offers the highest sensitivity for detecting bone necrosis. We evaluated osteonecrosis in rabbit models by calculating the percentage of fat to (fat + water) [F/(F+W)] on MR spectroscopy (MRS) and compared MR spectroscopy and imaging findings with corresponding histological results. METHODS To model the natural course of articular osteonecrosis, we removed the fourth tarsal bone in 45 rabbits, froze it for 5 min in liquid nitrogen to produce complete cellular necrosis, and then replaced the bone into the knee joint. We performed Carr-Purcell-Meiboom-Gill proton spectroscopic imaging to assess necrotic bone at 3 days and one, 2, 3, 4, 8, 12, 16, and 20 weeks after osteonecrosis and calculated the percentage of F/(F+W) of each bone. We also performed conventional T1- and T2-weighted imaging and compared all data to histological findings to analyze the natural course of necrosis. RESULTS T1-weighted MR imaging demonstrated obvious low signal intensity at 2 to 8 weeks and recovery at 12 to 20 weeks, whereas T2-weighted imaging demonstrated inconsistent intensities throughout the period. The postoperative percentage of F/(F+W) measured using line scan MRS decreased to 8.88% at 3 weeks, 6.22% at 8 weeks, and 34.40% at 20 weeks results that were mostly consistent with MR imaging findings. Histological findings demonstrated complete absence of osteocyte nuclei and loss of osteoid-osteogenesis at 3 to 8 weeks. Recovery of bone marrow was identified as an increase in the area of fat after 12 weeks. CONCLUSION Osteonecrosis delineated by T1-weighted MR imaging demonstrated fat content in the bone marrow that correlated with histology. The present MRS modality can be used to calculate the percentage of F/(F+W) of osteonecrosis to enable objective assessment of recovery and quantification of osteonecrosis to provide a numerical value for osteonecrosis.

Tarsal coalitions represent a cohort of conditions characterized by bony, cartilaginous, or fibrous union of two or more tarsal bones. These disorders are often poorly understood by medical professionals, often leading to delays in diagnosis and treatment. They may be asymptomatic or cause hindfoot pain, stiffness, decreased range of motion, and foot deformities. Coalitions can be investigated by an ascending sequence of imaging including radiography, computed tomography, and magnetic resonance imaging. They may be managed conservatively with orthoses, activity modification, physiotherapy, anti-inflammatory medications, or definitive surgical intervention. To our knowledge, cuboid-lateral cuneiform coalition has not been reported in the orthopedic literature. We describe a 40-year-old woman with this condition who reported a 1-year history of left foot pain and stiffness. She was definitively diagnosed with magnetic resonance imaging and was managed conservatively with an aircast boot and hydrocortisone injection.

Tarsometatarsal osseous coalition is extremely rare. Herein, we present a case of osseous coalition between the base of the third metatarsal and the lateral cuneiform. The patient is a 38-year-old male who presented with an acute episode of foot pain following strenuous activity. Radiographs of the left foot demonstrated an osseous coalition between the third metatarsal base and the lateral cuneiform. Tarsal coalition is a congenital defect that results when adjacent tarsals fail to separate during embryonic development. According to the literature, total osseous coalition is less common than cartilaginous coalition. This case serves as only the second known documented case of osseous coalition between the third metatarsal and the lateral cuneiform, with the first case published in an orthopedic journal. To our knowledge, no case of third metatarsal-lateral cuneiform coalition has been published in the literature otherwise. The intent of this publication is to add to the database of tarsometatarsal coalition cases with a specific emphasis on bony coalition between the third metatarsal and lateral cuneiform.

The calcaneus is the most commonly fractured tarsal bone. Displaced intraarticular calcaneal fractures are usually caused by a fall from height with one or both heels directly hitting the ground. Displaced intra-articular calcaneal fractures are complex and highly disabling injuries. There is ongoing debate regarding the optimal treatment for each type of displaced intra-articular calcaneal fracture. This review aims to summarize the classification of, various treatment options for, prevention of perioperative complications in, and management algorithms for displaced intra-articular calcaneal fractures. [ Orthopedics. 2017; 40(6):e921–e929.]

Introduction Cuboid fractures are very rare. Hence, their treatment has not been standardized. Advances in imaging techniques, particularly three-dimensional computed tomography (3D CT), and the introduction of cuboid-specific plates has improved the care of these injuries. The aim of this study was to determine the radiological and clinical outcomes of anatomical reconstruction of comminuted cuboid fractures with a locking plate. Hypothesis Fixation of comminuted cuboid fractures with a cuboid-specific locking plate leads to stable anatomical reduction and good functional outcomes. Material and methods This was a retrospective study of 9 consecutive cases of comminuted cuboid fracture treated at a single hospital between January 2009 and December 2015. A 3D CT scan was performed preoperatively with subtraction of the posterior tarsal bone to allow the articular facets to be viewed and analyzed. Fracture fixation was done with a Locking Cuboid Plate (DePuy Synthes™). Associated lesions in the foot were treated during the same procedure. The patients were reviewed by an independent observer who performed a clinical examination, and determined the AOFAS and Maryland Foot Score. The success of the reconstruction was determined by comparing the parameters on weight-bearing X-rays views between the fixed and non-operated cuboid. Results The mean follow-up was 4.1 years (range 1–6). The Maryland Foot Score was 93.1 [86–100] and the AOFAS was 91.9 [82–100]. The reconstruction was anatomical and long lasting in all 9 cases. There was no foot misalignment in the frontal plane, based on the radiographs (hindfoot axis 5.5° [0–9]). The mean Djian-Annonier angle was 123.9° [108–130]. Conclusion Cuboid fractures can be treated effectively through appropriate imaging and with a cuboid-specific locking plate as evidenced by very good midterm clinical and radiological outcomes in this study. Level of evidence IV Retrospective study.

In very fragmentary remains, the thorough inventory of skeletal elements is often impossible to accomplish. Mass has been used instead to assess the completeness of the skeleton. Two different mass-based methods of assessing skeleton completeness were tested on a sample of experimentally burned skeletons with the objective of determining which of them is more reliable. The first method was based on a simple comparison of the mass of each individual skeleton with previously published mass references. The second method was based on mass linear regressions from individual bones to estimate complete skeleton mass. The clavicle, humerus, femur, patella, metacarpal, metatarsal and tarsal bones were used. The sample was composed of 20 experimentally burned skeletons from 10 males and 10 females with ages-at-death between 68 and 90years old. Results demonstrated that the regression approach is more objective and more reliable than the reference comparison approach even though not all bones provided satisfactory estimations of the complete skeleton mass. The femur, humerus and patella provided the best performances among the individual bones. The estimations based on the latter had root mean squared errors (RMSE) smaller than 300g. Results demonstrated that the regression approach is quite promising although the patella was the only reasonable predictor expected to survive sufficiently intact to a burning event at high temperatures. The mass comparison approach has the advantage of not depending on the preservation of individual bones. Whenever bones are intact though, the application of mass regressions should be preferentially used because it is less subjective.

Tenosynovial giant cell tumor (also known as giant cell tumor of tendon sheath or pigmented villonodular synovitis) is a rare soft tissue tumor that arises from the tenosynovium of a tendon sheath or the synovium of a diarthrodial joint. This disease process occurs infrequently in the foot and ankle but can result in significant bone erosion and destructive changes of affected joints. These cases are challenging to treat, because the tumor most commonly presents in young, active patients and can be associated with extensive bone loss. We review a case of tenosynovial giant cell tumor of tendon sheath of the midfoot, which was treated with mass resection, structural femoral head allograft bone grafting, and internal fixation with dorsal plating. The patient had achieved successful bony fusion and acceptable functional outcomes at the final follow-up visit 40 months postoperatively.

The purpose of this brief chapter is to take a look at the five most distal tarsal bones in the foot, review the basic anatomy of these structures, and review the types of fractures, treatment methods, and some complications postoperatively. This brief review will give a quick insight into these anatomically small and sometimes forgotten bones of the midfoot.