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

Purpose: The authors experienced several cases of extra-articular calcaneal fracture accompanied by joint depression involving the entire posterior facet without joint involvement. This type of fracture and its characteristics and treatment outcomes have not been previously reported. The study was performed to analyze the characteristics of extra-articular calcaneal fractures of the joint depression type and their postoperative clinical and radiographic results and complications. Methods: Between February 2013 and March 2021, 23 extra-articular calcaneal fractures of the joint depression type were consecutively treated by a single surgeon. Relationships between fracture characteristics and patient demographics were assessed. Clinical results were quantified using visual analog scale, American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and Foot Function Index, radiographic results were evaluated using Böhler's angles, and calcaneal widths were determined using calcaneal axial and lateral radiographs obtained preoperatively and at last follow-up. Results: Twenty (87%) of the 23 cases occurred in women, and the mean age of all patients was 65.8 years (43–90). The three men were older than 65. Five (21.7%) patients had osteopenia, and 12 (52.2%) had osteoporosis. Bone mineral density testing could not be performed in the other six patients. Clinical and radiographic results were significantly improved after surgery. Conclusion: Extra-articular calcaneal fractures of the joint depression type are much more common in women and occur at an older age than calcaneal fractures commonly occur. These fractures are also more common in patients with a low bone mineral density. Level of evidence: Level IV. Case series. [ABSTRACT FROM AUTHOR]

Objectives: The study of puberty is a well‐established area of bioarcheological research, which greatly enhances our understanding of adolescence and growth in the past. Since the publications of Shapland and Lewis' works, which have become "standards" for estimating puberty in skeletal material, no additional osteological indicators of puberty have been proposed. Nevertheless, clinical practice constantly develops skeletal maturation markers that could be useful in bioarcheology. This study aims to assess the applicability and reliability of novel puberty indicators as a complementary tool to estimate puberty in skeletal remains. Materials and Methods: Four new maturation markers including spheno‐occipital synchondrosis, humeral head ossification, calcaneal apophysis ossification, and mandibular premolar mineralization were selected and applied to a sample of 85 adolescents from pre‐Roman southern Italy (Pontecagnano, 7th–4th BCE). Results: Despite some limits in adapting the original clinical methods to osteoarcheological material, the use of these novel skeletal indicators had moderate to excellent scoring repeatability and an overall high agreement with the puberty and menarche status previously estimated with standard methods. These results encourage us to apply these markers in bioarcheology. In some cases, minor adaptations of the original scoring systems are suggested to enhance reliability. Discussion: Including the proposed indicators in routine puberty data collection allows us to refine puberty estimation and improve the ability to identify key growth milestones in poorly preserved skeletons. Further application to osteological collections with diverse chronology and geographical differences is needed to assess how and to what extent the newly proposed maturation markers perform. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to provide reference data regarding the morphology of vascular foramina (VF) of calcaneus among the Turkish population. Methods: This study was performed using 49 dry calcanei (26 right, 23 left). The number as well as the location of VF in relation of each surface of calcaneus were evaluated. The total length (TL), the distance between the most posterior point of calcaneus and the largest foramina on the medial (LMS), lateral (LLS), superior (LSS) and inferior (LIS) surfaces were measured and foraminal indexes of the largest foramina on the medial (FI1), lateral (FI2), superior (FI3) and inferior (FI4) surfaces were calculated. Results: The mean values of the TL, LMS, LLS, LSS, LIS were measured to be 74.83 ± 6.00 mm, 41.34 ± 4.78 mm, 31.18 ± 7.63 mm, 49.61 ± 13.40 mm, 39.25 ± 13.56 mm, respectively. The mean values of the FI1, FI2, FI3 and FI4 were calculated to be 55.40 ± 6.21%, 41.73 ± 10.06%, 66.01 ± 16.82%, 52.16 ± 16.80%, respectively. The maximum numbers of VF were detected most commonly on the lateral (28.29%) and medial (26.45%) surfaces, and least commonly on the anterior (0.98%) and posterior (8.29%) surfaces. Conclusions: VF were observed to be most commonly located on the lateral and medial surfaces, and least commonly on the anterior and posterior surfaces. Having adequate knowledge of the morphologic and morphometric properties of the VF is important in regarding the surgical approaches to the calcaneus towards the aim of reducing the vascular damage, especially in lateral approaches for orthopedists and of using differential sign from cystic lesions for radiologists. [ABSTRACT FROM AUTHOR]

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

BACKGROUND: The calcaneus is located in the lower posterior part of the foot and is heavily stressed. Calcaneus is complex and irregular in shape, surrounded by thin cortical bone and filled with a large number of trabeculae. The study of the microstructure, movement, and distribution of trabeculae is helpful to improve the understanding of calcaneus fracture. OBJECTIVE: The image data of calcaneus were obtained by scanning the calcaneus specimens with micro-computed tomography, and the structure of trabecular bone in calcaneus was analyzed to explore the morphology, distribution and structural characteristics of trabecular bone in calcaneus. METHODS: Dry adult calcaneus specimens were continuously scanned by micro-computed tomography, and the images were obtained after scanning and stored in DICOM format. Image data were imported into Hiscan Analyzer software to display clear and complete images of the sagittal plane, coronal plane, and the horizontal plane of the adult calcaneus. The trabecular movement of bone was observed layer by layer. According to the trabecular movement characteristics, the sagittal plane of the calcaneus was divided into six parts. A 49-mm2 region of interest was selected for each part at the same thickness as 7 mm. The three-dimensional microstructure of calcaneus and trabecular bone was obtained after three-dimensional reconstruction. After binarization, the volume fraction, surface density, trabecular thickness, trabecular space, and trabecular number parameters of the trabecular bone in the region of interest were calculated by software. RESULTS AND CONCLUSION: (1) The cortical layer of the calcaneus was very thin and filled with a large amount of cancellous bone, and the cortical layer of the horn of Gissane was obviously thickened. (2) The trabecular volume fraction in the upper part of the calcaneus was greater than that in the anterior part of the lower part of the calcaneus, the central triangle, the posterior part of the lower part of the calcaneus, and the base of the calcaneus, and the trabecular volume fraction in the tubercle of the calcaneus was greater than that in the anterior part of the lower part of the calcaneus, the central triangle, the posterior part of the lower part of the calcaneus, and the base of the calcaneus. The surface density of the trabecular bone in the tubercle of the calcaneus was higher than that in the front of the lower calcaneus, the middle triangle area, and the bottom of calcaneus, and the surface density of the trabecular bone in the upper part of calcaneal bone, and the lower part of the calcaneus was higher than that in the middle triangle area. The thickness of the trabecular bone in the upper part of the calcaneus was greater than that in the tubercle of the calcaneal bone. The bone trabecular space in the middle triangle was larger than that in the upper part of the calcaneus and calcaneal tubercles. The number of bone trabeculae in the calcaneal tubercles was greater than that in the middle triangle area. (3) These results indicate that the trabeculae of rod bone were mainly distributed in the middle triangle area. The surface density of trabeculae was the smallest, the volume fraction was smaller, and the space between trabeculae was the largest. This part of the bone is relatively loose. The compression resistance is poor when subjected to high impact. The trabecular bone fractures first occur, which is a prone site for fractures. [ABSTRACT FROM AUTHOR]

Background: Fixation of calcaneus through the sinus tarsi approach is increasingly popular due to the lower rate of wound complications. The use of postoperative CT provided a better evaluation tool than using plain radiography. Our objective of the present study is to evaluate the quality of fracture reductions by postoperative 3D CT scans after surgical intervention using the sinus tarsi approach and fixation with 3.5 cortical screws. Methods: Between January 2018 and April 2020, 86 consecutive patients with 92 closed displaced intra-articular calcaneal fractures underwent ORIF with 3.5 mm screws constructed via a minimally invasive sinus tarsi approach by a single foot and ankle surgeon. Results: The preoperative radiographic assessment found 36 joint depression type and 56 tongue type fractures according to the Essex–Lopresti classification. Preoperative CT assessment found 82 type II and 10 type III according to the Sander classification. Analysis of pre- and postoperative CT parameters showed that the height of the posterior facet, the length of the posterior facet, Gissane, and Bohler's angle were significantly improved. In addition, the means of posterior facet step-off in postoperative CT was 1.07, and 72% of posterior facet reductions were < 2 mm step-offs. Conclusion: With postoperative CT scan assessment, the treatment of displaced intra-articular calcaneal fracture with 3.5 mm screws via sinus tarsi approach has achieved good quality of reduction. Therefore, the screws-only technique is an option for treating calcaneal fracture with less soft tissue damage and implant cost. [ABSTRACT FROM AUTHOR]

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Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity. A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n = 16) and Haglund non-resection (non-resection group, n = 13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment–Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively. Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38 ± 5.7 vs. 93.15 ± 12.17; P = 0.82), VAS (0.5 ± 0.52 vs. 0.61 ± 0.87; P = 0.66) and VISA-A questionnaire (82.56 ± 13.46 vs. 74.92 ± 16.4; P = 0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15 ± 2.51 weeks vs. 11.31 ± 4.06 weeks, P = 0.02). The Fowler-Philip angle of the resection group decreased from 55.55° ± 12.34° preoperatively to 44.52° ± 10.24° at the latest follow-up (P = 0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38° ± 8.41° preoperatively to 46.52° ± 8.02° at the latest follow-up (P = 0.016). The calcaneal pitch angle of the resection group increased from 22.76° ± 5.37° preoperatively to 25.98° ± 6. 4° at the latest follow-up (P = 0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm ± 5.37 mm preoperatively to 173.90 mm ± 8.07 mm at the latest follow-up (P = 0.018). Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformity. [ABSTRACT FROM AUTHOR]

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

Background: Acquired adult flatfoot deformity (AAFD) results in a loss of the medial longitudinal arch of the foot and dysfunction of the posteromedial soft tissues. Hintermann osteotomy (H-O) is often used to treat stage II AAFD. The procedure is challenging because of variations in the subtalar facets and limited intraoperative visibility. We aimed to assess the impact of augmented reality (AR) guidance on surgical accuracy and the facet violation rate. Methods: Sixty AR-guided and 60 conventional osteotomies were performed on foot bone models. For AR osteotomies, the ideal osteotomy plane was uploaded to a Microsoft HoloLens 1 headset and carried out in strict accordance with the superimposed holographic plane. The conventional osteotomies were performed relying solely on the anatomy of the calcaneal lateral column. The rate and severity of facet joint violation was measured, as well as accuracy of entry and exit points. The results were compared across AR-guided and conventional osteotomies, and between experienced and inexperienced surgeons. Results: Experienced surgeons showed significantly greater accuracy for the osteotomy entry point using AR, with the mean deviation of 1.6 ± 0.9 mm (95% CI 1.26, 1.93) compared to 2.3 ± 1.3 mm (95% CI 1.87, 2.79) in the conventional method (P =.035). The inexperienced had improved accuracy, although not statistically significant (P =.064), with the mean deviation of 2.0 ± 1.5 mm (95% CI 1.47, 2.55) using AR compared with 2.7 ± 1.6 mm (95% CI 2.18, 3.32) in the conventional method. AR helped the experienced surgeons avoid full violation of the posterior facet (P =.011). Inexperienced surgeons had a higher rate of middle and posterior facet injury with both methods (P =.005 and.021). Conclusion: Application of AR guidance during H-O was associated with improved accuracy for experienced surgeons, demonstrated by a better accuracy of the osteotomy entry point. More crucially, AR guidance prevented full violation of the posterior facet in the experienced group. Further research is needed to address limitations and test this technology on cadaver feet. Ultimately, the use of AR in surgery has the potential to improve patient and surgeon safety while minimizing radiation exposure. Clinical Relevance: Subtalar facet injury during lateral column lengthening osteotomy represents a real problem in clinical orthopaedic practice. Because of limited intraoperative visibility and variable anatomy, it is hard to resolve this issue with conventional means. This study suggests the potential of augmented reality to improve the osteotomy accuracy. [ABSTRACT FROM AUTHOR]

Background: Cadaver biomechanical testing suggests that the morphology of articulating bones contributes to the stability of the joints and determines their kinematics; however, there are no studies examining the correlation between bone morphology and kinematics of the subtalar joint. The purpose of this study was to investigate the influence of talar and calcaneal morphology on subtalar kinematics during walking in healthy individuals. Methods: Forty ankles (20 healthy subjects, 10 women/10 men) were included. Participants walked at a self-selected pace while synchronized biplane radiographs of the hindfoot were acquired at 100 images per second during stance. Motion of the talus and calcaneus was tracked using a validated volumetric model-based tracking process, and subtalar kinematics were calculated. Talar and calcaneal morphology were evaluated using statistical shape modeling. Pearson correlation coefficients were used to assess the relationship between subtalar kinematics and the morphology features of the talus and calcaneus. Results: This study found that a shallower posterior facet of the talus was correlated with the subtalar joint being in more dorsiflexion, more inversion, and more internal rotation, and higher curvature in the posterior facet was correlated with more inversion and eversion range of motion during stance. In the calcaneus, a gentler slope of the middle facet was correlated with greater subtalar inversion. Conclusion: The morphology of the posterior facet of the talus was found to a primary factor driving multiplanar subtalar joint kinematics during the stance phase of gait. Clinical Relevance: This new knowledge relating form and function in the hindfoot may assist in identifying individuals susceptible to subtalar instability and in improving implant design to achieve desired kinematics after surgery. [ABSTRACT FROM AUTHOR]

Purpose: There are still controversies on the effect of grafting during open reduction and internal fixation of calcaneal fractures. The aim of this study was to compare the radiological and functional outcomes in patients with or without intraoperative grafting. Methods: In a comparative retrospective study, among 442 operatively-treated calcaneal fractures, 60 patients with unilateral closed sanders type II intraarticular calcaneal fracture who underwent ORIF via lateral extensile approach using locking anatomical plates with at least 1 year follow-up without any postoperative wound complication were enrolled. The patients were separated into 2 groups: with bone allograft and without bone allograft. The functional outcome of the patients was assessed using visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, foot function index (FFI), and short-form (SF-36) health survey. Radiographic variables included Böhler angle, Gissane angle, calcaneal width, calcaneal height, and talar declination angle. Also, the differences (delta) of these values in comparison to the uninjured foot were calculated. Results: The mean age was 39.1 ± 12.7 (range, 13–67) years with 54 males, 90.0%. No statistically significant differences were detected in age, gender, affected side, and subtypes of calcaneal fractures between the two groups (p > 0.05). The average follow-up was 25.1 (range, 12–48) months. The differences for all radiographic measurements and also, the delta values between the groups were not statistically significant, except talar declination angle which was more in cases without grafting (p = 0.007). Although the differences between the two groups regarding AOFAS ankle-hindfoot scale (p = 0.257), VAS for pain (p = 0.645), and FFI (p = 0.261) were not statistically significant; the group with bone graft experienced less pain (19.7 ± 22.0) than the other group (26.7 ± 22.8). The difference between the groups was not statistically significant (p = 0.87) according to the SF-36 questionnaire. Conclusions: Incorporating allografts into the void defects during ORIF of displaced intraarticular calcaneal fractures may not improve functional outcomes and recover postoperative radiological parameters. Therefore, routine use of allograft to fill the defects during ORIF of calcaneus may not be recommended. Of note, that these findings solely relate to the treatment of Sanders type II fractures. Level of evidence III: Comparative retrospective study. [ABSTRACT FROM AUTHOR]

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

Purpose: Tarsal tunnel syndrome is well documented following lateralizing calcaneal osteotomy to manage varus hindfoot deformity. Traditionally, calcaneal osteotomy is performed with an oscillating saw. No studies have investigated the effect of alternative surgical techniques on postoperative tarsal tunnel pressure. The purpose of this study was to investigate the difference in tarsal tunnel pressures following lateralizing calcaneal osteotomy performed using a high-torque, low-speed "minimally invasive surgery" (MIS) Shannon burr versus an oscillating saw. Methods: Lateralizing calcaneal osteotomy was performed on 10 below-knee cadaveric specimens. This was conducted on 5 specimens each using an oscillating saw (Saw group) or MIS burr (Burr group). The calcaneal tuberosity was translated 1 cm laterally and transfixed using 2 Kirschner wires. Tarsal tunnel pressure was measured before and after osteotomy via ultrasound-guided percutaneous needle barometer. Mean pre/post-osteotomy pressures were compared between groups. Differences were analyzed using Student's t test. Results: The mean pre-procedure tarsal tunnel pressure was 25.8 ± 5.1 mm Hg in the Saw group and 26.4 ± 4.3 mm Hg in the Burr group (p = 0.85). The mean post-procedure pressure was 63.4 ± 5.1 in the Saw group and 47.8 ± 4.3 in the Burr group (p = 0.01). Change in tarsal tunnel pressure was significantly lower in the Burr group (21.4 ± 4.5) compared to the Saw group (37.6 ± 12.5) (p = 0.03). The increase in tarsal tunnel pressure was 43% lower in the Burr group. Conclusion: In this cadaveric study, tarsal tunnel pressure increase after lateralizing calcaneal osteotomy was significantly lower when using a burr versus a saw. This is likely because the increased width ("kerf") of the 3 mm MIS burr, compared to the submillimeter saw blade width, causes calcaneal shortening. Given the smaller increase in tarsal tunnel pressure, using the MIS burr for lateralizing calcaneal osteotomy may decrease the risk of postoperative tarsal tunnel syndrome. Future research in vivo should explore this. [ABSTRACT FROM AUTHOR]

Aim: The calcaneus has a significant role in the foot due to its location. It is used together with the pelvis and skull bones in gender determination. In this study, it was aimed to determine the morphometric characteristics of the calcaneus and determine the suitability of these measurement locations for gender estimation. Material and Method: In the study, seven measurements were taken bilaterally from 1,080 lateral foot radiographs of 540 individuals aged 20-65 years. For foot bone height (FBL), the distance between the anterior end of the distal phalanx of the most distal toe and the most posterior end of the foot was taken, while for maximum calcaneal length (maxCaL), the distance between the anterior end of the calcaneus and the posterior end of the calcaneus was taken. SPSS 21 program was used for statistical analyses and the ratio of gender prediction performances was examined by Receiver operating characteristic (ROC) analysis. Results: All length measurements were higher in males than females (p<0.05), and foot bone height (FBL) (p=0.035) and maximum calcaneus height (maxCaH) (p=0.007) were higher on the right side than on the left side. The study also found a weak negative correlation between age and the right-sided medial calcaneus length parameter (rmedCaL) and strong correlations between certain measurements. Foot bone length (FBL) was found to have the highest accuracy in predicting gender (AUC=0.913). Conclusion: The findings provide useful information for forensic cases, provide reference data for diagnosis and treatment processes in the clinic, and provide data for the development of machine learning software that can be used in medical and forensic cases. [ABSTRACT FROM AUTHOR]

BACKGROUND: Calcaneal defects are common in clinical practice. It is difficult for surgeons to evaluate the effect of calcaneal reconstruction due to the complex anatomical structure and motor function of the heel. Finite element analysis has become an effective method for biomechanical behavior simulation and numerical analysis. OBJECTIVE: To compare the clinical effect and biomechanical characteristics of total calcaneal reconstruction with the II-shaped and V-shaped fibular flap. METHODS: CT images of one left foot of a healthy 50-year-old male were acquired. Mimics software was used to obtain the preliminary three-dimensional model. Geomagic software was used to trim and curve the model. The model was imported into Solidworks software to simulate calcaneal reconstruction and complete the pre-processing of finite element calculation. Finally, Ansys software was used to solve the problem. The simulation results were compared with previous literature results to verify the effectiveness of the model. The surgical effect and biomechanical characteristics of the foot in different gait phases based on the simulated stress results were analyzed. RESULTS AND CONCLUSION: (1) Both II-shaped and V-shaped fibular flaps could be used to reconstruct completely missing calcaneus, which could restore the length, width and height of normal calcaneus, and fill up the missing calcaneus bone. (2) Compared with the normal calcaneus, both configurations of fibular flaps showed a tendency for over-concentration of stress after loading. The normal calcaneus stress was mostly concentrated around the calcaneus nodule, the subtalar process and the calcaneus groove, while the stress of the two fibular flaps was mostly concentrated at the junction between the bone flap with the talus and cuboid bones. (3) The maximum stress of calcaneus was different between the two models and normal calcaneus under different simulation conditions, with statistically significant differences (P < 0.05). Compared with the V-shaped fibular flaps, II-shaped fibular flaps had less force change in different gaits and were closer to the normal calcaneus. The V-shaped fibular flap bore excessive stress during the period of push-off, and the grafted bone material may yield under this condition and have the risk of fractures. [ABSTRACT FROM AUTHOR]

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

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

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

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

L'enthèse représente la zone d'ancrage d'un tendon, d'un ligament ou d'un fascia sur l'os. Les enthèses fibrocartilagineuses sont les plus fréquentes et sont concernées par les processus physiopathologiques. Elles sont composées de quatre zones qui permettent une répartition des contraintes (os, fibrocartilage calcifié et vasculaire, fibrocartilage non calcifié et avasculaire, tendon). La pathologie de l'enthèse (enthésopathie) est plus fréquemment d'origine mécanique mais elle peut être le mode d'entrée dans une maladie rhumatismale type spondyloarthrite (SpA) périphérique et il est important de pouvoir différencier les causes afin de débuter rapidement un traitement adapté. Bien que le diagnostic d'enthésopathie repose sur l'interrogatoire et l'examen clinique, il est difficile de différencier une enthésite rhumatismale d'une enthésopathie mécanique sur ces seules données qui ne sont pas spécifiques. Les tests biologiques et notamment la recherche de l'haplotype HLA B27 ne sont pas non plus discriminants (HLA B27 présent dans 30 à 70 % des cas dans les SpA périphériques et chez 7 % de la population générale). Certains auteurs se sont donc intéressés au rôle de l'imagerie et plus particulièrement de l'échographie pour différencier ces causes et il apparaît qu'il n'existe aucun critère spécifique en mode B. L'hypervascularisation du tendon en Doppler couleur ne présente pas non plus de caractère discriminant. Une hypervascularisation au contact de la corticale avait été initialement décrite comme spécifique mais ces données ont été contredites par des études ultérieures qui mettaient en avant le caractère avasculaire du fibrocartilage calcifié qui agit comme une barrière de protection. Cette hypervascularisation serait donc liée pour certains auteurs à un artéfact de scintillement (twinkling artefact). L'échographie ne présente donc pour le moment aucun critère spécifique pour différencier les enthésites rhumatismales des enthésopathies mécaniques. L'IRM pourrait quant à elle jouer un rôle en individualisant un œdème osseux étendu au stade précoce. The enthesis represents the anchoring area of a tendon, ligament or fascia on the bone. Fibrocartilaginous entheses are the most common and are affected by physiopathological processes. They are made up of four zones which allow stress distribution (bone, calcified and vascular fibrocartilage, non-calcified and avascular fibrocartilage, tendon). The pathology of the enthesis (enthesopathy) is more frequently of mechanical origin but it can be the beginning of a rheumatic disease such as peripheral spondyloarthritis (SpA) and it is important to be able to differentiate the causes in order to quickly begin treatment. Although the diagnosis of enthesopathy is based on history and clinical examination, it is difficult to differentiate rheumatic enthesitis from mechanical enthesopathy based on these data alone, which are not specific. Biological tests and in particular the search for the HLA B27 haplotype are also not discriminating (HLA B27 present in 30 to 70% of cases in peripheral SpA and in 7% of the general population). Some authors have therefore been interested in the role of imaging and more particularly ultrasound to differentiate these causes and it appears that there is no specific criterion in B mode. Hypervascularization of the tendon in color Doppler does not present no longer discriminatory. Hypervascularization in contact with the cortex was initially described as specific but these data were contradicted by subsequent studies which highlighted the avascular nature of the calcified fibrocartilage which acts as a protective barrier. This hypervascularization would therefore be linked for some authors to a twinkling artifact. Ultrasound therefore does not currently present any specific criteria to differentiate rheumatic enthesitis from mechanical enthesopathy. MRI could play a role in individualizing extensive bone edema at the early stage. [ABSTRACT FROM AUTHOR]

In this study, the calcaneus and talus bones of 20 male and female adult Simmental and Angus cattle were used. The age and sex of these animals were recorded before slaughter, and carcass weights were taken after slaughter. Calcaneus and talus morphometric measurements were used to obtain multipliers that allow the estimation of the carcass weight. These multipliers were found to be mean values of 3.346 and 4.642, respectively. Thus, multipliers were obtained that can be used in the evaluation of chronological differences in archaeological cattle size and consequently carcass weight. LSM (Least Square Means) analysis of calcaneus and talus GL values revealed the effect of sex but not of breed. Proportional factors were obtained for calcaneus and talus pairings and associated bone size (GL) estimates. [ABSTRACT FROM AUTHOR]

The anterior iliac crest is one of the most used options; however, pain and other complications have been reported. Other options for bone harvest in the lower extremity, such as the proximal tibia and calcaneus, can be useful sites for bone grafting. Computed tomography angiography images of the lower extremity were analyzed using 3-D Slicer™ medical imaging software, creating an advanced 3-dimensional model. Bone volume (cm3) and bone mineral density (Hounsfield units) were measured from the cancellous bone in the anterior iliac crest, posterior iliac crest, proximal tibia, and the calcaneus. Fifteen studies were included. The total volume measured it was of 61.88 ± 14.15 cm3, 19.35 ± 4.16 cm3, 32.48 ± 7.49 cm3, 26.40 ± 7.18 cm3, for the proximal tibia, anterior and posterior iliac crest, and calcaneus, respectively. Regarding Hounsfield units, the densities were 116 ± 58.77, 232.4 ± 68.65, 214.4 ± 74.45, 170.5 ± 52.32, for proximal tibia, anterior and posterior iliac crest, and calcaneus. The intraclass correlation coefficients were in average >0.94. In conclusion, the proximal tibia has more cancellous bone than the anterior and posterior iliac crest. The calcaneus has more cancellous bone than the anterior iliac crest. Bone mineral density was highest in the anterior iliac crest and in proximal tibia was the lowest value. [ABSTRACT FROM AUTHOR]

Standardized methods for osteomyelitis (OM) diagnosis of the lower extremity have proven to be difficult. Preoperative probability of foot osteomyelitis necessitates a combination of clinical, laboratory, imaging evidence (i.e., X-ray, CT, MRI), and bone biopsy to guide diagnosis and treatment. In the recent past, the relative weight that clinicians give to these collections of data to advise potential surgical intervention has been challenged, particularly with histologic evaluation of bone biopsy—traditionally considered "gold standard" in OM diagnosis. This study seeks to further expand this dialogue by retrospectively comparing calcaneal bone biopsies performed by direct visualization trephine approach (performed by Surgeons) vs fine needle biopsy with fluoroscopy guidance (performed by Interventional Radiologists). Results obtained from 57 patients with suspected calcaneal osteomyelitis demonstrate that Trephine obtained samples are significantly more likely to produce histopathologic evidence of OM (p -value:.013), microbiologic evidence of OM (p -value: <.001) and have better histopathologic and microbiologic concordance (p -value: <.001) than calcaneal bone biopsies obtained from Fine Needle Biopsy with fluoroscopy guidance. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Objective To investigate the clinical efficacy of using a "pickaxe" pattern peroneal nerve nutrient vascular flap in the repair of traumatic soft tissue defects of the calcaneus. Methods From January 2018 to June 2023, Department of Plastic Surgery, Gansu Provincial Hospital admitted 18 patients with traumatic soft tissue defects of the calcaneus admitted. According to the shape of the wound, a "pickaxe" pattern peroneal nerve nutrient vascular flap was designed at a point 6cm above the midpoint of the line connecting the ankle and Achilles tendon to perform reverse repair of the soft tissue defect and reconstruction of the heel. Results All flaps survived completely. After a follow-up of 6~12 months, the weight-bearing walking and wear resistance of the heel were fully restored to meet the patients daily life needs. Conclusion The "pickaxe" pattern peroneal nerve nutrient vascular flap can be individualized designed based on the shape of the soft tissue defect of the calcaneus after trauma, achieving the goals of wound repair, reconstruction, and restoration of heel function. [ABSTRACT FROM AUTHOR]

Introduction: The sustentaculum tali is displaced in almost half of calcaneal fractures and during surgical fixation represents one of the main reference points upon which the other bone has to be reduced. The purpose of this study was to investigate which subtalar joint fracture pattern is more frequently associated with sustentaculum tali involvement. Furthermore, correlation between postoperative clinical outcome and sustentaculum tali integrity was performed. Material and methods: Patients with isolated calcaneal fractures were analyzed. Sanders-type fracture and involvement of both sustentaculum tali and calcaneocuboid joint were detected on computed tomography imaging; postoperative AOFAS scores were analyzed according to sustentacular involvement. Results: Fifty calcaneus fractures in 47 patients were included in the final analysis. The sustentaculum tali was fractured in 18 cases (36.0%), thus contradicting its supposed constant position. Sanders type 3 and 4 fractures were more frequently associated with fractured sustentaculum than type 2 (p = 0.012). Sanders type 4 fractures were associated with displaced sustentacular fragment significantly more than type 2 and 3 (p = 0.043). Patients with intact sustentaculum tali reported significantly higher (p < 0.001) mean AOFAS scores than the uninjured group (84.4 ± 9.1 and 74.3 ± 9.5, respectively). Conclusion: Sanders type 3 and 4 fractures were more frequently associated with sustentaculum tali and/or calcaneocuboid joint involvement than simpler fractures. Injury of sustentaculum tali was related to significant worse postoperative clinical outcomes, underlying the relevance of this fragment on clinical course. [ABSTRACT FROM AUTHOR]

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

Background: In the presence of pain over the lateral aspect of the foot or recurrent ankle sprain in children, medical imaging is often employed to investigate potential causes, such as a calcaneonavicular coalition or a too-long anterior process (TLAP) of the calcaneus. Diagnosis and categorization of calcaneonavicular coalitions (synostosis, synchondrosis, or synfibrosis) is generally facilitated through imaging, in contrast to TLAP, which lacks well-defined semiological characteristics, apart from a calcaneonavicular space measurement of less than 5 mm. However, this measurement initially performed on an oblique view radiograph can be subject to a lack of precision due to positional variations of the foot and overlapping bones. Furthermore, the differentiation between TLAP as an anatomical variant and TLAP syndrome (characterized by symptomatic presentation), remains a subject of uncertainty. Objective: The objective of our retrospective study was to investigate the imaging diagnosis of TLAP syndrome. Materials and methods: A retrospective unmatched case-control study was conducted, covering data from February 2014 to January 2021. All patients, included retrospectively and consecutively, were initially managed in our hospital with radiography and/or computed tomography (CT) and/or magnetic resonance imaging (MRI). Two radiologists independently reviewed the images taken (radiographs, CT scans, and MRIs) of patients undergoing treatment in pediatric orthopedics for TLAP syndrome and control subjects, utilizing a standardized questionnaire. The control group consisted of subjects with no features suggestive of TLAP syndrome. The questionnaire included measurements of the calcaneonavicular space and identification of indirect signs associated with calcaneonavicular coalitions, as described in the related literature. Results: A total of 128 patients who met the inclusion criteria were included in the analysis, including 38 patients and 90 controls. The prevalence of TLAP was 71.5% in the study population and 62.6% among controls. A threshold measurement of the calcaneonavicular space at 3.2 mm favored TLAP syndrome (sensitivity=97%, specificity=70%, area under the curve [95% confidence interval] =0.881[0.812–0.949]), with better precision using CT. Three indirect signs were significant: the "anteater nose" sign, the talar beak, and the tapered anterior calcaneal process. These signs demonstrated an even stronger association with TLAP syndrome when observed in conjunction with a reduction in the calcaneonavicular space, particularly in CT scans. Conclusion: TLAP is common among control subjects. Therefore, a variant appears to be the most plausible explanation and it can be considered a mild form of calcaneonavicular coalition. However, in conjunction with symptoms suggestive of TLAP syndrome, the diagnosis is further supported by imaging, specifically with a calcaneonavicular space measurement of less than 3.2 mm. This measurement is most accurately obtained using CT with 2-dimensional reconstructions in all three planes. The simultaneous presence of the "anteater nose" sign, the talar beak, or the tapered anterior calcaneal process provides additional diagnostic evidence. In the diagnostic approach of calcaneonavicular coalition, oblique foot radiography seems useful in initially detecting abnormal coalition (bony or not), and complementarily, CT emerges as the best modality to characterize TLAP syndrome. [ABSTRACT FROM AUTHOR]

Calcaneal osteotomies correct hindfoot deformities and are often performed using a minimally invasive technique. The aim was to compare the safety of three calcaneal osteotomy techniques (oblique, chevron with apex anterior and chevron with apex posterior). Each osteotomy technique was performed on five cadavers (n = 15). These were then dissected to identify any injury to the neurovascular bundles. The distance between the burr and these structures was measured. Using the apex posterior technique, the burr was closer to the medial and lateral neurovascular structures, and in one case the sural nerve was injured. There were no neurovascular injuries using the other techniques. Minimally invasive surgery using a burr is generally a safe, reliable method for performing calcaneal osteotomies. The chevron with apex posterior osteotomy should be performed with caution given the closer relationship between the burr and neurovascular bundles. The other two techniques provide safer alternatives. 4 [ABSTRACT FROM AUTHOR]

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

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There are several eponyms used in the assessment and management of calcaneus fractures. However, the origin of these eponyms is no longer widely known. Named for orthopaedic surgeons who made substantial contributions to the management of calcaneus fractures as well as the field of orthopaedic surgery, understanding the context of how these descriptors were derived helps give context to their use in the present day. The purpose of this review is to provide a historical perspective and comprehensive collection of the most common eponyms related to calcaneus fractures. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

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

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

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

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