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Introduction: The calcaneus is the most commonly fractured tarsal bone. Diagnosis is often challenging due to subtle radiographic changes and requires timely identification to prevent complications, including subtalar arthritis, neurovascular injury, malunion, osteomyelitis, and compartment syndrome. Treatment varies based on fracture type, with non-surgical methods for non-displaced stress fractures and surgical interventions for displaced or intra-articular fractures. Methods: This study utilized the Wisdom in Diagnostic Imaging Simulation (WIDI SIM) platform, an emergency imaging simulation designed to assess radiology resident preparedness for independent call. During an 8-hour simulation, residents were tested on 65 cases across various imaging modalities of varying complexity, including normal studies. A single, unique case of calcaneal fracture was included within the simulation in four separate years of testing. Cases were assessed using a standardized grading rubric by subspecialty radiology faculty, with errors subsequently classified by type. Results: A total of 1279 residents were tested in five separate years on the findings of calcaneal fractures of 5 different patients. Analysis revealed a consistent pattern of missed diagnoses across all training years, primarily attributed to observational errors. There was limited improvement with training progression as all training years exhibited similar average performance levels. Conclusions: Calcaneal fractures pose a diagnostic challenge due to their frequent subtle radiographic findings, especially in stress fractures. Simulation-based evaluations using WIDI SIM highlighted challenges in radiology residents' proficiency in diagnosing calcaneal fractures. Addressing these challenges through targeted education and exposure to diverse cases is essential to improve diagnostic accuracy and reduce complications with calcaneal fractures. [ABSTRACT FROM AUTHOR]

Summary: Evidence regarding the risk factors and characteristics of those with foot fragility fractures compared to non-foot fragility fractures is limited. Foot fragility fracture patients are more likely to be younger female with a higher BMI. A foot fragility fracture is strongly predictive of a subsequent foot fragility fracture. Purpose: Osteoporosis can clinically result in fragility fractures. Evidence regarding the risk factors and characteristics of foot fragility fractures compared to non-foot fragility fractures is limited. The American Orthopaedic Association's Own the Bone (OTB) is a bone health initiative with a substantial dataset. The purpose of this study was to examine and compare characteristics of patients presenting with isolated foot fragility fracture to those with a non-foot fragility fracture. Methods: Between January 2009 and March of 2022, 58,001 fragility fractures occurred that were included in this cohort. A total of 750 patients had foot fragility fracture(s) and 57,251 patients had a non-foot fragility fracture that included shoulder, arm, elbow, forearm, wrist, spine, ribs, pelvis, hip, thigh, knee, tibia/fibula, and ankle. Demographics, fracture history, bone health factors, medication history, and medication use for each patient were reported in the OTB database. This data was utilized in our secondary cohort comparative analysis of characteristics and the risk of future fractures between foot fragility fracture and non-foot fragility fracture groups. Results: Foot fragility fracture patients have a significantly higher probability to be younger (66.9 years old), female (91.5%), and have a higher BMI (28.3 kg/m2) compared to non-foot fragility fracture (p < 0.0001) patients. Patients with a foot fragility fracture are nine times (OR = 9.119, CI = 7.44–11.18, p < 0.001) more likely to have had a prior foot fragility fracture. Young, female patients with a prior foot fragility fracture are at higher risk of a future foot fragility fracture, and this risk increased as BMI increased. Conclusions: Foot fragility fracture patients are more likely to be female and younger compared to patients with a non-foot fragility fracture. A foot fragility fracture is a sentinel event considering that a prior foot fragility fracture is strongly predictive of a subsequent foot fragility fracture. Level of evidence: 3 (retrospective cohort). [ABSTRACT FROM AUTHOR]

Purpose: Our aim in the study is to measure the area and volume of the tarsal bones and examine the typing of the talus and calcaneus joint surfaces according to sex. Methods: In our study, the area and volume measurements of 630 tarsal bones and the morphology of the talus/calcaneus were analyzed by transferring thin-section Computed Tomography (CT) images to the 3D Slicer program. Results: The volume and area sizes of the foot bones are calcaneus, talus, cuboid, navicular, medial cuneiform, lateral cuneiform, and intermediate cuneiform, respectively. All area and volume values of males were statistically higher than females (p < 0.05). The right side calcaneus area, intermediate cuneiform area, and lateral cuneiform area values were statistically higher than the left side (p < 0.045, p < 0.044, p < 0.030, respectively). There was no statistical relationship between age and area/volume values (p > 0.05). Three different types were seen in the calcaneus and seven in the talus. The most common type in the calcaneus was B1 (40%), and the least common type was A (27.8%). Regardless of the subgroups, the most common type in the talus was type B (37.8%), while the least common type was E2 (1.1%). Conclusion: Although morphometric measurements of tarsal bones differed according to sex, they did not differ according to age. The frequency of occurrence of the types of articular surfaces of the talus and calcaneus varies according to populations. We think that the morphometry and morphology of tarsal bones will contribute to invasive procedures regarding tarsal bones and surrounding structures, and that three-dimensional bone modeling can be used to create educational materials. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Calcaneus defect remains challenging with limited strategies for reconstruction. Current methods, including graft transplantation, substitution, and distraction osteogenesis, showed limited advantages with certain shortcomings. Current calcaneus lengthening for partial calcaneus loss reconstruction requires bone loss of less than 35%. We introduced our combination of tarsal bone fusion and gradual lengthening method in treating massive calcaneus loss.From January 2015 to December 2021, tarsal bone fusion and calcaneus gradual lengthening were performed in six patients with unilateral massive traumatic loss of the calcaneal tuberosity. A retrospective study was held to evaluate the outcomes of this novel technique. Clinical outcomes were assessed based on the American Orthopedic Foot and Ankle Score (AOFAS). Radiological data were assessed, which included tibio‐calcaneal angle (TCA), calcaneal interface angle (CIA), metatarsal declination angle (MDA), angle of longitudinal arch (ALA), and the amount of calcaneus axial lengthening (CAL).The mean calcaneal axial lengthening was 43.8 ± 3.1 mm (range, 39–49.5 mm), and the mean proportion of the lengthened calcaneus was 47.8% ± 3.7% (range, 42.8–55.3%). The mean external fixation time was 104.8 ± 67.5 days (range, 69 to 242 days), and the mean external fixation index was 2.4 ± 1.6 days/cm. All patients stuck to the postoperative follow‐up plan with an average follow‐up time (FT) of 35.0 ± 6.7 months (range, 26–40 months). Deformities of the injured limbs were all corrected according to radiography. Based on the AOFAS, three excellent and three good results were achieved.The Ilizarov technique remains an option for calcaneus reconstruction with a great amount of loss once combined with tarsal bone fusion. The function of the injured foot and ankle can be satisfactorily restored using these techniques in our study. Apart from calcaneus elongation, tarsal bone fusion is somehow necessary to reinforce the proximal segment of the distracted calcaneus for creating a larger distraction callus, correcting concomitant foot deformities, and enhancing hindfoot stability. It is necessary to choose flexibly when tarsal bones should be fused. [ABSTRACT FROM AUTHOR]

Aim: Bipartitism in the foot, especially in the tarsal bones, is a rare anatomical variant characterized by dividing one bone into two separate ossification centers. This condition can be congenital or acquired, often remains asymptomatic, and is only discovered incidentally during radiological imaging. This study aims to present a comprehensive retrospective analysis of bipartitism in tarsal bones, assessing its prevalence, type of articulation, and associated clinical features in a cohort of patients. Materials and Methods: A total of 4,645 patients were retrospectively evaluated from 6,145-foot images consisting of 4,975 computed tomography (CT) and 1,170 magnetic resonance imaging (MRI) scans obtained between 2015 and 2023. 15 patients with tarsal bipartitism were identified and contacted through the hospital system for in-person medical history and examination. Radiological exams assessed partial and complete bipartition, diastasis, and exostosis in the tarsal bones. Age, sex, side, trauma history, pain, foot deformity, gait disturbance, and other clinical findings were also recorded. Results: Bipartitism was detected in 15 patients (0.32%), predominantly affecting males (87%). The most common variant was medial cuneiform bipartitism, observed in 13 patients (0.28%). Talus and calcaneus bipartitism were each observed in one patient (0.02%). Bilateral involvement was present in 67% of the cases, with 60% of patients reporting chronic pain. Complete dissociation of bipartite bones was noted in 80% of cases. Accompanying bipartitism, two patients had pes planovalgus, and one had hallux varus deformity. Conclusion: Although bipartitism of the tarsal bones is rare, it remains a diagnostic challenge due to variability in clinical presentation and possible association with other foot deformities. Accurate diagnosis through advanced imaging techniques is essential to differentiate these variants from fractures and guide appropriate treatment. This study contributes valuable insights into the prevalence and clinical impact of bipartitism in the tarsal bones, emphasizing the importance of early diagnosis and individualized treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: The American Orthopedic Foot and Ankle Association (AOFAS) Midfoot scale is one of the most popular outcome measures for evaluating midfoot pathologies. We aimed to obtain a valid and reliable Turkish translation of the AOFAS Midfoot scale. Methods: Fifty-seven patients with midfoot pathologies were included, and the mean age was 38.47±12.54. To appraise construct validity, correlations were applied with the visual analog scale (VAS), the Turkish version of the foot and ankle ability scale (FAAM), and the 12-item short form health survey. Results: The AOFAS Midfoot-Turkish scale had adequate internal consistency (α=0.75) and test-retest reliability [intraclass correlation coefficient (ICC)2,1=0.86 for function, and ICC2,1=0.95 for total score]. The AOFAS Midfoot-Turkish scale total score had a moderate to strong correlation with VAS activity and FAAM-ADL, FAAM-Sports, and PCS-12 (rho=-0.69, p=0.001; rho=0.88, p=0.001, r=0.86, p=0.001, and r= 0.68, p=0.001, respectively). The lowest correlation was found between the AOFAS Midfoot-Turkish and the MCS-12 (rho=0.37, p=0.004). Conclusion: The Turkish version of the AOFAS Midfoot scale is a reliable and valid outcome measurement instrument that can be used to evaluate Turkish-speaking individuals with various midfoot pathologies, especially Lisfranc injuries. [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]

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Abstract Data from dry bone samples, collected from anatomical or archaeological collections, can improve the knowledge regarding accessory foot bones, including prevalence, size, shape and laterality, that can be useful in disparate fields of research, from medicine to bioarcheology. In the present study, the prevalence of six accessory foot bones (os trigonum, calcaneus secundarium, accessory navicular bone, os vesalianum, os sustentaculum and os intermetatarseum) was assessed in a sample of 486 individuals (226 females, 260 males) from the Coimbra Identified Skeletal Collection (CISC). The most frequent accessory bones are os trigonum (9.9%; 48/485) and calcaneus secundarium (6.0%; 29/486), while the most uncommon is os sustentaculum (0.4%; 2/486). No sex differences were observed. All accessory bones occur more often unilaterally, with the exception of the accessory navicular bone that, in the majority of cases, occurs bilaterally. The unilateral expression of os trigonum, calcaneus secundarium and os vesalianum was mostly in the right foot. The co-occurrence of accessory foot bones was recorded in 1.7% of the individuals (8/486), and the combinations of os trigonum and calcaneus secundarium were the most frequently observed. This research emphasizes the relevance of conducting studies on reference skeletal collections in order to gain a comprehensive understanding of anatomical variations in the foot. This understanding is crucial for accurate diagnoses and successful treatment in clinical settings, as well as for establishing population comparison standards in the fields of bioarchaeology and forensic anthropology.

Medial plantar foot pain can have various causes, and the painful Os tibiale externum should be considered in the differential diagnosis. A reliable diagnosis can be made through physical examination and multimodal imaging. We report on a 53-year-old man with severe, load-dependent pain consistent with an accessory navicular syndrome, caused by a pes planovalgus, which consecutively induced focal inflammation and tenosynovitis of the tibialis posterior tendon. Multifactorial conservative measures, including infiltration therapy, provided only moderate symptom relief. A final shockwave therapy ultimately led to a sustainable symptom relief. [ABSTRACT FROM AUTHOR]

Purpose: Congenital accessory navicular bone (ANB) is a common variant in the foot and is prone to cause several clinical symptoms. Wearing custom-made foot orthosis is considered a desirable option; however, there is limited evidence of its effectiveness. This study aims to report the mid-term effect of foot orthosis for symptomatic pediatric ANBs. Methods: School-age children with symptomatic ANBs combined with flexible flatfoot in the authors' institute were recruited and got custom-made foot orthosis treatment. They were followed up over 4 years. The general characteristics of these children were collected before treatment, including age, gender, and body mass index (BMI). The indicators of foot symptoms, including frequency and location of pain, visual analogue scale (VAS), arch index (AI), and hind foot valgus angle (HVA), were measured during pretreatment and at the last follow-up. Results: Twenty-seven children were recruited for this study. After 4 years of custom-made foot orthosis treatment, significant improvements showed in pain frequency, VAS, AI, and HVA (P < 0.001). Type II ANBs showed a higher pain index pretreatment (P < 0.001) and reduced after treatment (P < 0.001). Conclusion: Mid-term effect of custom-made foot orthosis is inspiring in clinical symptoms of pediatric congenital ANBs combined with flexible flatfoot and may be an optional nonoperative treatment. [ABSTRACT FROM AUTHOR]

The shape of the talus, its internal structure, and its mechanical properties are important in determining talar behavior during loading, which may be significant for the design of surgical tools and implants. Although recent studies using statistical shape modeling have described quantitative talar external shape variation, no similar quantitative study exists to describe the density distribution of internal talar structure. The goal of this study is to quantify statistical variation in talar shape and density to benefit the design of talar implants. To this end, weight‐bearing computed tomography (CT) scans of the ankle were collected in neutral, bilateral standing posture, and three‐dimensional models were generated for each talus. Local density derived from the Hounsfield unit of each CT voxel was extracted. A weighted spherical harmonic analysis was performed to quantify the talar external shape. One hundred and seventy‐nine volumes of interest were placed in the same relative position within each talus to quantify the talar density. Additionally, a finite element analysis (FEA) was conducted on a talus with both heterogeneous and homogeneous material properties to observe the effect of these properties on the stress and strain response. Significant differences were found in the talar density in sex and age, as well as in the stress and strain response between homogeneous and heterogeneous FEA. These differences show the importance of considering heterogeneity when examining the load response of tarsal bones. [ABSTRACT FROM AUTHOR]

The article discusses the similarities and differences between bone marrow edema syndrome (BMES) and chronic non-bacterial osteomyelitis (CNO), which can lead to misdiagnosis. BMES is a rare disease characterized by extremity pain and interstitial edema in the bone marrow, while CNO primarily affects children and adolescents and is an autoinflammatory bone disease. The article presents a case study of a pediatric patient with BMES who initially presented with foot pain and symmetrical bone marrow edema, which could have been misdiagnosed as CNO. The article emphasizes the importance of differentiating between these conditions for effective treatment planning. [Extracted from the article]

Data from dry bone samples, collected from anatomical or archaeological collections, can improve the knowledge regarding accessory foot bones, including prevalence, size, shape and laterality, that can be useful in disparate fields of research, from medicine to bioarcheology. In the present study, the prevalence of six accessory foot bones (os trigonum, calcaneus secundarium, accessory navicular bone, os vesalianum, os sustentaculum and os intermetatarseum) was assessed in a sample of 486 individuals (226 females, 260 males) from the Coimbra Identified Skeletal Collection (CISC). The most frequent accessory bones are os trigonum (9.9%; 48/485) and calcaneus secundarium (6.0%; 29/486), while the most uncommon is os sustentaculum (0.4%; 2/486). No sex differences were observed. All accessory bones occur more often unilaterally, with the exception of the accessory navicular bone that, in the majority of cases, occurs bilaterally. The unilateral expression of os trigonum, calcaneus secundarium and os vesalianum was mostly in the right foot. The co-occurrence of accessory foot bones was recorded in 1.7% of the individuals (8/486), and the combinations of os trigonum and calcaneus secundarium were the most frequently observed. This research emphasizes the relevance of conducting studies on reference skeletal collections in order to gain a comprehensive understanding of anatomical variations in the foot. This understanding is crucial for accurate diagnoses and successful treatment in clinical settings, as well as for establishing population comparison standards in the fields of bioarchaeology and forensic anthropology. [ABSTRACT FROM AUTHOR]

Background: The spring ligament fibrocartilaginous complex (SLFC), which is essential for stabilizing the medial longitudinal arch, features a little-explored fibrocartilaginous facet within its superomedial aspect, articulating with the talar head. This research aimed to provide a detailed anatomical description of this facet, designated as the spring ligament articular facet (SLAF). Methods: Nine normally aligned cadaveric lower limbs were dissected, approaching the SLFC from a superior direction. Following talus disarticulation, high-resolution images of the ligament complex were captured and analyzed. ImageJ software was used to determine the areas and dimensions of the superomedial calcaneonavicular (SMCN) spring and SLAF. Results: The fibrocartilage facet exhibited a trapezoid shape in all specimens. The mean area for SMCN spring was 280.39 mm², and for SLAF, it was 200 mm². The proximal-to-distal length for SLAF averaged 11.78 mm at its longest and 5.34 mm at its shortest. Attachment of the SLAF to the calcaneum and the navicular showed robust fibrous structures, with average measurements of 3.75 and 1.75 mm at the medial and lateral calcaneal margins, and 2.75 and 2.98 mm at the medial and lateral navicular margins, respectively. Conclusion: This study clearly delineated the individual structural components of the SLFC articulating with the talar head and detailed its dimensions, emphasizing the need for more specific anatomical terminology that respects the intricate anatomy of the SLFC. Level of Evidence: Level III, descriptive study. [ABSTRACT FROM AUTHOR]

Background: Os naviculare in general alters the functional and anatomical balances of the longitudinal plantar arch. A substantial number of the posterior tibialistendon fibersinsert on the accessory ossicle instead of its insertion on tarsal and metatarsal bones resulting in unbalanced stress forces on the tendon. The presence of an accessory navicular type II or type III is a risk factorfor PTT tendinopathy and possible PTT tear. Methodology: In this single subject case study, the participant reported with the pre-diagnosed Os naviculare. On examination at initial presentation, the navicular tuberosity of the affected foot was prominent as compared tothe contralateral limb. The site was tender on palpation. Ankle range of motion was within normal ranges except ankle dorsiflexion was slightly compromised. Mild pain on active and resisted was noted. Functional tests like star excursion balance test, single leg standing could not be performed due to pain. Pre and post protocol assessment was graded and measured on Cumberland ankle instability tool. The tenderness was recorded using numeric pain rating scale. Star excursion balance test was performed one on 8 th day and post protocol. MWM was performed at distal tibiofibular joint on 6 days every week for 3 weeks alongside the conventional regime exercises and ultrasound was applied post treatment session. Result: Result of this study suggested that addition of MWM of distal tibiofibular joint in theconservative exercise protocol was effective in the reduction of pain, dysfunction and improveddynamic control. Conclusion: The results of this study suggests that the addition of MWM of distal tibiofibular joint alongside conservative management shows appreciable effect in improving dysfunction, dynamic stability and reducing pain in individual with congenital Os naviculare. [ABSTRACT FROM AUTHOR]

Background: Physiological changes in the foot may be influenced by external factors such as shoe types or demographic parameters, leading to podiatric conditions in adulthood. The aim of this study was to assess the changes in morphological measurements of the feet of boys and girls during childhood and adolescence. Methods: A total of 1678 Ecuadorian children aged 8 to 17 years participated in the study. The length, width, and height of the foot were analyzed using a 3D scanner to obtain the arch height ratio for the diagnosis of pediatric flat foot. Results: Statistical differences were observed for lengths, widths, and perimeters of the foot in boys aged 5 to 15–16 years and girls aged 5 to 12–13 years. Differences in the height of the navicular bone were found in all age groups, with changes from 2.8 to 4.1% in boys and from 1.3 to 1.5% in girls. The greatest differences between boys and girls of the same age were found at 14 years old onwards. The highest prevalence of flat foot was found in 8-year-old girls (64.9%) and in 12-year-old boys (82.5%). Conclusions: The feet of Ecuadorian children develop progressively during childhood and adolescence. Boys presented with longer and wider feet than girls of the same age. The highest prevalence of flat foot was found in 12-year-old boys and 8-year-old girls. [ABSTRACT FROM AUTHOR]

Purpose: Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA). Methods: A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6–17). Mean follow-up was 7 ± 2.9 years (5–10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01. Results: Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing. Conclusions: SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications. Level of Evidence: IV [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the diagnostic accuracy, inter-reader agreement, and associated pathologies on MR images of patients with confirmed TC. Methods and materials: In this retrospective study, 168 ankle MRI exams were included, consisting of 56 patients with clinically or surgically confirmed TC and 112 controls without TC, matched for age and sex. Images were analyzed independently by three radiologists blinded to clinical information. The evaluation criteria included the presence, type, and location of TC, as well as associated pathologies. After calculating diagnostic accuracy and the odds ratio of demographic data and anatomic coalition type for associated pathologies, inter-reader agreement was assessed using kappa statistics. Results: The majority of TCs were non-osseous (91.1%) and located at the calcaneonavicular (33.9%) or talocalcaneal joint (66.1%). Associated pathologies included adjacent and distant bone marrow edema (57.1% and 25.0%), osteochondral defect of the talar dome (OCD, 19.6%), and joint effusion (10.7%) and accessory anterolateral talar facet (17.9%). Talar OCD was associated with increased patient age (p = 0.03). MRI exhibited a cumulative sensitivity and specificity of 95.8% and 94.3% with almost perfect inter-reader agreement (κ = 0.895). Conclusion: MRI is a reliable method for detecting tarsal coalition and identifying commonly associated pathologies. Therefore, we recommend the routine use of MRI in the diagnostic workup of patients with foot pain and suspected tarsal coalition. Clinical relevance statement: MRI is an accurate and reliable modality for diagnosing tarsal coalitions and detecting associated pathologies, while improving patient safety compared to computed tomography by avoiding radiation exposure. Key Points: • Despite the technological progress in magnetic resonance imaging (MRI), computed tomography (CT) is still regarded as the gold standard for diagnosing tarsal coalition (TC). • MRI had a cumulative sensitivity of 95.8% and specificity of 94.3% for detecting tarsal coalition with an almost perfect inter-reader agreement. • MRI demonstrates high accuracy and reliability in diagnosing tarsal coalitions and is useful for identifying associated pathologies, while also improving patient safety by avoiding radiation exposure. [ABSTRACT FROM AUTHOR]

Genetic disorders involved in skeleton system arise due to the disturbance in skeletal development, growth and homeostasis. Filamin B is an actin binding protein which is large dimeric protein which cross link actin cytoskeleton filaments into dynamic structure. A single nucleotide changes in the FLNB gene causes spondylocarpotarsal synostosis syndrome, a rare bone disorder due to which the fusion of carpels and tarsals synostosis occurred along with fused vertebrae. In the current study we investigated a family residing in north-western areas of Pakistan. The whole exome sequencing of proband was performed followed by Sanger sequencing of all family members of the subject to validate the variant segregation within the family. Bioinformatics tools were utilized to assess the pathogenicity of the variant. Whole Exome Sequencing revealed a novel variant (NM_001457: c.209C>T and p.Pro70Leu) in the FLNB gene which was homozygous missense mutation in the FLNB gene. The variant was further validated and visualized by Sanger sequencing and protein structure studies respectively as mentioned before. The findings have highlighted the importance of the molecular diagnosis in SCT (spondylocarpotarsal synostosis syndrome) for genetic risk counselling in consanguineous families. [ABSTRACT FROM AUTHOR]

Tarsal coalition occurs in 1% of the population and represents a congenital failure of segmentation in two or more tarsal bones. It most commonly occurs at the talocalcaneal and calcaneonavicular joint. Although commonly asymptomatic, it may present with pain, rigidity, and pes planus. Cubonavicular, multiple synchronous, and bilateral coalitions are rare but an awareness is required to ensure accurate diagnosis and management. In this article, we presented the first reported case (to the best of our knowledge) of bilateral cubonavicular coalition with synchronous talocalcaneal coalition and stress response within the intermediate cuneiform. [ABSTRACT FROM AUTHOR]

Aim. The study aimed to evaluate a group of patients who underwent consecutive surgeries between 2007 and 2020 due to a painful coalition of the tarsal bones, focusing exclusively on correcting valgus foot deformity. Materials and methods. A retrospective clinical and radiographic analysis was conducted on 11 adolescents (13 feet) who underwent surgery for talonavicular or talocalcaneal coalition combined with valgus deformity. Age at surgery ranged from 12 to 21 years. In each patient, the procedure involved performing opening wedge osteotomy of the anterior part of the calcaneus along with gastrocnemius muscle lengthening, with no coalition removal. The calcaneal osteotomy, using an autograft from the lateral malleolus, did not require stabilization. Two patients were operated on bilaterally. Before the surgeries, all the patients had painful valgus and abduction deformity and/or flatfoot with restriction of subtalar motion. Follow-up ranged from 2 to 14 years (mean 6). Results. Pain relief and foot shape improvement were achieved in all patients who underwent the procedure. Conclusion. In adolescents and young adults, deformity correction and improvement in foot shape without coalition resection alleviates the pain associated with the defect. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to quantify the articular surfaces of the naviculocuneiform (NC) joint to help clinicians better understand common pathologies observed such as navicular stress fractures and arthrodesis nonunions. Methods: Twenty cadaver NC joints were dissected and the articular cartilage of the navicular, medial, middle, and lateral cuneiforms were quantified by calibrated digital imaging software. Statistical analysis included calculating the mean cartilage surface area dimensions of the distal navicular and proximal cuneiform bones. Length measurements on the navicular were obtained to estimate the geographic location of the interfacet ridges. Lastly, all facets of the articular surfaces were described in regard to the shape and location of cartilaginous or fibrous components. Results were compared using Student t tests. Results: Navicular cartilage was present over 75.4% of the surface area of the proximal NC joint, compared with 72.6% of combined cuneiform cartilage distally. The mean height of the deepest (dorsal-plantar) measurement of navicular articular cartilage was 18 ± 3 mm. The mean heights of the distal medial, middle, and lateral cuneiform articular facets were 15 ± 1 mm, 17 ± 2 mm, and 15 ± 2 mm, respectively. Conclusion: There is significant variation among the articular surfaces of the NC joint. Additionally, the central third of the navicular was calculated to lie in the inter-facet ridge between the medial and middle articular facets of the navicular. Clinical Relevance: Surgeons may consider this study data when performing joint preparation for NC arthrodesis as cartilage was present to a mean depth of 18 mm at the NC joint. Additionally, this study demonstrates that the central third of the navicular, where most navicular stress fractures occur, lies in the interfacet ridge between the medial and middle articular facets of the navicular. [ABSTRACT FROM AUTHOR]

Background: The medial longitudinal arch (MLA) plays a major role in maintaining the biomechanics of the foot and is maintained with the help of active and passive systems. Dysfunction of active and passive support system can lead to a reduction of navicular height, leading to excessive pronation of the foot known as pes planus. Pes planus is caused by injury, prolonged stress on the foot, obesity, and faulty biomechanics which will result in posterior tibial tendon dysfunction, collapse of the foot archand flat foot. The patients with posterior tibial tendon dysfunction and pesplanus have reduced dorsiflexion and increased eversion. So, the aim was to study the effects of instrument assisted soft tissue mobilization and foot strengthening exercise on navicular height and ankle range of motion in college students with flexible flat feet. Method: Total 40 students were recruited for the study as per selection criteria and were divided into two groups (20 in each group). Group A was treated with Instrument Assisted Soft Tissue Mobilization (IASTM)and group B was treated with Foot Strengthening Exercise for five days a week for 4 weeks. Inter-group analysis by Mann Whitney U-test showed statistically significant improvement in navicular height and ankle range of motion (P value ≤ 0.001). Conclusion: This study showed statistically significant improvement in navicular height and ankle ROM with the use of IASTM and foot strengthening exercise. However, IASTM was found to be more effective in improving ankle ROM and foot strengthening exercise was found to be more effective in increasing navicular height. [ABSTRACT FROM AUTHOR]

Background: Arytenoid asymmetry is usually an incidental finding during video-pharyngo-laryngoscopic examinations, and few otolaryngologists have described the clinical implications of this among patient with laryngeal disorders. Aim: The aim of the study is to document the prevalence of arytenoid adduction asymmetry in patients who had video-pharyngo-laryngoscopy and determine if there is any possible association between arytenoid adduction asymmetry and hoarseness. Methods: This is a retrospective descriptive study involving patients who had video-pharyngo-laryngoscopic examinations for various indications. The medical charts and video-pharyngo-laryngoscopic examination findings recorded in the stored database in ENT outpatient departments of two institutions over a 2-year period were retrospectively reviewed for age, sex, occupation, presenting complaint, and indication for video-pharyngo-laryngoscopic findings and diagnosis. Arytenoid adduction asymmetry was defined in relation to the position of the corniculate cartilages, cuneiform cartilages, and aryepiglottic angle. All the variables in the data were analyzed using Statistical Product and Service Solution (SPSS) version 25. Results: A total of 152 out of 209 patients had complete information needed for the review, 59 were males and 93 females with age range 20–91 years, and mean age was 46 ± 15.5 years. The overall prevalence rate for adduction asymmetry was 44.7%. Arytenoid asymmetry was seen commonest among the 5th and 6th decades of life and highest among the professional voice users (55%), while the male-to-female ratio was 1.6:1. Hoarseness constituted 40.1% of all indications for video-pharyngo-laryngoscopy, with 71% of patients with hoarseness having a primary laryngeal lesion, 26% had laryngopharyngeal reflux, and 3.3% were due to pubertal voice changes. A significant association was found between arytenoid asymmetry of the male gender P-value 0.027 and hoarseness P-value 0.026. Conclusion: Arytenoid adduction asymmetry is prevalent in the 5th and 6th decades of life, among patients with hoarseness resulting from unilateral primary laryngeal disorders. [ABSTRACT FROM AUTHOR]

The 3D render volume reconstruction CT (3D-RVCT) produced detailed images of the PES region, determining its relationships with the surrounding structures. Despite extensive research in veterinary studies on the PES through gross anatomy and CT, there is a lack of studies on the PES of zebu cattle. The study aimed to analyze the PES of Zebu cattle using gross cross-sectional, radiographic, CT, and morphometric methods, with the use of 3D-RVCT to provide anatomical guidance for surgeons and students. The study was performed on sixteen PES regions to provide hard and soft tissues in CT images. Three are five tarsal bones and two large fused (III and IV) metatarsal bones that were completely fused except for their distal extremities, which were divided distally by the intertrochlear notch. The cortical thickness of the metatarsal bone was equal on both sides. The bony septum divided the medullary cavity between the two fused large metatarsal bones in the proximal distal half only and disappeared in the middle part. The reconstruction showed similar sizes in the right and left limbs, confirming the pes bones. The radiographic and CT images could be used as a normal reference for the interpretation of some clinical diseases in the PES. The 3D CT reconstruction of the pes bones was described by various CT oblique dorsal and plantar views. The study focuses on diagnosing PES disorders using CT imaging, improving medical interventions, improving Zebu cattle health outcomes, and empowering students to contribute to veterinary medicine research and advancements. Highlight: The study aimed to analyze the PES region of Zebu cattle using various methods, including 3D-RVCT, to provide anatomical guidance for surgeons and students. The study focused on sixteen PES regions, including three tarsal bones and two large fused metatarsal bones. The cortical thickness of the metatarsal bone was equal on both sides, and the bony septum divided the medullary cavity between the two fused large metatarsal bones in the proximal distal half only. The reconstruction showed similar sizes in the right and left limbs, confirming the pes bones. The radiographic and CT images could be used as a normal reference for interpreting clinical diseases in the PES. The 3D CT reconstruction of the pes bones was described by various CT oblique dorsal and plantar views. The study aims to diagnose PES disorders using CT imaging, improve medical interventions, improve Zebu cattle health outcomes, and empower students to contribute to veterinary medicine research and advancements. [ABSTRACT FROM AUTHOR]

Greater cane rats (Thryonomys swinderianus) are now being captive reared and domesticated in the sub-Saharan Africa because of increase in their demand for biomedical research and traditional medicine and as a source of meat. This research was performed to provide the normal radiological anatomy of the pelvis and pelvic limb in greater cane rats for a reference in biomedical research, in anatomical studies, and in clinical use. Radiological examination of the pelvis and right pelvic limb was done in five greater cane rats. Radiological results were correlated with bones of the pelvis and right pelvic limb. The pelvic bone had a prominent caudoventral iliac spine. The pelvic symphysis was long and obturator foramina appeared teardrop-shaped elongated craniocaudally. The prominent major trochanter extended proximally higher than the femoral head. The middle third of the body of the tibia presented a very prominent tuberosity. In all specimens, the tarsal sesamoid bone was visualised. Mineralised popliteal sesamoid bone was not visualised. In male greater cane rats, the os penis was visualised. The lateral and medial menisci of the stifle joint were seen with ossicles. The first metatarsal bone was rudimentary with greater plantar divergence. Despite of the pelvic limb and pelvis of greater cane rats sharing anatomical structures with other rodents, it retains some exceptional anatomical features. Findings of this study will serve as a reference for anatomical studies, clinical veterinary practice, and in biomedical research. [ABSTRACT FROM AUTHOR]

Purpose: Foot tuberculosis is a rare form of osteoarticular tuberculosis, accounting for less than 1% of cases. It presents unique diagnostic challenges due to its nonspecific clinical features and overlapping symptoms with other conditions. This study aimed to investigate the clinical presentation, radiographic findings, and prognosis of foot tuberculosis, with the goal of improving early recognition and appropriate intervention. Methods: A prospective study was conducted between November 2016 and July 2021, involving 39 patients diagnosed with foot tuberculosis. Clinical examinations, laboratory tests, X-rays, and MRI evaluations were performed to aid in the diagnosis. Biopsy was conducted on patients with radiological lesions. Patients were treated with an 18-month course of antitubercular therapy (ATT). Foot Function Index (FFI) scores were recorded before and after treatment. Statistical analysis was conducted to assess factors impacting prognosis. Results: Unilateral foot involvement was observed in all patients, with a male predominance (61.5%) and a mean age of 31.3 years. The most common symptoms were pain and edema, with sinus tracts present in 17.9% of patients. Radiographic findings showed cystic and sclerotic lesions, with the "spina ventosa" appearance primarily affecting the metatarsal bones. MRI played a valuable role in early detection. Histopathological examination confirmed tuberculosis in all cases, and acid-fast bacilli were found in 23% of patients. Most patients (79.4%) responded well to ATT without requiring surgery. Factors such as high initial ESR, delayed ATT initiation, multiple lesions, and tarsal involvement were associated with unfavourable outcomes. Conclusion: Foot tuberculosis presents with nonspecific symptoms, leading to misdiagnosis and delays in appropriate treatment. Clinical examination, radiographic evaluation, and biopsy are essential for accurate diagnosis. Early initiation of ATT is crucial for favourable outcomes. Factors such as high initial ESR, delayed treatment initiation, multiple lesions, and tarsal involvement negatively impact prognosis. This study highlights the importance of recognizing foot tuberculosis and provides insights into its clinical presentation, radiographic features, and treatment outcomes, facilitating timely intervention and improved patient management. [ABSTRACT FROM AUTHOR]

Aim To assess our personal experience of a case of tuberculosis of the talus, and to provide an overview of the literature about this tuberculosis manifestations, including all its aspects: epidemiology, clinical and imaging presentation, and all the treatments available to the current state of knowledge. Methods We present our experience in a case of a 34-year-old patient, who came to our attention with difficulty in walking and pain due to a talar tuberculosis, with consequent bone disruption and reabsorption, and foot deformities. Results A tibiotalocalcaneal arthrodesis with retrograde nail and bone graft was performed after antibiotic therapy. Today, almost two years after treatment, the patient can walk independently with no major limitations in everyday life. Conclusion Tibiotalocalcaneal arthrodesis with bone graft showed good functional results in this case study, with complete graft fusion and good functional and radiological outcomes. [ABSTRACT FROM AUTHOR]

Halicephalobus gingivalis is a free-living nematode that occasionally causes infections in horses. We report a rare case of limb fracture of horse caused by infection with H. gingivalis. An 8-year-old mare was referred to the Veterinary Hospital of the Federal University of Lavras with claudication grade 5 of the right hind limb, that had been started 3 months ago. The patient had aseptic arthritis in the tarsal joint and edema that extended to the quartile. The radiographic examination showed punctate osteolysis with exacerbation of bone trabeculation along the calcaneus, talus, proximal epiphysis of the third metatarsal and distal epiphysis of the tibia. Treatment for arthritis was initiated, and the animal showed a slight improvement in limb function. However, 21 days after hospitalization, due to a comminuted fracture of the tibia, it was euthanized. At necropsy, yellowish masses were found from the metatarsal to the tibia, and around the tarsal bones and joint. Similar masses were also found in the left kidney. Numerous nematodes compatible with H. gingivalis were identified. This is the first description of a pathological fracture caused by H. gingivalis infection in an equine limb. [ABSTRACT FROM AUTHOR]

Foot fractures account for about one-third of lower extremity fractures in adults. They are typically caused by a crush injury or an axial or twisting force on the foot. Patients usually present with bony point tenderness and swelling of the affected area. Weight-bearing varies based on the extent of the fracture and the patient's pain tolerance. When a foot or toe fracture is suspected, anteroposterior, lateral, and oblique radiography with weight-bearing should be obtained. The Ottawa foot and ankle rules can help determine the need for radiography after an acute ankle inversion injury. Many foot fractures can be managed with a short leg cast or boot or a hard-soled shoe. Weight-bearing and duration of immobilization are based on the stability of the fracture and the patient's pain level. Most toe fractures can be managed nonsurgically with a hard-soled shoe for two to six weeks. Close attention should be paid to the great toe because of its role in weight-bearing, and physicians should follow specific guidelines for orthopedic referral. Meta-tarsal shaft fractures are managed with a boot or hard-soled shoe for three to six weeks. The proximal aspect of the fifth metatarsal has varied rates of healing due to poor blood supply, and management is based on the fracture zone. Lis-franc fractures are often overlooked; radiography with weight-bearing should be obtained, and physicians should look for widening of the tarsometatarsal joint. Other tarsal bone fractures can be managed with a short leg cast or boot for four to six weeks when nonsurgical treatment is indicated. Common foot fracture complications include arthritis, infection, malunion or nonunion, and compartment syndrome. (Am Fam Physician. 2024; 109(2):119–129. Copyright © 2024 American Academy of Family Physicians.) Foot fractures account for about one-third of lower extremity fractures in adults. They are typically caused by a crush injury or an axial or twisting force on the foot. Patients usually present with bony point tenderness and swelling of the affected area. Weight-bearing varies based on the extent of the fracture and the patient's pain tolerance. When a foot or toe fracture is suspected, anteroposterior, lateral, and oblique radiography with weight-bearing should be obtained. The Ottawa foot and ankle rules can help determine the need for radiography after an acute ankle inversion injury. Many foot fractures can be managed with a short leg cast or boot or a hard-soled shoe. Weight-bearing and duration of immobilization are based on the stability of the fracture and the patient's pain level. Most toe fractures can be managed nonsurgically with a hard-soled shoe for two to six weeks. Close attention should be paid to the great toe because of its role in weight-bearing, and physicians should follow specific guidelines for orthopedic referral. Meta-tarsal shaft fractures are managed with a boot or hard-soled shoe for three to six weeks. The proximal aspect of the fifth metatarsal has varied rates of healing due to poor blood supply, and management is based on the fracture zone. Lis-franc fractures are often overlooked; radiography with weight-bearing should be obtained, and physicians should look for widening of the tarsometatarsal joint. Other tarsal bone fractures can be managed with a short leg cast or boot for four to six weeks when nonsurgical treatment is indicated. Common foot fracture complications include arthritis, infection, malunion or nonunion, and compartment syndrome. [ABSTRACT FROM AUTHOR]

Recently, the central and third tarsal bones of 23 equine fetuses and foals were examined using micro-computed tomography. Radiological changes, including incomplete ossification and focal ossification defects interpreted as osteochondrosis, were detected in 16 of 23 cases. The geometry of the osteochondrosis defects suggested they were the result of vascular failure, but this requires histological confirmation. The study aim was to examine central and third tarsal bones from the 16 cases and to describe the tissues present, cartilage canals, and lesions, including suspected osteochondrosis lesions. Cases included 9 males and 7 females from 0 to 150 days of age, comprising 11 Icelandic horses, 2 standardbred horses, 2 warmblood riding horses, and 1 coldblooded trotting horse. Until 4 days of age, all aspects of the bones were covered by growth cartilage, but from 105 days, the dorsal and plantar aspects were covered by fibrous tissue undergoing intramembranous ossification. Cartilage canal vessels gradually decreased but were present in most cases up to 122 days and were absent in the next available case at 150 days. Radiological osteochondrosis defects were confirmed in histological sections from 3 cases and consisted of necrotic vessels surrounded by ischemic chondronecrosis (articular osteochondrosis) and areas of retained, morphologically viable hypertrophic chondrocytes (physeal osteochondrosis). The central and third tarsal bones formed by both endochondral and intramembranous ossification. The blood supply to the growth cartilage of the central and third tarsal bones regressed between 122 and 150 days of age. Radiological osteochondrosis defects represented vascular failure, with chondrocyte necrosis and retention, or a combination of articular and physeal osteochondrosis. [ABSTRACT FROM AUTHOR]

Background: For the younger, more active patient with flexible symptomatic progressive collapsing foot deformity (PCFD), joint-sparing procedures may be preferred to preserve functional motion. Isolated talonavicular (TN) arthrodesis has been described for treatment of rigid and flexible PCFD for patients that are older and less active whose deformity is still correctable through the TN joint. The purpose of this study was to evaluate radiographic and clinical outcomes in patients with PCFD treated with isolated triplanar correction with a TN joint arthrodesis. Methods: Forty-nine patients (53 feet) with flexible PCFD underwent isolated TN arthrodesis. Weightbearing radiographs were performed pre- and postoperatively, and measurements included lateral talar-first metatarsal angle, calcaneal pitch, TN coverage angle, and the anteroposterior (AP) talar-first metatarsal angle. The Foot and Ankle Ability Measure (FAAM) and Veterans-Rand 12-Item Health Survey (VR-12) scores were also collected. Results: Thirty-five females and 14 males were evaluated with a mean age of 63 years, at an average follow-up of 41.3 months. Significant improvements were found radiographically. Lateral radiographs demonstrated improvements in lateral talar-first metatarsal angle from 25.2 degrees preoperatively to 9.5 degrees postoperatively (P < .001) and calcaneal pitch from 14.9 degrees preoperatively to 17.5 degrees postoperatively (P < .001). AP radiographs showed the TN coverage angle improving from 35.0 degrees to 4.9 degrees postoperatively (P < .001) and AP talar-first metatarsal angle improving from 17.3 degrees to 5.9 degrees postoperatively (P < .001). Clinical outcomes were improved in the FAAM pain score (48.6 to 39.2, P = .130), FAAM ADL score (53.8 to 69.2, P = .002), FAAM Sport score (29.5 to 40.7, P = .099), and the overall FAAM score (47.7 to 63.1, P = .006). Patient satisfaction with medical care was 85.2/100 postoperatively. Conclusion: Isolated TN arthrodesis is a viable surgical option for older, lower-demand patients with flexible PCFD. This study demonstrated significant improvements in radiographic alignment and FAAM scores. Comparative studies with other surgical procedures should be performed to determine which is the best technique for older, lower-demand patients with flexible PCFD. [ABSTRACT FROM AUTHOR]

Background: Hindfoot fusion procedures are common for the treatment of end-stage arthritis or deformity. Surgical treatments for these conditions include talonavicular joint (single) arthrodesis, talonavicular and subtalar (double) arthrodesis, or talonavicular, subtalar, and calcaneocuboid (triple) arthrodesis. This study evaluated the complication rate, revision surgery rate, and hardware removal rate for those treated with either single, double, or triple arthrodesis. Methods: A retrospective review was conducted for patients who underwent single (Current Procedural Terminology [CPT] code 28740), double (CPT 28725 and 28740), or triple (CPT 28715) arthrodesis to treat hindfoot arthritis/deformity (International Classification of Diseases, Ninth Revision [ICD-9] code: 734, International Classification of Diseases, Tenth Revision [ICD-10] codes: M76821, M76822, and M76829) from 2005 to 2022 using the South Carolina Revenue and Fiscal Affairs databank. Data collected included demographics, comorbidities, procedure data, and postoperative outcomes within 1 year of principal surgery. Student t test, chi-squared test, and multivariable logistic regression analysis were utilized during data analysis. Results: A total of 433 patients were identified, with 248 undergoing single arthrodesis, 67 undergoing double arthrodesis, and 118 undergoing triple arthrodesis. There was no significant difference between single, double, and triple arthrodesis in the rate of complications, hardware removals, revision surgeries, or 30-day readmission when controlling for confounding variables. However, a decrease in Charlson Comorbidity Index (CCI) was found to be predictive of an increase in the revision surgery rate (OR = 0.46, 95% CI 0.22-0.85, P = .02). Conclusion: We found no difference in the rate of complications, hardware removals, or revision surgeries in those undergoing single, double, or triple arthrodesis. Surprisingly we found that a lower Charlson Comorbidity Index, indicating a healthier patient had a significant relationship with a higher rate of revision surgery. Further study including radiographic indications for surgery or the impact of overall health status on revision surgery rates may further elucidate the other components of this relationship. [ABSTRACT FROM AUTHOR]

Background: Calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction. Methods: Between 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Results: Pre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees (P < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees (P < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees (P < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees (P < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months-11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference (P = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence. Conclusion: Symptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided. [ABSTRACT FROM AUTHOR]

Background: The surgical treatment of accessory navicular (AN) is divided into simple resection of AN and Kidner surgery used to reconstruct posterior tibial tendon (PTT) after AN resection. However, both of these procedures have certain disadvantages. Herein, we proposed a modified method to reconstruct PTT and compared the short-term clinical effect of our method with the modified Kidner procedure. Methods: We collected data from 23 adolescent children with painful type II AN treated in our department between January 2015 and June 2020. The American Orthopedic Foot and Ankle Society Ankle-Hind foot (AOFAS-AH) Scores, the Meary Angle, and Pitch Angle of the lateral weight-bearing plain radiographs status were recorded before and after the operation to evaluate the treatment outcomes. Results: In the modified Kidner surgery (MK) group, the median AOFAS-AH increased from 61 (59–68) to 87 (83–91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 13.0 (8–18) to 17.4 (14–22), and the Meary angle decreased from 18.3 (14–24) to 14.2 (8–20) (P < 0.05). In the PTT preservation folded suture (FS) group, the median AOFAS-AH increased from 61 (59–68) to 87 (85–91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 12.3 (7–18) to 18.4 (15–26), and the Meary angle decreased from 17.8 (13–23) to 5.7 (3–8) (P < 0.05). There was no significant difference in AOFAS-AH postoperative scores between the FS group and MK group; however, the improvement on Pitch and Meary angle of the lateral weight-bearing plain radiographs was significantly better in the FS group than in MK group (P < 0.05). Conclusions: For painful type II AN in juvenile patients, the insertion-preserving folding suture procedure had similar short-term results on AOFAS-AH scores but greater improvement in the Meary angle and the Pitch Angle than the modified Kidner method. Level of Evidence: III [ABSTRACT FROM AUTHOR]

Tarsal coalitions have only very infrequently been observed in the context of cavus foot abnormalities. Recognizing this diagnosis could be crucial to effective cavus repair. We report tarsal coalitions observed in cavus deformity here. Between 2022 and 2023, the records of every patient treated by one of the authors for a varus deformity who was later determined to have either a unilateral or bilateral tarsal coalition were examined. Two patients with cavus deformities who were treated by one of the authors have either a unilateral or bilateral tarsal coalition. Three foot (medial cuneiform–navicular n = 1 and calcaneonavicular n = 2) with tarsal coalition were examined. All of these cases occurred in patients with idiopathic cavus deformity. Computed tomography scans were used to make a firm diagnosis for each patient. We advise surgeons to keep an awareness for this potential comorbid issue in all cavus foot abnormalities and to take advanced imaging into consideration. In these uncommon cases, the medial cuneiform–navicular and calcaneonavicular joints formed an osseous coalition with pes cavus deformity, which successfully resolved with conservative and surgical treatment, respectively. Level of Clinical Evidence: IV. [ABSTRACT FROM AUTHOR]

The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: It is believed that Müller Weiss Disease (MWD) starts with narrowing of the lateral and dorsal side of the navicular, followed by lateral rotation and slight dorsal lifting of the talar head and medial rotation of the navicular, a varus heel, and ultimately additional changes in the hindfoot and midfoot. This study used the technique of distance mapping to measure the space of the "peri-navicular" joints on an averaged 3D foot model for both normal controls and a group of MWD feet, to prove the key pathologic changes of MWD. Methods: Weight bearing Scans of 55 health feet without deformities, trauma and surgical history, and 69 feet with MWD were included in this study. The Bonelogic program (Disior, Paragon28) was used to automatically segment the bones and 3D information of each foot in the same group was pooled to create an average foot model for both the controls and the MWD feet. On the two foot models, distance mapping was applied and compared to compare the space of the perinavicular joints (the talonavicular joint, the three navicular cuneiform joints, and the calcaneocuboid joint). The morphology of the navicular bone and the talonavicular articulation in the two groups were also studied. Results: In the MWD foot model, there was significant narrowing of the lateral pole and the dorsal side of the navicular compared with the average normal foot model. The bone articular surfaces of the two foot models matched well, meaning that the deformity changes occurred predominantly to the shape of the navicular but not the contour of the joint surface. The joint space measured using distance mapping was significantly greater in the talonavicular joint, middle and lateral naviculocuneiform joints, and the calcaneocuboid joint in the MWD feet than in normal controls. There was no difference in the joint space of the medial naviculocuneiform joint between the two foot models. Conclusion: It is the change in the shape of navicular bone but not articular surface contour which causes the development of the cascade of deformities in MWD. The sequalae includes increased joint space on both sides of navicular tail, and in the calcaneocuboid joint, lateral subluxation of the talus head, relative medial subluxation of the navicular, a varus heel with more opening in the sinus tarsi, proximal shift of the calcaneal tuberosity, a flat medial arch with subsidence at the talonavicular joint, decreased adduction of the forefoot, medial translation of the cuboid at the calcaneocuboid articulation, and a shortened 1st metatarsal. [ABSTRACT FROM AUTHOR]

Background: Lisfranc injuries, if not accurately diagnosed, can result in chronic pain and instability. Previous studies have examined ultrasonographs, radiographs, magnetic resonance imaging (MRI), and conventional computed tomography (CT) scan to differentiate Lisfranc instability, but they focused on a healthy/injured scale without differentiating subtle injury. Weightbearing CT (WBCT) has emerged as a diagnostic tool for detecting subtle Lisfranc injuries. This systematic review aimed to compare WBCT with conventional CT in diagnosing Lisfranc injury, and the ability to differentiate injuries of varying severities. Methods: The review encompassed PubMed, CINAHL, MEDLINE, SPORTDiscus, and Web of Science databases from inception until July 5, 2023. Inclusion criteria involved studies on CT and/or WBCT for Lisfranc injuries and nonoperative studies. Exclusion criteria composed case reports, commentaries, postoperative imaging studies, pediatric patients, studies with nonobjective radiographic measurements, studies exclusively focused on injury classification, and studies with fewer than 5 patients because of poor statistical power. Data extraction focused on radiographic measurements of the Lisfranc complex, categorized into conventional CT, partial WBCT, and total WBCT. Results: Out of the initially retrieved 489 articles, 9 met the inclusion criteria. Several studies consistently demonstrate that WBCT provides a higher level of accuracy in measuring the Lisfranc area, offering enhanced sensitivity to detect subtle alterations in joint structure. Moreover, WBCT exhibits superior sensitivity in distinguishing between healthy Lisfranc joints and those with injuries, particularly when identifying dorsal ligament damage. This imaging modality allows for the detection of significant variations in critical measurements like first-second metatarsal (M1-M2) distance, first cuneiform (C1)-M2 distance, and joint volumes, enabling a more comprehensive assessment of Lisfranc joint health especially with subtle instability. Conclusion: This review evaluates the extant literature on WBCT's utility in diagnosing Lisfranc injuries and compares its effectiveness to CT in distinguishing between injuries of varying severity. WBCT, with reliable measurement techniques, appears more adept at detecting subtle Lisfranc instability compared to CT, likely by allowing the assessment of injury under load. [ABSTRACT FROM AUTHOR]

Objectives: Estimation of stature from measurements of different human parts is a significant aspect of forensic medicine and forensic osteology to identify unknown individuals. Stature is dependent on several variables including genetics, race, age, geographical location, and climate conditions, so it is necessary to define a robust relationship for different people to aid in the identification of individuals. The current study was carried out to test a correlation between stature and foot parameters in a population from Najafabad, Iran. Methods: A total of 206 volunteer adults comprising 106 males and 100 females between the ages of 19 and 38 years were recruited for the study, and measurements of stature, foot length, foot width, medial arch height, lateral malleolus height, medial malleolus height, and navicular height were recorded. Linear regression models were used to estimate stature. Results: The results indicated a positive correlation between stature and foot measurements. Among all parameters, the left foot length (LFL) and right foot width showed the most (r=0.819) and the least (r=0.551) relationship with stature, respectively. A strong correlation between stature and foot dimensions was identified that could add a further dimension to the identification of individuals from skeletal parts. Conclusion: The LFL gives the best prediction of stature compared to other foot measurements. [ABSTRACT FROM AUTHOR]

Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits and frequently affecting the ring and middle fingers. The incidence is 1 out of 2500 children, predominantly occurring in boys and Caucasians. Clinically, the malformation may present as a soft tissue or bony fusion, resulting in the union of the fingers characterised as complete or incomplete. This fusion may involve the phalanges but may also extend to the carpal/tarsal bones, even to the metacarpal or metatarsal level, rarely to the distal end of the forearm and lower leg. The malformation is mostly isolated but may occur together with other disorders or malformations such as synostosis, acro-syndactyly, cleft hand, clinodactyly, or polydactyly. Syndromic syndactyly can be observed in cases of Apert syndrome, Poland's syndrome, Pfeiffer syndrome, and many others. A girl born in June of 2019 was diagnosed with congenital malformation of the right hand at birth—affecting the right middle, ring, and little fingers, respectively. After X-ray imaging, the fusion of the third and fourth proximal phalanges to a common metacarpal was identified, forming a unique diagnosis of clino-syndactyly with metacarpal aplasia. Surgical intervention was advocated for, including a wedge osteotomy to correct the synchondrosis at the phalangeal base and a dorsal flap to close the interdigital space created during the correction of the III and IV. fingers. A trapezoid flap for the release of the syndactyly of the IV and V. fingers was applied. The paper aims to present this surgical correction and its results regarding an atypical case of syndactyly with clinodactyly and metacarpal aplasia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intrinsic foot muscle (IFM) dysfunction and poor foot arch are associated with various foot conditions. Toe flexor exercise (TFE) has been used to improve it; however, the immediate effects of TFE on each IFM and how it relates to changes in navicular bone height (NH) are unclear. OBJECTIVE: This study aimed to investigate acute muscle swelling in the IFM after TFE and the association between changes in NH and IFM size. METHODS: Fourteen adults participated in this study. NH and cross-sectional area (CSA) of the IFM were acquired pre and post- TFE. The CSA of the IFM, including the abductor hallucis (AbH), flexor hallucis brevis, flexor digitorum brevis, and quadratus plantae, was acquired with ultrasonography. In the TFE, each participant completed five sets of eight repetitions with maximum strength. RESULTS: The NH and CSA of all IFM significantly increased significantly post-TFE (p < 0.01). Only the increase in AbH was moderately and positively correlated with the change in NH (r = 0.54, p < 0.01). CONCLUSION: This study suggests that the acute swelling of AbH after TFE is associated with an immediate increase in NH, supporting the important role of AbH in the formation of foot arch. [ABSTRACT FROM AUTHOR]

Tarsal navicular stress fractures are rare injuries, mostly occurring in long-distance runners, jumpers, and occasionally affecting athletes in high-contact sports such as rugby or American/Australian football. This condition generally represents a clinical challenge, resulting in considerable diagnostic delays. While the ideal treatment is still controversial, surgical treatment seems to provide good results in recovering function and return to play. Tarsal navicular stress fractures have been extremely rare in soccer players; only seven published cases have been located to date. This article is a paradigmatic report on a professional player with this injury and a successful outcome after a 12-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Calcaneus fracture comprising only about 2% of all fractures is the most common tarsal bone fracture, constituting about 60% of all tarsal bone fractures. Most of calcaneus fractures are intra-articular making them difficult to treat conservatively with unpredictable outcome. With surgical fixation, there is apprehension of soft-tissue complication. Hence, we decided to conduct this study to estimate radiological and functional outcome of closed calcaneus fractures treated by open reduction internal fixation (ORIF) with calcaneal plate and screws. Aims and Objectives: Study was conducted to estimate radiological and functional outcomes of closed calcaneus fractures treated by ORIF with calcaneal plate and screws. Materials and Methods: This prospective study included patients with calcaneus fractures operated by extended lateral approach and fixed by ORIF with standard calcaneal low-profile locking plates and screws at Bankura Sammilani Medical College, Department of Orthopaedics and reviewed at out or inpatient department between January 2021 and August 2022. 15 patients with total 19 calcaneus fractures, with 4 patients needing bilateral calcaneus fixation, were enrolled for the study. The data were then recorded as for duration to fracture union, satisfactory radiological reduction as for Bohler’s angle, and functional outcome using the American Orthopaedic Foot and Ankle Society score. Data were then processed and analyzed with the help of Microsoft Excel spreadsheet and SPSS (version 27.0) using descriptive statistics in terms percentage and frequency, range, and standard deviation. Results: Comparing pre-operative and post-operative Bohler’s angle, 17 (89.47%) had adequate reduction and for 2 (10.53%) cases, adequate reduction could not be achieved. In our study, overall 7 out of 19 limbs (36.84%) had excellent functional outcome, 10 (52.63%) had good result, and 2 (10.53%) had fair result. Conclusion: ORIF of displaced intra-articular calcaneal fractures through extended lateral approach with low-profile locking calcaneal plates gives good subtalar joint reduction in most cases with satisfactory functional outcome with few complications. [ABSTRACT FROM AUTHOR]

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Introduction: A plethora of pathologies can cause medial ankle pain. Material and methods: We present a case of 66-year-old male with medial ankle pain. Result: Bilateral CTEV (Congenital talipes equino varus) with impingement between the navicular and medial malleolus was present, which was contributing to medial ankle pain. Conclusion: One needs to be aware of this rare form of impingement in patients with medial ankle pain. [ABSTRACT FROM AUTHOR]

Lateroplantar foot pain may be caused by various entities, whereby painful os peroneum syndrome should be included in the differential diagnosis. Physical examination and multimodal imaging enable a definitive diagnosis. We report on a 59-year-old man with severe, load-dependent pain, corresponding to an os peroneum syndrome, triggered by a pes planovalgus with consecutively induced focal inflammation and tendovaginitis of the tendon of the peroneus longus muscle. Multifactorial conservative measures including infiltration and shockwave therapy finally led to a restoration of the original condition. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate the functional health status and quality of life of patients diagnosed with Müller-Weiss disease and, secondarily, determine the influence of factors such as gender, social status, race, body mass index, and surgical and non-surgical treatment in patient outcome. Methods: This study included 30 affected feet (18 patients) with follow-up from 2002 to 2016. Five patients were excluded from reassessment, resulting in 20 feet (13 patients). Questionnaires for functional and quality of life assessments were administered, and statistical analysis was performed. Results: Patients with obesity had poor functional results and low quality of life rates. Regarding quality of life, mainly in the mental health domain, there was a significant difference (p < 0.001) that was not observed in other domains investigated, except for surgical treatment, which was superior to non-surgical treatment in terms of the physical domain (p = 0.024). Bilateral treatment was also superior to unilateral treatment in Coughlin's classification (71.4% versus 66.7%). Conclusions: Müller-Weiss disease evolved with poor functional results and low quality of life rates in patients with obesity, with no method of treatment influence on patient outcome, except for the SF-12 physical domain, where surgical treatment showed better results than conservative treatment. [ABSTRACT FROM AUTHOR]

The introduction of carbon fiber plate footwear has led to performance benefits in runners. The mechanism for these changes in running economy includes altered biomechanics of the foot and ankle. The association of this footwear with injuries has been a topic of debate clinically, but not described in the literature. In this Current Opinion article, illustrated by a case series of five navicular bone stress injuries in highly competitive running athletes, we discuss the development of running-related injuries in association with the use of carbon fiber plate footwear. While the performance benefits of this footwear are considerable, sports medicine providers should consider injuries possibly related to altered biomechanical demands affecting athletes who use carbon fiber plate footwear. Given the introduction of carbon fiber plate footwear into athletics and other endurance sports, strategies may be required to reduce risk of injury due to altered foot and ankle mechanics. This article is intended (1) to raise awareness on possible health concerns around the use of carbon fiber plate footwear, (2) to suggest a slow gradual transition from habitual to carbon fiber plate footwear, and (3) to foster medical research related to carbon fiber plate technology and injuries. [ABSTRACT FROM AUTHOR]