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Objective: This study used the AOFAS score to assess the clinical functional results of patients who underwent tarsal coalition resection. Methods: This was a retrospective case series of patients who underwent tarsal coalition resection to correct rigid flat foot. Clinical and functional assessment was performed with the AOFAS score before and 6 months after surgical treatment. Descriptive analysis was performed for 7 patients (11 operated feet) using measurements of position and dispersion (mean, standard deviation, minimum, median and maximum value) for continuous variables and frequency tables (absolute and relative) for categorical variables. Results: The mean patient age was 10 years, 7 months, and the majority (71.43%) were male. The most affected joint was the calcaneonavicular. The right side was affected in 54.55% of the cases. The most frequent type of coalition was osseous (81.82% of the cases). The mean pre- and postoperative AOFAS scores were 32.7 and 70.2 points, respectively, which was a significant increase. Conclusion: The increased scores after coalition resection was considered the main change between the two assessments. Thus, it can be concluded that in rigid flat feet without severe hind- or forefoot deformities for which conservative treatment failed, bar resection should be the surgical procedure of choice. Level of Evidence IV; Therapeutic Studies; Case Series.

Background: Talar fractures are second in frequency among all tarsal bone fractures. Two percent of all lower extremity injuries and 5% to 7% of foot injuries involve fractures of the talus. The role of the talus in lower extremity function, the complexity of the anatomy, and the variability of fracture patterns often complicate treatment of talar fractures and often frustrate orthopaedic surgeon. The primary goal of treatment is to obtain stable, pain free subtalar and ankle joints and restoration of their maximum function. Aim: To study about the functional outcome of talus fracture following internal fixation by using cannulated cancellous screws. Materials and Methods: 20 patients [11males and 9 females] admitted in government thoothukudi medical college hospital thoothukudi with ankle injuries with talus fractues were included in this study. All the patients were treated with internal fixation with cannulated cancellous screw fixation. Patients were followed up and assessed for functional outcome with AOFAS scoring and Hawkins grading criteria. Results: 20 patients with talar fractures admitted at Government Thoothukudi medical college hospital, Thoothukudi were included in the study. All the patients were treated with internal fixation with cannulated cancellous screws. The longest follow up period was 18 months and shortest follow up period was 6 months, mean follow up period was 12 months. Follow up analysis was made using AOFAS scoring and Hawkins grading criteria. In our study, 65% of patients were less than 30 years of age. 70% of patients were male and there was no significant difference in the side affected (right-9, left-11). Most of the patients sustained injury by fall from height (55%). 55% of patients had fracture of neck of talus among others. In this study, 40% of patients had excellent outcome, 30% patients had good outcome and 30% had fair outcome, while none had poor outcome. In this study, only 1 patient developed screw prominence and wound infection, treated with IV antibiotics, and screw removal done. One patient developed avascular necrosis of the talus and one another developed subtalar arthritis, both of them were treated with subtalar arthrodesis. Conclusion: In conclusion, treatment of fracture of talus with closed / open reduction and screw fixation facilitated early mobilization of the patients and helped achieving stable, pain free subtalar and ankle joints and preventing avascular necrosis of talus and subtalar and ankle joint arthritis.

To describe a rare case of bilateral mirror feet with varus deformity and review of literature. AP and oblique radiographs of both feet were taken. On radiographs, right foot showed eight toes and seven metatarsals while left foot showed eight toes and seven metatarsals, the three extra toes were present preaxially (on hallux side) in both feet, showing characteristics of postaxial toes termed as “mirror foot”. Varus deformity was noted at the subtalar joint, otherwise tarsal bones appeared normal. No any syndromatic association was present. Mirror foot is a very rare congenital anomaly, we put forward this case for its rarity and unusual late presentation at the age of 22.

Introduction: Talus fracture is an uncommon fracture that can be encountered on day- to- day basis. However, it is the 2nd most common tarsal bone to get fractured after calcaneum and accounts for approximately 1% of all fractures around foot and ankle. The anastomotic ring around the talar neck is highly likely to get damaged at the time of the fracture, which, in turn, hampers the blood supply to the body of talus. As a result, the bone healing is delayed and the integrity of the healed fracture is poor which leads to poor functional outcome. Almost 39% cases are missed during the initial evaluation, and talus fracture accounts for almost 50% of all the missed injuries (6–8). A high level of clinical suspicion is required to avoid missing such injuries. Case Report: A 26-year-old male presented to the outpatient department with chief complaint of pain over the left foot while walking for past 6 months. There was a history of significant trauma to the foot 6 months back (fall from 12 feet) for which he sought medical advice and was managed with analgesics and rest for a couple of weeks. He presented to us 6 months later with chronic, dull aching, and continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with contralateral iliac crest cancellous bone grafting. Conclusion: Delay in diagnosing such injuries accelerates the vascular compromise, delays timely intervention, and ultimately leads to increased morbidity. Keywords: Talar neck fracture, non-union talus fracture, delayed union talus.

Introduction.The rigid form of static flat feet in children occurs in 18-20 % of cases of the musculoskeletal system pathology. Nowadays, neither objective diagnostic methods have been developed, nor algorithms for treating the rigid form of flat feet depending on the severity, deformity of the tarsal bones, foot mobility and dysfunction of the posterior tibialis tendon (PTT) have been found. Objective. To develop objective evaluation methods of rigid flat feet surgical treatment in children depending on the joints’ mobility, compression ratio, and PTT dysfunction stage. Methods and materials. The effectiveness of the rigid form of static stage II-III flat feet treatment was analysed in 15 children aged 14 to 18 years, who were divided into control and main groups. Clinical and radiological diagnostic methods were used. Patients of the control group (8 children) were operated using subtalar arthroereisis method. Patients of the main group (7 children) underwent surgery on bones and soft tissues. Results. Surgical treatment showed no effect using subtalar arthroereisis method in cases of the tarsal bone deformity, advanced stage of PTT dysfunction, and significant impairment of foot mobility. Positive results were also achieved using two-joint arthrodesis with the formation of navicular-tibial ligament with severe foot rigidity, stage III-IV of PTT dysfunction and navicular bone deformity. Conclusion. During treatment of rigid flat feet in children it’s necessary to take into consideration severity, compression ratio of the navicular bone, the mobility index, the stage of the posterior tibialis tendon dysfunction and the angle of its tension. Long-term results indicate the effectiveness of surgery on bones and soft tissues in the treatment of severe rigid flat feet.

The rigid form of static flatfeet occurs in 18 to 20% of cases of the musculoskeletal system pathology. To date, no objective diagnostic methods have been developed, no algorithms for treating the rigid form of flatfeet depending on the severity, deformity of the tarsal bones, foot mobility and dysfunction of the posterior tibialis tendon (hereinafter PTT). Objective. To develop objective evaluation methods for mobility in the joints and changes in the tarsal bones. Create algorithms for surgical treatment of rigid foot. Materials and methods. The effectiveness of the rigid form of static flatfeet treatment in 32 children (64 feet) aged 14 to 18 years, which were divided into main and control groups, was analyzed. Clinical and radiological diagnostic methods were used. Patients in the main group (15 patients) underwent surgery on bones and soft tissues.Patients in the control group (17 patients) were operated using subtalar arthroereisis method. Results. Surgical treatment was ineffective in the use of subtalar arthroereisis in cases of the tarsal bone deformity and significant impairment of foot mobility. Positive results were also achieved using two-joint arthrodesis with the formation of naviculo-tibial ligament with severe foot rigidity, stage III–IV of PTT dysfunction and navicular bone deformity. Conclusions. Treatment of rigid foot should take into account the severity, the compression ratio of the navicular bone, the mobility index, the stage of the posterior tibialis tendon dysfunction and the angle of its tension. Long-term results indicate the effectiveness of surgery on bones and soft tissues in the treatment of severe rigid flat feet. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: flatfeet, children, surgical treatment.

Tarsal coalition is an abnormal connection between tarsal bones, caused by an embryogenic failure. Its most common forms are calcaneonavicular and talocalcaneal coalition, which are present in 53% and 37% of the cases, respectively. The onset of symptoms is related to tarsal bone ossification, and mean age for this event is estimated at 16 years for calcaneonavicular coalition. Surgical treatment is indicated for patients who did not improve symptoms with conservative treatment. The aim of this study is to present a surgical technique as a treatment option for resection of calcaneonavicular coalition associated with abnormal cuboid-navicular joint. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Aseptic necrosis may be defined as a group of diseases that have bone necrosis as a common denominator. They usually appear in the epiphyses and in the carpal and tarsal bones. They generally appear during a growth period and principally at those skeletal points subjected to particular stress. In Müller–Weiss disease in the advanced stages, talonavicular-cuneiform arthrodesis, with or without back foot correction, is the best surgical option. In Freiberg–Kohler disease, treatment can be conservative and we can maintain the head of the metatarsal by performing a joint debridement of the metatarsophalangeal joint with removal of loose bodies. The lateral upper and lower faces of the distal extremity of the metatarsal are resected, preserving the joint cartilage that in its centre portion is always healthy. The osteophyte border that may be present in the phalanx is resected. Most frequently, avascular necrosis (AVN) of the talus is a sequel to talar fractures, with the possibility that the AVN increases with the severity of the trauma and the damage associated with the already precarious blood supply of the talus. The surgical treatment used for sesamoid AVN is partial excision of the affected bone. Cite this article: EFORT Open Rev 2020;5:684-690. DOI: 10.1302/2058-5241.5.200007

Introduction Tarsal malformation is a skeletal malformation of unknown aetiology associated with a variety of morphologic changes to the tarsal and metatarsal bones of the dog. Objective The aim of this study was to determine if early diagnosis and prevalence of tarsal malformation could be obtained at approximately 8 to 9 weeks of age in multiple litters of Bernese Mountain dogs. Methods A prospective study of 51 Bernese Mountain dog puppies were evaluated from 12 litters in northern Italy. Dorsoplantar radiographic views of the tarsus were obtained at 60 ± 5 days of age. Tarsal malformation was defined as an abnormal extension of the central tarsal bone on its medial side, or the presence of ectopic bone located medially to the central tarsal bone, talus and second metatarsal bones (proximomedial, distomedial and metatarsal ossification sites respectively). Results All puppies were found to be clinically normal. Thirty-nine of the 51 puppies showed ossification sites medial to the tarsus as defined. A metatarsal ossification was present in all dogs with either a proximo- or distomedial ossification site. No central tarsal bone extensions were observed. The remainder of the tarsometatarsal joints were normal. Clinical Significance Tarsal malformation can be identified in the 8- to 9-week-old Bernese Mountain dog. The clinical significance of tarsal malformation remains to be determined, either as an incidental finding or a precursor to the development of other clinically relevant and related issues in the tarsus.

Vascular origin tumors of bone are rare entities. Epithelioid hemangioendothelioma (EHE) is a rare tumor representing

Background The procedure of percutaneous Achilles tenotomy (PAT) is an important component of the Ponseti method. However, few studies reported the influence of Achilles tendon on kinematic coupling relationship between tarsal bones. The purpose of present study was to demonstrate the effect of Achilles tendon on the kinematic coupling relationship between tarsal bones, and to illustrate how kinematic coupling relationship between tarsal bones works in term of finite element analysis. Methods A three-dimensional finite element model of foot and ankle was constructed based on the Chinese digital human girl No.1 (CDH-G1) image database using the software of mimics, Geomagic studio, HyperMesh, and Abaqus. The last manipulation of the Ponseti method before the procedure of PAT was simulated. The talus head and the proximal tibia and fibula bone were fixed in all six degrees of freedom, and the outward pressure was added on the first metatarsal head to investigate the kinematic coupling relationship between tarsal bones. Results The least relationship of kinematic coupling between tarsal bones was found in calcaneus. Stress concentration was mainly observed at the navicular, talus and the medial malleolus. The difference in displacement of the navicular was only found with the Achilles tendon stiffness of 0 N/mm and others. No difference in the navicular displacement was found in the stiffness of Achilles tendon between 40, 80, 200, 400, and 1000 N/mm. The maximum displacement of navicular was observed at the ankle position of PF-20° (plantar flexion-20°). The difference in displacement of the navicular was greater at the ankle position of PF-20° with the Achilles tendon stiffness of 0 N/mm than that at the ankle position of PF-40° with the Achilles tendon stiffness of 40 N/mm. Conclusions Based on the findings from this study, it was demonstrated that the Achilles tendon existence or not and ankle position had great influence, while increased stiffness of Achilles tendon had no influence on kinematic coupling relationship between tarsal bones. For the cases with severe equinus, earlier implementation of PAT procedure (with the purpose of release the Achilles tendon and reduce the degree of ankle plantar flexion) may be beneficial to the deformity correction.

Little is known as to whether different operating voltages of X-ray fluorescence (XRF) can affect the accuracy rate for species identification. Here, we have addressed this question by comparing the rate of correct species identification using the elemental composition of either the carpal or tarsal bone obtained from a determination of the different energy values of XRF at 15 and 50 kV using energy-dispersive XRF (ED-XRF). Carpal bones were taken from 16 species and tarsal bones from 11 of these species. The data on the elemental profiles were analyzed by stepwise discriminant analysis for species discrimination. The classification results indicated that 94.1% and 63.7% of the originally grouped cases were correctly classified as carpal bones using 15 kV and 50 kV, respectively. Additionally, 69.4% and 77.3% of the originally grouped cases were correctly classified as tarsal bones using 15 kV and 50 kV, respectively. When the datasets of the elemental profiles obtained using two operating voltages were gathered, the classification results of the prediction rate appeared to be more accurate at 89.7% and 90.7% in the carpal and tarsal bones, respectively. In conclusion, our findings suggest that the elemental profiles of bones obtained using two operating voltages could effectively facilitate accurate species discrimination.

Both calcaneal and central tarsal bone fractures are commonly encountered in the racing greyhound. While isolated fractures of the numbered tarsal bones are uncommon, malleolar fractures are encountered frequently in small animal practice. Fractures of the central tarsal bone or calcaneal fractures in both dogs and cats may be either fatigue or stress fractures, or associated with Knees and Teeth Syndrome, which may alter the typically expected presentation and prompt assessment for additional fractures, both in the tarsus and elsewhere. Surgical stabilisation is often the treatment of choice, particularly for fractures with an articular component. In many cases, surgical stabilisation leads to a positive outcome, with Greyhounds often being able to return to racing. However, it is important to be aware that fractures in non-racing dogs tend to be more complex and that this good prognosis may not be appropriate to extrapolate. Depending on the nature and severity of injuries, joint preservation may not always be a realistic goal. If the joint cannot be preserved, arthrodesis may become necessary.

Objective The calcaneus is the most frequently injured tarsal bone, with calcaneal fractures meaning that 60% of the fractures affect the foot and about 1%–2% of all fractures. Methods Two 3D FE model of the foot were realized in order to compare the stress shielding occurring in a health foot and in a fractured one implanted with an easy step prosthesis by Stryker. This dispositive is indicated for calcaneus fractures. Results Results evidence the efficacy of this kind of prosthesis as the Eq. Von mises stresses are comparable in the two model. Higher concentration of stress are concentered on the Easy step. Conclusion In conclusion, the easy step staple prosthesis allows obtaining excellent results in terms of calcaneus fracture treatments. The correct implant size for a given patient can be determined by evaluating the patient's height, weight, functional demands and anatomy.

While fractures of the tarsal bones may not be common in non-racing dog and cat populations, an awareness of these injuries and the gold-standard treatment thereof remains important. Failure to diagnose these fractures and pursue appropriate treatment can have devastating consequences for long-term limb use; racing dogs may fail to return to racing and potentially be condemned to euthanasia while non-racing dogs may go on to suffer debilitating osteoarthritis. For many tarsal fractures, surgical stabilisation is indicated and in order to plan this, an accurate diagnosis must be made. While various radiographic views may assist in achieving this diagnosis, computed tomography is more sensitive for detection and classification of tarsal fractures. Fractures of the talus are generally classified as articular fractures of the body or non-articular fractures of the head or neck. Treatment of talar fractures depends on the site of the fracture and degree of comminution, with intra-articular and certain extra-articular fractures necessitating anatomical reconstruction with a lag screw or multiple K-wires. The prognosis is variable depending on fracture type and accuracy of reduction, but following articular fracture management, most patients will suffer from clinically relevant osteoarthritis later in life.

A tarsal coalition is an abnormal connection between two or more tarsal bones caused by failure of mesenchymal segmentation. The two most common tarsal coalitions are calcaneonavicular coalition (CNC) and talocalcaneal coalition (TCC). Both CNC and TCC can be associated with significant foot and ankle pain and impaired quality of life; there may also be concomitant foot and ankle deformity. Initial, non-operative management for symptomatic tarsal coalition commonly fails, leaving surgical intervention as the only recourse. The focus of this article is to critically describe the variety of methods used to surgically manage CNC and TCC. In review of the pertinent literature we highlight the ongoing treatment controversies in this field and discuss new innovations. The evidence-based algorithmic approach used by the authors in the management of tarsal coalitions is illustrated alongside some clinical pearls that should help surgeons treating this common, and at times complex, condition.Cite this article: EFORT Open Rev 2020;5:80-89. DOI: 10.1302/2058-5241.5.180106

Reduced numbers of carpal and tarsal bones (wrist and ankle joints) are extensively observed in the clade of Cetacea and Ruminantia (Cetruminantia). Homebox D11 (Hoxd11) is one of the important genes required for limb development in mammals. Mutations in Hoxd11 can lead to defects in particular bones of limbs, including carpus and tarsus. To test whether evolutionary changes in Hoxd11 underlie the loss of these bones in Cetruminantia, we sequenced and analyzed Hoxd11 coding sequences and compared them with other 5′ HoxA and HoxD genes in a taxonomic coverage of Cetacea, Ruminantia and other mammalian relatives. Statistical tests on the Hoxd11 sequences found an accelerated evolution in the common ancestor of cetaceans and ruminants, which coincided with the reduction of carpal and tarsal bones in this clade. Five amino acid substitutions (G222S, G227A, G229S, A240T and G261V) and one amino acid deletion (G254Del) occurred in this lineage. In contrast, other 5′ HoxA and HoxD genes do not show this same evolutionary pattern, but instead display a highly conserved pattern of evolution in this lineage. Accelerated evolution of Hoxd11, but not other 5′ HoxA and HoxD genes, is probably related to the reduction of the carpal and tarsal bones in Cetruminantia. Moreover, we found two amino acid substitutions (G110S and D223N) in Hoxd11 that are unique to the lineage of Cetacea, which coincided with hindlimb loss in the common ancestor of cetaceans. Our results give molecular evidence of Hoxd11 adaptive evolution in cetaceans and ruminants, which could be correlated with limb morphological adaptation.

Understanding of medial column biomechanics is paramount to a successful outcome in both conservative and surgical treatment. Dysfunctions of the dynamic stabilizers as well as the static stabilizers of the medial column play a role in pathomechanics. Conservative options for addressing the medial column include custom foot orthotics and bracing. Options for addressing the medial column surgically with the goal to restore a stable tripod configuration, include first tarsometatarsal joint arthrodesis, opening plantarflexory medial cuneiform osteotomy, and naviculocuneiform arthrodesis.

Purpose Tarsal coalitions are congenital fusions of two or more tarsal bones and can lead to foot pain and stiffness. Few studies examine the long-term reoperation rates following paediatric tarsal coalition surgery. Methods A population-based database, linking medical records at all medical centres to capture the entire medical history of the full population of a Midwest county, was used to identify tarsal coalitions in children between 1966 and 2018. Records were reviewed for clinical data, surgical records and followed up to identify any subsequent surgical interventions. Results A total of 58 patients (85 coalitions) were identified; 46 calcaneonavicular (CN) coalitions, 30 talocalcaneal (TC) coalitions and nine other coalitions (seven talonavicular, one naviculocuboid, one naviculocuneiform). In all, 46 coalitions were treated surgically (43 coalition resections, three arthrodeses) and 39 were treated nonoperatively. Patients treated surgically were less likely to report ongoing symptoms at final follow-up compared with patients managed nonoperatively (33% versus 67%; p = 0.0017). With a median 14.4 years (interquartile range 9.3 to 19.7) follow-up, there was an overall re-operation rate of 8.7% (4/46). Differences in reoperation rates by initial surgery (resection versus arthrodesis; p = 0.2936), coalition type (CN versus TC versus Other; p = 0.6487) or composition (osseous versus fibrocartilaginous; p = 0.29) did not reach statistical significance. Conclusion This is the first population-based study demonstrating the durability of surgical management of tarsal coalitions in a paediatric population. At final follow-up, patients treated surgically are less likely to report persistent symptoms compared with patients managed nonoperatively. Long-term reoperation rates appear to be low (8.7%). Level of evidence III

Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.

Title: Case Study of Physiotherapy Treatment of a patient after a Cuboid Fracture Objectives: The purpose of this Bachelor thesis is to address my patient's diagnosis after he had an occupational accident, and to describe the physiotherapeutic processes that led to his rehabilitation. X-Ray imaging undertaken just after his accident showed that the plantar and proximal edge of the cuboid of his left foot were broken off, as well as the lamella with decalcification. Main objective is to gain theoretical background/knowledge and processing of a case report of a patient after Cuboid fracture Methods: This thesis report, written by myself, under my professor's supervision, is divided into two main parts: The general part and the case study. The general part details all aspects of Cuboid bone fracture. It highlights important information on characteristics, pathology, epidemiology, and its pathokinesiological consequences for the musculoskeletal system. It also provides detailed research information on its examination and physiotherapeutic methods, procedures and prognosis and the effect of therapeutic approaches and procedures at the high level of Evidence Based Medicine (EBM). The second part of the report details the case study I conducted at Centrum Léčby Pohybového Aparátu (CLPA) during my clinical...