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PubMed1977

Posterior displacement osteotomy of the calcaneus.

In cases of established calcaneus after anterior poliomyelitis the deformity can be greatly reduced by combining an extensive plantar release with an oblique transverse osteotomy of the calcaneus that permits displacement upwards and backwards of the posterior weight-bearing part of the bone. The procedure greatly improves the mechanical advantage of subsequent tendon transplantations to the heel. Between 1956 and 1969 fifteen such osteotomies were carried out and the long-term results have been reviewed.

Adolescent↗
PubMed1986

Hemitransplantation of the tendo calcaneus in children with spinal neurological disorders.

In paralytic lesions in which the triceps surae is the only active muscle in the leg, elongation or division of the tendo calcaneus alone may not be enough to prevent recurrence of equinus deformity. In 10 patients (13 limbs) with this pattern of muscle activity, equinus deformity was treated by hemitransplantation of the tendo calcaneus. At follow-up, which was beyond the end of growth in seven limbs, there was no recurrence of deformity in nine. In three of the four failures, a technical fault may have caused loss of activity in the transplanted part of the tendon. The two-stage operation described is recommended in the management of this pattern of paralytic deformity.

Calcaneus↗
PubMed2001

Fractures of the tuberosity of the calcaneus.

We describe 24 fractures of the tuberosity of the calcaneus in 22 patients. Three were similar to the type of avulsion fracture which has been well-defined but the remainder represent a group which has been unrecognised previously. Using CT and operative findings we have defined the different patterns of fracture of the calcaneal tuberosity. Ten fractures extended into the subtalar joint, but did not fit the pattern of the common intra-articular fracture as described classically. We have defined a new pattern which consists of a fracture of the medial calcaneal process with a further fracture which separates the upper part of the tuberosity in the semicoronal plane. Non-operative treatment of displaced fractures resulted in a mis-shapen heel and a poor functional outcome. Open reduction and internal fixation with either a plate or compression screw did not give satisfactory fixation. We prefer to use an oblique lateral tension-band wire. This technique gave excellent fixation and we recommend it for the treatment of displaced fractures of the tuberosity of the calcaneus.

Adolescent↗
PubMed2004

Correlation of quantitative ultrasound parameters of the calcaneus with bone density of the spine and hip in women with prevalent hypovitaminosis D.

Quantitative ultrasound (QUS) of the calcaneus correlates modestly with axial dual-energy X-ray absorptiometry (DXA). Because bone mineral density (BMD) might be influenced by vitamin D status, we assessed the correlation between both techniques in 56 Arabian women, a population with high prevalence of hypovitaminosis D. The speed of sound (SOS), broadband ultrasound attenuation (BUA), and estimated BMD of the right calcaneus were determined by QUS. Spine and right hip BMD were measured by DXA scan. The serum 25-hydroxyvitamin D (25OHD) level was measured by radioimmunoassay. The correlations of QUS parameters (estimated calcaneal BMD, BUA, and SOS) with spine and hip BMD were modest (r = 0.50, r = 0.53, r = 0.41 for the spine and r = 0.54, r = 0.56, and r = 0.46 for the hip, respectively; p < 0.01 for all comparisons), but stronger in postmenopausal women. All postmenopausal women with low estimated calcaneal BMD (T-score pound -1) had a T-score pound -1 by DXA of the spine or hip. Of the 21 premenopausal women with spine or hip T-score pound -1 who had 25OHD measurements, 20 (95.2%) had levels below 50 nmol/L and 12 (57%) had levels below 30 nmol/L. The subgroup with 25OHD < 30 nmol/L had significantly lower spine (p < 0.01) and hip BMD (p < 0.05) than the subgroup with 25OHD >/= 30 nmol/L. QUS parameters were not significantly different between the two subgroups. The QUS and DXA correlated modestly well in women with prevalent hypovitaminosis D. QUS could be used in postmenopausal women with hypovitaminosis D to identify those at risk for osteoporotic fracture.

Absorptiometry, Photon↗
PubMed2007

[Prevalence of fracture risk estimated by quantitative ultrasound of the calcaneus in a population of postmenopausal women].

A strong aging tendency is currently being observed in the world population, leading to an increase n the prevalence of such diseases as osteoporosis and fractures. This study aimed to determine the prevalence of fracture risk, estimated by quantitative ultrasound of the calcaneus in a population of postmenopausal women residing in the Ilha de Paquetá neighborhood of Rio de Janeiro, Brazil. We conducted anthropometric measurements and quantitative ultrasound of the calcaneus using Sonost 2000 in 385 postmenopausal women. Some 59.22% of the sample showed a T-score < -1, while 16.88% had T-score < -2.5. The test parameters varied with increasing age, with a statistically significant difference (p < 0.05) between fracture risk groups according to age, time since menopause, weight, BMI, and body fat. There was a correlation between sound velocity and BMI (r = 0.155; p = 0.002). We concluded that some 60% of the female study population showed some degree of fracture risk. The women at highest risk (T-score < -2.5) were older, with more time since menopause, and had higher weight and BMI as compared to the other groups.

Adult↗
PubMed1994

Calcaneus and vertebrae bone mineral density values and fracture threshold.

The calcaneus bone mineral density values (BMDs) of healthy Japanese women peaked at 20 to 25 years of age with 435 +/- 66 mg/cm2 (mean +/- S.D.), decreased 0.51% on the average every year thereafter until 45 years of age, 1.72% between 45 and 55 years (menopause) and 0.55% thereafter. The vertebrae bone mineral density value peaked at 30 to 35 years of age with 1.06 +/- 0.13 g/cm2 (mean +/- S.D.), decreased 0.67% on the average every year thereafter until 45 years of age, 1.23% between 45 and 55 years (menopause) and 0.70% thereafter. Mean -2.0 S.D. of the peak bone mass was considered appropriate as the fracture threshold for both the calcaneus and vertebra, judging from the BMDs of osteoporosis patients.

Absorptiometry, Photon↗
PubMed1999

Fibrous dysplasia arising from the calcaneus.

A case of an 18-year-old woman with fibrous dysplasia arising in the calcaneus, which is extremely rare, is reported, with the emphasis placed on differential diagnosis from low-grade central osteosarcoma. She had a severe pain in her left ankle after sprain. Plain radiographs showed a radiolucent lesion measuring 6.3 x 2.5 cm with a sclerotic margin in the left calcaneus. CT scans showed a well-defined lytic lesion with disruption of the lateral cortex and an ossification or calcification in its center. On MR imaging, the lesion had isointensities and high intensities on T1 and T2 weighted images, respectively, but its central portions showed lower intensities both on T1 and T2 weighted images. The lesion was enhanced with gadolinium except for the central portions. The specimen obtained by open biopsy consisted of fibrous tissue and foci of irregular woven bone. None of the nuclear atypia, mitoses, longitudinal stream of bone or invasive nature of growth was detected. The diagnosis of fibrous dysplasia was histologically made. The lesion was curetted and packed with autogenous bone chips. No evidence of recurrence was noted postoperatively.

Adolescent↗
PubMed2005

Prominent vascular remnants in the calcaneus simulating a lesion on MRI of the ankle: findings in 67 patients with cadaveric correlation.

OBJECTIVE: Our objective was to prove through cadaveric correlation that a frequently seen focus of MRI signal in the calcaneus is benign. CONCLUSION: A characteristic focus of signal (increased T2, decreased T1) in the calcaneus near the attachment of the cervical and interosseous ligaments is a common, benign finding frequently seen on MRI of the foot and ankle.

Adolescent↗
PubMed1999

Diagnostic agreement of quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur.

OBJECTIVE: The aim of our study was to evaluate the diagnostic agreement between quantitative sonography of the calcaneus and dual X-ray absorptiometry (DXA) of the spine and femur for revealing osteoporosis. SUBJECTS AND METHODS: In 1252 patients (795 women, 54.9+/-15 years old; 457 men, 50.5+/-15 years old [mean+/-SD]), bone mineral density measurements of the lumbar spine (posteroanterior, L1-L4) and the proximal femur (neck, trochanter, intertrochanteric region, total proximal femur, and Ward's triangle) and quantitative sonographic measurements of the stiffness of the calcaneus were performed. The presence of osteoporosis is defined, according to the World Health Organization criteria, as a T-score lower than -2.5. The percentage of patients below the threshold (prevalence of osteoporosis) was calculated for each imaging technique. The diagnostic agreement in identifying individuals as osteoporotic was assessed using kappa scores. RESULTS: Forty-nine percent of the women and 42% of the men were classified as osteoporotic by quantitative sonography, 32% of women and 30% of men by DXA of the spine, and 23-54% of women and 16-54% of men by the different regions of interest revealed on femoral DXA. Kappa analysis showed the diagnostic agreement among these measures to be generally poor (kappa = .28-.41 [women] and .25-.45 [men]). CONCLUSION: The considerable diagnostic disagreement between quantitative sonography and DXA could cause confusion in the daily practice of radiology and make establishing the correct diagnosis a difficult task. The choice of imaging technique influences which patients are diagnosed as osteoporotic.

Absorptiometry, Photon↗
PubMed2001

Diagnostic disagreement of imaging quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur.

OBJECTIVE: This study evaluates the diagnostic agreement between imaging quantitative sonography of the calcaneus and dual X-ray absorptiometry of the spine and femur for diagnosing osteoporosis. MATERIALS AND METHODS: In 498 female patients (56 +/- 18 years old), bone mineral density measurements by dual X-ray absorptiometry of the lumbar spine (posteroanterior, L1--L4) and the proximal femur and imaging quantitative sonography of the calcaneus were performed. The percentage of patients having T-scores less than or equal to a threshold of -2.5 standard deviations below a young normal reference was used to compare quantitative sonography with dual X-ray absorptiometry. The diagnostic agreement was assessed using kappa scores. RESULTS: Approximately 30% of the patients had a T-score less than or equal to -2.5 standard deviations as assessed by imaging quantitative sonography (broadband ultrasound attenuation), 26.5% as assessed by dual X-ray absorptiometry of the spine, and 16.7--56.4% as assessed by dual X-ray absorptiometry of the different regions of interest at the femur. Kappa analysis showed that severe diagnostic disagreement exists among broadband ultrasound attenuation and dual X-ray absorptiometry (kappa = 0.28-0.42). CONCLUSION: Considerable diagnostic disagreement exists between imaging quantitative sonography and dual X-ray absorptiometry of the spine and femur. The disagreement is in the same range as that reported recently in comparisons of dual X-ray absorptiometry and nonimaging quantitative sonography. In general, no distinct advantage for imaging quantitative sonography could be found when compared with other techniques.

Absorptiometry, Photon↗
PubMed2003

Comparison of imaging-guided and non-imaging-guided quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur.

OBJECTIVE: The purpose of our study was to evaluate the diagnostic agreement between imaging-guided and non-imaging-guided quantitative sonography of the calcaneus and dual X-ray absorptiometry of the spine and femur to show osteoporosis. SUBJECTS AND METHODS: In 113 patients (73 women, 59 +/- 14 years old; 40 men, 48 +/- 16 years old), dual X-ray absorptiometry of the lumbar spine and the proximal femur, imaging-guided quantitative sonography, and non-imaging-guided quantitative sonography of the calcaneus were performed. The percentage of patients having a T-score equal to or less than a threshold of -2.5 SDs (prevalence of osteoporosis) was calculated for each imaging technique. The diagnostic agreement of the three techniques in identifying individuals with osteoporosis was assessed. RESULTS: Eleven percent of the women and 8% of the men were classified as osteoporotic by imaging-guided quantitative sonography, and 38% of the women and 25% of the men were so classified by non-imaging-guided quantitative sonography. At dual X-ray absorptiometry of the spine, 44% of the women and 38% of the men were classified as osteoporotic, and, at different femoral regions, 19-60% of the women and 8-38% of the men were so classified. Kappa analysis for both quantitative sonography techniques was not significant. Kappa analysis for both quantitative sonography techniques and dual X-ray absorptiometry showed diagnostic agreement to be generally poor. CONCLUSION: No advantage in diagnostic accuracy could be found for imaging-guided quantitative sonography. The considerable diagnostic disagreement between both quantitative sonography techniques and dual X-ray absorptiometry could be confusing in daily clinical practice.

Absorptiometry, Photon↗
PubMed1995

Ultrasound attenuation of the calcaneus in normal subjects and in patients with wrist fracture.

We determined broadband ultrasound attenuation (BUA) of the calcaneus, and bone mineral density (BMD) of the spine, proximal femur and radius in 137 healthy subjects (79 women and 58 men) and in 56 women with Colles' fracture. The repeated measurements on 9 healthy subjects indicated a short-term reproducibility (coefficient of variation) of 4 percent for BUA. There was a small (7 percent) but significant difference in BUA between normal men and women. The age-dependence in normal subjects was weak. When all the study subjects were pooled, modest correlations between BUA of the calcaneus and BMD at all measured skeletal sites were found (rs values 0.3-0.4). However, it was not possible to make an accurate prediction of the axial BMD, using BUA. BUA values were 13 percent lower in the wrist fracture patients than in the age-matched normals. In general, BUA could discriminate the fracture patients from normals as effectively as BMD. As suggested by the physical theory of ultrasound attenuation, our results support the idea that BUA reflects not only the bone density but also other factors related to the structural properties of bone.

Absorptiometry, Photon↗
PubMed2001

Association between current nutrient intakes and bone mineral density at calcaneus in pre- and postmenopausal Japanese women.

The association between nutrient intake and bone mineral density (BMD) at calcaneus was cross-sectionally examined in 243 pre- (aged 29-60 years) and 137 postmenopausal (aged 39-60 years) Japanese women who participated in a BMD checkup and have kept a stable diet for at least 3 previous years and had no dietary therapy. Nutrient intakes were assessed with a self-administered diet history questionnaire. BMD at calcaneus was measured with dual-energy X-ray absorptiometry. In a multiple regression analysis with adjustments for nondietary factors such as age, body height, fat body weight, nonfat body weight, and number of deliveries, calcium (p<0.01) and niacin (p<0.05) significantly and positively, and phosphorus and dietary fiber (p<0.05 for both) significantly and negatively correlated in premenopausal women, and only potassium (p<0.05) significantly and positively correlated in postmenopausal women with BMD. The results suggest that several nutrients correlate with BMD, and the associations differ depending on menopausal status. epidemiology, diet, nutrients, bone mineral density. Japanese women

Adult↗
PubMed2002

[Axial calcaneus roentgenograph].

Low-frequency noise caused by intestinal gas, bone, or high-contrast subjects on roentgenographs often makes them difficult to read. The plantodorsal projection of the calcaneus taken by the conventional method has low-frequency noise because of its own high contrast for the long axis. Even if a higher X-ray tube voltage is used to reduce the low-frequency noise, middle- or high-frequency signals such as those of bone trabeculae are also reduced. We investigated a new method that takes into consideration the subject contrast between the part of the posterior calcanean articulation and distal part on the calcaneus projection, the spectrum of bone trabeculae, and the scatter fraction. The technique we introduced has some merit compared with the conventional method in that it reduces image distortion, provides low contrast for the long axis, and sharpens trabeculae images and articulations.

Calcaneus↗
PubMed1999

Biomechanics as a basis for management of intra-articular fractures of the calcaneus.

This article presents a critical examination of biomechanics studies in the literature that could shed light on or contribute to the development of methods of managing intra-articular calcaneal fractures. An appreciation and understanding of such studies is predicated on a sound knowledge of a number of germane topics: the anatomy of the normal calcaneus, the pathomechanics of the calcaneus, fracture-classification schemes, and fracture-management methods. The first part of this review presents overviews of these topics. The biomechanics studies are then reviewed in detail. The article concludes with a description of research areas that might close the gaps identified in these studies.

Biomechanical Phenomena↗
PubMed1976

[Relationship between calcium salt content in the trunk skeleton and the extremities (calcaneus measurement) (author's transl)].

No statistically significant correlation could be found in a comparative investigation regarding the mineral salt content of the calcaneus and the first lumbar vertebral body in the same test person. Conclusions based on localized individual measurements of the mineral salt content of the calcaneus for the respective vertebral body are, in our opinion not possible with the desired exactness. For orthopedic surgeons in the private practice, only the interpreation of a x-ray of the vertebral column can be used in addition to clinical and laboratory findings to diagnose the onset of generalized osteoporosis. In order to keep the source of error as low as possible in the attempt to diagnose osteoporosis from an x-ray, constant, reproduceable conditions for taking the x-ray (same film,same lighting, same film development and same x-ray focus on the same part of the skeleton) must be used for observing the course of the disease.

Bone and Bones↗
PubMed1998

[30 years experience in articular fractures of the calcaneus bone].

Results of 150 (123 in males, 27 in females) articular fractures of the calcaneus treated by various methods over period of 30 years have been evaluated. Mean age of the patients was 43 years. Minimum follow-up was 18 months. An analysis of the material indicates the need for reduction in every case. Westhues method is suitable for tongue type fracture, joint depression type should be managed by Palmer's method. Best results have been achieved after K-wire fixation of the reduced fracture and early mobilization. In fractures with no displacement or with a minor one functional treatment led to good results also. Unreduced fractures gave poor results; pain below lateral ankle was produced by compression of peroneal tendons with deformed calcaneus. Seventy per cent of the results were rated good, 15% fair and 15% poor.

Adult↗