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PubMed1993

Reconstructive osteotomy of the calcaneus with subtalar arthrodesis for malunited calcaneal fractures.

A technique of dealing with the late complications of malunited calcaneal fractures is based on the philosophy of reversing the deformity associated with late complications. The primary fracture is a shearing fracture that runs obliquely down the length of the calcaneus from superolateral to inferomedial and anterolateral to posteromedial. This permits the tuberosity of the calcaneus to translate laterally and proximally, and often splits the posterior facet. The complications of malunion are loss of height of the heel with concomitant dorsiflexion of the talus, widening of the heel, lateral impingement of the peroneal tendons and the distal fibula, and subtalar posttraumatic arthritis. The primary fracture deformity contributes directly to the late complications. The reconstructive osteotomy recreates the primary fracture. This permits repositioning of the tuberosity that narrows the heel, alleviates impingement, and returns height to the heel. The subtalar arthrodesis alleviates the symptoms of posttraumatic arthritis. The reconstruction is not dependent on cortical bone grafts for stability. The clinical series involved ten feet with an average follow-up period of 14 months. Two were revisions of previous triple arthrodeses. Results were satisfactory in nine feet.

Arthrodesis↗
PubMed1995

[Measurements of calcaneus bone density by ultrasonography in children and adolescents].

In recent years the interest in growing in the use of ultrasonographic method for the assessment of bony tissue density. However, studies using this method were conducted almost exclusively in adult patients. The aim of this study was to apply this method for measurements in children in wide age range (7-18 years) and to determine value range of the parameters SOS, BUA and Stiffness for children in Warsaw in age and sex groups. The studies included 233 children of either sex, aged 7-18 years, healthy on medical examination coming from Warsaw schools. Achilles (Lunar Corp. WI, USA) bone densitometer was used with producer's software, 1.5c version. During examination with the Achilles device, the velocities of ultrasound beam passage through the calcaneus (SOS m/s) and the damping factor of ultrasound wave depending on its frequency (BUA db/MHz) were measured. Additionally the so called "stiffness factor" was calculated. The Achilles device was adapted for measurements in children reducing the diameter of the measuring beam to 1 cm and using pads positioning the child's foot in the device. Equal increase of SOS, BUA and Stiffness parameters with age was observed with the exception of the SOS parameter in girls which increased intensively from 7 to 12 years of age while over 12 years of age its increase was slight. Using linear regression analysis it was found that the values of SOS, BUA and Stiffness parameters depended directly proportionally on age, body weight and height. Respective correlation factors (r) were from 0.49 (body weight-SOS to 0.80 (height-BUA). The observed dependence of the SOS, BUA and Stiffness parameters on body weight, height and especially age enables presuming that the results of calcaneus density measurements by ultrasonographic method reflect the skeletal development in children.

Adolescent↗
PubMed1996

Unilateral hypoplasia of the calcaneus associated with other abnormalities. A new entity?

A 7-year-old boy followed since infancy for unilateral hypoplasia of the calcaneus is reported. In the present case, which seems to be the second in the literature, the hypoplasia of the calcaneus is similar to the one previously reported, but the involvement is unilateral. In addition, the child presents the following defects: a. absence of the fifth metatarsal, b. an ectrotic fifth toe, c. generalized hypoplasia of the foot and to a minor degree of the tibia, d. abnormalities of the ear lobes, upper lip, high arched palate, and e. a mild pectus excavatum. At the age of 7 years the child is of normal intelligence. He walks with a minimal limp as he has shortening of one centimeter and slight equinus on the affected side. Nevertheless he participates in all school activities and sports.

Abnormalities, Multiple↗
PubMed1997

[A rare entity: intraosseous synovial cyst of the calcaneus].

The authors report a rare case of a histologically proven intraosseous ganglion found in the calcaneus. A 59 year old carpenter was referred to our institution because of progressive talalgia with swelling of the hindfoot, increasing with prolonged standing and walking at job. X rays showed a multilobular radiolucent cyst developed in the anterior part of the left calcaneus, outlined by a rim of sclerotic bone. A lateral cortical split revealed by CT was deemed to be a traumatic communication with the soft tissue. At biopsy, a gelatinous and hematic content was noted but pathologic examination of the cyst walls failed to reveal the diagnosis; there were no malignant cells. 5 weeks later, the cyst and its contents were excised through lateral approach and the defect filled with cancellous bone graft. At pathological examination, a final diagnosis of ganglion cyst was determined. One year after surgery, the patient was asymptomatic; no sign of recurrence was observed. Intraosseous ganglia are benign subchondral cysts which rarely involve foot bones. When pain becomes consistent and swelling occurs because of overlooked fracture, malignant bone tumors should be ruled out. Histological examination is mandatory to confirm the diagnosis. Excision of the cyst and bone grafting are effective; recurrence is infrequent.

Calcaneus↗
PubMed2005

Postmenopausal women with Colles' fracture have bone mineral density values similar to those of controls when measured with calcaneus quantitative ultrasound.

BACKGROUND: It is a matter of controversy whether or not Colles' fracture is an osteoporotic fracture. Indeed, the usefulness of quantitative ultrasound in distinguishing Colles' fracture from normal fractures is also unclear. METHODS: A cross-sectional case-control study was done on 469 postmenopausal Spanish women, 121 with Colles' fracture and 348 controls. Assessment of risk factors for osteoporosis and measurement of calcaneus quantitative ultrasound were carried out using a Sahara, Hologic device. RESULTS: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls, and no statistically significant differences were found. We estimated ROC curves for SOS and a score based on a linear combination of height and SOS (SH-Score). The areas under both curves were 0.56 and 0.61, respectively, which was statistically significant. To obtain 5% false-negative and 10% false-positive figures, the T-score cut-off for SOS was -2.45 and -0.045, respectively. Of these, only 9.2% were classified as high risk and 11% as low risk with 79.8% undetermined. CONCLUSIONS: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls. Nevertheless, ROC curves calculated by a combination of height and SOS showed that quantitative calcaneus ultrasound may be a useful tool for identifying postmenopausal women with Colles' fracture. These results indicate that measuring bone mineral density with ultrasound only captures limited aspects of the pathophysiology of Colles' fractures.

Journal Article↗
PubMed1999

Loading conditions and cortical bone construction of an artiodactyl calcaneus.

Customary nonuniform distributions of physiological bone strains are thought to evoke heterogeneous material adaptation in diaphyseal cortices of some limb bones. Recent studies of artiodactyl calcanei have suggested that the regional prevalence of specific mechanical strain features such as mode and magnitude correlate with specific variations in cortical bone ultrastructure, microstructure and mineralization. These data are also consistent with predictions of current algorithms of mechanically induced bone adaptation. However, detailed characterization of the customary functional strain environment of these bones is needed to understand better the mechanisms of these adaptations. An in vitro loading method and rosette strain gauges were used to record principal strains, maximum shear strains and principal strain angles at multiple locations on ten calcanei of adult male mule deer (Odocoileus hemionus hemionus). Each hind limb was fixed in an apparatus to mimic the mid-support phase of the gait and loaded via the Achilles tendon over a broad range of functional loads (0 to 2943 N). Strains were recorded on the craniolateral, craniomedial, caudal, medial and lateral cortices at mid-diaphysis. Loading variations included the progressive elimination of the ligament and tendon along the caudal calcaneus. The results showed that the cranial cortex experiences longitudinal compressive strains that are nearly equal to the principal minimum strains and that the caudal cortex receives longitudinal tensile strains that are nearly equal to the principal maximum strains. With a 981 N load, the mean principal compressive strain on the cranial cortex was -636+/-344 micro(&egr;) (mean +/- s.d., N=9) and the mean principal tensile strain on the caudal cortex was 1112+/-68 micro;(&egr;)x (N=9). In contrast to the cranial and caudal cortices, principal strains in the medial and lateral cortices displayed relatively large deviations from the longitudinal axis (medial, 24 degrees cranial; lateral, 27 degrees caudal). Although shear strains predominated at all gauge sites, variations in maximum shear strains showed no apparent regional pattern or consistent regional predominance. The plantar ligament and tendon of the superficial digital flexor muscle were shown to have important load-sharing functions. These results demonstrate that the functionally loaded artiodactyl calcaneus generally behaves like a cantilevered beam with longitudinal compression and tension strains predominating in opposing cranial and caudal cortices, respectively. Differences in osteon remodeling rates, osteon morphology and mineral content reported previously between the cranial and caudal cortices correlate, in part, with the magnitudes of the principal compressive and tensile strains, respectively. However, material differences that distinguish the medial and lateral cortices from the cranial and caudal cortices could not be primarily attributed to locally increased shear strains as previously suggested. Variations in osteon and/or collagen fiber orientation may correlate more strongly with principal strain direction.

Animals↗
PubMed2002

[Anatomical and surgical study of the medial calcaneus branch of the tibial nerve].

To better understand the anatomical variations of the medial calcaneus branch, the tibia nerve were dissected in 20 ankles of fresh black African cadavres. The medial calcaneus branch which is a collateral branch of tibial nerve was constant. It was unique in 80% of cases and was detaching itself from the trunck of the tibial nerve ot the entrance of the calcaneal sulcus. It was in the form of two small nerves with point of departure from the common tibial nerve trunk. These anatomic constatations confronted with those published in literature permits us to understand the etiopathogenic aspects of certain neuropathies of the ankles. To add this they impose a certain order if precaution in the operational surgnical route of the posterior section of the ankle.

Ankle↗
PubMed2002

[Anatomical and surgical study of the medial calcaneus branch of tibial nerve].

To better understand the anatomical variations of the medial calcaneus branch, the tibia nerve were dissected in 20 ankles of fresh black African cadavers. The medial calcaneus branch which is a collateral branch of tibial nerve was constant. It was unique in 80% of cases and was detaching itself from the trunk of the tibial nerve at the entrance of the calcaneal sulcus. It was in the form of two small nerves with point of departure from the commun tibial nerve trunk. These anatomic constatations confronted with those published in literature permits us to understand the etiopathogenic aspects of certain neuropathies of the ankle. To add this they impose a certain order if precautions in the operational surgical route of the posterior section of the ankle.

Duplicate Publications as Topic↗
PubMedDate not supplied

[The treatment of spastic equinovarus in the adult by transplantation of peroneus brevis and lengthening of the tendo-calcaneus (author's transl)].

A new technique is proposed for the treatment of spastic equinovarus foot. After lengthening the tendo calcaneus, the peroneus brevis tendon is divided at the junction with its muscle belly and the distal end of the tendon is transferred through the interosseous membrane to be sutured to the tendo calcaneus. This technique aims to correct the varus as well as the equinus deformity. It was performed in seven cases with good results. The technique is compared with other methods designed to treat this condition. The method is worthwhile in cases without bony deformity.

Achilles Tendon↗
PubMed1993

Aggressive osteoblastoma of the calcaneus.

Aggressive osteoblastoma of the left calcaneus in 29-year-old Japanese woman is reported. Her initial symptom was heel pain while walking. This was a primary calcaneal tumor, initially diagnosed as a benign osteoblastoma. After a 5-year follow-up (from the initial curettage), there was local recurrence. The histologic findings of aggressive osteoblastoma were confirmed after right lower leg amputation. The recurrent tumor was mildly aggressive to the talocalcanean joint and the retrocalcaneal area, without distant metastasis. The characteristics of the primary and recurrent tumors were examined by the radiologic, histologic, and electron microscopic procedures. Although there are questions about aggressive osteoblastoma, the authors believe that there are osteoblastic tumors of borderline malignancy between benign osteoblastoma and low-grade osteosarcoma. The current case was an example compatible with an aggressive osteoblastoma with the proposed name of Dorfman classification Group 4.

Adult↗
PubMed1988

Calcaneus secundarius: an osteo-archaeological note.

Calcaneus secundarius, a minor anatomical variant in the foot, is subclinical and its true prevalence in modern populations is uncertain. The trait is clearly visible in dry bones, and osteo-archeological evidence suggests that it may be a more frequent occurrence than was formerly thought. The etiology of the trait is outlined, and its possible value is assessing "biological distance" in past populations is considered.

Adolescent↗
PubMed1990

Calcaneus secundarius: description and frequency in six skeletal samples.

The calcaneus secundarius (CS) is a small accessory ossicle of the anterior calcaneal facet. A sample of 1,367 calcanei including early 20th century U.S. blacks and whites, XIIth Dynasty Egyptians, Islamic Period Bahrainis, and protohistoric American Indians from two states were examined to determine the frequency of this nonmetric trait. Statistical testing of the correlation of the trait with sex could only be performed on the blacks and whites, a documented cadaver collection. Tests of chi 2 indicated that, although sex differences were insignificant, significant group (not necessarily racial or geographical) differences existed at the .05 level. There was no correlation of side dominance in the overall sample, although significant population differences existed. The trait frequencies of the black and white samples were more similar to one another than to the nonindustrial groups who, in turn, were more similar to each other than to the Terry sample. The findings suggest that a CS is of genetic or congenital origin resulting in a secondary center of ossification in the anterior calcaneal facet.

Adolescent↗
PubMed1994

Fractal organization of trabecular bone images on calcaneus radiographs.

Bone density is not the unique factor conditioning bone strength. Trabecular bone microarchitecture also plays an important role. We have developed a fractal evaluation of trabecular bone microarchitecture on calcaneus radiographs. Fractal models may provide a single numeric evaluation (the fractal dimension) of such complex structures. Our evaluation results from an analysis of images with a varying range of gray levels, without binarization of the image. It is based on the fractional brownian motion model, or more precisely on the analysis of its increment, the fractional gaussian noise (FGN). The use of this model may be considered validated if two conditions are fulfilled: the gaussian repartition and the self-similarity of our data. The gaussian repartition of intermediate lines of these images was tested on a sample of 32,800 lines from 82 images. Following a chi-square goodness-of-fit test, it was checked in 86% of these lines for alpha = 0.01. The self-similarity was tested on 20 images by two estimators, the variance method of Pentland and the spectrum method of Fourier. Self-similarity is defined by lined-up points in a log-log plot of the FGN spectrum or of the variance as a function of the lag. We found two self-similarity areas between scales of analysis ranging from 105 to 420 microns, then above 900 microns, where linear regression produced high mean correlation coefficients (r > or = 0.97). Following this validation, we studied the reproducibility of this new technique. Intra- and interobserver reproducibility, influence of transferring the region of interest, and long-term reproducibility were assessed and given CV of 0.61 +/- 0.15, 0.68 +/- 0.47, 0.53 +/- 0.16, and 2.07 +/- 0.84%, respectively. These data have allowed us to validate the use of this fractal model by checking the fractal organization of our radiographic images analyzed by the model. The good reproducibility of successive x-rays in the same subject allows us to undertake population studies and to envisage longitudinal series.

Calcaneus↗
PubMed1990

Scintigraphy in the diagnosis of occult fractures of the calcaneus.

Four toddlers presented with acute limp due to fracture of the calcaneus. Such fractures were originally described as rare, a contributory factor for this view almost certainly being the absence of radiographic abnormalities in a significant number of cases. The importance of bone scintigraphy early in the course of investigation is emphasized.

Calcaneus↗
PubMed1995

Ultrasound and densitometry of the calcaneus correlate with the failure loads of cadaveric femurs.

We assessed the bone mineral density (BMD) of 16 matched sets of cadaveric proximal femurs and feet using dual-energy x-ray absorptiometry (DXA). We also estimated the femoral neck length from the DXA scans. Quantitative ultrasound densitometry was used to measure the velocity of sound and broadband ultrasound attenuation (BUA) in the calcaneus of each foot. The proximal femurs were then tested to failure in a loading configuration designed to simulate a fall with impact to the greater trochanter. Femoral neck BMD and trochanteric BMD were strongly associated with the femoral failure load (r2 = 0.79 and 0.81, respectively; P < 0.001), whereas femoral neck length was modestly correlated with femoral failure load (r2 = 0.27, P = 0.04). Calcaneal BMD (r2 = 0.63, P < 0.001) and BUA (r2 = 0.51, P = 0.002) were also significantly associated with femoral failure load. Given the small sample size, we were unable to detect differences in the strength of the correlations between the independent parameters and femoral failure load. Using linear multiple regression analyses, the strongest predictor of femoral failure load was a combination of femoral neck BMD and femoral neck length (R2 = 0.85, P < 0.001). Thus, it appears that both femoral and calcaneal bone mineral properties may be useful for identifying those persons at greatest risk for hip fracture.

Absorptiometry, Photon↗
PubMed1995

Ultrasound and dual X-ray absorptiometry measurement of the calcaneus: influence of region of interest location.

Ultrasound measurements of the calcaneus are related to incidence of osteoporotic fracture. Such measurements are generally made at fixed coordinates relative to a footplate. This study compares measurements at an anatomically located region of interest (ROIanat) and at fixed coordinates (ROIfixed), with bone mineral density measurements, in 84 postmenopausal women. Bone mineral density (BMD) was assessed using dual energy X-ray absorptiometry at both ROIs as well as at lumbar spine and femoral neck. Broadband ultrasound attenuation and velocity of sound were measured using a CUBA system at ROIanat and ROIfixed. Additionally, broadband ultrasound attenuation at ROIfixed was measured using a Walker Sonix instrument. Mean bone mineral density, broadband ultrasound attenuation and velocity of sound did not differ significantly between ROIfixed and ROIanat, although broadband ultrasound attenuation by Walker Sonix (81.4 +/- 14.6 dBMHz-1) was significantly (P < 0.001) greater than that by CUBA (63.7 +/- 14.2 dBMHz-1). The relationship between broadband ultrasound attenuation and BMD differed significantly between the 2 ROIs and the correlation of this relationship was significantly greater at ROIfixed than at ROIanat(r = 0.74 versus 0.46, P < 0.01). The differing relationship may reflect structural variation at different regions. ROI selection may thus be a possible confounding factor in ultrasound measurement.

Absorptiometry, Photon↗
PubMed1993

Spine and femur density and broadband ultrasound attenuation of the calcaneus in normal Spanish women.

Bone density of the spine and femoral neck and broadband ultrasound attenuation of the calcaneus were measured in 111 normal Spanish women between the ages of 30 and 70 years. The cross-sectional study showed that spine and hip density decreased by 36 and 29%, respectively, and the ultrasound attenuation value decreased by 32% between 30 and 70 years of age. The rate of bone loss at the three sites was significant in women over age 50 and in postmenopausal women. These normative data will be helpful in assessing bone mass in Spanish women suspected of having osteoporosis.

Adult↗
PubMed1992

Ultrasound attenuation of the calcaneus in the female population: normative data.

Broadband ultrasound attenuation (BUA) on the os calcis has been proposed as a safe and reliable technique for evaluating skeleted status. The present study provides preliminary normative BUA results on 93 female subjects divided into five age groups. These data can be used as a guide for comparing the results of individual studies. The diagnosis of osteoporosis was determined from lateral calcaneus and spine radiographs. Postmenopausal osteoporotic female subjects had significantly lower BUA values than normal women (P less than 0.001). There was a significant negative linear relationship between BUA and age in the postmenopausal subjects. No correlation was found between body size parameters (weight, height, and body mass index) and ultrasound attenuation. These results indicate that BUA may be a useful technique for detection of persons at risk.

Adult↗