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PubMed2004

[Repair of calcaneus and skin defects with allograft and sural neurovascular flap].

OBJECTIVE: To investigate the clinical results of allograft and sural neurovascular flap in repairing calcaneus and skin defects. METHODS: From February 1996 to December 2002, allograft and sural neurovascular flap were used to repair calcaneus and skin defects in 6 cases. The causes included road accident in 3 cases, strangulation in 2 cases and crashing object in 1 case. The defect locations were at the back of the calcaneus (1/3, 1/2 and 2/3 of calcaneus in 3 cases, 2 cases and 1 case respectively). The flap area ranged from 6 cm x 7 cm to 12 cm x 17 cm. RESULTS: The flaps survived completely in 4 cases; the distal flaps necrosed partly in 2 cases and the wound healed by dressing. The postoperative X-ray films showed that the repaired bone and joint had normal position and the arcus plantaris recovered. After a follow up of 6 months to 3 years all the patients were achieved bone union in allograft and had no complications of absorption, infection and repulsion. The weight-bearing and walking functions were restored and the injured foot obtained a satisfactory contour. After 3-6 months of operation, the sensory recovery of foot occurred. CONCLUSION: The used allograft is easy to be obtained and arcus plantaris is easy to recover. The reverse sural neurovascular flap in repairing calcaneus and skin defects has the following advantages: the maintenance of blood supply for injured foot, the less dangerous operation, the simple procedure, the recovery of walking function, and the good appearance and sensation.

Adolescent↗
PubMed1990

An innovated treatment for intra-articular fracture of calcaneus.

An innovated composite treatment for intra-articular fracture of the calcaneus has been developed. A Steinmann's pin is introduced into the calcaneus percutaneously to release the impaction of the fragments and to lift the compressed subtalar joint facet, which forms a potential cavity in the calcaneal body facilitating restoration of Bohler's angle and correction of widening of the calcaneus by manual reduction. A new type external fixation device, the calcaneus fixation boot, is used to substitute for the traditional plaster immobilization. The boot can exert continuous centripetal pressure on both sides of the calcaneus to control transverse displacement and to maintain the normal height of the heel. The patient is allowed to do functional exercises 24 hours after reduction with the aid of the spring stepping roller, which not only helps dissipate swelling in the early stage but also remold the articular facet. Biomechanical determination showed that the power of triceps surae muscles returned to nearly normal in 4-5 weeks. The patients were allowed to bear weight with crutches in 6-7 weeks. In this series, 94 (87.8%) of 107 cases with an average follow-up period of 2 years and 9 months attained excellent and good results.

Adolescent↗
PubMed1986

[Combined lateral ligament-plasty and calcaneus osteotomy in recurrent foot dislocation].

The risk of a supination trauma is particularly high in patients with pathological calcaneus varus as opposed to physiological calcaneus valgus. If in these patients only the lateral ligaments are operatively treated after a trauma, there is a high incidence of recurrence, as the abnormal position of the calcaneus means that the supinating forces acting laterally have a stronger effect than in normal cases. We therefore suggest a combination of fibulotalar syndesmoplasty with osteotomy of the calcaneus according to Dwyer in such cases. In the last 7 years we have carried out this operation eight times with no recurrence in any of these patients so far. In four patients, a gait analysis was performed. It was established that the abnormal floor reaction forces seen in the presence of calcaneus varus normalize following the operation.

Adolescent↗
PubMed1975

[Fatigue fractures of the calcaneus in soldiers of the Federal Forces].

Fatigue fractures of the calcaneus occur more frequently today than the typical march fractures of the metatarsal bones. The cause lies in the altered method of training with repeated jumping exercises and increased strain on the calcaneus. 203 fatigue fractures of the calcaneus were seen in 5 years, almost exclusively in recruits in the first 3 months of enlistment. 10 day after the beginning of pain in the calcaneus and swellings--in half of them bilateral-the X-ray showed typical zones of densification in the calcaneus. The treatment consists of decompression for 2 weeks until the complaint disappears.

Adult↗
PubMed1993

Anatomy of the calcaneus.

The calcaneus is the largest tarsal bone in the foot and is well designed to sustain high tensile, bending, and compressive forces. However, high instantaneous loads often result in fracture. Any treatment of calcaneal fractures requires a working knowledge of the anatomy. The major neurovascular structures are located medially and are well insulated by the medial soft tissues. These structures are at risk, however, during medial approaches to the calcaneus. Laterally, there are several bony landmarks that are palpable primarily because of the relative paucity of the soft-tissue elements. Lateral approaches to the calcaneus have been associated with the areas of skin necrosis that may be related to the arterial anatomy. The calcaneus has four articular surfaces. The congruity of these articular surfaces and their relationship to one another can be assessed roentgenographically. With adequate knowledge of the bony anatomy of the calcaneus and its soft tissue envelope, a rational approach in assessment and treatment of calcaneal fractures can be developed.

Calcaneus↗
PubMed1995

Dual-energy X-ray absorptiometry of the calcaneus: comparison with vertebral dual-energy X-ray absorptiometry and quantitative computed tomography.

The purpose of this study was to determine the efficacy of using bone mineral measurements of the calcaneus to evaluate osteoporosis. Dual energy X-ray absorptiometry (DXA) of the calcaneus was compared with posteroanterior lumbar absorptiometry (DXA) and vertebral quantitative computed tomography (QCT) measurements in 171 white women (78 normal and 93 osteoporotic). DXA measurement of os calcis mineralization decreased significantly in osteoporosis, but to a lesser extent than in vertebral sites. In normal subjects, good correlations were observed between calcaneal and lumbar DXA (0.69) and QCT (0.56). In subjects with vertebral fractures, there was also good correlation between calcaneal DXA and QCT (0.59-0.69). This suggests that trabecular bone in calcaneus and vertebrae have related involution in cases of vertebral osteoporosis. However, the extent of bone loss is less marked in the calcaneus than in the vertebrae and is not sufficient to be accurately measured over time. We conclude, therefore, that although the global densitometric measurement at this site is not sufficiently sensitive for general use, it can be useful as a epidemiological research tool.

Absorptiometry, Photon↗
PubMed1998

[Calcaneus cyst--an indication for surgery? Case report and review of the literature].

Simple bone cysts are asymptomatic, benign lesions which are usually an incidental finding on a radiograph. Etiology and treatment are controversially discussed. The weight-bearing status of the calcaneus and possible pathologic fracturing lead many authors to recommend therapeutic measures after diagnosis has been made. We present a case report of an intact unicameral bone cyst of the calcaneus concomitant with tibial and talar fractures following crush trauma. Several types of treatment for simple bone cysts of the calcaneus have been suggested. The question whether treatment is unconditionally necessary is controversially discussed. It is the author's opinion, that asymptomatic bone cysts of the calcaneus require no further treatment.

Adult↗
PubMed2003

Preferential reductions of paraarticular trabecular bone component in ultradistal radius and of calcaneus ultrasonography in early-stage rheumatoid arthritis.

Rheumatoid arthritis (RA) is a major cause of secondary osteoporosis and is frequently associated with both paraarticular and generalized osteoporosis. The present study was designed to investigate the preferential sites of reduction of bone mineral density (BMD), in the early stage of RA, with special emphasis on the differential effect of RA on BMD in trabecular and cortical components. The participants (30 RA patients and 26 healthy participants) were all female with disease duration of less than 1 year. BMD in the radius was measured at 4% (ultradistal site) and 20% (midshaft) to the ulnar length proximal to the end of radius by peripheral quantitative computed tomography. BMD in lumbar spine was measured by dual X-ray absorptiometry and the osteo-sono assessment index (OSI) of the calcaneus by ultrasound. RA patients showed lower BMD preferentially in the trabecular component, but not in cortical bone component of the ultradistal radius than age-matched normal controls. Calcaneus OSI was also significantly reduced. The radial midshaft and lumbar spine did not differ significantly between RA patients and normal controls. Trabecular BMD in the ultradistal radius exhibited negative correlations with serum CRP, ESR, and RF, and calcaneus OSI with M-HAQ score. In conclusion, it was suggested that disease activity of RA and impairment of daily physical activity might be a significant determinant of deterioration of bone structure in paraartciular distal radius and calcaneus, respectively, in early-stage RA patients.

Activities of Daily Living↗
PubMed2004

Bone structure of the calcaneus: analysis with magnetic resonance imaging and correlation with histomorphometric study.

The purpose of this study was to compare structural measurements obtained from MR images of the calcaneus with those obtained from conventional histomorphometry. Sagittal magnetic resonance (MR) images of the calcaneus of 24 fresh human cadaveric feet were obtained at a spatial resolution achievable in vivo. A three-dimensional gradient echo-sequence was used with a slice thickness of 700 microm and in plane resolution of 172 x 172 microm. Structural analysis (four histomorphometric parameters; seven connectivity parameters) was performed in the superior region of the calcaneus. Bone biopsy specimens were obtained in the same area and were sectioned for histomorphometric study. Most of the MR histomorphometric parameters were overestimated (by a factor ranging from 0.8 to 3), as compared with histomorphometry. However, significant ( P<0.05) correlations were found between MR imaging and histomorphometric measurements for bone volume/tissue volume, trabecular separation, trabecular number, star volume of the marrow space, node count and terminus count. MR histomorphometric parameters correlated much better with histomorphometry than connectivity parameters. This study suggests that structural parameters characterizing cancellous bone in the calcaneus can be derived from MR images in the limited spatial resolution regime applicable in vivo.

Absorptiometry, Photon↗
PubMed2005

Imaging of the calcaneus.

The anatomy of the calcaneus is complex with multiple processes and grooves for support of related bony and soft tissue structures. With respect to imaging, the calcaneus and its articulations are a diagnostic challenge to radiologists and clinicians. This article focuses on the use of commonly employed radiologic modalities with respect to the anatomy of the calcaneus and some of the more common and challenging conditions that affect the calcaneus.

Calcaneus↗
PubMed2004

Comparison of the trabecular architecture and the isostatic stress flow in the human calcaneus.

It is a common theory that the architecture of trabecular bone follows the principal stress trajectories, as suggested by Wolff's pioneering studies of the proximal femur. Since first published in the late 19th-century, this observation (popularized as "Wolff's law") has been supported by numerous studies, but nearly all of them have been focused on the femoral head and neck. In this study, the manifestation of Wolff's law in the human calcaneus has been analyzed. For this purpose, finite element (FE) analysis of the entire complex of the foot during standing was undertaken. Orientation of the principal stress flow through the calcaneus was compared with the trabecular alignment in a single cadaveric calcaneal specimen, by fitting second-order polynomials to real trabecular paths and FE-predicted isostatics and calculating their angle of inclination with the calcaneal cortex at their insertion points. Four dominant trabecular patterns were identified in the cadaveric sagittal section of the specimen of the calcaneus: one directed primarily in the dorsal-plantar direction, one aligned anteriorly-posteriorly, and two that are strongly oblique. Subsequent numerical simulations showed that the dorsal-plantar oriented and posterior oblique trabecular paths are aimed to support compressive stresses, while the antero-posteriorly directed and anterior oblique groups act to bear tension. Insertion angles of real trabecular paths into the calcaneal cortex were similar to those of the isostatics that were computed under musculoskeletal loading conditions of standing (maximum absolute local difference 13 degrees, maximum local error 60%). This suggests that the trabecular patterns of the calcaneus are mainly shaped by isostatics (static principal stress flow) that are characteristic of the standing posture. The present modeling approach can be utilized to explore effects of abnormal alterations in the isostatic flow on the microarchitecture of the calcaneal trabeculae, as well as for better understanding of the mechanisms of calcaneal fractures.

Adult↗
PubMed2003

Quantitative ultrasound of the calcaneus in Arabian women: relation to anthropometric and lifestyle factors.

OBJECTIVES: To determine factors influencing quantitative ultrasound (QUS) parameters of the calcaneus in a population-based sample of United Arab Emirates (UAE) women, and to compare QUS parameters of the calcaneus for healthy young UAE women with the manufacturer's reference ranges for other populations. METHODS: All subjects completed a questionnaire on reproductive and life style factors. Height and weight were measured, and body composition was determined by bioelectric impedence. Estimated bone mineral density (BMD), Speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) of the right calcaneus were determined by Sahara ultrasound. RESULTS: In premenopausal women (n=330), age, weight, body mass index (BMI), lean weight, fat weight, education, age at menarche, and number of pregnancies, correlated significantly with QUS parameters. Multiple regression analysis showed that age at menarche, number of pregnancies, and BMI, were the best predictors of QUS parameters although these factors explained only small amounts of the variance (R(2)=0.05). In postmenopausal women (n=81), age, BMI and physical activity were the best predictors of BUA (R(2)=0.35), SOS (R(2)=0.39), and QUI (R(2)=0.43). Mean estimated BMD, QUI and SOS for healthy young UAE women were significantly lower than the manufacturer's reference ranges for U.S. Caucasian, European Caucasian, and Chinese Asian healthy young women of the same age range (P<0.001 for all comparisons). Mean BUA was not significantly different, however. CONCLUSIONS: Menopausal status, age, BMI and physical activity are strong predictors of QUS parameters of the calcaneus in Arabian women. Healthy young Arabian women have lower estimated calcaneal BMD compared with the manufacturer's reference ranges for other populations.

Absorptiometry, Photon↗
PubMedDate not supplied

Anterior process fracture or calcaneus secundarius: a case report.

Avulsion of the anterior process of the calcaneus accounts for nearly 15% of calcaneal fractures according to some sources. Yet, this fracture rarely has been reported in the radiology literature. Lateral plain radiography of the foot may demonstrate an ossific structure, distinct from the distal end of the calcaneus, overlying the head of the talus. However, the fracture may be particularly subtle and go undetected on plain radiography. Furthermore, it may be mistaken for the calcaneus secundarius (CS), an accessory ossicle of the anterior facet of the calcaneus identified in up to 5% of the population during cadaveric studies. This article describes the physical and radiological findings in a patient with an anterior process fracture and how this fracture can be distinguished from the CS.

Calcaneus↗
PubMed1996

Magnetic resonance imaging of the calcaneus: preliminary assessment of trabecular bone-dependent regional variations in marrow relaxation time compared with dual X-ray absorptiometry.

RATIONALE AND OBJECTIVES: Marrow transverse relaxation time (T2*) in magnetic resonance (MR) imaging may be related to the density and structure of the surrounding trabecular network. We investigated regional variations of T2* in the human calcaneus and compared the findings with bone mineral density (BMD), as measured by dual X-ray absorpiometry (DXA). Short- and long-term precisions were evaluated first to determine whether MR imaging would be useful for the clinical assessment of disease status and progression in osteoporosis. METHODS: Gradient-recalled echo MR images of the calcaneus were acquired at 1.5 T from six volunteers. Measurements of T2* were compared with BMD and (for one volunteer) conventional radiography. RESULTS: T2* values showed significant regional variation; they typically were shortest in the superior region of the calcaneus. There was a linear correlation between MR and DXA measurements (r = .66 for 1/T2* versus BMD). Differences in T2* attributable to variations in analysis region-of-interest placement were not significant for five of the six volunteers. Sagittal MR images had short- and long-term precision errors of 4.2% and 3.3%, respectively. For DXA, the precision was 1.3% (coefficient of variation). CONCLUSION: MR imaging may be useful for trabecular bone assessment in the calcaneus. However, given the large regional variations in bone density and structure, the choice of an ROI is likely to play a major role in the accuracy, precision, and overall clinical efficacy of T2* measurements.

Absorptiometry, Photon↗
PubMed2003

[Calcaneus fractures. Open reduction and internal fixation].

AIM OF THIS STUDY: Critical analysis of the medium-term results of open reduction and internal fixation (ORIF) of displaced intra-articular calcaneus fractures with a standardized protocol in a greater patient cohort. METHODS: From October 1993 to December 1999 314 patients (mean age 42.3 years) with 348 calcaneus fractures were seen at the Dresden University Hospital. 41 fractures were open, 4 with 1st degree, 28 with 2nd and 9 with 3rd degree soft tissue damage. 275 displaced intra-articular fractures were treated with ORIF, 262 (95.3 %) with plate osteosynthesis via an extended lateral approach. 169 patients could be evaluated at a mean of 18 months (range 10-47 months) postoperatively with an extended protocol of questionnaire, physical and radiographic examination. RESULTS: The Maryland Foot Score after 18 months follow-up averaged 80.8/100, the mean Zwipp score averaged 146.4/200. The functional result with the Merle d'Aubigné score was judged good to excellent in 86% of cases. Rates of deep infection and superficial wound edge necrosis increased significantly with open fractures and delay in surgery of more than 2 weeks after injury in closed fractures. Clinical results were adversely affected by even minor residual steps in the posterior facet (1-2 mm) as judged by CT or Brodén views (p < 0.001). Böhler's tuberosity-joint-angle had an impact on the final result when falling short compared to the unaffected contralateral side by more than 30% (p < 0.001). CONCLUSIONS: Management of intra-articular calcaneus fractures with a standardized protocol of ORIF and early mobilization leads to reproducible good or excellent clinical results in a majority of patients. New approaches like an interlocking calcaneus plate, the use of subtalar arthroscopy, early soft tissue coverage for complex open injuries and percutaneous screw fixation for selected fractures should further improve prognosis.

Adult↗
PubMed1997

Ultrasound analyses of the calcaneus predict relative risk of the presence of at least one vertebral fracture and reflect different physical qualities of bone in different regions of the skeleton.

Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were determined together with bone mineral density (BMD) of the lumbar spine and of the proximal right hip (QDR 2000, Hologic) in 1252 females (mean age 56 +/- 11). We then calculated the predictive power of BUA and SOS for at least one vertebral fracture and correlation-coefficients of BMD of the spine and hip as well as BUA and SOS in different age groups (SPSS PC + Vers. 2.2. for IBM PC software). The overall prevalence of at least one vertebral fracture was 10.14% (127 out of 1252 patients). The relative risk for the presence of at least one vertebral fracture was 2.7 for BMD spine below 0.7 g Calcium/cm2 (69 out of 249 patients), 1.8 for BMD hip below 0.7 g Calcium/cm2 (106 out of 589 patients), 1.9 for SOS calcaneus below 1500 m/s (99 out of 499 patients) and 1.7 for BUA calcaneus below 110 dB/MHz (103 out of 605 patients). The relative risk for the presence of at least one vertebral fracture increases significantly (p < 0.01). In the age group < 50 the coefficients of correlation were 0.4655 between BMD spine and BUA calcaneus, 0.5259 between BMD spine and SOS calcaneus, 0.4327 between BMD hip and BUA, 0.2760 between BMD hip and SOS. In the age group > 70 the coefficients of correlation were 0.3699 between BMD spine and BUA, 0.3481 between BMD spine and SOS, 0.5946 between BMD hip and BUA, 0.5138 between BMD hip and SOS, respectively. All coefficients of correlation were highly statistically significant (p < 0.001). We conclude that BUA and SOS predict relative risk of the presence of at least one vertebral fracture as well as BMD spine and BMD hip. With increasing age BUA and SOS appear to be an independent predictor, not being inevitably correlated to BMD but possibly reflecting different qualities of bone at different sites of the skeleton.

Absorptiometry, Photon↗
PubMed1997

A comparison between the patella and the calcaneus using ultrasound velocity and attenuation as predictors of bone mineral density.

The bone mineral density (BMD), ultrasound velocity (UV) and attenuation were examined in sixteen matched sets of human patellae and calcanei. For the sixteen calcanei, BMD was strongly correlated with all ultrasound parameters. Calcaneal UV appeared to be inferior to attenuation in the ability to predict BMD. For the sixteen patellae, the average UV was found to be greater in the superior/inferior direction than in the anterior/posterior and medial/lateral directions. It was found that patella BMD was significantly correlated with each of three directional ultrasound velocities. The relationship between BMD and ultrasound attenuation parameters was not significant in the patella. A comparative study of the two different bone sets demonstrated that the BMDs of the patella and calcaneus were significantly correlated with each other. Ultrasound velocity of calcaneus, measured in the medial/lateral direction, was not significantly associated with any of three directional ultrasound velocities in the patella. Similarly, ultrasound attenuation parameters of calcaneus were not significantly correlated with those of patella. The present study also demonstrated evidence that when predicting BMDs at their respective sites using ultrasound, the calcaneus appeared to be superior to the patella.

Aged↗
PubMed1994

Pinless calcaneus traction: a preliminary report.

Calcaneus traction with a Steinmann-pin or K-wire inserted into the dorsal aspect of the calcaneus is a common temporary procedure in fractures of the lower leg when internal fixation has to be delayed. Infection due to this simple manoeuvre is rare, but is a very serious complication. In 1991, a so-called pinless external fixator was introduced in clinical trials, based on the idea of external fixation without transosseus pins, thus preserving local blood supply and lowering the risk of pin track infection. This pinless clamp also represents a handy tool for calcaneus traction. We have used this pinless clamp for calcaneus traction in 39 patients without any major problems or complications. Of these, 29 patients were scheduled for delayed internal fixation, and in 10 patients this clamp was used intraoperatively in closed tibial nailing for traction on the fracture table. Tips and tricks for the use of this pinless clamp, and its advantages and disadvantages are discussed.

Adolescent↗