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[Rheumatic diseases of the ankle joint and tarsus].

Diseases of the hindfoot are associated with considerable functional impairment and therefore may hamper patients' movements during gait considerably. Because of biomechanical overload, articular structures, tendons and ligaments are prone to early degenerative changes during the course of rheumatic diseases as visible with plain film radiography, sonography (US), or magnetic resonance imaging (MRI). Findings may occur as arthritis of major joints or in the form of fibroostitis and bursitis of the os calcis. Despite the progressive course of rheumatic diseases and characteristic imaging findings, high variability of X-ray signs may occur. Plain film radiograms and high-resolution ultrasonography play a key role in imaging rheumatic diseases of the hindfoot. MRI supports imaging diagnosis in selected cases. The principal goals of diagnostic imaging are precise and reproducible documentation of morphologic abnormalities and differentiated analysis for planning proper conservative or surgical treatment.

Ankle↗

Intrinsic proportions of the human tarsus: an original approach to tarsal biometry.

Few precise biometrical data on human tarsal bones are available, and those published consist principally of linear and angular measurements made on dried bones or on radiographs. The material consisted of 86 complete adult human tarsi (dried bones). The tarsal proportions were determined using the relative tarsal weights (Weight of each of the seven tarsal bones/Weight of the total tarsusx100). The calcaneus was the greatest tarsal bone (41.95%), and the talus the second-largest (28.45%). The medial cuneiform, the cuboid, and the navicular had very similar proportions (7.00-8.38%), as did the intermediate and lateral cuneiforms (2.98% and 3.81%). The study of the ranks of each bone by decreasing proportion allowed the determination of individual variability. The posterior tarsal row was considerably larger (70.40%) than the anterior row (29.60%), resulting in an antero-posterior ratio of 0.42. The medial and lateral tarsal columns had quite similar proportions (50.63% and 49.37%), resulting in a latero-medial ratio of 0.98. The intrinsic tarsal proportions are fundamental biometrical data which seem to be of interest for a better characterization of the human foot in clinical practice and for quantitative approaches in functional and comparative morphology and in paleontology.

Adult↗

Radiological changes in serial x-rays of the foot and tarsus in leprosy.

Most bone abnormalieis seen in serial films of the feet in leprosy were static being the end result of old disease. Changes over a period of time were observed in serial fims of 214 feet and these changes were due to a combination of infection, neuropathic changes and avascular necrosis occurring in anaesthetic feet. The bone abnormalities seen were absorption of toes and metatarsals; bone destruction; a neuropathic arthropathy of toes and metatarsals and various patterns of tarsal disintegration.

Arthropathy, Neurogenic↗

[Sonographic diagnosis of the juvenile tarsus. Clinical application possibilities demonstrated by examples].

Radiologic assessment of foot deformities in young children is limited especially by the ossification status. Ultrasonography proved to be a useful diagnostic supplement e.g. in idiopathic talipes equinovarus, vertical talus, and tarsal coalitions. Effects of treatment and three-dimensional movements of the tarsal joint complex can be delineated. Sonographic assessment of tarsal alignment is applicable already in the first months of life. This study deals with first experiences in clinical application of this new diagnostic technique.

Ankle↗

Treatment of dysthyroid lower lid retraction with autogenous tarsus transplants.

Lower lid retraction is commonly seen in dysthyroid orbitopathy. We have treated 55 lower lids in 38 patients with lower lid retraction by a tarsal transplant from the upper lid to the lower lid. An overall effect of 2-mm improvement +/- 0.7 mm occurred. Eighty-nine percent of the lids achieved the position of the lower lid within 1 mm of the limbus. We think that the upper to lower tarsal transplant offers a technically easy and reasonable solution to moderate lower lid retraction associated with dysthyroid orbitopathy.

Adult↗

Correction of involutional entropion by horizontal tangential wedge excision of the tarsus.

Involutional entropion, a condition in which the lower eyelid margin is rotated inward, occurs often in elderly people. It can result in corneal and conjunctival irritation by the inverted eyelashes. The pathophysiology has been attributed to multiple factors, including attenuation of the tarsal plate with age, enophthalmus occurring with aging, decreased action of the inferior palpebral muscle, and the overridge of the preseptal orbicularis oculi. Many surgical options have been described for the treatment of involutional entropion. We present an innovative surgical procedure for correction of involutional entropion by a horizontal tangential wedge excision of the tarsal plate.

Aged↗