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PubMed2002

Assessment of the position of the navicular by three-dimensional magnetic resonance imaging in infant foot deformities.

As the navicular is unossified in infants with foot deformities, until 5 years old (boys) and 3 years old (girls), it is difficult to give the exact position of hindfoot bones. Magnetic resonance imaging associated with three-dimensional reconstruction allows the visualization of the cartilaginous volume of the bones and the measurement of the relationships of the navicular with the talus. In normal feet, we noted that in the coronal plane the navicular was laterally situated (75%) relative to the talus. In club feet (17 patients), the navicular and the cuboid had a large medial displacement (77%) with a slight pronation movement in the sagittal plane. In suspected skewfoot (seven feet) we noted three cases with a lateral subluxation of the navicular. This objective technique of measurement may be of value for diagnosis and treatment of foot deformities.

Case-Control Studies↗
PubMedDate not supplied

Clubfoot analysis with three-dimensional computer modeling.

Which way are the bones rotated in a clubfoot? This question has long been debated by clubfoot surgeons. Opinions have been based on observations from surgery, radiographs, and autopsies. These methods all have pitfalls and are subject to misinterpretation. We used three-dimensional computer modeling to analyze histologic sections of a newborn clubfoot and a newborn normal foot. Relative to the bimalleolar axis in the axial plane, the normal talus demonstrated 5 degrees of internal rotation of its body and 25 degrees internal rotation of its neck. The clubfoot talus showed 14 degrees of external rotation of its body and 45 degrees of internal rotation of its neck. The calcaneus was externally rotated 5 degrees in the normal foot and internally rotated 22 degrees in the clubfoot.

Calcaneus↗
PubMed1995

Clear cell chondrosarcomas arising from rare sites.

Three cases are reported of clear cell chondrosarcoma arising from unusual sites: talus, rib and vertebra. Radiographically, two tumors showed osteolytic features and the vertebral tumor showed osteoplastic change. Histologically, all tumors consisted of clear cells that had a centrally placed nucleus surrounded by clear cytoplasm, osteoclast-like giant cells, areas of conventional chondrosarcoma, and various amounts of reactive bone. The tumor in the talus was initially diagnosed as benign chondroblastoma, but it recurred. The rib tumor showed marked cystic formation stimulating aneurysmal bone cyst. The osteoplastic radiographic feature in vertebral tumor was considered to be due to the abundant bone formation.

Adolescent↗
PubMed1984

Talar ridges, osteophytes, and beaks: a radiologic commentary.

Several types of osseous outgrowths that may appear on the dorsal surface of the talus are described. A normal talar ridge, located between the trochlea and distal articular surface of the talus, may hypertrophy in response to exaggerated stress. In addition, typical osteophytes may appear, indicative of osteoarthritis of the talocrural or talonavicular joint. Finally, a broad excrescence extending distally from the region of the talar ridge represents a sign of tarsal coalition. The location and the appearance of the bony outgrowths differ, allowing precise radiographic diagnosis.

Ankle Injuries↗
PubMed1988

Pylon fractures of the ankle: a distinct clinical and radiologic entity.

Pylon fractures are a distinct clinical and radiologic entity that should not be confused with trimalleolar fractures. Radiographic and clinical comparison of 20 surgically documented pylon and ten trimalleolar fractures revealed four major features of pylon fractures distinguishing them from trimalleolar fractures: (a) the presence of profound distal-tibial comminution, (b) intra-articular extension of tibial fractures through the dome of the plafond, (c) the presence of a fractured talus, and (d) anatomic relationship of the lateral malleolus to the talus at the level of the ankle mortise. With use of clinical history in addition to plain radiography, pluridirectional tomography, and computed tomography, these two fractures can be clearly separated. This distinction carries important surgical and prognostic implications.

Ankle Injuries↗
PubMedDate not supplied

Simulated lateral ankle ligamentous injury. Change in ankle stability.

The effect of simulated ankle ligamentous injury on ankle-subtalar joint complex laxity was studied. Thirty-six intact ankles were loaded in inversion-eversion and anterior-posterior directions. Motions of the talus and calcaneus were measured with respect to the tibia. Ankles were tested at neutral, 15 degrees of dorsiflexion, and 15 degrees of plantar flexion. In all the specimens the anterior talofibular ligament was sectioned and then the calcaneofibular ligament was sectioned; testing was then repeated. With sectioning of the anterior talofibular ligament, motion increased primarily in dorsiflexion with both anterior-posterior and inversion-eversion loading. This increase was primarily caused by a large increase in subtalar motion. Additional sectioning of the calcaneofibular ligament produced little change in ankle subtalar joint motion except in dorsiflexion. Clinically, these findings show that if an anterior-posterior drawer test shows less laxity in dorsiflexion than in neutral and greater laxity than the contralateral asymptomatic side, then an isolated anterior talofibular ligamentous tear exists. Similarly, laxity in 15 degrees of dorsiflexion and in neutral suggests calcaneofibular ligament disruption. During inversion-eversion loading, the increase in ankle-subtalar joint complex rotation with calcaneofibular ligament sectioning occurred primarily in the ankle joint, implying that the calcaneofibular ligament constrains the talus through the calcaneus. Therefore, a talar tilt on stress radiographs demonstrates a torn calcaneofibular ligament.

Ankle Injuries↗
PubMedDate not supplied

Deltoid and syndesmosis ligament injury of the ankle without fracture.

Ankle diastasis without fracture is a rare injury with few examples reported. We report on four male patients, aged 16 to 18 years, who sustained this injury playing football. Swelling and tenderness over both the deltoid and syndesmosis ligaments are the most common physical findings. Plain ankle radiographs demonstrated lateral talus subluxation in three patients, and a stress radiograph demonstrated subluxation of the talus in one patient. Treatment consisted of reduction and fixation of the syndesmosis with a screw followed by 6 weeks of cast immobilization. Using the scale developed by Edwards and DeLee, three patients had excellent results and one had a good result. Diagnosis of tears of the deltoid and syndesmosis ligaments without fracture requires a high index of suspicion on the physician's part. In patients whose mortise is more than 1 mm subluxated, reduction and screw fixation will produce good results.

Adolescent↗
PubMed2000

A determination of ankle kinematics using fluoroscopy.

In vivo weight-bearing studies utilizing dynamic video fluoroscopy have been shown to offer an accurate and reproducible method for determining the kinematics of a joint. The purpose of this study was to evaluate translational and rotational motions of the distal tibia relative to the talus in the sagittal and frontal planes. Ten subjects, each having a normal ankle and a total ankle arthroplasty on the opposite side (Buechel-Pappas Total Ankle, Endotec, South Orange, NJ), were studied under in vivo, weight-bearing conditions using video fluoroscopy. All ten subjects were judged to have a successful arthroplasty without demonstrable pain or ligament instability. Under weight-bearing conditions, each subject performed successive motions moving from maximum dorsiflexion to plantarflexion. At maximum dorsiflexion, both the normal and implanted ankles had similar sagittal midline talar contact positions but with plantar flexion, implanted ankles had increased posterior talar contact. Contact points on the distal tibia revealed that the lateral surface contacted at the midline or posterior throughout range-of-motion with minimal translation. The medial distal tibia contacted the talus posterior on plantarflexion and often moved anteriorly with dorsiflexion. This translation described relative external rotation of the distal tibia on plantar flexion and internal rotation on dorsiflexion. The measured distances were larger for the implanted ankles with higher variability. The average range-of-motion was 37.4 degrees for normal ankles and 32.3 degrees for implanted ankles. This study defines the normal kinematic rotational and translational motions of the ankle joint by accurately describing the three dimensional joint orientations. The implanted ankles experienced rotational and translational motions but had contacts more posterior, possibly related to surgical technique or alterations of ligamentous tension.

Ankle Joint↗
PubMed2000

Closed talar body fracture with talonavicular dislocation; a case report.

Closed fracture dislocation of the body of the talus is rare. The dislocation of the subtalar and ankle joints (associated with fracture body) has been reported and already described in the current classifications. We report a case of closed fracture of the body of the talus associated with talonavicular dislocation. Open reduction and internal fixation was performed after failed attempt of closed reduction. The fracture has healed and there is no evidence of avascular necrosis after 2 years follow up. We recommend early evaluation of this injury by CT scan or by proper radiographic views under sedation and urgent open reduction if one attempt at closed reduction has failed.

Adult↗
PubMed2002

Treatment of talar osteochondral lesions using local osteochondral graft.

Twelve patients with an osteochondral lesion of the talus were treated with excision of the lesions and local osteochondral autogenous grafting. The lesion was accessed through a replaceable bone block removed from the anterior tibial plafond. The graft was harvested from the medial or lateral talar articular facet on the same side of the lesion. The average age of the patients was 41 years and duration of symptoms was 90 months (ave.). There were six males and six females with the right talus involved in eight and the left in four patients. Graft sizes ranged from four to eight millimeters in diameter. There was a significant improvement in the AOFAS score from 64.4 (ave.) pre-operatively to 90.8 (ave.) postoperatively (p<0.0001), at a follow-up of 25.3 months (ave.). The AOFAS score was slightly higher in patients under 40 years of age and in those without pre-existing joint arthritis. All patients were very satisfied with the procedure. Arthroscopy performed in two patients at six and 12 months following surgery showed good graft incorporation. No complications occurred at the donor site or the site of bone block removal on the distal tibia. The results show that stage III and IV talar osteochondral lesions can be accessed successfully excising a tibial bone block and using local autogenous osteochondral graft harvested from the ipsilateral talar articular facet.

Adult↗
PubMed2003

Kinematic changes after fusion and total replacement of the ankle: part 3: Talar movement.

INTRODUCTION: The purpose of this study was to determine talar movement (e.g., talar rotation and talar shift during (dorsiflexion/plantarflexion) with respect to the tibia in the normal ankle, in the fused ankle, and in the replaced ankle by currently used prosthetic designs. METHODS: A 6-df device with an axial load of 200 N and a four-camera high-speed video system were used for the measurement of the range of motion in six fresh-frozen cadaveri leg specimens. While moving the foot through the whole range of motion for plantarflexion/dorsiflexion, segmental motion of the marked bones of the foot and shank were measured dynamically. Rotation and medial-lateral shift of the talus were then calculated with regard to flexion position of the foot. RESULTS: In the normal ankle, plantarflexion movement was coupled with talar inversion of 3.5 degrees, and dorsiflexion movement with talar eversion of 1.0 degree, in totally accounting for 4.5 degrees of talar rotation. While both the HINTEGRA and the S.T.A.R. prostheses did not show changes to the normal condition during the dorsiflexion/plantarflexion cycle (p < .05), talar rotation had a 60% decrease (p < .05) for the AGILITY prosthesis. In the normal ankle joint, a lateral talar shift of 1.4 mm was found to occur during dorsiflexion, and a lateral talar shift of 5.2 mm during plantarflexion. In both, the HINTEGRA and S.T.A.R. ankles, talar shift was converted into medial direction during dorsiflexion of the foot (difference to normal: p < .05), whereas talar shift in the lateral direction was found to occur during plantarflexion of the foot which was comparable to the normal ankle. The AGILITY ankle evidenced an 80% decrease of talar shift (p < .05) during the whole dorsiflexion/plantarflexion cycle. DISCUSSION: The two-component ankle (AGILITY) obviously tends to restrict tremendously talar motion within the ankle mortise, whereas the three-component ankles (HINTEGRA, S.T.A.R.) seem to allow talar range of motion comparable to that in the normal ankle. It is suggested that such a restriction of talar motion results in an increase of stress forces within and around the prosthesis, leading to polyethylene wear and potential loosening at the bone-implant interfaces. Therefore, a successful prosthetic design for the ankle should consist of three components that are shaped as anatomically as possible to provide a normal range of motion and to allow the full transmission of movement transfer between foot and shank and unconstrained movement of the talus within the ankle mortise.

Aged↗
PubMed2004

Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability.

BACKGROUND: Trimalleolar fractures usually include a lateral malleolar fracture, a triangular fracture of the posterolateral corner of the tibial plafond, and a horizontal or oblique fracture of the medial malleolus. A subtype of a trimalleolar fracture is reported, differing in the shape and extent of the medial malleolar fracture and the posterior lip fracture, with implications for treatment. METHODS: In a 3-year period, 10 patients were treated for a trimalleolar fracture with a multifragmentary transverse fracture of the entire posterior tibial lip, including the posterior colliculus of the medial malleolus. The radiographs of all patients showed a pathognomonic double-contour or flake-fragment sign above the medial malleolus. One patient's posteromedial fracture was not initially recognized and he had a standard lateral fracture repair. A double posterior approach was used in nine patients, with fracture repair proceeding from medial to lateral. Intraoperatively, eight of nine patients had impacted osteochondral fragments at the posteromedial corner of the tibial plafond that blocked anatomic reduction and allowed posteromedial subluxation of the talus. RESULTS: Nine patients had anatomic reconstruction of the posteromedial corner. All fractures healed, and function was normal at one year. One patient had moderate loss of joint space. The patient with the malunited fracture developed symptomatic posteromedial instability of the talus and required an osteotomy of the malunited fragment. He had a good result at 18 months. CONCLUSIONS: This unique subtype of trimalleolar fracture has distinct radiological features and implications for the strategy of the operative treatment. If recognized immediately and treated appropriately, the results were excellent. If missed initially, reconstructive osteotomy was possible and led to a good result.

Adult↗
PubMed2006

Ankle alignment on lateral radiographs. Part 2: reliability and validity of measures.

BACKGROUND: In ankles with end-stage osteoarthritis or after total ankle replacement (TAR), radiographic landmarks based on joint surface morphology usually are obscured and inadequate for measurement. Two methods for quantifying anteroposterior tibial-talar alignment without relying on those landmarks were identified in a corollary cadaver-based study. This study aimed to verify reliability and validity of those candidate measures. METHODS: On clinical radiographs of 33 nonarthritic and 35 arthritic ankles, the anteroposterior tibial-talar alignment was quantified by the two methods; the tibial-axis-to-talus ratio (T-T ratio: the ratio into which the midlongitudinal axis of the tibial shaft divides the longitudinal talar length) and the posterior-tibial-line-to-talus ratio (P-T ratio: a similar ratio, but using the posterior longitudinal line along the tibial shaft). Two observers performed every measurement twice to evaluate intraobserver and interobserver reliability of the candidate measures. For nonarthritic ankles, the anteroposterior tibial-talar alignment was further determined by a control measure that directly quantified orientation of the talar dome relative to the tibial shaft. Correlation of the T-T and P-T ratios with the control measure was then evaluated for validity. RESULTS: Measurement of the T-T ratio with arthritic ankles was highly reproducible with the coefficients of determination (R(2)) greater than 0.95, for either interobserver or intraobserver. Correlation between this measure and the control measure was supported (R(2) = 0.60, p < 0.0001). Reliability of the P-T ratio also was strong (R(2) > 0.91), although both reliability and validity of this measure were relatively inferior to the T-T ratio. CONCLUSIONS: The T-T ratio reliably and validly described the anteroposterior tibial-talar alignment on clinical radiographs, regardless of the condition of ankle joint surface. This measure appears to be a reliable radiographic measure for determining the magnitude of anteroposterior talar subluxation in ankles with articular degeneration or after TAR and can facilitate clinical investigations.

Adolescent↗
PubMed1981

Talonavicular joint surface anatomy and prototype resurfacing prostheses.

The curvature and extent of a joint surface largely determine the type and range of motion possible. The talonavicular surface anatomy of 10 human foot specimens has been determined quantitatively, and the data have been compared with the design parameters for a prototype prosthetic joint. It was found that, in general, the natural talus as compared with the navicular was slightly larger in surface area and in mean arc length, but slightly smaller in mean radius of curvature. The arc length of the joint was found to be generally slightly longer along an axis positioned from slightly medial of dorsal to slightly lateral of ventral. In contrast, no general orientation of the radius of curvature was observed. Also, it was found that the congruency between the talus and navicular surfaces, as indicated by corresponding radii of curvature, varied widely. In comparison to the human specimens, a previously designed prototype talonavicular prosthesis proved somewhat smaller in radius, arc length, and surface area. Experimental studies related to other prosthesis design parameters, besides type and range of motion, are in progress.

Female↗
PubMedDate not supplied

The modified Blair fusion.

The Blair fusion is the accepted method to achieve an ankle arthrodesis in the presence of avascular necrosis or absence of the body of the talus. This procedure has not however, been reliable. A pseudarthrosis rate of 28% and fibrous ankylosis of the foot secondary to prolonged immobilization compromise the end result. A tibiotalar compression arthrodesis has been developed using an intermediate hip compression screw and a modified Stone staple. Five patients with avascular necrosis of the talus underwent a modified Blair fusion. Protected weightbearing was started at 6 weeks and healing occurred within 3 months. Although the number of cases is small, this study indicates that the addition of compression fixation to the Blair arthrodesis will significantly decrease the pseudarthrosis rate and perhaps the healing time.

Adult↗
PubMed1989

Intra-articular talar fractures: repair using the Herbert bone screw.

Intra-articular fractures of the talus remain a problem because of the difficulty in achieving and maintaining anatomic reduction, and because of the risk of degenerative arthritis of the hindfoot if such reduction is not achieved. We report our experience with three cases in which intra-articular talar fractures were repaired by use of the Herbert bone screw. In addition, we discuss the biomechanical features of the Herbert bone screw which make it particularly well suited for intra-articular fractures of the talus.

Adult↗
PubMed1991

Tibio-talar stability in bimalleolar ankle fractures: a dynamic in vitro contact area study.

A dynamic weight-bearing model has been developed in a cadaveric ankle model to assess the contact areas of the talus in varying degrees of bimalleolar ankle fractures. A surgically created transverse fibula osteotomy with up to 6 mm of displacement did not cause a significant change in the contact area. Sectioning of the deltoid ligament, regardless of fibular displacement, created a 15% to 20% decrease in the contact area (P less than .001). This model represents a clinically relevant situation, as it examines motion of an unconstrained, axillary loaded ankle. Additional medial side disruption increases ankle instability by allowing anterior and lateral translation of the talus out of the mortise. Isolated lateral malleolar displacement does not appear to cause ankle instability.

Adult↗
PubMed1991

Biomechanical evaluation of the anterior drawer test: the contribution of the lateral ankle ligaments.

The contributions of the lateral ankle ligaments to resisting anterior-posterior displacement of the talus were evaluated in eight unembalmed cadaveric ankles. While holding the distal tibia fixed, loads of 150 N were applied to the talus in the anterior and posterior directions in the neutral, dorsiflexed, and plantarflexed positions using an hydraulic test system. Tests were performed on the intact specimens then after sequential sectioning of the lateral ligaments of the ankle. Under strictly anteroposterior loading and without an axial (weight-bearing) load applied, no single ligament could be isolated as having a dominant stabilizing function.

Ankle Joint↗