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Age-related changes of bone mineral density in human calcaneus, talus, and scaphoid bone.

To examine whether the bone mineral density (BMD) decreases uniformly with aging in any spongy bones, the authors investigated age-related changes of BMD in the calcaneus, talus, and scaphoid bone. After the ordinary dissection by medical students was finished, calcanei, tali, and scaphoid bones were resected from the subjects, and BMDs were measured by dual-energy X-ray absorptiometry. Their BMDs seemed to decrease gradually with aging in the calcanei, tali, and scaphoid bones. It was found that there were statistically significant relationships between age and BMD in the men's and women's scaphoid bones, women's tali, and women's calcanei, but not in the men's tali and calcanei. It should be noted that there were significant relationships between age and BMD in both men's and women's scaphoid bones. In regard to relationship in BMD between the bones of the upper and lower limbs in individuals, it was found that the relationship between the calcaneus and talus was higher than that between the calcaneus and scaphoid bone. This suggests that there is a higher relationship in BMD between the two tarsal bones compared with that between the tarsal and carpal bones.

Aged↗

Comparison of ultrasound and bone mineral density assessment of the calcaneus with different regions of interest in healthy early menopausal women.

This study investigated the effect of different sized regions of interest (ROIs) on quantitative ultrasound (QUS) variables of the calcaneus. The effect on QUS of using a fixed ROI as opposed to an ROI adjusted for foot length was also assessed. Eighty Caucasian women, aged 50-57 yr (mean 53 +/- 2) who were healthy and within 0. 5-5 yr of the onset of menopause participated in this study. Using the QUS-1(trade mark) Ultrasonometer (Metra Biosystems, Mountain View, CA), we assessed broadband ultrasound attenuation ([BUA] and UBI-4, dB/MHz), the average transit time through the heel ([TTH], mus) and a multiple-factor index (UBI-4T = UBI-4/TTH, dB/[MHz. mus]). The QUS measurement results were calculated from three different sizes of ROI as well as one in a fixed location and one adjusted for foot size. Bone thickness, bone width, bone mineral content ([BMC], g/cm), bone mineral density area ([BMD(a)], g/cm(2)), and bone mineral density volume ([BMD(v)], g/cm(3)) were measured by single-energy photon absorptiometry. Lateral radiography of the foot was used to ensure the QUS scanning location in a subgroup. The results showed that there was a 1.4-5.9% difference in QUS parameters among different ROIs (p = 0.076-0.001). No significant differences between fixed and adjusted location were found regarding the mean values of QUS. The correlation between the fixed and adjusted locations was very strong, although there was a 12-42% unexplained variation. On the other hand, QUS in the size-adjusted ROI increased the correlation with BMC/BMD compared to the fixed QUS assessments. After controlling for body weight and height, a significant correlation between QUS and bone mass variables remained, and in some cases correlations became stronger. Lateral radiography showed that when using a fixed location to scan a large foot, the scanning area might be close to the bone edge, an area of higher BMD and potential acoustic artifacts. When scanning a small foot, the scanning area was confined to the middle of the calcaneus. Our results indicate that bone size has a modest effect on BUA. There is a better correlation with BMD when the measurement region is appropriately located in the calcaneus. This suggests that measurement location based on foot size may improve the accuracy of the measurements, resulting in good diagnostic sensitivity.

Bone Density↗

Effects of lifestyle factors on stiffness index of calcaneus measured by quantitative ultrasound system among Japanese women aged 40 years and over: the Hizen-Oshima Study.

To explore how the stiffness index of the calcaneus is related to lifestyle factors, we examined the associations of lifestyle factors, age, and years since menopause, with stiffness index of the calcaneus among 573 community-dwelling Japanese women aged 40-89 years. Stiffness index of the calcaneus was obtained from quantitative ultrasound measurement. Body height and weight were measured, from which body mass index (BMI) was calculated. Physical activity index was calculated using a validated questionnaire. Dietary calcium intake and amount of ingested alcohol were estimated by a semiquantitative food frequency questionnaire. Current smoking status was obtained by questionnaire. In univariate analysis, stiffness index was positively related to physical activity index and BMI, and inversely to age and years since menopause, but not to dietary calcium intake. Stiffness index of drinkers and current smokers was not significantly different from that of non-drinkers and non-smokers, respectively. Among the natural menopausal women, multiple regression analysis showed that advancing age and years since menopause were associated with lower stiffness index, while higher physical activity index and greater BMI were associated with higher stiffness index. In conclusion, higher physical activity, in combination with adequate nutrition for weight maintenance, should be emphasized as a part of a healthy lifestyle in order to maintain bone health among middle-aged and elderly Japanese women.

Adult↗

Computed tomography of the calcaneus: normal anatomy.

The normal sectional anatomy of the calcaneus was studied as the background for interpretation of computed tomography (CT) of fractures. Multiplanar CT examination of the normal calcaneus was obtained, and sections were matched with a simplified anatomic model. Sectional anatomy in the four most important planes is described. This facilitates three-dimensional understanding of the calcaneus from sections and interpretation of CT sections obtained in any atypical plane.

Adult↗

Calcaneus as a site for assessment of bone mineral density: evaluation in cadavers and healthy volunteers.

OBJECTIVE: The value of calcaneal dual-energy X-ray absorptiometry for monitoring changes in bone mineral density has not yet been established. Accordingly, the focus of this study was to determine the usefulness of the calcaneus as the site for bone mineral density measurement with dual-energy X-ray absorptiometry. SUBJECTS AND METHODS: Dual-energy X-ray absorptiometry of the calcaneus was performed in 19 specimens derived from 11 cadavers and 337 healthy volunteers to assess accuracy, in vivo precision, and age-related changes in bone mineral density. We also compared calcaneal bone mineral density determined by dual-energy X-ray absorptiometry with lumbar spine bone mineral density determined by dual-energy X-ray absorptiometry (L1-L4) or quantitative CT (L3). RESULTS: Studies of specimens showed that dual-energy X-ray absorptiometry had an error rate of 6%. In addition, strong correlations were found between bone mineral content and ash weight (r = .97, p < .0001) and between bone mineral density and ash density (r = .87, p < .0001). In vivo studies showed moderate correlations between calcaneal bone mineral density determined by dual-energy X-ray absorptiometry and lumbar spine bone mineral density determined by dual-energy X-ray absorptiometry (men, r = .77, p < .0001; women, r = .76, p < .0001) and lumbar spine bone mineral density by quantitative CT (men, r = .68, p < .0001; women, r = .68, p < .0001). Calcaneal bone mineral density measured by dual-energy X-ray absorptiometry and lumbar spine bone mineral density measured by quantitative CT continued to decrease throughout the postmenopausal period. However, lumbar spine bone mineral density determined by dual-energy X-ray absorptiometry did not show further decreases in subjects more than 70 years old. CONCLUSION: Taken together, these results suggest that the calcaneus can be used as an additional site for determining bone mineral density to assess osteopenia in patients when deformities of the spine make quantitative CT or other methods of density measurement impossible.

Absorptiometry, Photon↗

Fractures of the calcaneus. A comparison of open and closed treatment.

Twenty patients with displaced intraarticular fractures of the calcaneus treated by open reduction and early postoperative motion exercises were compared after 2-12 years with 19 patients with similar fractures treated closed. The two groups were comparable regarding follow-up time, age, sex-distribution, and preinjury occupation. The pain and disability were almost equal in both groups. Three patients in both groups had marked residual symptoms, and equally many had negligible symptoms. The operated patients had less reduced subtalar motion, better ability to jump and run, longer walking distances on uneven surfaces, and reduced forward tilting of the lateral part of the posterior articular surface, but only a slightly improved Böhler angle. Nine operated and eight conservatively treated patients had radiographic signs of osteoarthrosis. Open reduction of the intraarticular fracture of the calcaneus may provide stability, allowing early motion and eventually improved subtalar function. However, postoperative complications are common, and the overall end results of open and closed treatment are almost equal. Primary operation of the fractured calcaneus should therefore rarely be indicated.

Adult↗

Calcaneus fracture in the child.

We reviewed 80 fractures of the calcaneus in 78 children through a 30-year period. The fractures were more equally distributed between the sexes than in adults. In contrast to adults, intraarticular fractures of the calcaneus in children constitute less than half, probably because a lower proportion of children sustain the fracture as a result of a fall. Associated injuries were mainly encountered by children who were traffic accident victims. It is disputable that the calcaneus in children is more resistant to fracture than in adults. The rarity of the fracture in children is more likely the result of less exposure to trauma leading to calcaneal fractures and also that the fracture is often overlooked.

Accidental Falls↗

Calcaneus secundarius. Variation of a common accessory ossicle.

The calcaneus secundarius is an accessory ossicle of the anterior calcaneal facet. Dry bone examination of 1,367 calcanei revealed this trait 47 times (3.4%). Familiarity with the calcaneus secondarius may prove to be of clinical and radiographic value in distinguishing pathologic from normal variants in the calcaneus.

Adolescent↗

Treatment of a simple bone cyst of the calcaneus by endoscopic curettage with cancellous bone injection.

The authors report a case of simple bone cyst involving the calcaneus, treated by curettage under endoscopy with cancellous bone injection, and its course and follow-up at two years. This new technique has not yet been published for simple bone cysts of the calcaneus. Endoscopic curettage of the cavity of a simple bone cyst can be advocated for the calcaneus to minimize incisions and to avoid cutaneous complications.

Adolescent↗

[Ultrasound measurement of calcaneus: a promising method for prediction of osteoporotic fractures].

When carrying out quantitative ultrasound (QUS) measurements of the calcaneus, broadband ultrasound attenuation (BUA, in dB/MHz) and speed of sound (SOS, in m/s) are assessed. From in vitro studies it is known that the mechanical properties of trabecular bone (stiffness and strength) can be better predicted with QUS than with dual energy X-ray absorptiometry (DEXA). Bone mineral density (BMD) measurements with DEXA are currently used for the diagnosis of osteoporosis according to the WHO criteria. There is no consensus regarding the diagnosis of osteoporosis with QUS measurements of the calcaneus. In prospective studies in women of 65 years and older it has been shown that fracture risk assessment with QUS measurements is feasible. The value of QUS measurements for the follow-up of patients with skeletal disorders is not yet known. At present there are important differences between ultrasound devices and there is no standardisation. The development of quality standards for and cross-calibrations of QUS scanners is necessary, so that results from different devices can be compared. Although QUS of the calcaneus is a promising method for the prediction of osteoporotic fractures, its routine use in clinical practice cannot yet be recommended.

Absorptiometry, Photon↗

[Resection of the tip of the lateral malleolus by Ibister's method in the treatment of painful sequelae of calcaneus fractures].

Persistent pain below the tip of the lateral malleolus may occur after comminuted fractures of the calcaneus. The pain is the result of compression of the peroneal tendons or abutment between the calcaneus and the lateral malleolus. Computerized tomography clearly shows the etiology. In these cases, the excision of the tip of the lateral malleolus, procedure described by Isbister, was performed. The clinical results of fifteen procedures in thirteen patients who had persistent pain below the tip of the lateral malleolus after fracture of the calcaneus are reported. All the patients were completely relieved of lateral pain. Subjectively, for nine patients, the results were excellent (7) or good (2). 4 patients are not satisfied. In these cases, pain arising from the subtalar joint was the main complain.

Adolescent↗

[Experimental study on the viscoelastic properties of cancellous bone of the os calcaneus, os lunatum and os capitalum].

We have researched the viscoelastic properties of the cancellous bones of the os calcaneus, os lunatum and os capitalum. The compressing stress relaxation experiment and the creep experiment in the vertical, horizontal and 45 degree directions on the os calcaneus were performed. The data and curve of the compressing stress relaxation and creep were obtained. By masing regression analysis we worked out the compressing reduced stress relaxation and creep functions and curves. The results show that the quantities of compressing stress relaxation and creep of the calcaneus in the vertical direction are larger than those in the other two directions. The initial quantities of creep of the os capitalum are larger than those of the os lunatum, and there are no significant different between the quantities of stress relaxation of the cancellous bones of the os lunatum and os capitalum.

Adult↗

Discriminant function sexing of the calcaneus of the South African whites.

The skull and some postcranial elements, such as the humerus, femur, and tibia, have been used in their intact states for sex determination in forensic and archaeological cases. But, in practice, these bones are often recovered in fragmented states, which render them unsuitable for use in sex determination. The calcaneus is a compact bone that is able to withstand high tensile forces. Some of its parameters have been used for sex determination in American whites and blacks (1) and Italians (2). This bone has not been used for sex determination in the South African white population. Therefore, the aim of this study was to assess the degree of sexual dimorphism of the calcaneus of the South African white population sample, derive discriminant function score equations for use in sex determination, and determine the level of accuracy of its sex-determining ability. Nine parameters were measured on each pair of 53 male and 60 female calcanei of known South African white skeletons, obtained by a random sampling technique from the Raymond A. Dart Collection of Human Skeletons, School of Anatomical Sciences, University of the Witwatersrand, Johannesburg. Basic statistic and discriminant function analysis was performed on the acquired data. The basic statistics showed that all measured parameters were sexually dimorphic. Discriminant function score equations were generated for use in sex determination. The average accuracy of sex classification ranged from 73 to 86% for the univariate method, 81 to 91% for the stepwise method, and 82 to 92% for the direct method. It is concluded that the calcaneus is useful for sex determination in the South African white population.

Adult↗

Transfer of the tibialis anterior for calcaneus deformity in myelodysplasia.

We evaluated the results of transfer of the tibialis anterior in the management of calcaneus deformity in young patients who had myelodysplasia; fifteen patients (twenty-two feet) were operated on between 1978 and 1985. The neural deficit was at the fourth and fifth lumbar levels. The average age at the time of the operation was seven years and two months (range, two to nineteen years). The average age at the latest follow-up was thirteen years (range, five to twenty-four years). The average duration of follow-up was five years and ten months (range, two to eleven years). Seventeen feet (twelve patients) had a good result (no ulceration of the heel or osteomyelitis and correction of the calcaneus deformity), and five feet (three patients) had a poor result (persistent ulceration, signs of osteomyelitis, recurrent or persistent calcaneus deformity, or the need for additional operative intervention). Children who were less than five years old had a better outcome, as determined by the Fisher exact test (p less than 0.5).

Adolescent↗

Insufficiency fractures of the calcaneus: a diagnostic pitfall for ankle arthritis.

OBJECTIVE: To highlight the differential diagnosis between insufficiency fractures (IF) of the calcaneus and arthritis of the ankle. METHODS: We retrospectively reviewed clinical charts and imaging findings for 6 patients with 7 IF of the calcaneus who were referred with the diagnosis of ankle arthritis. The main predisposing factors, clinical features, therapy, and outcome were recorded. IF was considered when occurring spontaneously or with minimal trauma. RESULTS: All patients were women, with a mean age of 73.8 +/- 6.3 years. The median delay to diagnosis was 6 weeks (25th, 75th percentiles: 1, 12). Two had previous IF at other locations. Three patients had a history of chronic inflammatory conditions while receiving longterm steroid therapy. All complained of moderate to severe pain that interfered with daily activities and was relieved with rest. Physical examination revealed ankle inflammation in all cases. Radiographs were normal in 5 patients. Magnetic resonance imaging (MRI) was diagnostic. All received conservative treatment with complete resolution of symptoms without sequelae. CONCLUSION: IF of the calcaneus are relatively rare but can be mistaken for ankle arthritis. MRI is recommended because this type of fracture is difficult to detect on plain films. Although IF have a good prognosis with conservative treatment, increased awareness is of importance for prompt diagnosis and proper management.

Aged↗

[Experimental study of the classification of intra-articular calcaneus fractures].

Improvement of the diagnostic techniques applied in calcaneus fractures, particularly the increased use of computed tomography, calls for a detailed fracture classification. Thirty lower leg cadaver specimens were submitted to axial loading. Fracture lines could be divided into a relatively constant primary fracture, running from the posterior subtalar joint surface to the tuber calcanei, and highly variable secondary fractures. In order to classify the fracture specimens, the calcaneus was divided into four segments: the sustentacular segment, the posterior subtalar joint segment, the segment of the anterior process, and the tuberosity segment. In addition, the following joints were identified at the calcaneus: the posterior subtalar joint, the anterior subtalar joint, and the calcaneo-cuboid joint. Each specimen was classified by the number of segments (x) and the number of joints (y) affected, and accordingly labelled as x-segment, y-joint fracture. The addition of both numbers was used to grade the severity of the fracture. This classification was easily applicable to all 25 experimental fracture specimens, and also to 33 clinical cases.

Adult↗

Surgical treatment of tarsal sheath effusion associated with an exostosis on the calcaneus of a horse.

A 2-year-old Thoroughbred colt was referred for evaluation of effusion within the tarsal sheath and associated lameness of the right hind limb. Conservative treatment consisting of needle aspiration and pressure bandaging had been unsuccessful. Radiography of the right tarsus revealed proliferative periosteal reaction along the distal caudal border of the sustentaculum tali and medial aspect of the calcaneus. The owners elected conservative treatment, using a local injection of corticosteroid and pressure bandaging the tarsus. Five months later, the severity of the effusion and lameness had increased. Radiography revealed increased reactive bone along the sustentaculum tali and mineralization of the plantar tarsal ligament and tarsal sheath. Surgical exploration revealed fibrous adhesions between the medial aspect of the calcaneus and the flexor tendon and associated soft tissue mineralization. The adhesions were broken down and the reactive bone along the calcaneus was removed. The mineralized soft tissue within the tarsal sheath was excised. Five months after surgery, the horse was sound at the trot, with only minimal tarsal sheath effusion. The response to treatment for tarsal sheath effusion and lameness caused by bony changes of the sustentaculum tali is often unsatisfactory. After responding poorly to conservative treatment, the horse in this report had a favorable outcome to the surgical intervention of this condition.

Animals↗

[Study of the talus and calcaneus using microdurometry, penetrometry and compression].

The authors give the results of various methods such as hardness micrometry, indentation tests and the radiographic study of fracture patterns, which they have applied to the talus and to the calcaneus. It appeared to them that: --these techniques outline the phenomenon of rupture behaviour of both talus and calcaneus; --the talus behaves as a fragile type of material whereas the calcaneus is of the intermediate type. The authors therefore think that these methods can be of great interest in a better understanding of the biomechanical properties of bone.

Biomechanical Phenomena↗