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The Spring Ligament Complex —Anatomy and Function
This article provides an overview of the soft tissue contributions to the normal structures that surround the talo-calcaneal-navicular (TCN) joint of the human arch. The TCN joint has a multiplanar range of motion that makes it essential to the kinetic coupling that links the forefoot and hindfoot. The soft tissue connection surrounding this joint is known as the spring ligament complex. More accurate knowledge of the anatomy of this complex will enhance the understanding of its role in the support of the head of the talus and, potentially, its critical interactions with the normal or abnormal function of the arch. (Source...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Andrew M. Belis, Gregory A. Foote Source Type: research

Anatomy
The fibrocartilaginous component of the plantar plate offers stability at the metatarsophalangeal joint. In conjunction with the attachments of the deep transverse metatarsal ligaments and collateral ligaments, the plantar plate complex resists tensile forces anchored by the plantar fascia and compression forces under the metatarsal heads. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Daniel J. Hatch Source Type: research

Fibrocartilaginous Tissue
Tendons and ligaments are critical components in the function of the musculoskeletal system, as they provide stability and guide motion for the biomechanical transmission of forces into bone. Several common injuries in the foot and ankle require the repair of ruptured or attenuated tendon or ligament to its osseous insertion. Understanding the structure and function of injured ligaments and tendons is complicated by the variability and unpredictable nature of their healing. The healing process at the tendon/ligament to bone interface is challenging and often frustrating to foot and ankle surgeons, as they have a high failu...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: John T. Marcoux, Lowell Tong Source Type: research

Nonoperative Treatment of Plantar Plate Tears
The plantar plate is a critical structure involved in stabilizing the metatarsophalangeal joint. Its disruption can not only be painful for the patient but also may lead to subsequent structural deformities. There are several conservative treatment modalities available to help mitigate symptoms including splinting, offloading, and intraarticular injections. That being said, once the pathology progresses to advanced stages, these treatments are not efficacious. Reported success with conservative treatment modalities is limited to case studies and series with a low level of clinical evidence. As such, this represents an area...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Karan Malani, Madison Ravine, Harry P. Schneider Source Type: research

Injuries to the Spring Ligament
The fibrocartilage within the superomedial calcaneonavicular (spring) ligament is part of an interwoven complex of ligaments that span the ankle, subtalar, and talonavicular joints. Acute isolated rupture of the spring ligament has been reported in association with an eversion ankle sprain. Attenuation and failure of the spring ligament causes complex 3D changes called the progressive collapsing foot deformity (PCFD). This deformity is characterized by hindfoot eversion, forefoot supination, collapse of the medial longitudinal arch, and forefoot abduction. Nonoperative treatment of an isolated spring ligament rupture and P...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Douglas H. Richie Source Type: research

Nonoperative Management of the Achilles Tendon Insertion
Insertional Achilles tendinopathy can be a very challenging clinical syndrome with various nonoperative measures typically attempted before surgical intervention. Associated complications are known with surgical repair and can be limb altering. Owing to the longevity of clinical symptoms before clinical presentation, changing the pathophysiologic process and halting the inflammatory changes becomes paramount. Here we discuss nonoperative techniques and updates in the foot and ankle literature. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Jeffrey E. McAlister Source Type: research

Operative Management
The plantar plate is a vital structure for maintaining lesser metatarsophalangeal joint (MPJ) stability. Its primary role is to provide static stabilization of the MPJs, working in conjunction with the long and short flexor and extensor tendons. When insufficiency or attenuation of the plantar plate occurs, a sagittal plane deformity will slowly develop, eventually leading to a “crossover toe” transverse plane deformity. Coughlin coined this descriptive term to describe the later stages of deformity, most commonly affecting the second MPJ. Shortly after, Yu and Judge elaborated on this condition describing it as “pre...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Brett D. Sachs, Laura B. Adler, Robert J. Cavaliere Source Type: research

Operative Management
Pes planovalgus is a multiplanar deformity consisting of a combination of hindfoot valgus, collapse of the medial longitudinal arch, forefoot varus, and forefoot abduction. This deformity is often associated with posterior tibial tendon dysfunction. Collapse of the medial longitudinal arch increases stress to the static stabilizers of the medial column including the deltoid ligament, spring ligament, plantar fascia, plantar and talocalcaneal interosseous ligaments, as well as the talonavicular and naviculocuneiform capsules. There is a higher incidence of concomitant spring ligament pathology in pes planovalgus deformity a...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Jacob Jones, Alan Catanzariti Source Type: research

A Critical Biomechanical Evaluation of Foot and Ankle Soft Tissue Repair
The objective of this article is to review the biomechanical stresses that occur during normal physiologic function of lower extremity soft tissue anatomic structures and to use this as a baseline for a critical analysis of the medical literature because it relates to surgical reconstruction following injury. The Achilles tendon, anterior talofibular ligament, plantar plate, and spring ligament are specifically evaluated. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Sara Mateen, Laura E. Sansosti, Andrew J. Meyr Source Type: research

Update on Fibrocartilaginous Disease Clinical Examination
This article provides an update on fibrocartilaginous disease clinical examination. Lesser metatarsophalangeal joint instability is a challenging entity for the foot and ankle surgeon. A correct diagnosis is crucial to instill an appropriate treatment plan that will result in a successful outcome and a satisfied patient. Insertional Achilles tendon disorders are common among active and inactive patients. There is also a high predilection for Achilles tendon pathology among athletes. In this article demographics and patient history, causative factors, differential diagnosis, physical examination, clinical tests, and radiogr...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Michelle L. Butterworth, Alan J. Block Source Type: research

Gross Anatomy
The Achilles tendon is well known as the strongest tendon within the body. Its anatomic composition is unique to allow absorption of extreme loads. Historically, there has been a longstanding belief that rupture of the Achilles tendon occurs within a “watershed” region of ischemia. However, experimental data have demonstrated uniform hemodynamic flow throughout the tendon to challenge this widespread notion. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Jason Kayce Source Type: research

Normal and Diseased Imaging
This article describes the technical considerations of ultrasound and MRI and provides examples of the normal and abnormal appearances of these structures. The pros and cons of each imaging modality are also discussed. (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Adam E. Fleischer, Rachel H. Albright Source Type: research

Update on Fibrocartilaginous Disease
It is an honor to serve as a guest editor for Clinics in Podiatric Medicine and Surgery and to present on a topic that impacts with regularity lower extremity physicians and their patients. Fibrocartilage disorders are the cause of several derangements identified the human foot. I have had great interest in this topic. The ability to restore the normal physiologic function of this tissue without other sacrifices makes it an ongoing challenge. The development of lesser metatarsophalangeal joint instability and progression of the digital deformity, advancing collapse of the foot resulting from spring ligament failure, and ch...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Michael H. Theodoulou Tags: Preface Source Type: research

Foreword
It is my pleasure to introduce this issue on fibrocartilaginous disease. As foot and ankle surgeons, we fully appreciate the contributions of soft tissue to almost every structural and positional deformity we encounter. We know what appears to be a “simple” bunion deformity is a 4-dimensional deformity with transverse, sagittal, frontal plane, and length concerns. This is a combination of a bone and soft tissue pathologic condition, and both need to be considered. There are often biomechanical stresses imparted to the lesser metatarsal pha langeal joints and flexor/plantar plate injuries are common. (Source: Clinics in...
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Thomas J. Chang Source Type: research

Update on Fibro-Cartilaginous Disease
CLINICS IN PODIATRIC MEDICINE AND SURGERY (Source: Clinics in Podiatric Medicine and Surgery)
Source: Clinics in Podiatric Medicine and Surgery - June 16, 2022 Category: Podiatry Authors: Michael H. Theodoulou Source Type: research