The Subtalar Joint: It Is More Complicated Than You Think
Understanding the subtalar joint is extremely important in order to grasp the complexity of the foot. The anatomy and biomechanics are crucial to the function of the hindfoot, ankle, midfoot, and even forefoot. This issue provides expertise in areas ranging from anatomy, radiology, biomechanics, congenital and acquired conditions, and treatment options of the subtalar joint. Proper history and physical examination, along with imaging, are important to diagnose and appropriately treat the patient. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 22, 2015 Category: Orthopaedics Authors: J. Kent Ellington Tags: Preface Source Type: research
Subtalar Coalition in Pediatrics
Subtalar tarsal coalition is an autosomal dominant developmental maldeformation that affects between 2% and 13% of the population. The most common locations are between the calcaneus and navicular and between the talus and calcaneus. If prolonged attempts at nonoperative management do not relieve the pain, surgery is indicated. The exact surgical technique(s) should be based on the location of the pain, the size and histology of the coalition, the health of the other joints and facets, the degree of foot deformity, and the excursion of the heel cord. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 18, 2015 Category: Orthopaedics Authors: Vincent S. Mosca Source Type: research
Subtalar instability is a common clinical entity. Clinicians should have a high index of suspicion of this diagnosis in patients who have been diagnosed with chronic lateral ankle instability but have failed standard management and have continued pain in the sinus tarsi. As with ankle instability, nonoperative management is the initial mainstay of treatment. Operative management includes ligamentous reconstruction of key lateral stabilizers of the subtalar joint. Future research on this subject should be focused at improving diagnosis and recognition of this entity. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 18, 2015 Category: Orthopaedics Authors: Michael Aynardi, David I. Pedowitz, Steven M. Raikin Source Type: research
The Spectrum of Indications for Subtalar Joint Arthrodesis
This article reports on several cases of subtalar joint fusion. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 11, 2015 Category: Orthopaedics Authors: Ettore Vulcano, J. Kent Ellington, Mark S. Myerson Source Type: research
Subtalar Joint Arthrodesis
Arthrodesis of the subtalar joint can be performed via both open and arthroscopic techniques. Both groups of procedures have their own relative indications and contraindications, as well as complications. Good results have been reported for both general procedures, although some studies suggest superiority with arthroscopic subtalar arthrodesis. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 11, 2015 Category: Orthopaedics Authors: Brent Roster, Christopher Kreulen, Eric Giza Source Type: research
Subtalar Coalitions in the Adult
Tarsal coalitions, while relatively uncommon, are typically identified in adult patients during an evaluation for ankle instability, sinus tarsus pain, and/or pes planovalgus. The true incidence of tarsal coalition is unknown with estimates ranging from 1% to 12% of the overall population. The most common area of involvement of the subtalar joint is the middle facet, and heightened awareness should be present in adult patients with limited motion of the subtalar joint. Standard radiographic imaging, to include a Harris heel view, is recommended initially, although computerized tomography scan and MRI are often necessary to...
Source: Foot and Ankle Clinics - April 11, 2015 Category: Orthopaedics Authors: James F. Flynn, Dane K. Wukich, Stephen F. Conti, Carl T. Hasselman, Macalus V. Hogan, Alex J. Kline Source Type: research
Distraction Subtalar Arthrodesis
There is a high potential for disability following calcaneal fracture. This potential exists whether a patient is treated with conservative or operative management. Subfibular impingement and irritation of the peroneal tendon and sural nerve may also be present. Posttraumatic arthritis of the subtalar joint can occur. In patients with symptomatic calcaneal malunion, systematic evaluation is required to determine the source of pain. Nonsurgical treatment may be effective. One surgical treatment option is subtalar distraction arthrodesis. High rates of successful arthrodesis and patient satisfaction have been reported with t...
Source: Foot and Ankle Clinics - April 10, 2015 Category: Orthopaedics Authors: J. Benjamin Jackson, Lance Jacobson, Rahul Banerjee, Florian Nickisch Source Type: research
Imaging of the Subtalar Joint
This article reviews the anatomy and common anatomic variants as seen with different imaging techniques. Although radiography remains the initial mode of imaging, computed tomography and MRI are frequently needed to better delineate the joint anatomy and improve the sensitivity and the specificity of detection of joint pathology. A short review of arthrographic techniques and various examples of imaging of common pathology involving this joint are also included. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - April 4, 2015 Category: Orthopaedics Authors: Robert Lopez-Ben Source Type: research
Medial Approach to the Subtalar Joint
The medial approach to the subtalar joint allows good visualization of the articular surfaces. Compared with the lateral approach, advantages are found particularly in flatfoot correction, in which the single-incision technique can be used for corrective fusions of rigid flatfoot deformity. Union rates are comparable with the traditional lateral approach; however, wound healing problems occur less frequently. Avascular necrosis of the talus is a rare but serious complication, although frequency seems to be independent of the approach chosen. Clinical studies showed no increased morbidity when comparing the medial to the la...
Source: Foot and Ankle Clinics - March 30, 2015 Category: Orthopaedics Authors: Markus Knupp, Lukas Zwicky, Tamara Horn Lang, Julian Röhm, Beat Hintermann Source Type: research
Subtalar dislocations make up 1-2% of all dislocations, about 75% of them being medial dislocations. Treatment consists of early reduction under adequate sedation. In cases of soft tissue interposition or locked dislocations, open reduction is warranted. More than 60% of subtalar dislocations are associated with additional fractures, therefore a postreduction CT is recommended. Complications include avascular necrosis of the talus, infection, posttraumatic arthritis, chronic subtalar instability, and complex regional pain syndrome with delayed reduction. The prognosis of purely ligamentous injuries is excellent after early...
Source: Foot and Ankle Clinics - March 30, 2015 Category: Orthopaedics Authors: Stefan Rammelt, Jens Goronzy Source Type: research
This article reviews various endoscopic techniques for the treatment of equinus contracture, Achilles rupture, Haglund's deformity, and noninsertional Achilles tendinopathy. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 28, 2015 Category: Orthopaedics Authors: Dominic Carreira, Alicia Ballard Source Type: research
Arthroscopic Ankle Arthrodesis
Arthroscopic ankle arthrodesis is a good option for the treatment of end-stage ankle arthritis. The surgical technique involving the use of a standard 4.5-mm arthroscope is described. Standard anteromedial and anterolateral portals are used. Joint surfaces except the lateral gutter are prepared to point bleeding with motorized burr, abraider, and curettes. Rigid fixation is achieved with cannulated screws. The postoperative regime includes 12 weeks protection, staged from non–weight bearing through partial to full weight bearing. Advantages compared with the open procedure include shorter hospital stay and short...
Source: Foot and Ankle Clinics - February 28, 2015 Category: Orthopaedics Authors: Anna O. Elmlund, Ian G. Winson Source Type: research
Arthroscopy and Endoscopy
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 28, 2015 Category: Orthopaedics Authors: Rebecca A. Cerrato Source Type: research
Opinions differ regarding the surgical treatment of posterior calcaneal exostosis. After failure of conservative treatment, open surgical bursectomy and resection of the calcaneal prominence is indicated by many investigators. Clinical studies have shown high rates of unsatisfactory results and complications. Endoscopic calcaneoplasty (ECP) is a minimally invasive surgical option that can avoid some of these obstacles. ECP is an effective procedure for the treatment of patients with posterior calcaneal exostosis. The endoscopic exposure is superior to the open technique and has less morbidity, less operating time, fewer co...
Source: Foot and Ankle Clinics - December 30, 2014 Category: Orthopaedics Authors: Joerg Jerosch Source Type: research
Hallux Metatarsophalangeal Arthroscopy
With mounting attention focused on decreasing postsurgical pain and dysfunction, emphasis has been placed on approaching disorders using minimally invasive techniques. Surgical procedures of the hallux, such as hallux valgus correction, have earned the reputation for high postsurgical pain and prolonged recovery. Arthroscopic hallux procedures have the advantages of minimizing pain, swelling, and disability. Certain conditions, such as synovitis, loose bodies, and early-grade hallux rigidus, are better addressed arthroscopically. With the correct indications, hallux metatarsophalangeal arthroscopy can be a valuable tool fo...
Source: Foot and Ankle Clinics - December 29, 2014 Category: Orthopaedics Authors: Alberto Siclari, Marco Piras Source Type: research
Current Techniques and Future Direction
Arthroscopy of the foot and ankle has evolved from simply a diagnostic tool to a versatile treatment modality for a variety of pathologic abnormalities. With the reputation of prolonged swelling and higher wound complication risks, the benefits of performing these foot and ankle procedures through a minimally invasive approach is evident. In addition, advancements in small joint arthroscopes and instrumentation have provided surgeons the tools to effectively expand their indications. This issue of Foot and Ankle Clinics of North America presents various arthroscopic techniques and their results, reviewing established surgi...
Source: Foot and Ankle Clinics - December 16, 2014 Category: Orthopaedics Authors: Rebecca A. Cerrato Tags: Preface Source Type: research
Anterior Ankle Arthroscopy
Anterior ankle arthroscopy is a useful, minimally invasive technique for diagnosing and treating ankle conditions. Arthroscopic treatment offers the benefit of decreased surgical morbidity, less postoperative pain, and earlier return to activities. Indications for anterior ankle arthroscopy continue to expand, including ankle instability, impingement, management of osteochondritis dissecans, synovectomy, and loose body removal. Anterior ankle arthroscopy has its own set of inherent risks and complications. Surgeons can decrease the risk of complications through mastery of ankle anatomy and biomechanics, and by careful preo...
Source: Foot and Ankle Clinics - December 15, 2014 Category: Orthopaedics Authors: David M. Epstein, Brandee S. Black, Seth L. Sherman Source Type: research
Ankle Instability and Arthroscopic Lateral Ligament Repair
Over the last 50 years, the surgical management of chronic lateral ankle ligament insufficiency has focused on 2 main categories: local soft-tissue reconstruction and tendon grafts/transfer procedures. There is an increasing interest in the arthroscopic solutions for chronic instability of the ankle. Recent biomechanical studies suggest the at least one of the arthroscopic techniques can provide equivalent results to current open local soft-tissue reconstruction (such as the modified Brostrom technique). Arthroscopic lateral ankle ligament reconstruction is becoming an increasingly acceptable method for the surgical m...
Source: Foot and Ankle Clinics - December 15, 2014 Category: Orthopaedics Authors: Jorge I. Acevedo, Peter Mangone Source Type: research
Hindfoot Endoscopy for Posterior Ankle Impingement Syndrome and Flexor Hallucis Longus Tendon Disorders
Hindfoot endoscopic surgery is an alternative to conventional open surgery for treatment of posterior ankle pain. This procedure can be applied not only for accurate diagnosis under direct visualization but also for low-invasive therapy. Common indications for hindfoot endoscopy are posterior ankle impingement syndrome and damaged soft tissue. Several studies have reported good clinical outcomes of hindfoot endoscopy with lower complication rates than in the conventional open procedure. Nerve injury remains a common complication. To avoid such injury, make a posterolateral portal just lateral to the Achilles tendon and per...
Source: Foot and Ankle Clinics - December 15, 2014 Category: Orthopaedics Authors: Wataru Miyamoto, Masato Takao, Takashi Matsushita Source Type: research
Endoscopic Coalition Resection
This article describes indications, preoperative planning, surgical techniques, and results of arthroscopic/endoscopic CNC and TCC resection. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 15, 2014 Category: Orthopaedics Authors: Davide Edoardo Bonasia, Phinit Phisitkul, Annunziato Amendola Source Type: research
Small Joint Arthroscopy in Foot and Ankle
This article reviews the clinical indications, technical details, outcomes, and potential complications of small joint arthroscopies of the foot. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 15, 2014 Category: Orthopaedics Authors: Tun Hing Lui, Chi Pan Yuen Source Type: research
Peroneal tendoscopy is indicated for peroneal tenosynovitis, subluxation or dislocation, snapping, partial tears requiring debridement, and postoperative adhesions and scarring. Peroneal tendoscopy was also found to be valuable as a diagnostic tool in some instances. It is generally reported to have good to excellent outcomes in most patients with a relatively low occurrence of complications. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 15, 2014 Category: Orthopaedics Authors: Tun Hing Lui, Lung Fung Tse Source Type: research
Posterior Tibial Tendoscopy
This article focuses on PTT tendoscopy and tries to provide an understanding of the pathomechanics of the tendon, indications for surgery, surgical technique, advantages, complications, and limitations of this procedure. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 13, 2014 Category: Orthopaedics Authors: Manuel Monteagudo, Ernesto Maceira Source Type: research
This article reviews the clinical indications, surgical techniques, and outcomes of subtalar arthroscopy. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 13, 2014 Category: Orthopaedics Authors: Gerardo Muñoz, Sergio Eckholt Source Type: research
The Grand Rapids Arch Collapse classifications create a novel system for categorizing and correlating numerous common foot and ankle conditions related to a falling arch. The algorithm for treating these conditions is exceptionally replicable and has excellent outcomes. Gastrocnemius equinus diagnosis plays a crucial role in the pathology of arch collapse. A contracture of the gastrocnemius muscle is increasingly recognized as the cause of several foot and ankle conditions. The authors have expanded their indications for gastrocnemius recession to include arch pain without radiographic abnormality, calcaneus apophysitis, p...
Source: Foot and Ankle Clinics - November 26, 2014 Category: Orthopaedics Authors: John G. Anderson, Donald R. Bohay, Erik B. Eller, Bryan L. Witt Source Type: research
It is remarkable how our thinking has changed over the past few decades regarding the influence of the gastrocnemius on foot and ankle pathology. While the debate still continues and skepticism remains, it is quite clear to many surgeons that contracture of the gastrocnemius has a role in the development of clinical pathology of the foot. I too was a “nonbeliever” up until recently. Gastrocnemius recession? You have to be kidding me. This was my attitude two decades ago. My understanding of the role of the gastrocnemius in the pathogenesis of various foot problems was so limited, albeit naïve. (Source...
Source: Foot and Ankle Clinics - November 26, 2014 Category: Orthopaedics Authors: Mark S. Myerson Source Type: research
In Memory of Pau Golanó 1964-2014
Pau Golanó was an anatomist by profession and a gifted artist in his chosen field. He was an amazing individual whose work will be a resource for surgeons for decades to come. His work was always done to perfection and is exemplified in this issue with his profound insight into the gastrocnemius complex. I have asked his coauthors to write a dedication in Spanish, which I have not translated so as to maintain the sentiment expressed by his friends and coworkers. An additional dedication has been provided by Professor C. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 26, 2014 Category: Orthopaedics Authors: Mark S. Myerson Tags: Dedication Source Type: research
The Use of Ultrasound to Isolate the Gastrocnemius-Soleus Junction Prior to Gastrocnemius Recession
Gastrocnemius recession has become a popular procedure to release isolated gastrocnemius tightness. Using visual anatomic landmarks alone to plan the incision can be deceiving. The use of ultrasound preoperatively has been highly reproducible in isolating the gastrocnemius-soleus junction in the authors' practice. This provides confidence for incision placement, a smaller incision, and isolated release of the gastrocnemius fascia while leaving the underlying soleus undisturbed. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 7, 2014 Category: Orthopaedics Authors: Eugene P. Toomey, Nicholas R. Seibert Source Type: research
In memoriam Pau Golanó (1965–2014)—Anatomist, Scientist, Artist, Teacher, and Friend
It was a Saturday in April 2004. At 4.00 am, at the Luz de Gas discotheque, we were celebrating our successful 2-day dissection course for my residents. We talked about life. “I will not get old,” he said. And he looked serious, “another 10 years.” Then, we laughed and took another beer. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 7, 2014 Category: Orthopaedics Authors: C. Niek van Dijk, Angel Calvo, Stefano Zaffagnini Tags: Dedication Source Type: research
Technique, Indications, and Results of Proximal Medial Gastrocnemius Lengthening
Gastrocnemius proximal lengthening was first performed to correct spasticity in children, and was adapted for the patient with no neuromuscular condition in the late 1990s. Since then, the proximal gastrocnemius release has become less invasive and has evolved to include only the fascia overlying the medial head of the gastrocnemius muscle. The indications for performing this procedure are a clinically demonstrable gastrocnemius contracture that influences a variety of clinical conditions in the forefoot, hindfoot, and ankle. It is a safe and easy procedure that can be performed bilaterally simultaneously, and does not req...
Source: Foot and Ankle Clinics - October 4, 2014 Category: Orthopaedics Authors: Pierre Barouk Source Type: research
Gastrocnemius Shortening and Heel Pain
Pain and reduced function caused by disorders of either the plantar fascia or the Achilles tendon are common. Although heel pain is not a major public health problem it affects millions of people each year. For most patients, time and first-line treatments allow symptoms to resolve. A proportion of patients have resistant symptoms. Managing these recalcitrant cases is a challenge. Gastrocnemius contracture produces increased strain in both the Achilles tendon and the plantar fascia. This biomechanical feature must be properly assessed otherwise treatment is compromised. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 2, 2014 Category: Orthopaedics Authors: Matthew C. Solan, Andrew Carne, Mark S. Davies Source Type: research
The Effect of Gastrocnemius Tightness on the Pathogenesis of Juvenile Hallux Valgus
This article describes an oblique windlass mechanism that can be a causative or a contributory factor in the pathogenesis of juvenile hallux valgus. This article presents a study of 108 patients who underwent a proximal gastrocnemius release and hallux valgus correction using a scarf osteotomy. We believe that assessment of gastrocnemius tightness in juvenile hallux valgus is important and that gastrocnemius lengthening should be routinely considered as part of the operative strategy. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 1, 2014 Category: Orthopaedics Authors: Louis Samuel Barouk Source Type: research
Introduction to Gastrocnemius Tightness
Looking for a retraction of the gastrocnemius should be an essential part of the foot and ankle examination for practitioners, not just surgeons. Even though the equinus has been recognized for 50 years as having an influence on the foot, only a few practitioners routinely search for it. The proportion of gastrocnemius tightness is high in the normal population, but it is significantly higher in populations that have foot and ankle problems. Why do we have short gastrocs? The evolution of the human race, especially walking at a certain pace and extending the knee, is probably one of the explanations. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 1, 2014 Category: Orthopaedics Authors: Pierre Barouk Tags: Preface Source Type: research
Recientemente, nuestro amigo y maestro Pau Golanó se nos fué para siempre y sin avisar. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 1, 2014 Category: Orthopaedics Authors: Jordi Vega Source Type: research
Anatomy of the Triceps Surae
This article describes and discusses the general anatomy of the triceps surae and the surgical anatomy of the gastrocnemius. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 30, 2014 Category: Orthopaedics Authors: Miquel Dalmau-Pastor, Betlem Fargues-Polo, Daniel Casanova-Martínez, Jordi Vega, Pau Golanó Source Type: research
Functional Hallux Rigidus and the Achilles-Calcaneus-Plantar System
Functional hallux rigidus is a clinical condition in which the mobility of the first metatarsophalangeal joint is normal under non-weight-bearing conditions, but its dorsiflexion is blocked when first metatarsal is made to support weight. In mechanical terms, functional hallux rigidus implies a pattern of interfacial contact through rolling, whereas in a normal joint contact by gliding is established. Patients with functional hallux rigidus should only be operated on if the pain or disability makes it necessary. Gastrocnemius release is a beneficial procedure in most patients. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 27, 2014 Category: Orthopaedics Authors: Ernesto Maceira, Manuel Monteagudo Source Type: research
A silent gastrocnemius contracture can gradually do so much harm when left undetected and unattended. The calf is a common source of a majority of acquired, nontraumatic adult foot and ankle problems. When it comes to surgical lengthening procedures, whether at the Achilles, at the musculotendinous junction, or more proximal, the search must move on to find the safest, most accurate, and quickest recovery method possible. Addressing the calf contracture as definitive treatment and, better yet, as prevention will no doubt become a mainstay of the treatment of many foot and ankle problems. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 25, 2014 Category: Orthopaedics Authors: James Amis Source Type: research
Clinical Diagnosis of Gastrocnemius Tightness
The diagnosis of gastrocnemius tightness is primarily clinical using the Silfverskiold test, which shows an equinus deformity at the ankle with the knee extended but that disappears with the knee flexed. The manner in which the Silfverskiold test is performed must be consistent with respect to the applied strength of the maneuver, correction of a flexible hindfoot valgus deformity while performing the test, and reproducibility. Although this is a diagnosis based on the clinical examination, this article presents additional clinical signs that can help to make the diagnosis when the retraction is not clinically evident. The...
Source: Foot and Ankle Clinics - September 25, 2014 Category: Orthopaedics Authors: Pierre Barouk, Louis Samuel Barouk Source Type: research
The Effect of the Gastrocnemius on the Plantar Fascia
This article summarizes past and current literature linking these 2 structures and gives a mechanical explanation based on functional models of the relationship between gastrocnemius tightness and plantar fascia. The effect of gastrocnemius tightness on the sagittal behavior of the foot is also discussed. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 25, 2014 Category: Orthopaedics Authors: Javier Pascual Huerta Source Type: research
Effects of Gastrocnemius Tightness on Forefoot During Gait
This article discusses these properties combining the major biomechanical topics of anatomy, dynamics, kinetics, and electromyography. This muscle is remarkable in that it has very low energy consumption and very high mechanical efficacy. In addition to the biomechanical features, the consequences of its tightness are discussed. The dysfunction also appears in all the biomechanical topics and clarifies the reasons of the location of symptoms in the midfoot and on the plantar aspect of the forefoot. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 20, 2014 Category: Orthopaedics Authors: Cyrille Cazeau, Yves Stiglitz Source Type: research
Surgical Techniques of Gastrocnemius Lengthening
This article summarizes the various alternatives for direct gastrocnemius lengthening and elucidates the relative strengths and tradeoffs of each as a means of providing balanced perspective in selecting the appropriate procedure for any given patient. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 20, 2014 Category: Orthopaedics Authors: Raymond Y. Hsu, Scott VanValkenburg, Altug Tanriover, Christopher W. DiGiovanni Source Type: research