Calcaneal fractures involving subtalar joint can be associated with prolonged and severe disability. Many different methods have been tried for the treatment in order to search for better results. From March 1983 to December 1985, 8 cases of calcaneal fractures involving subtalar joint were treated by open rcduction and internal fixation. and the results were as follows: 1. Satisfactory results were obtained from 7 cases out of 8. 2. Anatomic reduction was obtained by open reduction and internal fixation. 3. When medial approach failed, combined lateral and medial approaches gave better visualization of articular fecets and ensured anatomic reduction.
Subtalar Joint

PURPOSE: This study was performed to determine the involvement of joints by screws, inserted on the anterior process of the calcaneus, using cadaveric specimens. MATERIALS AND METHODS: An L-shaped lateral incision was performed on 32 embalmed feet (16 cadavers). An H-plate was applied on lateral wall of the calcaneus and it's anterior margin was located at 4 mm posterior to the lateral margin of the calcaneocuboidal joint. 3.5 mm cortical screws were inserted perpendicularly to the lateral calcaneal wall through the plate. Each calcaneus was dissected and taken out from the foot, and whether the tips of screws penetrated joints on the anterior process was evaluated. RESULTS: 11 (17.2%) of 64 screws, inserted on the anterior process, penetrated joints. Among them, seven screws involved the calcaneocuboidal joint and four screws penetrated the anterior facet of the subtalar joint. In two cases, both joints were penetrated by screws. CONCLUSION: This study shows that joint surfaces could be penetrated by screws inserted from the lateral surface on the anterior process of the calcaneus. Care should be given to selecting the length and insertional angle of screws. Intraoperative radiography would be needed to observe the articular surface on the anterior process, when screws were inserted to the anterior process close to the calcaneocuboidal joint.
Cadaver ; Calcaneus ; Foot ; Joints* ; Radiography ; Subtalar Joint

Inappropriate treatment for calcaneus fracture may result in malunion causing long-lasting pain and functional deficits. When such complications occur, the ideal principle of management is preserving congruence and motion of adjacent joints. For three patients with calcaneus fracture malunion, subtalar joint-preserving surgery using exostectomy and corrective osteotomy was performed, and satisfactory outcomes were achieved postoperatively.
Calcaneus ; Humans ; Joints ; Osteotomy* ; Subtalar Joint

Open reduction and internal fixation is currently considered as a gold standard of treatment in most of the intra-articular calcaneal fractures. Among various different approaches, extensile lateral approach is the most popular since it provides good exposure to the subtalar joint. However, wide skin incision followed by extensive soft tissue dissection leading to increased risk of wound breakdown is the most serious drawback. Sinus tarsi approach, a minimal invasive technique to approach the subtalar joint and reduce the intra-articular calcaneal fractures, provides good clinical outcome and less wound complications compared to the extensile lateral approach. This article introduces the surgical technique and review of the literature regarding the sinus tarsi approach.
Calcaneus ; Skin ; Subtalar Joint ; Wounds and Injuries

OBJECTIVE: To evaluate the influence of weight-bearing on foot shape measured by 3-D foot scanner. METHOD: Forty-two feet of twenty-one normal subjects were studied. The foot length, width, girth and arch parameters under non weight-bearing and weight-bearing conditions were measured by 3-D foot scanner (Nexcan(R), K & I, Korea), analysis software (EnFOOT(r), K & I, Korea) and 3-D foot arch measurement program. RESULTS: The foot length, ball width, ball girth, waist girth, instep girth, short heel girth, long heel girth and length from heel point to proximal arch point significantly increased under weight-bearing condition (p<0.01). However, vamp height, waist height, instep height, length of arch, height of arch, width of arch, length from heel point to distal arch point, maximal arch height and volume of arch were significantly decreased under 50% weight-bearing condition (p<0.01). CONCLUSION: Foot parameters associated with length, width and girth increased but volume, width, length, and height of medial longitudinal arch decreased under weight bearing condition. We suggest that these findings under weight- bearing condition result from the pronation of subtalar joint and the decrement of heights of transverse and longitudinal arch heights.
Foot* ; Heel ; Pronation ; Subtalar Joint ; Weight-Bearing*

PURPOSE: The study examined the fusion site and characteristics of the subtalar arthrodesis after intraarticular calcaneal fractures using computed tomography. MATERIALS AND METHODS: The clinical results and computed tomographic analysis of the fusion site were reviewed in 18 patients who were followed-up for a minimum of six months after undergoing subtalar arthrodesis due to traumatic arthritis caused by an intra-articular calcaneal fracture from December 2012 to April 2017. RESULTS: An evaluation of clinical results after subtalar arthrodesis revealed statistically significant improvements. In all cases, arthritis was found in the injured articular surface, which was displaced superolaterally from the initial primary fracture line of the calcaneus. Six months after arthrodesis, the subtalar fusion rate was 80.0% (16/20). Of these, 14 cases had a cannulated screw inserted in the uninjured site that is medial to the primary fracture line. Joint fusion was observed on the uninjured articular surface in 17 cases (85.0%). CONCLUSION: Joint fusion was initially achieved at the uninjured posterior facet after subtalar arthrodesis due to traumatic arthritis caused by a displaced intra-articular calcaneal fracture. This suggests that meticulous surgical techniques and cannulated screw positioning at the uninjured site will promote joint fusion.
Arthritis ; Arthrodesis ; Calcaneus ; Humans ; Joints ; Subtalar Joint

PURPOSE: The purpose of the present study was to define the factors that affect the treatment and clinical result of displaced calcaneal fracture with use of the pre- operative and final follow-up computed tomography scanning. MATERIALS AND METHODS: Present study included the 17 patients(18 feet) whom we performed surgery for displaced intra-articular calcaneal fracture at our institution between March 2000 and March 2002 and had a minimum follow-up of 12 months. For all patients, the Bohler's angle and posterior facet incongruity were measured with computed tomography pre- and post-operatively. The Creighton-Nebraska Health Foundation Assessment Scale for Fractures of the Calcaneus (CN scale) was used to evaluate the clinical results. RESULTS: Of all eighteen fractures, the clinical results were excellent in three (16.6%), good in six (33.3%), fair in six (33.3%), and poor in three (16.6%). The Bohler's angle averaged 21degrees, 15degrees, 27degrees, 25degrees at final follow-up in each above clinical result group. The step-off averaged 1.0, 1.6, 3.9 and 6.0 mm and the average range of motion of the subtalar joint at final follow-up were 85, 76, 60 and 45% of normal. CT evaluation showed intra-articular screws in the posterior subtalar joint in three (16.6%) of the eighteen fractures but their average clinical result was good (80.3 points). CONCLUSION: The restoration of the congruity and range of motion of posterior subtalar joint are considered important factor that affect clinical result.
Calcaneus ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Subtalar Joint

BACKGROUNDSubtalar joint (STJ) neutral position is the position typically used by clinicians to obtain a cast representation of a patient's foot before fabrication of biomechanical functional orthosis. But no method for measuring STJ neutral position has been proven accurate and reproducible by different testers. This study was conducted to investigate the STJ neutral position in normal feet in cadavers.

METHODSTwelve fresh-frozen specimens of amputated lower legs were used. Pressure-sensitive films were inserted into the anterior and posterior articulation of STJ. The contact areas for various foot positions and under axial loads of 600 N were determined based on the gray level of the digitized film. The STJ neutral positions were determined as the ankle-foot position where the maximum contact area was achieved, because the neutral position of a joint was defined as the position where the concave and convex surfaces were completely congruous.

RESULTSIn ankle-foot neutral position, the contact area of STJ was (2.79 +/- 0.24) cm(2). In the range of motion of adduction-abduction (ADD-ABD), the maximum contact area was (3.00 +/- 0.26) cm(2) when the foot was positioned 10 degrees of ABD (F = 221.361, P < 0.05). In the range of motion of dorsiflexion-plantarflexion (DF-PF), the maximum contact area was (3.61 +/- 0.25) cm(2) when the foot was positioned 20 degrees of DF (F = 121.067, P < 0.05). In the range of motion of inversion-eversion (INV-EV), the maximum contact area was (3.14 +/- 0.26) cm(2) when the foot was positioned 10 degrees of EV (F = 256.252, P < 0.05).

CONCLUSIONSJoints, such as STJ, therefore, are not necessarily in neutral position when the ankle-foot is placed in the traditional concept of neutral position. The results demonstrate that the most approximate STJ neutral position was in the foot position of 10 degrees of abduction, 20 degrees of dorsiflexion and 10 degrees of eversion.

Osteochondroma, which is an osteocartilaginous exostosis, is essentially the most common primary bone tumor. These benign neoplasms are generally asymptomatic and have a relatively small potential for adverse effects. Calcaneal osteochondroma is rare, furthermore osteochondroma accompanying with gouty arthritis is very rare. Also, the subtalar joint is not a classic site of acute gout. In this report, we report the case of a patient who experienced an unusual calcaneal osteochondroma with undiagnosed gouty arthritis of the subtalar joint.
Arthritis, Gouty ; Calcaneus ; Gout ; Humans ; Osteochondroma ; Subtalar Joint

In closed calcaneus fractures, the occurrence of FHL interposition in subtalar joint is relatively rare and difficult to diagnosis preoperatively. But careful physical examination and significant radiologic findings could be useful tools to diagnosis preoperatively. This findings is shearing off a superior medial fragment made up of the sustentaculum talus connected to a significant portion of the medial wall and medial aticular surface of the posterior facet.
Calcaneus* ; Diagnosis ; Physical Examination ; Subtalar Joint ; Talus ; Tendons*