OBJECTIVE: To investigate the effectiveness of spring ligament repair combined with subtalar arthroereisis (STA) and the Kidner procedure for treating children's flexible flatfoot with painful accessory navicular. METHODS: A retrospective analysis was conducted on clinical data from 45 children (45 feet) aged 7-14 years with flexible flatfoot and painful accessory navicular who met the selection criteria and were treated between February 2018 and May 2022. Among them, 23 cases (23 feet) were treated with spring ligament repair combined with STA and Kidner procedure (observation group), while 22 cases (22 feet) received STA with Kidner procedure alone (control group). Comparison of baseline data between the two groups including gender, age, affected side, preoperative visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, talonavicular coverage angle (TCA), talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle) showed no significant differences ( P>0.05). The following parameters were recorded and compared between the two groups: operation time, intraoperative blood loss, incision length, hospital stay, time to full weight-bearing, and complication rates. Foot pain and functional recovery were assessed using the VAS score and AOFAS score preoperatively and at last follow-up. Radiographic measurements including TCA, T1MT, T2MT, Meary angle, and Pitch angle were analyzed by comparing preoperative to last follow-up values. RESULTS: Both groups of patients successfully completed the surgery without any procedure-related complications such as vascular, neural, or tendon injury. The operation time in the observation group was significantly longer than that in the control group ( P<0.05). There was no significant difference between the two groups in terms of intraoperative blood loss, incision length, hospital stay, or time to full weight-bearing ( P>0.05). All patients were followed up 23-47 months (mean, 33.7 months). In the control group, 1 patient experienced discomfort during walking, attributed to screw irritation in the sinus tarsi, which resolved after 2-3 months of rehabilitation. None of the remaining patients developed complications such as sinus tarsi screw loosening, peroneal tendon contracture, or wound infection. At last follow-up, the observation group showed significantly better improvements in radiographic parameters (TCA, T1MT, T2MT, Meary angle, Pitch angle) and greater reductions in VAS and AOFAS scores compared to the control group ( P<0.05). CONCLUSION The combined procedure of spring ligament repair, STA, and Kidner procedure for children's flexible flatfoot with painful accessory navicular demonstrates significant improvements in foot appearance, arch collapse correction, and pain relief. This technique offers technical simplicity, minimal intraoperative complications, and satisfactory clinical outcomes.
Humans ; Flatfoot/surgery* ; Child ; Retrospective Studies ; Adolescent ; Male ; Female ; Treatment Outcome ; Tarsal Bones/abnormalities* ; Subtalar Joint/surgery* ; Ligaments, Articular/surgery* ; Orthopedic Procedures/methods* ; Foot Diseases

OBJECTIVE: To evaluate the mid-term efficacy of talonavicular joint fusion alone combined with navicular stress adjustment in Müller-Weiss disease with significant paradoxical flatfoot deformity. METHODS: Between January 2016 and March 2021, a total of 13 patients diagnosed with Müller-Weiss disease underwent simple talonavicular joint fusion combined with navicular stress adjustmentadjustment.Among them, 5 patients were male and 8 patients were female;age ranged from 42 to 67 years old. The duration of the disease ranged from 8 to 20 years. According to Maceira staging system, 5 patients were in stage III and 8 patients were in stage IV. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS), and foot length were evaluated preoperatively and 10 months postoperatively. Additionally, the talonavicular coverage angle, the talus-first metatarsal angle, and the calcaneal inclination angle were assessed preoperatively and 6 months postoperatively. RESULTS: All 13 patients were followed up a period ranging from 24 to 40 months. All patients achieved clinical healing within a period of 3 to 6 months. However, one patient experienced a screw fracture. The VAS decreased from a range of 3 to 7 points preoperatively to a range of 0 to 2 points at the 10 months postoperative. The AOFAS midfoot score improved from a preoperative range of 12 to 66 points to a range of 72 to 100 points at the 10 months postoperative. Based on the AOFAS midfoot score evaluated at 10 months postoperatively, the outcomes were rated as excellent in 3 feet, good in 6 feet, and fair in 4 feet. The talo-navicular coverage angle, the preoperative talus-first metatarsal angle, calcaneal inclination angle were 14.3° to 33.4°, -4.6° to -19.6°, and 3.0°to 16.4° respectively. Six months postoperatively, these angles improved to 2.7°to 9.6°, -8.4°to 1.1°, and 18.8°to 24.9°respectively. Additionally, the foot length increased by 0 to 6 mm at 10 months post-surgery. CONCLUSION Simple talonavicular arthrodesis combined with scaphoid stress adjustment has satisfactory clinical efficacy in Müller-Weiss disease in terms of deformity, foot length, foot function and pain.
Humans ; Male ; Female ; Adult ; Middle Aged ; Arthrodesis/methods* ; Aged ; Flatfoot/physiopathology* ; Tarsal Bones/physiopathology* ; Tarsal Joints/surgery* ; Treatment Outcome

OBJECTIVE: To establish foot and ankle models of different lateral collateral ligament injuries of ankle joint, and conduct finite element analysis on, and to explore the force conditions of subtalar articular cartilage during foot inversion movements under different gait stages and under different loads. METHODS: A normal ankle CT scan of a 30-year-old male healthy volunteer (heighted 175 cm and weighted 60 kg) was selected. The CT images were imported into software such as Mimics 21.0, Geomajic 2017, and Solidworks 2017 respectively, extract the normal ankle bone model. Then, the foot and ankle finite element models of different lateral collateral ligament injuries of ankle joint were constructed and divided into anterior talofibular ligament(ATFL) rupture group, ATFL and calcaneo fibular ligament (CFL) rupture group, ATFL, CFL and posterior talofibular ligament (PTFL) rupture group, and control group with intact ligament function by ANSYS 2021. Corresponding horizontal and vertical loads and torques were applied respectively on tibia and talus according to the force conditions of different phases to simulate landing phase, neutral and off-ground phase in walking gait. The changes in stress distribution area and stress peak of subtalar articular cartilage in the loading phase, neutral phase and off-ground phase gaits among four groups were observed. Simulate varus sprain action, apply different loads of 600, 1, 800, and 4, 200 N respectively, and changes in stress distribution area and the stress peak of subtalar articular cartilage among four groups of models were observed. RESULTS: In the gait simulation, the stress results of loading phase in ATFL fracture group, ATFL and CFL fracture groups, ATFL, CFL and PTFL fracture groups, and control group were 0.889 54, 0.960 89, 1.139 20, and 0.722 64 MPa, respectively. The neutral response force results were 1.250 60, 1.358 50, 1.363 70, 1.246 40 MPa respectively;the results of corresponding forces off-ground phase were 1.029 90, 1.138 70, 1.145 90 and 0.832 40 MPa respectively. In the inversion simulation, the stresses of ATFL fracture group, ATFL and CFL fracture groups, ATFL, CFL and PTFL fracture groups, and control group under load of 600 N were 2.191 3, 2.208 5, 2.215 7, and 2.156 6 MPa respectively. The stresses under a load of 1 800 N were 7.134 7, 9.715 2, 10.064 0, and 7.107 0 MPa respectively;the stresses under a load of 4 200 N were 17.435 0, 25.309 0, 26.119 0 and 16.010 0 MPa respectively. CONCLUSION The lateral collateral ligament of ankle joint plays an important role in the stability of the subtalar joint, especially CFL plays an important role in restricting calcaneal varus. If these ligaments are damaged, it will cause instability of the subtalar joint and further lead to lesions in the subtalar articular cartilage. Relevant exercises should be reduced or the ligament injuries should be treated in a timely manner.
Humans ; Finite Element Analysis ; Male ; Adult ; Cartilage, Articular/physiopathology* ; Ankle Injuries/physiopathology* ; Ankle Joint/physiopathology* ; Biomechanical Phenomena ; Subtalar Joint/injuries* ; Tomography, X-Ray Computed

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.
Adult ; Humans ; Child ; Flatfoot/surgery* ; Orthopedic Procedures/methods* ; Absorbable Implants ; Subtalar Joint/surgery* ; Heel/surgery* ; Pain/surgery*

OBJECTIVE: To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease. METHODS: The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone. RESULTS: Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue. CONCLUSION Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.
Adult ; Aged ; Bone Diseases/diagnostic imaging* ; Cartilage Diseases ; Female ; Foot Diseases/diagnostic imaging* ; Humans ; Hyperplasia/pathology* ; Male ; Middle Aged ; Talus/pathology* ; Tarsal Bones/surgery* ; Tarsal Joints

OBJECTIVE: To explore clinical effect of early incision and decompression combined with screw fixation in treating Lisfranc injury and foot osteofascial compartment syndrome. METHODS: Clinical data of 5 patients with Lisfranc injury and foot osteofascial compartment syndrome were retrospective analysized from January 2017 to December 2018, including 4 males and 1 female, aged from 19 to 62 years old. All patients were suffered from closed injuries. The time from injury to treatment ranged from 1 to 14 h. According to Myerson classification, 1 patient was type A, 1 patient was type B, and 3 patients were type C. All patients were performed early incision decompression and screw fixation. Maryland foot functional scoring standard at 12 months after opertaion was used to evaluate clinical effect. RESULTS: All patients were followed up for 10 to 48 months. All fractures were achieved bone union, and healing time ranged from 3 to 9 months. All metatarsal and tarsal joints were reached to anatomical reduction. No infection, osteomyelitis, loosening or breaking of internal fixation occurred. Postopertaive Maryland foot function score at 12 months was from 44 to 97, and 2 patients got excellent result, 2 good, and 1 poor. CONCLUSION Early incision and decompression with screw fixation for the treatment of Lisfranc injury and foot osteofascial compartment syndrome, which has advantages of simple opertaion, thoroughly decompression, screw fixation does not occupy space, stable decompression and fixation, and could receive satisfied clinical effect.
Adult ; Bone Screws ; Compartment Syndromes/surgery* ; Decompression ; Female ; Foot Injuries ; Fracture Fixation, Internal ; Fractures, Bone/surgery* ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tarsal Joints ; Treatment Outcome ; Young Adult

Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations, commonly caused by high-energy mechanisms, which include falls from height, motor vehicle crashes, and twisting leg injuries. The dislocations are divided into medial, lateral, anterior, and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus. The most common type is medial dislocation resulted from inversion injury. Subtalar dislocation may accompany with other fractures. Physical examination must be performed carefully to assess for neurovascular compromise. Most of the subtalar dislocations can be treated with closed reduction under sedation. If this is not possible, open reduction without further delay should be conducted. After primary treatment, X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures. We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football. The patient was successfully treated by closed reduction, and a good alignment was observed at the last follow-up. The pathogenesis and treatment method of this case were analyzed, and the related literature were reviewed, which provided a reference for future clinical treatment.
Adult ; Closed Fracture Reduction/methods* ; Follow-Up Studies ; Football/injuries* ; Humans ; Joint Dislocations/surgery* ; Male ; Subtalar Joint/injuries* ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To investigate short-term clinical efficacy of open reduction and percutaneous Kirschner wire fixation for Chopart joint dislocation. METHODS: From August 2014 to August 2017, 13 patients with Chopart joint dislocation were treated by open reduction and percutaneous Kirschner wire fixation, including 7 males and 6 female aged from 13 to 58 years old. American Orthopaedic Foot and Ankle Society(AOFAS)criteria system and visual analogue scale (VAS) were applied to evaluate function of foot and ankle at 12 months after operation. RESULTS: All patients were followed up from 8 to 24 months. AOFAS score at 12 months after operation ranged from 65 to 99; 8 cases got excellent results, 4 good and 1 moderate. VAS score ranged from 0 to 4. All wounds were primary healed from 12 to 16 days, and no skin necrosis, infection, Kirschner broken, or other complications occurred. One patient occurred Kirschner's wire loosening at 4 weeks after operation. CONCLUSIONS Open reduction and percutaneous Kirschner wire fixation for Chopart joint dislocation could relieve pain and improve functional activities and obtain satisfactory short-term clinical results.
Adolescent ; Adult ; Bone Wires ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Tarsal Joints ; Treatment Outcome ; Young Adult

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: This study evaluated the radiologic and clinical results in patients who underwent minimal invasive surgery using sinus tarsi approach in Sanders type IV calcaneal fracture. MATERIALS AND METHODS: This retrospective study evaluated 13 cases of Sanders type IV calcaneus fractures that were treated by minimal invasive surgery using the sinus tarsi approach from July 2012 to April 2017. Further, these cases could be followed up for more than 12 months. Bone union, radiologic parameters such as Böhler's angle, Gissane's angle, calcaneal height, length, and width, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the postoperative complications were evaluated. RESULTS: Bony union was achieved in all the cases at the final follow up, and the mean union time was 5.5 months. One patient underwent reoperation for a surgical site infection, six patients had post traumatic arthritis, and two of them underwent subtalar joint fusion. The mean AOFAS ankle-hindfoot score was 81.2. At the final follow-up, the mean values of Böhler's angle and Gissane's angle were 20° and 119.8°, respectively, and the mean values of the calcaneus height, length, and width were 46.8 mm, 81.8 mm, and 45.6 mm, respectively. CONCLUSION: Minimal invasive surgery using the sinus tarsi approach for Sanders type IV calcaneal fracture resulted in satisfactory anatomic reduction and stable fixation, and satisfactory clinical and radiologic results were obtained in most of the patients. Minimal invasive surgery is thought to reduce the soft tissue-related complications as compared to surgery using the extensile lateral approach.
Ankle ; Arthritis ; Calcaneus ; Follow-Up Studies ; Foot ; Humans ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Subtalar Joint ; Surgical Wound Infection