OBJECTIVE: To explore the morphological characteristics of the postero-superior protuberance of the calcaneus and to explore its relationship with Haglund malformation. METHODS: Ankle lateral X-ray films of 391 hospitalized patients between May 2021 and June 2024 were retrospectively collected. The morphological parameters of the postero-superior protuberance of the calcaneus were measured, including the length of the base, the height of the base, and the tip angle of the postero-superior protuberance of the calcaneus, and the morphological types were classified according to the above parameters, including the peak type, the hill type, and the flat type. The related parameters of Haglund malformation were measured, including Fowler-Philipp angle (FPA), calcaneal pitch angle (CPA), parallel pitch line (PPL), Chauveaux-Liet angle (CLA), and X/Y ratio (total calcaneal length/length of greater tuberosity of calcaneus). The differences of the morphological parameters of the postero-superior protuberance of the calcaneus and the related indicators of Haglund deformity among the three types and between the males and the females were compared and analyzed, and the differences of the positive numbers of the related indicators of Haglund deformity among the three types were compared. RESULTS: According to the morphological parameters of the postero-superior protuberance of the calcaneus, there were 64 cases of peak type, 245 cases of hill type, and 82 cases of flat type. There was no significant difference in the length of the base of the postero-superior protuberance of the calcaneus, CPA, CLA, and X/Y ratio among the three types ( P>0.05). Among the three types, the peak type had the largest FPA and the flat type had the smallest ( P<0.05); the peak type had the smallest tip angle of the postero-superior protuberance of the calcaneus and the flat type had the largest ( P<0.05); the positive rate of PPL in the hill type was significantly higher than that in the peak type and flat type ( P<0.05); the height of the base of the postero-superior protuberance of the calcaneus in the flat type was the smallest ( P<0.05). FPA, CPA, CLA, PPL, and X/Y ratio were positive in 2, 42, 172, 142, and 77 patients, respectively. There was no significant difference in the number of positive Haglund deformity indicators among the three types ( P>0.05). There was no significant difference between male and female patients in the tip angle of the postero-superior protuberance of the calcaneus, FPA, the positive rate of PPL, and X/Y ratio ( P>0.05). The length and the height of the base of the postero-superior protuberance of the calcaneus, CPA, and CLA in male patients were significantly higher than those in female patients ( P<0.05). CONCLUSION The postero-superior protuberance of the calcaneus can be divided into three types: the peak type, the hill type, and the flat type. The peak type is more likely to suffer from Haglund deformity, and the males are more likely to suffer from Haglund deformity than the females.
Humans ; Calcaneus/anatomy & histology* ; Male ; Female ; Retrospective Studies ; Adult ; Middle Aged ; Adolescent ; Young Adult ; Radiography ; Child ; Aged

OBJECTIVE: To evaluate the positional relationship between protective channel and sural nerve while treating acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique based on anatomical observations of cadaver specimens. METHODS: Twelve adult cadaveric lower limb specimens (6 left, 6 right) were utilized. A CAMIR device was implanted at a distance of 4 cm from the proximal end of the specimen to the Achilles tendon insertion. The skin was incised along the tendon's medial side, the sural nerve was dissected, and the positional relationship with the protective channel was observed. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion, the vertical distance between protective channel and the calcaneal insertion, and the horizontal distance between the sural nerve and protective channel were measured by using vernier caliper. RESULTS: Anatomical examination demonstrated a variable positional relationship between the sural nerve and protective channel, with the sural nerve positioned above (8 specimens) or below (4 specimens) the protective channel. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion was (105.67±14.94) mm, the vertical distance between protective channel and the calcaneal insertion was (93.20±9.57) mm, and the horizontal distance between the sural nerve and protective channel was (0.31±0.14) mm. CONCLUSION The use of CAMIR technique for the treatment of acute Achilles tendon rupture can effectively avoid iatrogenic injury to the sural nerve.
Humans ; Achilles Tendon/injuries* ; Sural Nerve/anatomy & histology* ; Cadaver ; Minimally Invasive Surgical Procedures/methods* ; Tendon Injuries/surgery* ; Rupture/surgery* ; Adult ; Male ; Calcaneus/injuries* ; Female ; Plastic Surgery Procedures/methods*

OBJECTIVETo establish the three-dimensional finite element model of calcaneus, and to discuss mechanism of calcaneal fracture.

METHODSThe calcaneus of normal person was scanned with spinal CT, and the finite element model was established with the Sap 93 software. The node and element number of this model was 1 959 and 1 496 respectively. After establishing the finite element model of the calcaneus, the axial load of 500 N was applied on the model in neutral position and back stretches 20 degree position. The stress distribution and the displacement of the models were observed.

RESULTSThe fracture line passed through the lateral articular facet of talocalcaneal joint when the ankle joint was in neutral position, and the stress distribution was maximal at calcaneus from posteromedial to anterolateral aspect. In addition, the stress distribution was maximal from calcaneus to position between posterior talar articular surface and calcaneal tendon when the ankle joint was in back stretch position of 20 degree.

CONCLUSIONWhen falling down, the fracture line will pass through the facet of talocalcaneal joint from lateral to posteromedial side if the ankle joint was in neutral position; and the line will through pass the calcaneus body to post spinula joint, as well as avulsion fracture of calcaneal tendon occurred if the ankle joint was in back stretch position of 20 degree.

Adult ; Calcaneus ; anatomy & histology ; diagnostic imaging ; Finite Element Analysis ; Fractures, Bone ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Male ; Tomography, X-Ray Computed

OBJECTIVETo observe and analyze the intraoperative state of calcaneal fractures, and summarize the law of displacement after calcaneal fractures, so as to guide fracture reduction and fixation.

METHODSFrom March 2002 to March 2009, among 572 patients with calcaneal fractures, 427 patients were male and 145 patients were female, ranging in age from 17 to 73 years, averaged 37 years. The patients were injured from falling or road accidents, and all the patients were closed fracture. The 189 patients with complete clinical data were treated with reduction and fixation through the lateral approach after observation of displacement type of the fractures.

RESULTSAmong 189 patients,the fractures were found at the lower part of the articular surface in all patients, which was hillock point of calcaneus; the fractures were found at the Gissans Corner in 134 patients, and the type include cross-sectional fracture or oblique fracture; the fractures were found at calcaneal tubercle in 118 patients, and the fractures were divided into two parts from top to bottom; the fractures were found at the distal part of calcaneus only in 67 patients.

CONCLUSIONCalcaneal fractures show clear law of dislocation. Preoperative and intra-operative detailed analysis and evaluation, as well as reduction and fixation according to certain sequences can insure to get better operative effects.

Adolescent ; Adult ; Aged ; Calcaneus ; anatomy & histology ; injuries ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; pathology ; surgery ; Humans ; Male ; Middle Aged

OBJECTIVE: To provide anatomic evidence for choosing medial calcaneal nerve(MCN ) as recipient cutaneous nerve to rebuild heel sensation. METHODS: We chose 20 adult cadavers' lower limbs, dissected the MCNs, observed their original sites, shapes, courses and distribution, and measured the perpendicular distance from original sites of MCNs from tibial nerve, original sites of their branches to the tip of medial malleolus, and the external diameters of their main trunks and branches. RESULTS: The frequency of the MCN was 95% in this array. All the MCNs arose from the tibial nerve at 3.3 cm up the horizontal plane of the tip of medial malleolus. They sent out anterior branches and posterior branches from 0.3 cm below the horizontal plane of the tip of medial malleolus on average. The anterior branch dominated the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominated the sensation of the posterior and median part. The shape of MCNs, main trunks, anterior branches and posterior branches was like circular cylinder. At the origination, the external diameter of the MCN, the anterior branch and the posterior branch was 1.58, 1.13 and 0.90 mm on average, respectively. CONCLUSION The anatomical position of MCN is relatively constant, and its external diameter is suitable. The initiation is not close to the heel weight loading area. Its anatomic characteristics meet the requirements of sensation recovery of the heel, especially the heel weight loading field.
Adult ; Cadaver ; Calcaneus ; innervation ; Heel ; innervation ; Humans ; Peripheral Nerves ; anatomy & histology ; Tibial Nerve ; anatomy & histology

Normal sectional anatomy of the calcaneus with multiplanar CT examination was studied in 5 volunteers as thebackground for interpretation of various abnormalities. Major 3 sectional anatomy including plantar, coronal,sagittal and additional tuberosity planes are described. With CT examination of the calcaneus, 1. More detailedanatomy of 3 facets of subtalar joint(anterior, middle, and posterior facet) can be well visualized. 2. Itsclinical applications in the tarsal trauma, tarsal coalition, subtalar infectin, degenerative arthritis, clubfoot, pes planus and tarsal tumor could provide much more informations, which not obtained by conventionalradiographic studies.
Anatomy, Cross-Sectional ; Calcaneus ; Clubfoot ; Flatfoot ; Osteoarthritis ; Volunteers