Bilateral Cubonavicular and Synchronous Talocalcaneal Tarsal Coalition with Stress Response-Case Report and Review of Literature.
The Indian journal of radiology & imaging
Tarsal coalition occurs in 1% of the population and represents a congenital failure of segmentation in two or more tarsal bones. It most commonly occurs at the talocalcaneal and calcaneonavicular joint. Although commonly asymptomatic, it may present with pain, rigidity, and pes planus. Cubonavicular, multiple synchronous, and bilateral coalitions are rare but an awareness is required to ensure accurate diagnosis and management. In this article, we presented the first reported case (to the best of our knowledge) of bilateral cubonavicular coalition with synchronous talocalcaneal coalition and stress response within the intermediate cuneiform.
10.1055/s-0043-1776064
Excision of a Middle Facet Tarsal Coalition.
JBJS essential surgical techniques
Middle facet tarsal coalition is one of the commonly seen tarsal coalitions in clinical practice that can cause pain and associated flatfoot deformity. Excision of the coalition is one of the treatment options for symptomatic cases. Although symptoms may subside in children following a period of immobilization, resection should be considered as a treatment alternative for children and adolescents because of the potential for restoration of subtalar joint movement. The indications for excision of the coalition are not consistently reported in the literature, and the procedure is not always easy to perform. In this article, we describe the steps for a successful excision of a middle facet tarsal coalition. DESCRIPTION:The incision is marked from 1 cm inferior to the medial malleolus, extending distally to the navicular tuberosity and inferior to the level of the posterior tibial tendon. The coalition is first located by retracting the flexor tendons and the neurovascular bundle. The bone on the surface of the coalition is gradually removed to expose the middle facet. A 2-mm guide pin and a cannulated dilator probe inserted through the sinus tarsi into the tarsal canal that exits anterior to the posterior facet help with identifying the margins of the coalition. The middle facet is then removed either partially or totally, depending on the size, shape, and location of the coalition, until the posterior facet is visualized. Following excision, bone wax is used on the exposed surfaces or fat is inserted to prevent adhesion and recurrent bone formation. If there is an associated flatfoot deformity, additional surgeries, including a medial translational osteotomy or a lateral column lengthening of the calcaneus, a Cotton osteotomy, an arthroereisis, or a calcaneus stop procedure, may be necessary. ALTERNATIVES:The alternative treatment for managing a middle facet coalition is immobilization of the foot in a boot or cast for 6 to 8 weeks to decrease pain. This will not improve the function of the hindfoot, which remains stiff, but may alleviate pain temporarily. Excision of the coalition in combination with other procedures for correction of the flatfoot is an alternative to an arthrodesis of the subtalar joint and works well in children and adolescents, particularly in those with reasonable subtalar joint flexibility. A triple arthrodesis is rarely performed for an isolated middle facet coalition, even in adults, unless there is peritalar arthritis and more severe abduction of the talonavicular joint with associated stiffness. RATIONALE:The rationale for excision of a middle facet tarsal coalition is to maximize the mobility of the hindfoot, in particular, the subtalar joint. The success of excision of the coalition is associated with the rigidity of the hindfoot and the presence of a flatfoot deformity. The stiffer the hindfoot and the flatter the foot, the less likely is excision of the coalition to be successful. Since the alternative to resection of a middle facet coalition is arthrodesis of the subtalar joint, one must distinguish between feet in which there is mobility, and excision is more likely to be successful, and those that are rigid, for which arthrodesis is preferable. In many feet, however, the size of the coalition is not associated with the flexibility of the hindfoot, and in an extremely rigid hindfoot, we recommend an arthrodesis, even in an adolescent patient. Rigidity increases with increasing age, and it is uncommon to excise the middle facet coalition in adult patients or in a patient in whom subtalar arthritis is evident.
10.2106/JBJS.ST.18.00114
Medial subtalar arthroscopy: a cadaveric study of the tarsal canal portal.
Lui Tun Hing,Chan Lap Ki,Chan Kwok Bill
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
PURPOSE:To study the safety of the tarsal canal portal in medial subtalar arthroscopy. METHODS:Twenty-three fresh frozen foot and ankle specimens were divided into two groups with different orientation of the portal tract. Three types of tarsal canal portals were identified. The relationships of the metal rod and the flexor digitorum longus tendon and the posterior neurovascular bundle were studied. RESULT:In group A, a type 1 tarsal canal portal tract was established in seven specimens, a type 2 portal tract in three specimens, and a type 3 portal tract in two specimens. In group B, a type 1 portal tract was established in ten specimens and a type 2 portal tract in one specimen. No type 3 portal tract was established in group B. There was no statistical significance demonstrated for establishment of a type 1 portal tract and "non type 1" (type 2 or 3) portal tract in group A and group B. The average shortest distance between the rod and the posterior tibial neurovascular bundle was 7 mm in group A and 9 mm in group B. CONCLUSIONS:This study provides the anatomic basis for the establishment of the tarsal canal portal. There is a risk of injury to the flexor digitorum longus tendon and the posterior tibial neurovascular bundle with the tarsal canal portal, and it should be used with great caution.
10.1007/s00167-012-2047-x
Anatomy of ligamentous structures in the tarsal sinus and canal.
Jotoku Tsuyoshi,Kinoshita Mitsuo,Okuda Ryuzo,Abe Muneaki
Foot & ankle international
BACKGROUND:The descriptive morphology of the interosseous talocalcaneal ligament and other structures in the tarsal sinus and canal vary. An anatomical investigation of the ligamentous structures in the tarsal sinus and canal identified two distinct ligaments, the interosseous talocalcaneal ligament and the anterior capsular ligament, and three components of the medial root of the inferior extensor retinaculum. METHODS:Forty embalmed cadaver feet were examined. After disarticulation of the ankle joint, the posterior half of the talus was removed. The length, width, and thickness of the two ligaments and the three components of the extensor retinaculum in the tarsal canal and sinus were measured with calipers. Anatomical variations were recorded. RESULTS:The interosseous talocalcaneal ligament was band-like in 92.5% (38 of 40) of examined specimens, and the anterior capsular ligament was present in 95% (39 of 40) of specimens. The interosseous talocalcaneal ligament, the medial component of the inferior extensor retinaculum, and the talar component of the inferior extensor retinaculum had one or two distinct anatomical variations of morphology and attachments. The interosseous talocalcaneal ligament and the medial component of the extensor retinaculum formed a V shape in the tarsal sinus and canal. CONCLUSION AND CLINICAL RELEVANCE:We demonstrated the morphology and dimensions of the ligaments and components of the extensor retinaculum in the tarsal sinus and canal. Precise anatomy of the structures in the tarsal sinus and canal will strengthen our understanding of their function in the motion or stabilization of the subtalar joint. There may be a functional link between the medial component of the inferior extensor retinaculum and the interosseous talocalcaneal ligament.
10.1177/107110070602700709
Computed tomography review of tarsal canal anatomy with reference to the fitting of sinus tarsi implants in the tarsal canal.
Bali Navi,Theivendran Kanthan,Prem Hari
The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
Sinus tarsi implants are used in the treatment of symptomatic hyperpronating flexible flatfeet in children. Although some implants are inserted only into the sinus tarsi, others occupy both the sinus tarsi and the tarsal canal. The stem that is anchored in the tarsal canal depends on interference fit for the initial resistance to slippage. The first part of this computed tomography anatomic study in children was aimed at finding and measuring the dimensions in the narrowest point in the canal that provided the interference fit. The second part of the study assessed the possibility of the implant being loaded with axial body weight in the tarsal canal. All foot computed tomography scans performed consecutively at Birmingham Children's Hospital from January 2008 to December 2011 were reviewed to assess the tarsal canal dimensions on the sagittal views. A total of 52 scans fulfilled the inclusion criteria. The average age was 12.7 years. The narrowest mean anteroposterior diameter of the canal was 7.3 ± 1.12 (range 5.2 to 10.0) mm. The narrowest mean superoinferior diameter was 9.2 ± 1.32 (range 6.3 to 12.7) mm. A total of 50 patients had the narrowest dimension in the anteroposterior plane. A positive linear correlation was found between the anteroposterior diameter and the superoinferior distance (r = 0.51, p < .01). We have concluded that the stem of an arthroereisis implant extending into the tarsal canal is unlikely to be constantly bearing body weight, because it obtains an interference grip in the anteroposterior direction in almost all patients and not in the superoinferior line of axial body weight.
10.1053/j.jfas.2013.07.008
The dimensions of the tarsal sinus and canal in different foot positions and its clinical implications.
Kleipool R P,Blankevoort L,Ruijter J M,Kerkhoffs G M M J,Oostra R J
Clinical anatomy (New York, N.Y.)
This study presents a reference for the dimensions of the tarsal sinus and canal in healthy adults in different foot positions to facilitate understanding of the kinematics of the subtalar joint, the effect of an implant, and other clinical issues. In a 3D CT stress test on 20 subjects, the right foot was forced into a neutral and eight different extreme foot positions while CT scans were obtained. The bones were segmented in the neutral foot position. The kinematics of the bones in the extreme positions were determined relative to the neutral position. The dimensions of the tarsal sinus and canal were calculated by determining the radii of the maximal inscribed spheres at 20 equidistant locations along an axis in 3D surface models of the tali and calcanei in each foot position. The radii were small on the medial side and increased laterally. Medial from the middle, the radii were small and not significantly different among the various foot positions. At the lateral side, the dimensions were affected mainly by eversion or inversion and less by dorsiflexion or plantarflexion. The pattern was reproducible among subjects, but there were between-subject differences. The dimensions are mostly determined by rotation in the frontal plane. A pivot point was found medial from the middle. These data serve as a reference and model for predicting the effect of sinus implants and understanding such clinical problems as sinus tarsi syndrome. Between-subjects differences have to be taken into account. Clin. Anat. 30:1049-1057, 2017. © 2017 Wiley Periodicals, Inc.
10.1002/ca.22908
Ligament structures in the tarsal sinus and canal.
Li Shu-Yuan,Hou Zhi-Dian,Zhang Peng,Li Hong-Liang,Ding Zi-Hai,Liu Yu-Jie
Foot & ankle international
BACKGROUND:The concrete anatomy and functional characteristics of the subtalar ligaments have been a matter of debate that some believe has hampered the progress of clinical ligament reconstruction. METHODS:In 32 fresh-frozen cadaver feet, the course of the inferior extensor retinaculum (IER) and other subtalar ligaments was carefully measured and photographed both from the portal of the tarsal sinus and from a posterior view. RESULTS:The IER inserted inside the tarsal sinus and canal by means of 3 roots: a lateral, an intermediate, and a medial one. These roots, along with the tarsal canal, divided the subtalar space into 3 parts. In front of the IER and inside the tarsal sinus, the thick cervical ligament (CL) lay at a 45-degree angle to the calcaneus. Behind the IER and inside the posterior capsule, in most cases (25 of 32 specimens), the posterior capsular ligament (PCaL) lay directly in front of the posterior talocalcaneal facet. Inside the tarsal canal, the fan-shaped medial root of the IER spread from outside upper lateral to lower medial, and the interosseous talocalcaneal ligament (ITCL) ran from upper medial to lower lateral; fibers of these 2 ligaments blended tightly together to form a V-shaped ligament complex. Just anterior to this complex in some cases (20 of 32 specimens), a short narrow upright ligament, the tarsal canal ligament (TCL), was located behind the middle talocalcaneal joint. CONCLUSION:The results of this study show that the CL is the primary ligament in the tarsal sinus and that the ITCL is a thin single band rather than a strong bilaminar ligament located inside the tarsal canal. Instead, the medial root of the IER is the primary ligamentous structure in the tarsal canal. CLINICAL RELEVANCE:The anatomical description provided here may provide a more accurate theoretical foundation for clinical subtalar stability restoration.
10.1177/1071100713500653
Anatomy of the Tarsal Canal and Sinus in Relation to the Subtalar Joint Capsule.
Yamaguchi Reiko,Nimura Akimoto,Amaha Kentaro,Yamaguchi Kumiko,Segawa Yuko,Okawa Atsushi,Akita Keiichi
Foot & ankle international
BACKGROUND:Anatomical knowledge of the tarsal canal and sinus is still unclear owing to the complexity of the ligamentous structures within them, particularly the relationship with the capsules of the subtalar joints. The aim of this study was to examine the anatomical relationship between the fibrous tissues of the tarsal canal and sinus and the articular capsules of the subtalar joint. METHODS:We conducted a descriptive anatomical study of 21 embalmed cadaveric ankles. For a macroscopic overview of the subtalar joint, we removed the talus in 18 ankles and separated the fibrous tissues from the surrounding connective tissues to analyze the layered relationship between the inferior extensor retinaculum (IER) and the subtalar joint capsule. Additionally, we histologically analyzed the tarsal canal and the medial and lateral sides of the tarsal sinus using Masson's trichrome staining in 3 ankles. RESULTS:The medial and intermediate roots of the IER and interosseous talocalcaneal ligament (ITCL) were located in the same layer and were connected to each other, between the capsules of the posterior talocalcaneal and talocalcaneonavicular joints. The intermediate root of the IER and the cervical ligament (CL) had adjacent attachments on the tarsal sinus, and synovial tissues originating from the joint capsules filled the remaining area in the tarsal canal and sinus. CONCLUSION:We determined that the tarsal canal and sinus tarsi contained 3 layered structures: the anterior capsule of the posterior talocalcaneal joint, including the anterior capsule ligament; the layer of ITCL and IER; and the posterior capsule of the talocalcaneonavicular joint, including the CL. CLINICAL RELEVANCE:The results of this study may help with the understanding of the pathomechanism of subtalar instability and sinus tarsi syndrome, resulting in better treatment.
10.1177/1071100718788038