Structures involved in posterior tibial tendon dysfunction

NewsBot · Nov 11, 2024

Ultrasound assessment of the spring ligament and posterior tibial tendon in healthy subjects: A descriptive study
Beatriz Martínez-Sañudo et al
Journal of Tissue ViabilityVolume 33, Issue 3, August 2024, Pages 481-486

Highlights
•There are differences between the thickness of the SMSL between men and women.
•There are differences between age and the thickness of the PTT.
•In healthy subjects the PTT was on average 0.7 times the size of the SMSL.
•A high degree of agreement was found between the measurements taken by the investigators.
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Background
The main aim of this study was to ultrasonographically analyse the thickness and the relationship between the Superomedial Bundle of the Spring Ligament and the Posterior Tibial Tendon in healthy subjects and its relationship with different epidemiological variables.
Methods
Fifty-five healthy feet with a mean of 47 years old measuring the same ultrasound model and researcher. Demographic variables (age, sex, laterality, BMI, type of sports activity performed, and type of work activity) were collected from all participants. The thickness of the PTT and the Spring Ligament was measured in both longitudinal and transverse diameters. The intraclass correlation coefficient (ICC) was also analysed to assess the agreement of the measurements between a researcher and the ultrasound specialist radiologist.
Results
The mean thickness of the Spring ligament was 5.07 mm (95 % CI 4.75–5.38), while that of the PTT in its long axis was 3.58 mm (95 % CI 3.37–3.79). Regarding the interobserver agreement analysis, the intraclass correlation coefficient for measurements between observers was 0.91 (CI95 %: 0.698–0.977) which denotes a high degree of similarity between the clinician and the radiologist.
Conclusion
This study describes the relationships between the thickness of the posterior tibial tendon and the superomedial Bundle of the Spring ligament in healthy subjects, as well as their variability according to certain epidemiological variables such as age, gender, occupation, and sport. On the other hand, the measurements taken by a researcher high agreement with those taken by a radiologist specialized in ultrasound.
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NewsBot · Nov 21, 2024

Chronic Deltoid Insufficiency in Stage IV Adult
Acquired Flatfoot Deformity: Do We Have a Good
Answer?
Jacob C. Tiell , Matias Malkamaki , Patrick O'Connor , Nicholas C. Cheney
Source

Stage IV adult acquired flatfoot deformity (AAFD) with secondary chronic deltoid ligament insufficiency is a
challenging deformity to treat, with minimal consensus in the literature concerning its surgical
management. Many surgical treatment options have been described, including joint-sparing techniques,
fusions, osteotomies, and even arthroplasties. However, questions remain as to what, if any, treatment is
optimal. This contribution reviews studies on surgical treatments for stage IV AAFD with deltoid ligament
failure and provides a critical analysis regarding the quality of outcomes reported for those different
treatment options.
PubMed and Google Scholar databases were searched between June 1, 2022, and August 15, 2022, for studies
published between 1990 and 2022 that describe the treatment of stage IV AAFD with deltoid ligament
insufficiency. Articles included in the study focused on subjects with stage IV AAFD and associated deltoid
ligament insufficiency undergoing surgical correction. Exclusion criteria included stage I, II, and III AAFD,
as well as deltoid ligament repair following acute injury/rupture.
Nine studies covering five different treatment options for patients with stage IV AAFD and chronic deltoid
insufficiency were included, with minimal overlap in outcome measures used to assess the efficacy of the
procedure. Triple arthrodesis with deltoid ligament reconstruction resulted in a 62.5% (5/8) success rate with
a residual tibiotalar (TT) angulation of 2° (success defined as <3°). Tibiotalar arthrodesis of four patients
resulted in an average post-operative tibiotalar angulation of 4.8° with all patients showing progressive
destabilization of the hindfoot complex at 12-18 year follow-ups. Deltoid arthroscopic laminoplasty
(Brostrom) resulted in an increased American Orthopaedic Foot and Ankle Society (AOFAS) score from 49.7
pre-op to 91.9 post-op. There was no long-term follow-up of these patients. Deltoid ligament reconstruction
using autografts of the peroneus longus resulted in a post-operative valgus of 2.1° in one study and <5° in
another. Deltoid ligament reconstruction using an anterior tibial tendon autograft resulted in a gain of 126.4
+ 40.2% in stiffness compared to an intact ligament. Twinfix suture anchors resulted in a post-operative
hindfoot angle averaging 5.3°. Combined deltoid and spring ligament reconstruction resulted in a 5.1° valgus
angulation.
There is currently no standard of care or clinical consensus regarding surgical treatment for stage IV AAFD
with deltoid insufficiency. Several studies imply that mild valgus malalignment around the tibiotalar joint
can result in satisfactory outcomes. A few studies even deemed <5° of valgus tilt post-operatively successful.
However, it has been described that any imbalance in tibiotalar tilt is a significant risk factor for progressive
arthritis and future ligamentous failure. No treatment option was able to correct valgus tilt to an anatomical
standard (i.e., to normal anatomy). These varied findings, along with the lack of consensus on post-surgical
measures to assess efficacy, are worrisome and emphasize the need for better surgical options. Moreover,
there is a critical need for additional research on the long-term outcomes following stage IV AAFD and
deltoid insufficiency repair, particularly, as over five million people in the United States and 10% of the
geriatric population are affected by AAFD with a risk of progressing to stage IV.
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NewsBot · Nov 29, 2024

Comparative Analysis of Structural Differences in Progressive Collapsing Foot Deformity With and Without Hallux Valgus
Chien-Shun Wang et al
Foot Ankle Int. 2024 Nov 26

Background: Progressive collapsing foot deformity (PCFD) and hallux valgus (HV) are complex 3-dimensional deformities of the foot. This study aimed to investigate structural and alignment differences between PCFD with and without HV using weightbearing computed tomography.

Methods: Patients with PCFD aged 18 years or older who underwent weightbearing computed tomography were consecutively enrolled. Standard 2-dimensional PCFD and HV parameters were assessed semiautomatically. Foot and ankle offset, forefoot arch angle, and pronation of the medial column bones in the coronal plane, with the ground as a reference, were manually measured. Additionally, the angles from the inferior aspect of subtalar posterior facet of the talus to the ground (subtalar horizontal angle), from the inferior (posterior facet) to superior facets of the talus (infratalar-supratalar angle), and from the inferior (posterior facet) of the talus to the superior facet of the calcaneus (infratalar-supracalcaneal angle) were examined. HV deformity was defined by an HV angle of ≥15 degrees.

Results: Among 72 feet (58 patients) studied, 33 displayed HV, whereas 39 did not. In the coronal plane, the PCFD with HV group showed a higher infratalar-supratalar angle and greater pronation at the first tarsometatarsal joint, first metatarsal bone, and head. The PCFD with HV group also exhibited greater naviculocuneiform joint supination. Generalized estimating equation logistic regression analysis revealed significant associations of HV deformity with the intrinsic rotation of the first metatarsal bone (P < .001), infratalar-supratalar angle (P = .004), and rotation of the first tarsometatarsal joint (P < .001).

Conclusion: This study confirmed significant structural and alignment differences between PCFD with and without HV. Notably, the infratalar-supratalar angle, rotation of the first tarsometatarsal joint, and intrinsic rotation of the first metatarsal bone were associated with HV deformity.
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Structures involved in posterior tibial tendon dysfunction

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Share This Page

Structures involved in posterior tibial tendon dysfunction

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Personality Traits linked to Foot Structures

"Haleem’s Hen"; A mnemonic for the anatomy of hindfoot structures

A New Classification of Foot Structures Based on Foot Embryology is proposed

Palpation Skills in Foot and Ankle Anatomic Structures

A New Classification of Foot Structures Based on Foot Embryogenesis

which structures are in dysfunctions in LAS or CAI?

A comparison of foot kinetic parameters between pronated and normal foot structures during forward j

Share This Page

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