Variations in the origin of the medial calcaneal nerve

Previous anatomic studies of the medial heel region were done on embalmed human cadavers. Here, the innervation of the medial heel region was studied by dissecting living tissue with the use of 3.5-power loupe magnification during decompression of the medial ankle for tarsal tunnel syndrome in 85 feet. The medial heel was found to be innervated by just one medial calcaneal nerve in 37% of the feet, by two medial calcaneal nerves in 41%, by three medial calcaneal nerves in 19%, and by four medial calcaneal nerves in 3%. An origin for a medial calcaneal nerve from the medial plantar nerve was found in 46% of the feet. This nerve most often innervates the skin of the posteromedial arch, where it is at risk for injury during calcaneal spur removal or plantar fasciotomy. Knowledge of the variations in location of the medial calcaneal nerves may prevent neuroma formation during surgery and provide insight into the variability of heel symptoms associated with tarsal tunnel syndrome.     

Double calcaneal osteotomy: realignment considerations in eight patients

Posterior calcaneal displacement and anterior calcaneal distraction osteotomies have been recommended for surgical management of flexible flatfoot deformity. We combined these procedures for surgical management of adolescent flatfoot and late stage II posterior tibial tendon dysfunction in the adult. Lateral column distraction has been shown to reduce rearfoot valgus and forefoot abduction by stabilizing the midtarsal joint. Posterior calcaneal displacement osteotomy, which results in medial translation of the tuberosity, converts the posterior muscle group from an everter to an inverter. A supinatory moment, therefore, is created about the subtalar joint axis, which results in supination during the midstance phase of gait. These procedures may be considered when calcaneal valgus, forefoot abduction, and midtarsal joint instability are clinically significant. We also include rearfoot alignment radiographs, long leg calcaneal axial radiographs, and malleolar valgus indices to further evaluate alignment of the foot, ankle, and leg. Ideal realignment is achieved when the heel is vertical in resting calcaneal stance position, the forefoot is parallel to the rearfoot in the frontal plane, and the medial column is stabilized, with elimination of forefoot abduction.     

两种内固定方案治疗SandersⅢ型跟骨骨折疗效比较

目的：比较经跗骨窦切口有限切开复位内固定与经外侧“L”型切口内固定治疗SandersⅢ型跟骨骨折的疗效。方法选取2013年1月至2015年1月我院骨外科收治的96例SandersⅢ型跟骨骨折患者(共96足)为研究对象,采用随机数表法将患者分为观察组和对照组,每组48例(48足)。对照组患者采用经外侧“L”型切口内固定法治疗,观察组患者采用经跗骨窦切口有限切开复位内固定法治疗。比较两组患者的住院时间、手术时间、住院费用、治疗前后的Bohlers角、Gissanes角、跟骨宽度、跟骨高度、跟骨长度,以及术后足部功能恢复情况。结果对照组患者的住院时间、手术时间、治疗费用均明显多于观察组,差异均具有统计学意义(P<0.05);治疗前,两组患者的放射学检测结果比较差异均无统计学意义(P>0.05),治疗后,观察组患者的Bohlers角、Gissanes角、跟骨高度及跟骨长度的增大程度和跟骨宽度的降低程度均比对照组明显,差异均具有统计学意义(P<0.05);治疗后观察组患者的创伤性关节炎、切口并发症、距下关节僵硬的发生率均明显低于对照组,差异均具有统计学意义(P<0.05)。结论 SandersⅢ型跟骨骨折患者经跗骨窦切口有限切开复位内固定治疗可以缩短住院时间及手术时间,减少手术费用,且手术并发症少,术后功能恢复良好,可在临床上进一步推广应用。     

Use of plantar contact area to predict medial longitudinal arch height during walking

A study was conducted to determine whether plantar surface contact area measures calculated from footprints collected during walking can be used to predict the height of the medial longitudinal arch. Thirty healthy women participated in the study. Arch height was determined by the distance from the navicular tuberosity to the floor and by the "bony" arch index. Dynamic plantar surface contact area was recorded using a pressure platform as the subjects walked across a 12-m walkway. The arch index and the total plantar surface contact area were determined from the pressure sensor data. The results indicated that plantar surface contact area could be used to estimate only approximately 27% of the height of the medial longitudinal arch as determined by navicular tuberosity height and the bony arch index. These findings demonstrate the inability of the clinician to predict the vertical height of the medial longitudinal arch on the basis of the amount of foot plantar surface area in contact with the ground during walking.     

Effect of the low-Dye strap on pronation-sensitive mechanical attributes of the foot

The low-Dye strap is used routinely to temporarily control pronation of the foot and, thereby, to diagnose and treat pronatory sequelae. However, the exact biomechanical effects of this strapping technique on the foot are not well documented. The main purpose of this study was to establish the specific mechanical effects of the low-Dye strap on the pronatory foot. Within this context, the specific aim was to assess the effect of the low-Dye strap on three distinct pronation-sensitive mechanical attributes of the foot in the weightbearing state: 1) calcaneal eversion, 2) first metatarsophalangeal joint range of motion, and 3) medial longitudinal arch height. Weightbearing measurements of these three attributes were made before and after application of a low-Dye strap, and statistical comparisons were made. The results of this study indicate that the low-Dye strap is effective in reducing calcaneal eversion, increasing first metatarsophalangeal joint range of motion, and increasing medial longitudinal arch height in the weightbearing state. Knowledge of the exact mechanisms of action of the low-Dye strap will provide practitioners with greater confidence in the use of this modality.     

3-matic软件测量负重状态平足指标的可行性分析

目的:比较3-matic软件与传统X线平片对平足指标测量结果是否具有一致性。方法:在3-matic软件中,根据重建的足踝部负重状态三维骨骼模型,获取足踝部负重状态下的正位、侧位及后足冠状位图像,然后进行平足相关指标的测量,并与同一个体、同一指标的普通平片测量结果进行对比。结果:两种方法对于跟骨倾斜角、距舟覆盖角、正位距骨第一跖骨角的测量,两种测量方法没有统计学差异(P>0.05)。对于侧位距骨第一跖骨角、距骨倾斜角、跟骨外移距离、内侧柱长度、内侧足弓角、外侧柱长度、外侧足弓角和跟骨外翻角的测量,两种测量方法具有显著统计学差异(P<0.05)。结论:在3-matic软件中进行平足相关指标的测量具有直观清楚、非侵袭性、测量结果稳定等优点,测量时可以根据需要去除不相关的骨块,消除骨骼重影的干扰。对于平足各指标的测量,3-matic软件测量与平片测量结果不具有一致性,因此,利用数字化技术进行平足模拟手术时,不能直接参考平片测量的正常范围。     

切开复位内固定术治疗跟骨关节内骨折疗效观察

目的观察切开复位内固定术治疗跟骨关节内骨折的疗效。方法回顾性分析骨科应用跟骨＂Y＂型解剖接骨板治疗跟骨骨折21例患者的临床资料,术后观察切口愈合情况及Maryland足部评分。结果术后复查X线片提示跟骨高度、Blher’s角及Gissane角均较术前明显改善。术后21例患者Maryland足部评分结果为：优11例,良8例,中2例,优良率90.48%。结论对于跟骨关节内骨折,我们认为需要积极行切开复位内固定术治疗,术中注意软组织保护,尽可能骨折复位,充分引流和术后加强切口管理是取得较满意疗效的关键。     

不同微创术式应用于SandersⅡ~Ⅲ型跟骨骨折治疗的临床疗效分析

目的 分析不同微创术式应用于SandersⅡ~Ⅲ型跟骨骨折治疗的临床疗效。方法 选取2018年6月到2019年6月我院SandersⅡ~Ⅲ型跟骨骨折患者100例,采用随机数字表法将其分为对照组和观察组,每组各50例。对照组采用经跟骨外侧跗骨窦入路手术治疗,观察组采用距下关节镜辅助后侧小切口手术治疗。比较两组患者的手术情况、足部功能以及并发症发生情况。结果 观察组手术时间、术中及术后出血量明显低于对照组(P<0.05),两组骨折愈合时间、Maryland足部评分优良率比较无明显差异(P>0.05);术后,两组Bohler角、Gissane角明显高于术前(P<0.05),两组Bohler角、Gissane角比较无明显差异(P>0.05);观察组并发症发生率明显低于对照组(P<0.05)。结论 采用距下关节镜辅助后侧小切口手术治疗SandersⅡ~Ⅲ型跟骨骨折患者,能够有效改善患者足部功能,患者手术情况良好,并发症发生可能性较小。     

跗骨窦切口手术入路治疗跟骨骨折的疗效

目的比较跗骨窦切口手术入路和传统手术入路对跟骨骨折病人的治疗效果。方法选取跟骨骨折病人60例,其中34例行跗骨窦切口手术入路（跗骨窦组）,26例行传统手术入路（传统组）。比较2组病人的手术时间、术后引流量、住院时间、术后并发症发生情况和术后3个月的Gissane角、Bohler角,并通过踝-后足评分（AOFAS）对病人术后6个月的恢复情况进行随访。结果2组病人手术时间差异无统计学意义（P>0.05）,跗骨窦组病人术后引流量和住院时间均明显少于传统组（P < 0.01）。术后3个月,2组病人Gissane角和Bohler角均较手术前明显改善（P < 0.01）,且跗骨窦组病人术后Gissane角明显优于传统组术后（P < 0.01）。跗骨窦组术后并发症发生率低于传统组（P < 0.05）,术后6个月的AOFAS评分情况优于传统组（P < 0.05）。结论跗骨窦切口手术入路治疗跟骨骨折的疗效较传统手术好,可有效提高病人术后恢复情况及减少术后并发症的发生。     

经跗骨窦小切口无头加压螺钉与外侧L形切口钢板固定治疗跟骨骨折的对比研究

目的 比较经跗骨窦小切口无头加压螺钉与外侧L形切口钢板固定对跟骨骨折内侧壁复位与跟骨力线纠正效果的影响。方法 选取2018年1月—2021年12月淮北矿工总医院收治的62例跟骨骨折患者，按随机数字表法分为研究组和对照组，每组31例。对照组给予外侧L形切口钢板固定治疗，研究组给予经跗骨窦小切口无头加压螺钉治疗。术后随访6个月。比较两组手术情况、视觉模拟评分法（VAS）及踝足关节功能，比较两组跟骨力线解剖学参数和跟骨骨折内侧壁复位情况，统计两组并发症发生情况。结果 研究组手术切口长度小于对照组（P <0.05），手术时间短于对照组（P <0.05），术中出血量少于对照组（P <0.05）。两组术前、术后3 d、术后7 d、术后1个月VAS评分比较：不同时间点的VAS评分有差异（P <0.05），研究组与对照组的VAS评分有差异（P <0.05），研究组与对照组的VAS评分变化趋势有差异（P <0.05）。两组术后6个月的踝足关节功能比较，差异无统计学意义（P>0.05）。两组术前、术后6个月的跟骨长度、跟骨宽度、跟骨高度、Bohler角、Gissa...     

Static stance response to different types of foot orthoses

Many different types of foot orthoses are used to treat biomechanical dysfunction of the foot. Little evidence is available to guide clinicians in the selection of foot orthoses. The aim of this project was to determine whether resistance of the foot to supination or the Foot Posture Index could predict the static stance response to different types of prefabricated foot orthoses. The Foot Posture Index score was determined and resistance to supination was measured in 18 subjects (36 feet). Changes in the frontal plane calcaneal angle and navicular height were then measured as the subjects stood on six different types of foot orthoses. All orthoses resulted in an increase in navicular height, but only three orthoses changed the calcaneal angle in the frontal plane. Resistance to supination did not predict the response to the different types of orthoses, but the Foot Posture Index score was associated with changes from using some of the orthoses.     

Examining the validity of selected measures of foot type: a preliminary study

The rationale that subtalar joint position, reflected by calcaneal alignment, determines foot morphology was used to formulate an approach to examination of the validity of three measures of "foot type": the Staheli Arch Index, the Chippaux-Smirak Index, and navicular height. Each measure was calculated in five positions, progressively inverting from a reference position of maximal comfortable eversion. Pearson product moment correlations (Staheli Arch Index: r = 0.5; Chippaux-Smirak Index: r = 0.6; and navicular height: r = 0.8) indicated that each measure progressively increased with inversion. The change in calcaneal position required to produce significant changes in each measure was investigated using analysis of variance with Scheffé post hoc analysis. This analysis revealed that changes of 15 degrees and 20 degrees were required to produce significant differences in Chippaux-Smirak Index and Staheli Arch Index scores, respectively, threatening their validity. Navicular height was sensitive to smaller changes of 10 degrees and thus displays greater sensitivity to changes in calcaneal position than the footprint parameters tested.     

Function of the windlass mechanism in excessively pronated feet

The foot postures of 39 subjects were evaluated for excessive pronation by means of six static weightbearing and five nonweightbearing measurements, and two types of footprint indexes. Visual evidence of windlass function was recorded by video. Chi-square analysis revealed that excessive pronation does not affect the establishment of the windlass mechanism. The position of the forefoot relative to the rearfoot, subtalar joint axis position, and navicular drift/foot length ratio were significantly associated with dynamic windlass function. These results suggest that selected static measurements may have value in predicting some aspects of dynamic foot function during the propulsive phase of the gait cycle.     

膝骨性关节炎患者膝关节疼痛指数与足底压力变化的相关性研究

目的：探讨膝骨性关节炎患者足底压力改变及疼痛对足底压力的影响。方法运用足底压力测试系统对28例单侧膝骨性关节炎疼痛患者自然行走时的步态进行测试,观察受试者单足支撑分期时段参数、足角及膝关节疼痛指数,对健、患侧足底压力各指标进行统计学分析并分析膝关节疼痛指数与各指标相关性。结果膝骨性关节炎患者患侧前足着地阶段时间百分比为（57.90±32.93）、全足支撑阶段时间百分比为（57.93±2.93）低于健侧对应百分比（60.26±2.66,P =0.007;51.53±3.84,P <0.001）;患侧足角（16.24±4.50）明显高于健侧足角（14.67±4.09）,差异有统计学意义（P =0.014）;膝关节疼痛指数与患侧前足着地阶段时间百分比（r =-0.53,P =0.004）、全足支撑阶段时间百分比（r =-0.56,P =0.002）呈负相关;与患侧足角无明显相关性（r =0.245,P =0.193）。结论膝骨性关节炎患者足底压力具有特征性,前足着地时段、全足支撑时段明显缩短、足角变大,疼痛严重影响膝骨性关节炎患者步态。     

跟骨骨折畸形愈合致平足症的手术治疗

目的 探讨跟骨骨折畸形愈合后导致平足症的手术治疗方法及疗效.方法 1998年1月至2008年1月,手术治疗跟骨骨折畸形愈合致平足症116例,男94例,女22例,年龄16～46岁,平均33.5岁.单侧跟骨骨折110例,双侧6例.所有患者均为跟骨闭合性骨折后高度丢失,继发创伤性平足症.采用的手术方法为保留距下关节的切开复位截骨矫形术或跟骨丘部重建及距下关节融合术.结果 101例患者获得随访12～24个月,平均14个月.伤口Ⅰ期愈合,无感染.所有患者均牢固愈合,未再次发生平足畸形.截骨植骨处愈合时间10～14周,平均12周.患者术后平均13周(11～15周)时可完全负重行走,无明显疼痛不适.足弓高度由术前的(4.2±1.7)mm(1.8～6.2mm)恢复到术后的(14.1±4.1)mm(9.8～19.0 mm)(P＜0.05),跟骨倾斜角由术前的(11.2±2.5)°(8.1～14.2°)恢复到术后的(19.1±4.4)°(14.3～25.5°)(P＜0.05),Bohler角由术前的(5.4±3.5)°(1.6～10.2°)恢复到术后的(25.8±5.2)°(19.7～31.6°)(P＜0.05),Meary角反向成角由术前的(22.2±4.4)°(17.1～27.5°)恢复到术后的(5.1±3.2)°(2.5°～8.5°)(P＜0.05),采用美国足踝外科协会(AOFAS)踝、后足评分标准,评分由术前的33.4分(27～43分),上升到术后的85.8分(78～98分).结论 对于跟骨骨折畸形愈合致平足症的患者应积极进行手术治疗,根据跟骨骨折畸形愈合的具体情况采用不同的治疗方案,以达满意疗效.     

新型双向加压钉治疗跟骨骨折畸形愈合的疗效分析

目的:评价新型双向加压钉治疗跟骨骨折畸形愈合的临床疗效.方法:2010年1月至今我院收治的跟骨骨折畸形愈合28例,采用新型双向加压钉手术方法,按Maryland足部评分系统评价术后功能.术后平均随访5个月.结果:95%的病人跟距关节创伤性关节炎消失,100%的病人跟骨外侧畸形膨隆消失,后足功能改善有效率达到95%以上,...     

Arch index as a predictor of pes planus: a comparative study of indigenous Kenyans and Tanzanians

We determined the arch index of able-bodied indigenous Kenyan and Tanzanian individuals free of foot pain by using their dynamic footprints to classify the foot arch type and determine the prevalence of pes planus according to a previously described method. Males had a significantly higher arch index than females in both groups, and the prevalence of pes planus in Kenyans was 432 per 1,000 population, the highest ever documented and twice as high as that in Tanzanians (203 per 1,000 population). The arch index is useful in determining the prevalence of pes planus and possibly predicting pathologic foot conditions, and it may serve as an early warning sign of structural and functional defects of the foot in a given population.     

经跗骨窦入路钢板内固定结合切口负压封闭吸引治疗跟骨关节内骨折的研究

目的 随访观察经跗骨窦入路钢板内固定结合切口负压封闭吸引治疗跟骨关节内骨折的临床疗效及术后切口并发症情况。 方法 选择2014年10月-2016年3月温州医科大学附属第二医院收治的38例患者,共40足跟骨关节内骨折。38例患者均大于18周岁,Sanders Ⅱ、Ⅲ、Ⅳ型闭合性跟骨关节内骨折,无合并同侧足踝部其他骨折及严重的软组织损伤,无合并糖尿病或下肢血管性疾病,无明显软组织感染或皮肤疾病。该组病例均在受伤后4~12 d,平均6.5 d,行经跗骨窦入路钢板内固定结合切口负压封闭吸引。观察术前术后及末次随访时跟骨的B hler角,Gissane角、跟骨长度、宽度、高度的变化,末次随访的Maryland足部评分,以及切口感染等术后并发症。 结果 全部38例患者经过12~24个月的随访,平均随访时间15.5个月,术后B hler角、Gissane角、跟骨长度、跟骨宽度及跟骨高度分别为32.820°±5.770°,116.500°±8.000°,(71.045±7.487)mm,(27.642±2.115)mm,(40.306±4.520)mm,末次随访情况分别32.270°±5.234°,115.900°±7.801°,(72.270±6.813)mm,(27.212±2.483)mm,(39.833±4.598)mm,Maryland足部评分优良率为80.25%,术后无一例发生切口愈合不良、浅表或深部感染。 结论 经跗骨窦入路能很好暴露距下关节面,恢复跟骨B hler角、Gissane角、跟骨长度、跟骨宽度及跟骨高度,结合切口负压封闭吸引能更好的避免切口感染并发症,并减少早期换药次数,减轻患者的痛苦和临床医生的负担。      

足外侧区复合组织瓣移植的应用解剖

目的 :为踝周部骨折、骨不连或合并软组织缺损的修复提供一种新术式。方法 :在 33侧乳胶灌注下肢标本上解剖并观测了足背外侧区血管的走行、分支、分布及吻合情况。结果 :足外侧区血管来自于跗外侧动脉、跟外侧动脉、外踝前动脉及腓动脉穿支的降支 ,彼此相互吻合 ,并分支滋养趾短伸肌和皮肤 ,其中 ,跗外侧动脉是骰骨的主要血供来源。结论 :以上述 4条不同血管为蒂切取复合组织瓣 ,能一次性修复胫骨远端、踝部或距骨骨折、骨不连或合并软组织缺损。     

108例维吾尔族青年足跟骨X线测量

目的 :测量维吾尔族青年足跟骨 X线片上 6项指标的正常值 ,并探讨其临床意义。方法 :拍摄 10 8例维吾尔族青年右侧足跟骨侧位片 ,分别测量跟骨长、跟骨高、前力线长、后力线长、Cissane's角及 Boehler's角 ,并进行统计学处理。结果:维吾尔族青年男、女上述各项指标除 Cissane's角及 Boehler's角之外差异均有统计学意义 (P<0 .0 0 1) ;跟骨长、跟骨高、前力线长、后力线长有性别间差异 ;正常跟骨高长比 >1/2 ;Boehler's角和 Cissane's角无性别间差异。 结论:足跟骨 X线测量可为临床医学、法医学及人类学研究提供参考依据