Ankle pain and anatomy

Tendinous and muscular anatomical variants around the ankle are usually an unexpected finding on imaging. Magnetic resonance imaging offers the best visualization of the accessory muscles; however, they can also be detected on radiography, ultrasonography, and computed tomography. Their accurate identification facilitates appropriate management of the rare symptomatic cases, mostly caused by accessory muscles in the posteromedial compartment. Symptomatic patients present with chronic ankle pain, most commonly as tarsal tunnel syndrome...

BACKGROUND: Peroneal split tears are an underrated cause of ankle pain. While magnetic resonance imaging (MRI) is useful for diagnosis, split tears are challenging to identify. The aim of the study was to investigate the association of peroneus brevis split rupture with abnormalities of the superior peroneal retinaculum (SPR), anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), joint effusion, morphology of the malleolar groove, presence of the bone marrow oedema and prominent peroneal tuberculum...

The sinus tarsi is a funnel-shaped region at the junction of mid-foot and hind-foot which contains fat, vessels, nerves and ligaments. The ligaments help stabilise the subtalar joint and maintain the longitudinal arch of the foot. The nerve endings contain proprioceptive fibres indicating a role for the sinus tarsi in movement of the foot. Sinus tarsi syndrome is a clinical entity characterised by lateral hind-foot pain with worsening on palpation and weight-bearing, and perceived instability. It is associated with both traumatic and non-traumatic causes...

BACKGROUND: Given the growing number of primary total ankle replacements (TAR), an increase in the number of patients undergoing subsequent revisions might be expected. Achieving a stable and balanced ankle while preserving the remaining bone stock as much as possible is crucial for success in revision TAR. Most reported techniques rely on bulky implants with extended fixation features. Since 2018, we have used a novel, three-component ankle prosthesis for revision that is converted in situ to a fixed-bearing, two-component ankle prosthesis once the components have found their position according to an individual's anatomy...

BACKGROUND: Talar fractures are relatively uncommon, and the complex anatomy of the talus impedes their visualization, reduction, and fixation without performing an arthrotomy or osteotomy. To date, few studies have evaluated the complications of arthroscopically assisted percutaneous talar osteosynthesis. This clinical retrospective study aimed to investigate the effectiveness of this procedure according to the complications and functional outcomes. METHODS: Arthroscopically assisted percutaneous talar osteosynthesis was performed in 15 patients (10 men and 5 women) with 16 fractures (one bilateral)...

INTRODUCTION: Various mouse and rat models of neuropathic pain after nerve injury exist. Whilst some models involve a proximal nerve lesion or ligation of the sciatic trifurcation in mice and rats, others consists of a transection or ligation of distal nerves at the tibial bifurcation in mice or rats. The level of nerve cut directly affects the magnitude of hypersensitivity, and anatomical differences between mice and rats might therefore impact the development of hypersensitivity after distal tibial nerve transection as well...

Background and Objectives : Treating segmental tibial and ankle bone loss after radical surgery for chronic osteomyelitis is one of the most challenging problems encountered by orthopaedic surgeons. Open tibia and ankle fractures occur with an incidence of 3.4 per 100,000 and 1.6 per 100,000, respectively, and there is a high propensity of developing fracture-related infection with associated chronic osteomyelitis in patients. Segmental tibial and ankle bone loss have recently received new and improved treatments...

The peroneal tendons play a critical role in stabilizing the foot and ankle especially in athletes with high demands on lateral ankle strength. A complete understanding of the anatomy of the lateral ankle as well as a careful physical examination is imperative to diagnosing peroneal pathology, which is commonly misdiagnosed and can lead to chronic pain and inability to perform high level sport. Although low-demand patients do well with a conservative approach, most high-demand athletes will benefit from surgical intervention...

The medial ankle ligamentous complex, which includes the deltoid, talocalcaneal, and calcaneonavicular ligaments, functions to provide stability to the medial ankle. Injuries to the deltoid ligament can lead to medial-sided ankle pain, subsequent instability, and posttraumatic osteoarthritis given the altered biomechanics of the ankle joint. After completing a thorough physical examination, imaging modalities such as stress radiographs and magnetic resonance imaging can be used to confirm the diagnosis. Acute injuries to the deltoid ligament should be managed conservatively with a short course of immobilization...

Background: Quantifying normal sesamoid movement in relation to first metatarsophalangeal joint (MTPJ1) motion is essential to identifying aberrant kinematics and understanding how they may contribute to forefoot pain and dysfunction. The present study aims to report sesamoid displacement in relation to MTPJ1 extension and to compare sesamoid displacement with MTPJ1 range of motion (ROM) from several imaging modalities. Methods: Using 10 fresh frozen cadaveric feet, sesamoid displacement was evaluated during simulated MTPJ1 extension...

An active, obese young patient was admitted to our clinic complaining of chronic ankle pain after fixation of his lateral malleolus fracture. His symptoms consisted of intermittent pain after prolonged walking, swelling, and feeling of instability. His clinical and radiological evaluations indicated chronic mechanical instability of his distal tibiofibular syndesmosis that remained unresponsive to conservative treatment. Considering his age and activity level, we proceeded to a global syndesmotic reconstruction of the three major syndesmotic ligaments with split-thickness peroneus longus graft...

Chronic limb-threatening ischemia (CLTI) is on the rise due to the increasing prevalence of diabetes, which is a significant cause of morbidity and mortality worldwide. Due to diabetes, many patients with CLTI present with a predominance of tibial and pedal artery disease. Despite best care, limb amputation cannot always be prevented. Surgical bypass has always been the mainstay in distal revascularization and limb salvage; however, many patients with CLTI have comorbidities, insufficient vein, and anatomic abnormalities that prevent them from undergoing surgery...

PURPOSE: Posttraumatic fibular malunion alters ankle joint biomechanics and may lead to pain, stiffness, and premature osteoarthritis. The accurate restoration is key for success of reconstructive surgeries. The aim of this study was to analyze the accuracy of a novel three-dimensional (3D) registration algorithm using different segments of the contralateral anatomy to restore the distal fibula. METHODS: Triangular 3D surface models were reconstructed from computed tomographic data of 96 paired lower legs...

The fibularis (peroneus) quartus is a variant muscle found within the lateral leg compartment in ~11.5% of cadaveric specimens, though recent studies have shown a higher prevalence of ~20.9 - 21.9%. The proximal muscular attachments can originate from the fibula, fibularis brevis, fibularis longus, and/or the intermuscular septi that form the boundaries of the lateral leg compartment, but it then descends to reside posterior to the lateral malleolus of the fibula. The distal attachment of the fibularis quartus varies greatly, and fibularis quartus muscular variants are often named according to location of its distal attachment...

A 13-year-old girl presented to the traumatology outpatient clinic with a painful right ankle after an inversion trauma. She was unable to bear weight on the right foot. Additional radiographic imaging and CT-scan revealed a Tillaux fracture of the right ankle. As the fracture fragment was displaced 8 mm, open reduction and screw fixation was performed to restore the anatomy of the ankle joint.

Considerable variations have been reported regarding the branching pattern of tibial nerve (TN) close to its termination in foot. In order to comprehend the clinical anatomy of heel pain awareness of all the possible variations in relation to terminal branching pattern of TN (close to the tarsal tunnel) is essential. The present study was conducted to undertake a comprehensive review of the variations in TN branches in foot with particular emphasis on the implications for sensory distribution of these branches...

While flatfeet are normal in children, persistence into adolescence with associated pain or asymmetry warrants additional evaluation. Rigidity of a flatfoot deformity, whether a clinical report or evident on examination, should raise suspicion for pathology. The differential diagnosis includes tarsal coalition, neurogenic planovalgus, and peroneal spasticity. History must include pointed inquiry into birth and neurologic histories to probe for a source of central spasticity. Examination must include standing assessment of hindfoot and midfoot alignment...

PURPOSE: Many etiologies are known to lead to a tarsal tunnel syndrome (TTS). One rare cause is mass-occupying lesions, and particularly accessory or variant muscles (AVM). This study aimed to systematically collect published clinical cases of TTS caused by AVM. METHODS: An electronic literature search was conducted from inception to April 2021. The diagnosis of AVM should be reported in one of the following methods: ultrasonography, magnetic resonance imaging (MRI), or per-operatively...

PURPOSE: The purpose of this study was to evaluate the stiffness of the inferior extensor retinaculum (IER) using shear-wave elastography (SWE) in neutral and varus positions in healthy adults, and to assess the reliability and reproducibility of these measurements. METHODS: Both ankles were analyzed by shear-wave elastography (SWE) in 20 healthy patients (10 females/10 males) resting on a hinge support with their ankles in neutral, valgus 20°, and varus 30° positions...

Objective: To investigate the vascular anatomy and the clinical application of type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery on skin soft tissue defect at the limbs. Methods: Vascular anatomy of anterolateral thigh flap was performed on a 43-year-old male cadaver perfused with red latex, and the travel and perforating distribution of the oblique branches of lateral circumflex femoral artery were observed. A retrospective case series study was used to analyze the clinical data of 12 patients with skin soft tissue defects of the extremities admitted between January 2018 and September 2019, including 9 males and 3 females; aged from 18 to 65 years, with a median age of 32 years...