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Hegazy MA, Khairy HM, Hegazy AA, Sebaei MAEF, Sadek SI. Talus bone: normal anatomy, anatomical variations and clinical correlations. Anat Sci Int 2023:10.1007/s12565-023-00712-y. [PMID: 37017903 DOI: 10.1007/s12565-023-00712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/28/2023] [Indexed: 04/06/2023]
Abstract
Talus is a pivotal bone that assists in easy and correct locomotion and transfers body weight from the shin to the foot. Despite its small size, it is implicated in many clinical disorders. Familiarity with the anatomy of the talus and its anatomical variations is essential for the diagnosis of any disorder related to these variations. Furthermore, orthopedic surgeons must be fully aware by this anatomy during podiatry procedures. In this review, we attempt to present its anatomy in a simple, updated and comprehensive manner. We have also added the anatomical variations and some clinical points relevant to the unique and complex anatomy of talus. The talus has no muscle attachment. However, it does have many ligaments attached to it and others around it to keep it in place. Moreover, the bone plays a pig role in movements due to its involvement in many joints. Most of its surface is covered with articular cartilage. Therefore, its blood supply is relatively poor. This puts the talus at greater risk for poor healing as well as more complications in the event of injury than any other bone. We hope this review will make it easier for clinicians to pursue and understand the updated essential knowledge of one of the most complex bone anatomies that they need in their clinical practice.
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Affiliation(s)
| | - Hossam Mohammed Khairy
- Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt
| | - Abdelmonem Awad Hegazy
- Basic Medical Science Department, Faculty of Dentistry, Zarqa University, Zarqa City, 13110, Jordan.
- Human Anatomy and Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt.
| | | | - Sami Ibrahim Sadek
- Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt
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de Cesar Netto C, Saito GH, Roney A, Day J, Greditzer H, Sofka C, Ellis SJ, Richter M, Barg A, Lintz F, de Cesar Netto C, Burssens A, Ellis SJ, Deland J, Ellis SJ. Combined weightbearing CT and MRI assessment of flexible progressive collapsing foot deformity. Foot Ankle Surg 2021; 27:884-891. [PMID: 33358266 DOI: 10.1016/j.fas.2020.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the correlation between Weightbearing CT (WBCT) markers of pronounced peritalar subluxation (PTS) and MRI findings of soft tissue insufficiency in patients with flexible Progressive Collapsing Foot Deformity (PCFD). We hypothesized that significant correlation would be found. METHODS Retrospective comparative study with 54 flexible PCFD patients. WBCT and MRI variables deformity severity were evaluated, including markers of pronounced PTS, as well as soft tissue degeneration. A multiple regression analysis and partition prediction models were used to evaluate the relationship between bone alignment and soft tissue injury. P-values of less than .05 were considered significant. RESULTS Degeneration of the posterior tibial tendon was significantly associated with sinus tarsi impingement (p = .04). Spring ligament degeneration correlated to subtalar joint subluxation (p = .04). Talocalcaneal interosseous ligament involvement was the only one to significantly correlate to the presence of subfibular impingement (p = .02). CONCLUSION Our results demonstrated that WBCT markers of pronounced deformity and PTS were significantly correlated to MRI involvement of the PTT and other important restraints such as the spring and talocalcaneal interosseus ligaments. LEVEL OF EVIDENCE Level III, Retrospective comparative study.
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Affiliation(s)
- Cesar de Cesar Netto
- The Hospital for Special Surgery, New York, NY, US; University of Iowa, Department of Orthopaedics and Rehabilitation, Iowa City, IA, US.
| | | | - Andrew Roney
- The Hospital for Special Surgery, New York, NY, US
| | - Jonathan Day
- The Hospital for Special Surgery, New York, NY, US
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- International Weight Bearing CT Society, Brussels, Belgium
| | | | - Alexej Barg
- The Hospital for Special Surgery, New York, NY, US
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Takao M, Lowe D, Ozeki S, Oliva XM, Inokuchi R, Yamazaki T, Takeuchi Y, Kubo M, Matsui K, Katakura M, Glazebrook M. Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study. BMC Musculoskelet Disord 2021; 22:558. [PMID: 34144675 PMCID: PMC8214304 DOI: 10.1186/s12891-021-04444-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022] Open
Abstract
Background Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system. Methods The MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex. Results The normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29–62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion. Conclusion Our results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.
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Affiliation(s)
- Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.
| | - Danielle Lowe
- Department of Orthopaedic Surgery, Lions Gate Hospital, North Vancouver, BC, Canada
| | - Satoru Ozeki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Xavier M Oliva
- Department of Human Anatomy, University of Barcelona, Calle Casanova, 143, 08038, Barcelona, Spain
| | - Ryota Inokuchi
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan
| | - Takayuki Yamazaki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Yoshitaka Takeuchi
- Tokyo National College of Technology, 1220-2, Kunugida-machi, Hachioji, Tokyo, Japan
| | - Maya Kubo
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Mai Katakura
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan
| | - Mark Glazebrook
- Division of Orthopaedic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), 1796 Summer Street, Halifax, NS, B3H3A7, Canada
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The double fascicular variations of the anterior talofibular ligament and the calcaneofibular ligament correlate with interconnections between lateral ankle structures revealed on magnetic resonance imaging. Sci Rep 2020; 10:20801. [PMID: 33247207 PMCID: PMC7695848 DOI: 10.1038/s41598-020-77856-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
The anterior talofibular ligament and the calcaneofibular ligament are the most commonly injured ankle ligaments. This study aimed to investigate if the double fascicular anterior talofibular ligament and the calcaneofibular ligament are associated with the presence of interconnections between those two ligaments and connections with non-ligamentous structures. A retrospective re-evaluation of 198 magnetic resonance imaging examinations of the ankle joint was conducted. The correlation between the double fascicular anterior talofibular ligament and calcaneofibular ligament and connections with the superior peroneal retinaculum, the peroneal tendon sheath, the tibiofibular ligaments, and the inferior extensor retinaculum was studied. The relationships between the anterior talofibular ligament's and the calcaneofibular ligament's diameters with the presence of connections were investigated. Most of the connections were visible in a group of double fascicular ligaments. Most often, one was between the anterior talofibular ligament and calcaneofibular ligament (74.7%). Statistically significant differences between groups of single and double fascicular ligaments were visible in groups of connections between the anterior talofibular ligament and the peroneal tendon sheath (p < 0.001) as well as the calcaneofibular ligament and the posterior tibiofibular ligament (p < 0.05), superior peroneal retinaculum (p < 0.001), and peroneal tendon sheath (p < 0.001). Differences between the thickness of the anterior talofibular ligament and the calcaneofibular ligament (p < 0.001), the diameter of the fibular insertion of the anterior talofibular ligament (p < 0.001), the diameter of calcaneal attachment of the calcaneofibular ligament (p < 0.05), and tibiocalcaneal angle (p < 0.01) were statistically significant. The presence of the double fascicular anterior talofibular ligament and the calcaneofibular ligament fascicles correlate with connections to adjacent structures.
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Kobayashi T, Suzuki D, Kondo Y, Tokita R, Katayose M, Matsumura H, Fujimiya M. Morphological characteristics of the lateral ankle ligament complex. Surg Radiol Anat 2020; 42:1153-1159. [PMID: 32227271 DOI: 10.1007/s00276-020-02461-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The relevance of each ligament comprising the lateral ankle ligament complex, including the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), has not been sufficiently elucidated; therefore, we aimed to clarify the morphological characteristics and relevance of these ligaments. METHODS Total 152 legs from 152 Japanese cadavers were investigated. The lengths and widths of the ATFL, CFL, and PTFL were measured using a caliper. The ATFL was classified according to the number of fiber bundles (Types I, II, and III corresponded to one, two, and three fiber bundles, respectively), and the lengths and widths of the three ligaments were compared between the Type groups. In addition, the ratio of each ligament's length and width to the tibial length was calculated, and the correlation of the ratio of ligament length and width between the ATFL, CFL, and PTFL was examined about 34 legs. RESULTS The ATFL, CFL, and PTFL were found to connect at the anterior/inferior tip of the lateral malleolus each other. The Type II group of the ATFL was most common (54.6%) in our investigated specimens. However, there were no significant inter-group differences in the lengths and widths of the CFL and PTFL. CONCLUSIONS This study demonstrates that the lateral ankle ligaments may stabilize the ankle joint through interconnections.
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Affiliation(s)
- Takumi Kobayashi
- Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose, Japan.
| | - Daisuke Suzuki
- Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan
| | - Ryo Tokita
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Masaki Katayose
- Department of Physical Therapy, Sapporo Medical University, School of Health Science, Sapporo, Japan
| | - Hirofumi Matsumura
- Department of Physical Therapy, Sapporo Medical University, School of Health Science, Sapporo, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University of Medicine, Sapporo, Japan
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Advanced Ankle and Foot Sonoanatomy: Imaging Beyond the Basics. Diagnostics (Basel) 2020; 10:diagnostics10030160. [PMID: 32183398 PMCID: PMC7151198 DOI: 10.3390/diagnostics10030160] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
Ankle/foot pain is a common complaint encountered in clinical practice. Currently, due to the complex anatomy, the diagnosis and management of the underlying musculoskeletal disorders are extremely challenging. Nowadays, high-resolution ultrasound has emerged as the first-line tool to evaluate musculoskeletal disorders. There have been several existing protocols describing the fundamental sonoanatomy of ankle/foot joints. However, there are certain anatomic structures (e.g., Lisfranc ligament complex or Baxter nerve) which are also clinically important. As they are rarely elaborated in the available literature, a comprehensive review is necessary. In this regard, the present article aims to brief the regional anatomy, illustrate the scanning techniques, and emphasize the clinical relevance of the ankle/foot region.
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Higashiyama R, Sekiguchi H, Takata K, Endo T, Takaso M. Arthroscopic Reconstruction of the Anterior Talofibular Ligament, Lateral Talocalcaneal Ligament, and Calcaneofibular Ligament Using a Triangle-Shaped Tendon Graft (ALC-Triangle). Arthrosc Tech 2020; 9:e217-e223. [PMID: 32099775 PMCID: PMC7029097 DOI: 10.1016/j.eats.2019.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/30/2019] [Indexed: 02/03/2023] Open
Abstract
The lateral talocalcaneal ligament (LTCL) connects the talus and calcaneus on the lateral side of the hindfoot. Although its function remains has not yet been clearly elucidated, the LTCL is thought to be important for the stabilization of the subtalar joint. Ankle sprains often include not only the talocrural joint but also the subtalar joint; therefore, LTCL injuries occur at a certain rate. Moreover, surgeons often encounter and reluctantly dissect the LTCL during arthroscopic anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) reconstruction because the LTCL connects to the ATFL at the talus in 42% of people and connects to the CFL at the calcaneus in 18% of people. As a result, LTCL reconstruction might be necessary for those patients. We describe the arthroscopic reconstruction technique of the ATFL, LTCL, and CFL using a triangle-shaped tendon graft (ALC-triangle). This technique provides a possible advantage of an anatomical and stable talocrural joint and subtalar joint.
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Affiliation(s)
- Reiji Higashiyama
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Kanagawa, Japan,Address correspondence to Reiji Higashiyama, Department of Orthopaedic Surgery, Shonantobu General Hospital, 500, Nishikubo, Chigasaki, Kanagawa, 253-0083, Japan.
| | - Hiroyuki Sekiguchi
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Kanagawa, Japan
| | - Ken Takata
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tachio Endo
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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3D MRI evaluation of morphological characteristics of lateral ankle ligaments in injured patients and uninjured controls. J Orthop Sci 2020; 25:183-187. [PMID: 30885728 DOI: 10.1016/j.jos.2019.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND With ultrasonography or 2D magnetic resonance imaging (MRI) of the lateral ankle ligament, it is particularly difficult to show the entire calcaneofibular ligament (CFL). The purpose of this study was to evaluate the morphological characteristics of the lateral ankle ligaments in injured patients and uninjured controls using 3D MRI. METHODS A total of 64 ankles of 59 healthy volunteers and lateral ligament injury patients (mean age of 32.4 years) were examined. The 64 ankles included a healthy group of 11 ankles, an acute injury group of 12 ankles that underwent MRI a month after injury, and a chronic injury group of 41 ankles that underwent MRI more than 3 months after injury. Using a 3.0-T MRI system, imaging was done with fast imaging employing steady-state acquisition cycled phases. Oblique sagittal images that most clearly depicted the entire anterior talofibular ligament (ATFL) and CFL were prepared manually and evaluated using a workstation. RESULTS In the healthy group, both the ATFL and CFL were clearly and entirely visualized. The mean width in the central portion was 4.0 ± 1.0 mm in the ATFL and 4.8 ± 0.6 mm in the CFL. 3D MRI in the acute injury group showed findings of diffuse swelling with hyperintensity in the ATFL of all patients. The CFL in 7 of 12 ankles showed findings of diffuse swelling with hyperintensity. In the chronic injury group, morphological abnormalities of the ATFL were seen in 19 of 41 ankles. The ligament signal disappeared in 2 ankles, thinned in 4 ankles, and showed swelling in 13 ankles. Morphological abnormalities of the CFL were seen in 17 of 41 ankles. The ligament signal disappeared in 1 ankle, thinned in 2 ankles, and showed swelling in 14 ankles. CONCLUSION 3D MRI may be a useful modality to visualize both the ATFL and the CFL.
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