Medial canthopexy is a permanent and stable fixation of the internal canthus and its elements in an anatomical position. Transnasal canthopexy is difficult to perform. The specific material includes two square pins, a large and a small one, plus material to explore the lachrymal duct. After infiltration with adrenalin xylocaine at 1 %, the Tessier's orbitonasal incision follows a bayonet route along the medial canthus and then a sub-tarsal route. A succession of broken lines allows increasing the maxillary upward branch and a larger sub-periosteal dissection. The medial canthal tendon (MCT) is exposed. After intubating the inferior lachrymal duct and pushing the lachrymal sac downwards, any resistance to medial traction is freed with a raspatory. The contralateral approach is arch formed, in front of the MCT, 10mm away from the medial eyelid commissure. The frontal apophysis of the maxillary bone is exposed. The bone is perforated with a square pin while protecting the lachrymal sac and the ocular globe. The MCT is pulled by twisted metallic wire, which is anchored on a wedge. Closing the wound is performed in two layers. A large dressing is applied for 48hours. In case of medial bone defect, parietal bone graft is used to stabilize canthopexy. There are few complications and esthetic and functional results are favorable and long lasting.

Sinus tarsi syndrome, described by O'Connor in 1958 and Brown in 1960, is a clinical finding often seen after an accident, consisting of a painful reaction to pressure on the sinus tarsi. This syndrome has also been described in dancers, volleyball and basketball players, overweight individuals, and patients with foot deformities (flatfoot). We looked for mechanical and functional macroscopic structures in the canalis and sinus tarsi that can be associated with sinus tarsi syndrome in order to deduce therapeutic consequences. We found a complex fibrous layer in the sinus and canalis tarsi that forms slips around the synovial sheats of the extensor tendons under the inferior extensor retinaculum. Both limbs run deep to the base of the sinus and canalis tarsi. The lateral band inserts into the sinus tarsi at the calcaneus, while the medial band inserts at the canalis tarsi at the talus and calcaneus. Instead of the term "interosseous ligaments," we recommend referring to the "fundiform ligament" with one lateral and one medial band. Regarding function, one can assume that the medial band of these fundiform ligaments controls the talus at eversion and inversion together with the well-vasculated and well-innervated interarticular fat pads in the sinus and canalis tarsi. While contracting the long extensor muscles of the toes, the ligament forms a control mechanism for the longitudinal arch of the foot in the moving phase.A question is how variations in vascularization or disorders in innervation will alter the turgor of the pads of fat tissue. That is, such alterations would influence the distribution of synovia in the neighboring joints as well as the tension of the involved ligaments.

Acquired adult flat foot, despite numerous research projects, is a controversial clinical entity. Recently the role of plantar calcaneonavicular ligament complex (spring ligament) in stabilization of the longitudinal arch of the foot has drawn an attention. Since there are differences in anatomical description of his complex in the literature, the main aim of our study was to anatomically evaluate this complex. Ten cadaver feet were examined. In four cases spring ligament complex comprised two components: superomedial calcaneonavicular ligament and inferior calcaneonavicular ligament. In six cases complex was composed of three ligaments and we were able to identify structure of the third ligament. In this subgroup in two cases the spring ligament had its own fibrocartilage surface connected by tiny fibrous band with fibrocartilage articular surface. In summary, the spring ligament complex comprises superomedial calcaneonavicular ligament and inferior calcaneonavicular ligament. In majority of cases one can distinguish structure of the third ligament.

Entrapment of the medial heel region nerves is often mentioned as a possible cause of heel pain. Some authors have suggested that the medial and inferior calcaneal nerves may be involved in such heel pain, including plantar fasciitis, heel pain syndrome and fat pad disorders. The aim of this study was to give a detailed description of the medial heel that would determine the variability and pattern of the medial and inferior calcaneal nerves, as well as to relate these findings to the currently used incision line for tarsal tunnel, fixations of fractures with external nailing, medial displacement osteotomy and nerve blocks in podiatric medicine.The origin, relationship, distribution, variability and innervation of medial and inferior calcaneal nerves were studied with the use of a 3.5 power loupe magnification for dissection of 25 adult male feet of formalin-fixed cadavers. The medial heel was found to be innervated by just one medial calcaneal nerve in 38% of the feet, by two medial calcaneal nerves in 46%, by three medial calcaneal nerves in 12% and by four medial calcaneal nerves in 4%. 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.In our dissection, the rate of occurrence of the medial and inferior calcaneal nerves in medial heel region was 100%. When compared with the inferior calcaneal nerve, the medial calcaneal nerve was posterior, superior and thicker. The inferior calcaneal nerve supplies deeper structures. In the majority of the cases, inferior calcaneal nerve aroused from the lateral plantar nerve, but it may also arise from the tibial nerve, sometimes in a common origin with the medial calcaneal nerve.Knowledge of fine anatomy of the calcaneal nerves is necessary to ensure safe surgical intervention in the medial heel region.

Much of the work describing support of the medial longitudinal arch has focused on the plantar fascia and the extrinsic muscles. There is little research concerning the function of intrinsic muscles in the maintenance of the medial longitudinal arch. Ten healthy volunteer adults served as subjects for this study, which was approved by the University Investigational Review Board. The height of the navicular tubercle above the floor was measured in both feet while subjects were seated with the foot in a subtalar neutral position and then when standing in a relaxed calcaneal stance. Subtalar neutral was found by palpating for talar congruency. Recordings of muscle activity from the abductor hallucis muscle were performed while the subjects maintained a maximal voluntary contraction in a supine position by plantarflexing their great toes. An injection of lidocaine (1% with epinephrine) was then administered by a Board-certified orthopedic surgeon in the region of the tibial nerve, posterior and inferior to the medial malleolus. Measurements were repeated and compared by using a paired t test. After the nerve block, the muscle activity was 26.8% of the control condition (P =.011). This corresponded with an increase in navicular drop of 3.8 mm. (P =.022). The observation that navicular drop increased when the activity of the intrinsic muscles decreased indicates that the intrinsic pedal muscles play an important role in support of the medial longitudinal arch.