- Kinematics reduction applied to the comparison of highly-pronated, normal and highly-supinated feet during walking. [Journal Article]
- GPGait Posture 2019; 68:269-273
- Kinematic analysis could help to study how variations in the static foot posture affect lower limb biomechanical function. The analysis of foot kinematics is complex because it involves managing the …
Kinematic analysis could help to study how variations in the static foot posture affect lower limb biomechanical function. The analysis of foot kinematics is complex because it involves managing the time-dependent joint angles in different joints and in all three planes of motion. But it could be simplified if joint angles are coordinated.
- Normal Anatomy and Traumatic Injury of the Midtarsal (Chopart) Joint Complex: An Imaging Primer. [Journal Article]
- RRadiographics 2019 Jan-Feb; 39(1):136-152
- The midtarsal (Chopart) joint complex consists of the talonavicular and calcaneocuboid joints and their stabilizing ligaments. Detailed assessment of this complex at MRI can be challenging owing to f…
The midtarsal (Chopart) joint complex consists of the talonavicular and calcaneocuboid joints and their stabilizing ligaments. Detailed assessment of this complex at MRI can be challenging owing to frequent anatomic variation and the small size of the structures involved. Nevertheless, a wide spectrum of pathologic conditions affect the joint complex, and its imaging evaluation deserves more thorough consideration. This review focuses on MRI evaluation of normal ligamentous anatomy and common variations about the Chopart joint, presenting practical imaging tips and potential diagnostic pitfalls. Imaging findings across a spectrum of traumatic Chopart joint injuries are also reviewed, from midtarsal sprains to Chopart fracture-dislocations. Midtarsal sprains-commonly associated with ankle inversion injuries-are emphasized, along with their often predictable radiographic and MRI injury patterns. Online DICOM image stacks are available for this article. ©RSNA, 2018.
- Trimalleolar fracture and associated Achilles tendon rupture: Ten year follow up of an unusual water-skiing injury. [Case Reports]
- TCTrauma Case Rep 2018; 17:33-38
- A 49 year old professional fitness instructor sustained a high velocity rotational injury to his right ankle while waterski-ing. The ski bindings did not release, exacerbating the injury. This result…
A 49 year old professional fitness instructor sustained a high velocity rotational injury to his right ankle while waterski-ing. The ski bindings did not release, exacerbating the injury. This resulted in a trimalleolar fracture and a rupture of his Achilles tendon. A trimalleolar fracture in association with a rupture of the Achilles tendon has not been previously reported. This combination of injuries posed a dilemma in treatment options and postoperative management. The authors felt that ensuring that the Achilles tendon healed with no shortening was the priority for future function in this professional athlete. It was decided to treat the Achilles tendon rupture by open repair and to place the ankle in equinus postoperatively. It was also decided to openly reduce and internally fix the medial and lateral malleolar fractures before immobilising the ankle in equinus. Any residual stiffness in the ankle, subtalar and midtarsal joints would be treated with aggressive physiotherapy. It was felt that the rotational forces may have resulted in a degree of degloving around the ankle. Care was therefore taken in the choice and placement of the surgical incisions. In spite of this, the lateral surgical wound broke down postoperatively, needing treatment with a fasciocutaneous flap. When reviewed at ten years following the injury, the patient was continuing to work as a fitness instructor with a view to continuing to retirement in five years at the age of 65. There was a slight decrease in dorsiflexion of the right ankle but flexion was full and movement of the subtalar and midtarsal joints were also full. There remained 1 cm of wasting of the right calf. Radiology of the ankle showed no joint space narrowing or evidence of degenerative change at ten years following the injury.
- Effect of plano-valgus foot posture on midfoot kinematics during barefoot walking in an adolescent population. [Journal Article]
- JFJ Foot Ankle Res 2018; 11:55
- CONCLUSIONS: Significant postural and kinematic alterations are present at the midtarsal and tarso-metarsal joints of adolescents with plano-valgus feet. Objective identification and quantification of plano-valgus foot alterations, via non-invasive gait-analysis, is relevant to improving the diagnosis of this condition and to evaluating the effect of conservative treatments and of surgical corrections by different techniques.
- The Role of the Midfoot in Drop Landings. [Journal Article]
- MSMed Sci Sports Exerc 2019; 51(1):114-122
- CONCLUSIONS: The midfoot contributes substantially to landing mechanics during a barefoot single-leg landing task. Static foot posture measures have limited value in predicting midfoot kinematics and kinetics during sportlike landings.
- Imaging of Chopart (Midtarsal) Joint Complex: Normal Anatomy and Posttraumatic Findings. [Review]
- AAAJR Am J Roentgenol 2018; 211(2):416-425
- CONCLUSIONS: Traumatic midtarsal injuries, particularly midtarsal sprain, are often overlooked clinically and on imaging but are relatively common and typically are associated with inversion ankle injuries. Radiologists should be familiar with Chopart joint anatomy and the imaging features of midtarsal injuries because early diagnosis may help optimize clinical management.
- Functional evaluation of bilateral subtalar arthroereisis for the correction of flexible flatfoot in children: 1-year follow-up. [Journal Article]
- GPGait Posture 2018; 64:152-158
- CONCLUSIONS: According to the present analysis, both implants appear effective in restoring physiological alignment of the rearfoot, however the endo-orthotic implant appeared more effective in restoring a more correct frontal-plane mobility of foot joints.
- Management of Talar Body Fractures. [Journal Article]
- IJIndian J Orthop 2018 May-Jun; 52(3):258-268
- Fractures of talar body are uncommon injuries often associated with fractures of other long bones and in polytraumatized patients. The integrity of the talus is essential for the normal function of t…
Fractures of talar body are uncommon injuries often associated with fractures of other long bones and in polytraumatized patients. The integrity of the talus is essential for the normal function of the ankle, subtalar, and midtarsal joints. The relative infrequency of this injury limits the number of studies available to guide treatment. They occur as a result of high-velocity trauma and are therefore associated with considerable soft tissue damage. Axial compression with supination or pronation is the common mechanism of injury. Great care is necessary for diagnosing and treating these injuries. Clinically, talar body fractures present with soft tissue swelling, hematoma, deformity, and restriction of motion. Associated neurovascular injury of the foot should be carefully examined. The initial evaluation should be done with foot, and ankle radiographs and computed tomography is often done to analyze the extent of the fracture, displacement, intraarticular extension, comminution, and associated fractures. Differentiating talar neck from body fractures is important. Optimal treatment relies on an accurate understanding of the injury and the goals of treatment are the restoration of articular surface and axial alignment. Indications for nonoperative management are seldom indicated and are few as in nonambulatory patients, or in with multiple comorbidities who are not able to tolerate surgery. Splinting, followed by short leg casting for 6 weeks until fracture union should be undertaken. Surgery is indicated in most of the cases, and different approaches have been described. Sometimes, a dual approach with a malleolar osteotomy is necessary for articular restoration. Clinical outcomes depend on the severity of the initial injury and the quality of reduction and internal fixation. The various complications are avascular necrosis, malunion, infections, late osteoarthritis, and ankylosis of subtalar joint.
- Modulations of Foot and Ankle Frontal Kinematics for Breaking and Propulsive Movement Characteristics during Side-Step Cutting with Varying Midsole Thicknesses. [Journal Article]
- ABAppl Bionics Biomech 2018; 2018:9171502
- This study is aimed at determining the effects of midsole thickness on movement characteristic during side cutting movement. Fifteen athletes performed side-step cutting while wearing shoes with vary…
This study is aimed at determining the effects of midsole thickness on movement characteristic during side cutting movement. Fifteen athletes performed side-step cutting while wearing shoes with varying midsole thicknesses. Temporal-spatial and ground reaction force variables as well as foot and ankle frontal kinematics were used to describe breaking and propulsive movement characteristics and modulation strategies. Regardless of midsole thickness, temporal-spatial variables and breaking and propulsive force during side cutting were statistically unchanged. Significantly greater peaks of ankle inversion and plantarflexion with a thicker sole and greater midtarsal pronation with a thinner sole were observed. Current results demonstrated that hypotheses formed solely based on material testing were insufficient to understand the adaptations in human movement because of the redundancy of the neuromusculoskeletal system. Participants were able to maintain temporal-spatial performance during side cutting while wearing shoes with midsoles of varying thicknesses. Increased pronation for a thinner sole might help reduce the force of impact but might be associated with an increased risk of excessive stress on soft tissue. Increased peak of ankle inversion and plantarflexion for a thicker sole may be unfavorable for the stability of ankle joint. Information provided in human movement testing is crucial for understanding factors associated with movement characteristics and injury and should be considered in the future development of shoe design.
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- Midtarsal locking, the windlass mechanism, and running strike pattern: A kinematic and kinetic assessment. [Journal Article]
- JBJ Biomech 2018 05 17; 73:185-191
- Changes in running strike pattern affect ankle and knee mechanics, but little is known about the influence of strike pattern on the joints distal to the ankle. The purpose of this study was to explor…
Changes in running strike pattern affect ankle and knee mechanics, but little is known about the influence of strike pattern on the joints distal to the ankle. The purpose of this study was to explore the effects of forefoot strike (FFS) and rearfoot strike (RFS) running patterns on foot kinematics and kinetics, from the perspectives of the midtarsal locking theory and the windlass mechanism. Per the midtarsal locking theory, we hypothesized that the ankle would be more inverted in early stance when using a FFS, resulting in decreased midtarsal joint excursions and increased dynamic stiffness. Associated with a more engaged windlass mechanism, we hypothesized that a FFS would elicit increased metatarsophalangeal joint excursions and negative work in late stance. Eighteen healthy female runners ran overground with both FFS and RFS patterns. Instrumented motion capture and a validated multi-segment foot model were used to analyze midtarsal and metatarsophalangeal joint kinematics and kinetics. During early stance in FFS the ankle was more inverted, with concurrently decreased midtarsal eversion (p < 0.001) and abduction excursions (p = 0.003) but increased dorsiflexion excursion (p = 0.005). Dynamic midtarsal stiffness did not differ (p = 0.761). During late stance in FFS, metatarsophalangeal extension was increased (p = 0.009), with concurrently increased negative work (p < 0.001). In addition, there was simultaneously increased midtarsal positive work (p < 0.001), suggesting enhanced power transfer in FFS. Clear evidence for the presence of midtarsal locking was not observed in either strike pattern during running. However, the windlass mechanism appeared to be engaged to a greater extent during FFS.