A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

ABSTRACT Calcaneal tuberosity fractures comprise only 1 to 2% of all calcaneal fractures. Treatment of these injuries has traditionally included open reduction and internal fixation with various means including lag screws, suture anchors and K-wires. We report on a series of cases treated with excision of the tuberosity fragment with repair of the Achilles tendon supplemented by a flexor hallucis longus tendon transfer. Parekh S, Bertrand T, Zura R, Adams S, Yan A. Novel Techniques in Treating Calcaneal Tuberosity Fractures. The Duke Orthop J 2014;4(1):3-7.

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Differential expression of TGF beta isoforms in murine palatogenesis

Development ◽

10.1242/dev.109.3.585 ◽

1990 ◽

Vol 109 (3) ◽

pp. 585-595 ◽

Cited By ~ 5

Author(s):

D.R. Fitzpatrick ◽

F. Denhez ◽

P. Kondaiah ◽

R.J. Akhurst

Keyword(s):

Developmental Process ◽

Biological Activities ◽

In Situ Hybridisation ◽

Tgf Beta ◽

Temporal And Spatial Distribution ◽

Palatal Shelf ◽

Genes Encoding ◽

Beta 2 ◽

Medial Edge

We have studied the expression of genes encoding transforming growth factors (TGFs) beta 1, beta 2 and beta 3 during development of the secondary palate in the mouse from 11.5 to 15.5 days postcoitum using in situ hybridisation. The RNA detected at the earliest developmental stage is TGF beta 3, which is localised in the epithelial component of the vertical palatal shelf. This expression continues in the horizontal palatal shelf, predominantly in the medial edge epithelium, and is lost as the epithelial seam disrupts, soon after palatal shelf fusion. TGF beta 1 RNA is expressed with the same epithelial pattern as TGF beta 3, but is not detectable until the horizontal palatal shelf stage. TGF beta 2 RNA is localised to the palatal mesenchyme underlying the medial edge epithelia in the horizontal shelves and in the early postfusion palate. The temporal and spatial distribution of TGF beta 1, beta 2 and beta 3 RNAs in the developing palate, together with a knowledge of in vitro TGF beta biological activities, suggests an important role for TGF beta isoforms in this developmental process.

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The fate of medial edge epithelial cells during palatal fusion in vitro: an analysis by DiI labelling and confocal microscopy

Development ◽

10.1242/dev.114.2.379 ◽

1992 ◽

Vol 114 (2) ◽

pp. 379-388 ◽

Cited By ~ 5

Author(s):

M.J. Carette ◽

M.W. Ferguson

Keyword(s):

Laser Scanning ◽

Time Course ◽

Laser Scanning Microscopy ◽

Confocal Laser ◽

Palatal Fusion ◽

Morphological Criteria ◽

Medial Edge ◽

Mesenchymal Transformation

Fusion of bilateral shelves, to form the definitive mammalian secondary palate, is critically dependent on removal of the medial edge cells that constitute the midline epithelial seam. Conflicting views suggest that programmed apoptotic death or epithelial-mesenchymal transformation of these cells is predominantly involved. Due in part to the potentially ambiguous interpretation of static images and the notable absence of fate mapping studies, the process by which this is achieved has, however, remained mechanistically equivocal. Using an in vitro mouse model, we have selectively labelled palatal epithelia with DiI and examined the fate of medial edge epithelial (MEE) cells during palatal fusion by localisation using a combination of conventional histology and confocal laser scanning microscopy (CLSM). In dynamic studies using CLSM, we have made repetitive observations of the same palatal cultures in time-course investigations. Our results concurred with the established morphological criteria of seam degeneration; however, they provided no evidence of MEE cell death or transformation. Instead we report that MEE cells migrate nasally and orally out of the seam and are recruited into, and constitute, epithelial triangles on both the oral and nasal aspects of the palate. Subsequently these cells become incorporated into the oral and nasal epithelia on the surface of the palate. We hypothesize an alternative method of seam degeneration in vivo which largely conserves the MEE population by recruiting it into the nasal and oral epithelia.

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Avulsion Fracture of the Calcaneal Tuberosity: A soft tissue complication from delayed treatment

The Foot and Ankle Online Journal ◽

10.3827/faoj.2010.0306.0001 ◽

2010 ◽

Cited By ~ 1

Author(s):

M. Radzilani MBChB ◽

E. D’Alton MBChB,(Pret), MMed (Orth) ◽

R.G. Golele, MBChB (Natal) ◽

MF GP (SA), MMed (Orth), FCS Orth (SA)

Keyword(s):

Soft Tissue ◽

Avulsion Fracture ◽

Delayed Treatment ◽

Soft Tissue Complication ◽

Calcaneal Tuberosity

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Partial Resection of Posterior Calcaneal Tuberosity for Haglund's Disease

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1998.33.5.1273 ◽

1998 ◽

Vol 33 (5) ◽

pp. 1273

Author(s):

Kyung Tai Lee ◽

Hyun Cheol Kim ◽

Sang Bo Tak

Keyword(s):

Partial Resection ◽

Calcaneal Tuberosity

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Endoscopic treatment of Achilles tendon enthesopathies: An anatomical and clinical feasibility study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00008 ◽

2020 ◽

Vol 8 (2_suppl) ◽

pp. 2325967120S0000

Author(s):

Olivier Boniface ◽

Thomas Vervoort

Keyword(s):

Achilles Tendon ◽

Feasibility Study ◽

Open Surgery ◽

Wound Complications ◽

Operating Technique ◽

Clinical Series ◽

Open Reconstruction ◽

Tendon Insertion ◽

Calcaneal Tuberosity

Background: One possible treatment for Achilles tendon enthesopathy is open reconstruction of the Achilles tendon insertion by resection of calcified enthesis and the calcaneal tuberosity followed by reinsertion of the tendon with anchors. Subcutaneous dissection of the tendon in open procedure is at risk of wound complications. We hypothesized that this procedure could be performed under endoscopy. Methods: An innovative operating technique was described. It consisted in removal and reinsertion of the Achilles tendon under endoscopy using five portals with resection of the calcaneal tuberosity and calcified enthesis. A feasibility study was first conducted on five cadaveric feet followed by an in vivo study on five patients. Results: In all cases, the Achilles tendon could be reinserted with the same technique than in open surgery. None of the ten surgical procedures technically failed. It was possible to correctly resect calcifications and the calcaneal tuberosity. Resection was performed under endoscopic and fluoroscopic control for the ten cases. Proper reinsertion was verified under endoscopy, by placement of the ankle in physiological equinus for clinical series and by dissection for cadaveric cases. There were no complications in the clinical series 3 months postoperatively. Conclusion: Achilles enthesopathies can be treated by detachment/reinsertion of the Achilles tendon under endoscopy with resection of calcified enthesis and the calcaneal tuberosity. This endoscopic technique should now be validated by analyzing longer-term clinical and anatomical results and comparing them with the results of open surgery.

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Observation of Dynamic Cellular Migration of the Medial Edge Epithelium of the Palatal Shelf in vitro

Frontiers in Physiology ◽

10.3389/fphys.2019.00698 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 4

Author(s):

Gozo Aoyama ◽

Hiroshi Kurosaka ◽

Ayaka Oka ◽

Kohei Nakatsugawa ◽

Sayuri Yamamoto ◽

...

Keyword(s):

Cellular Migration ◽

Palatal Shelf ◽

Medial Edge

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Calcaneoplasty coupled with an insertional Achilles tendon reattachment procedure for the prevention of secondary calcaneal impingement: a retrospective study

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320944793 ◽

2020 ◽

Vol 11 ◽

pp. 204062232094479

Author(s):

Yanbin Pi ◽

Yuelin Hu ◽

Qinwei Guo ◽

Dong Jiang ◽

Xin Xie ◽

...

Keyword(s):

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Pain Scale ◽

Mri Findings ◽

Aofas Score ◽

Foot Function ◽

Magnetic Resonance Imaging Mri ◽

Pain Symptoms ◽

Tegner Score ◽

Calcaneal Tuberosity

Background: Posterior heel pain may occur after an Achilles insertional rupture reattachment procedure and could be attributed to an impingement between the calcaneal tuberosity and Achilles tendon, which could be observed using postoperative magnetic resonance imaging (MRI). Moreover, such impingement, which may be associated with postoperative pain symptoms, could be relieved by calcaneoplasty. Methods: Postoperative Visual Analog Pain Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, Foot Function Index (FFI), Ankle Activity Score (AAS), and Tegner score were obtained and compared between 10 patients who underwent calcaneoplasty (calcaneoplasty group) and 11 patients who did not receive calcaneoplasty (non-calcaneoplasty group). Several signs of calcaneal tuberosity impingement identified in MRI were also compared between the two groups, which included retrocalcaneal bursitis, postoperative tendinopathy, tendon calcification, bone marrow edema, increased Achilles tendon diameter, and bony spurs. Results: The VAS score was 2.00 ± 1.41 and 2.18 ± 1.83 ( p = 0.803), the AOFAS score was 90.60 ± 4.22 and 81.82 ± 7.77 ( p = 0.005), the FFI was 5.00 ± 2.86 and 17.18 ± 15.92 ( p = 0.028), the AAS was 5.50 ± 2.55 and 5.82 ± 2.04 ( p = 0.750), and the Tegner score was 4.30 ± 1.49 and 4.45 ± 1.21 ( p = 0.797) in the calcaneoplasty and non-calcaneoplasty groups, respectively. The AOFAS score and FFI were significantly different between the groups. MRI findings revealed that the non-calcaneoplasty group had significant signs of calcaneal impingement compared with the calcaneoplasty group. Conclusions: Secondary calcaneal impingement due to insertional tendon enlargement may occur, and prophylactic calcaneoplasty coupled with an insertional reattachment procedure could achieve promising postoperative outcomes for patients with insertional Achilles tendon rupture.

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Sonographic Evaluation of Plantar Fasciitis and its Relation to Body Mass Index and Heel Pad Thickness

Nepalese Journal of Radiology ◽

10.3126/njr.v9i2.27427 ◽

2020 ◽

Vol 9 (2) ◽

pp. 32-39

Author(s):

Prashant Khatiwada ◽

Dinesh Chataut ◽

Kamal Subedi

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Plantar Fasciitis ◽

Plantar Fascia ◽

Skin Surface ◽

Control Group ◽

Heel Pad ◽

And Control ◽

Calcaneal Tuberosity ◽

Symptomatic Side

Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT). Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity. Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p <0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p <0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels). Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.

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