Biomechanical Evaluation of Longitudinal Arch Stability

In spite of the common occurrence of pes planus and multiple operations that have been reported to relieve the associated symptoms, there is little published on the relative contribution of various structures to stabilization of the arch of the foot. Twelve fresh-frozen human cadaveric feet were loaded along the tibial axis with compressive loads of 230, 460, and 690 newtons with the specimens intact and after sequential sectioning of plantar fascia, plantar ligaments, and spring ligament. Structures were sectioned in six different sequences and changes in vertical and horizontal dimensions of the medial arch were measured. The highest relative contribution to arch stability was provided by the plantar fascia, followed by plantar ligaments and spring ligament. Plantar fascia was a major factor in maintenance of the medial longitudinal arch. Its division in the cadaveric feet decreased arch stiffness by 25%.

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Biomechanical Consequences of Total Plantar Fasciotomy

Journal of the American Podiatric Medical Association ◽

10.7547/0990422 ◽

2009 ◽

Vol 99 (5) ◽

pp. 422-430 ◽

Cited By ~ 13

Author(s):

Jo L. Tweed ◽

Mike R. Barnes ◽

Mike J. Allen ◽

Jackie A. Campbell

Keyword(s):

Center Of Pressure ◽

Plantar Fascia ◽

In Vivo Studies ◽

Medial Longitudinal Arch ◽

Foot Structure ◽

Longitudinal Arch ◽

Plantar Fasciotomy ◽

Postoperative Problems

Background: Plantar fascia release for chronic plantar fasciitis has provided excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential postoperative problems, most commonly weakness of the medial longitudinal arch and pain in the lateral midfoot. Methods: An electronic search was conducted of the MEDLINE, ScienceDirect, SportDiscus, EMBASE, CINAHL, Cochrane, and AMED databases. The keywords used to search these databases were plantar fasciotomy and medial longitudinal arch. Articles published between 1976 and 2008 were identified. Results: Collectively, results of cadaveric studies suggested that plantar fasciotomy leads to loss of integrity of the medial longitudinal arch and that total plantar fasciotomy is more detrimental to foot structure than is partial fasciotomy. In vivo studies, although limited in number, concluded that although clinical outcomes were satisfactory, medial longitudinal arch height decreased and the center of pressure of the weightbearing foot was excessively medially deviated postoperatively. Conclusions: Plantar fasciotomy, in particular total plantar fasciotomy, may lead to loss of stability of the medial longitudinal arch and abnormalities in gait, in particular an excessively pronated foot. Further in vivo studies on the long-term biomechanical effects of plantar fasciotomy are required. (J Am Podiatr Med Assoc 99(5): 422–430, 2009)

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Proximal Medial Longitudinal Arch Incision for Plantar Fascia Release

Foot & Ankle ◽

10.1177/107110078700800309 ◽

1987 ◽

Vol 8 (3) ◽

pp. 152-155 ◽

Cited By ~ 36

Author(s):

William G. Ward ◽

Frank W. Clippinger

Keyword(s):

Plantar Fasciitis ◽

Tibial Nerve ◽

Plantar Fascia ◽

Surgical Approaches ◽

Medial Longitudinal Arch ◽

Posterior Tibial Nerve ◽

Posterior Tibial ◽

Longitudinal Arch ◽

Plantar Incision ◽

Plantar Fascia Release

A curved, oblique plantar incision in the proximal aspect in the medial longitudinal arch was used to release the plantar fascia in eight feet with recalcitrant plantar fasciitis. Seven feet became pain free and the eighth was 75% improved. Normal sensation to the heel was preserved in all cases. No painful scars or neuromas of the calcaneal branch of the posterior tibial nerve developed. This approach represents a significant improvement over previously reported surgical approaches.

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Anomalous plantar intrinsic foot muscle attaching to the medial longitudinal arch: possible mechanism for medial nerve entrapment: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02676-x ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

R. Claire Aland ◽

Alana C. Sharp

Keyword(s):

White Male ◽

Nerve Entrapment ◽

Medial Longitudinal Arch ◽

Spring Ligament ◽

Longitudinal Arch ◽

Plantar Aspect ◽

Tendon Insertion ◽

The Right ◽

Intrinsic Foot Muscle ◽

Medial Nerve

Abstract Background Muscular variations are potentially symptomatic and may complicate imaging interpretation. Intrinsic foot musculature and extrinsic tendon insertion variations are common. Distinct supernumerary muscles are rare. We report a novel anomalous intrinsic foot muscle on the medial longitudinal arch. Case presentation An accessory muscle was encountered on the medial arch of the right foot of a 78-year-old white male cadaver, between layers two and three of the foot intrinsics. It did not appear to be a slip or variant of a known foot muscle. This muscle consisted of two slips that ran transversely on the plantar aspect of the medial arch, crossing the medial transverse tarsal joint and attaching to the tuberosity of the navicular, the short and long plantar ligaments, and spring ligament. Conclusions The medial plantar vessels and nerve passed from deep to superficial between the two slips, and this suggests a possible location for medial nerve entrapment.

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Morphometric Dimensions of the Calcaneonavicular (Spring) Ligament

Foot & Ankle International ◽

10.3113/fai.2007.0927 ◽

2007 ◽

Vol 28 (8) ◽

pp. 927-932 ◽

Cited By ~ 24

Author(s):

Vishwas Patil ◽

Nabil A. Ebraheim ◽

Alexandra Frogameni ◽

Jiayong Liu

Keyword(s):

Ankle Joint ◽

Clinical Relevance ◽

Posterior Tibial Tendon ◽

Medial Longitudinal Arch ◽

Posterior Tibial ◽

Spring Ligament ◽

Longitudinal Arch ◽

Dynamic Support ◽

Complex Methods ◽

Adult Cadaver

Background: The spring ligament complex (SLC) is a static support of the head of the talus and a major anatomical contributor to the integrity of the medial longitudinal arch, particularly if the dynamic support of the posterior tibial tendon is compromised. For this reason, we sought to further elucidate the anatomical components and dimensions of this ligamentous complex. Methods: Dissection was performed on 30 adult cadaver feet disarticulated at the ankle joint that were preserved by embalming technique. Results: The superomedial ligament (SML) averages 42.51 ± 3.93 mm and 33.44 ± 3.34 mm at the superomedial and inferolateral borders, respectively. The width at the level of sustentaculum tali and navicular tuberosity averaged 20.00 ± 2.35 mm and 10.26 ± 2.05 mm, respectively. The medioplantar oblique (MPO) ligament averaged 23.56 ± 2.15 mm and 21.20 ± 1.42 mm at the medial and the lateral borders, respectively. The widths at the navicular and calcaneal side were 2.71 ± 0.39 mm and 8.14 ± 0.56 mm, respectively. The inferoplantar longitudinal (IPL) ligament measured 4.26 ± 0.43 mm and 2.66 ± 0.42 mm at the medial and lateral borders, respectively. The width at the calcaneal and navicular insertions measured 5.21 ± 0.53 mm and 3.39 ± 0.39 mm, respectively. Conclusions: The distinction between the SML and MPO components of the spring ligament complex is difficult. This study tried to clarify the dimensions and configurations of these components of the SLC. Clinical relevance: This effort may aid surgeons who wish to repair this ligament with more precision.

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The Plantar Support of the Navicular-Cunieform Joint

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00338 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0033

Author(s):

Lyndon Mason ◽

Eric Swanton ◽

Lauren Fisher ◽

Andrew Fisher ◽

Andrew Molloy

Keyword(s):

Lower Limbs ◽

Human Anatomy ◽

Tibialis Posterior ◽

Posterior Tibial Tendon ◽

Medial Longitudinal Arch ◽

Average Width ◽

Posterior Tibial ◽

Spring Ligament ◽

Longitudinal Arch ◽

Medial Cuneiform

Category: Midfoot/Forefoot Introduction/Purpose: Weight-bearing radiographic analysis of pes planus deformities shows, with varying degree of severity, a break in Meary’s line, uncovering of the talar head and an increase in talar-first metatarsal angle. Work by Alsousou (BOFAS 2016) has shown the break in Meary’s line to occur not only at the talonavicular joint (2/3rds of cases) but also at the navicular-cuneiform joint (1/3 rd of cases), distal to the spring ligament and reported posterior tibial tendon insertion. There are currently no anatomical studies analysing the medial longitudinal arch distal to the spring ligament insertion. We aimed to examine this area and assess the anatomy supporting the distal medial longitudinal arch. Methods: We examined 11 cadaveric lower limbs that had been preserved for dissection at the Human Anatomy and Resource Centre at Liverpool University, in a solution of formaldehyde. The lower limbs were carefully dissected to identify the plantar aspect of the medial longitudinal arch Results: In all specimens, the posterior tibial tendon inserted into the plantar medial aspect of the navicular with separate slips to the intermediate and lateral cuneiform. Following insertion, on the navicular, a tendon-like structure extended from this navicular insertion point to the medial cuneiform. This tendon-like structure is statically inserted between the navicular and medial cuneiform allowing the pull of tibialis posterior to act on the navicular and medial cuneiform in tandem. The average width of this ligament (15.2 mm) is much greater than that of the tibialis posterior tendon (9.5 mm). A separate smaller plantar ligament is also present between the navicular and medial cuneiform. Conclusion: The posterior tibialis tendon inserts into the navicular, and what is likely an anthropological remnant, extends onto the medial cuneiform as the navicular cuneiform ligament. This provides a static restraint between two bony insertions and increases the lever arm of the posterior tibial tendon. The major support of the distal aspect of the medial longitudinal arch (i.e. the navicular-cuneiform joint) is provided by the substantial navicular cuneiform ligament.

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Biomechanical Evaluation of the Efficacy of External Stabilizers in the Conservative Treatment of Acquired Flatfoot Deformity

Foot & Ankle International ◽

10.1177/107110070202300809 ◽

2002 ◽

Vol 23 (8) ◽

pp. 727-737 ◽

Cited By ~ 38

Author(s):

Carl W. Imhauser ◽

Nicholas A. Abidi ◽

David Z. Frankel ◽

Kenneth Gavin ◽

Sorin Siegler

Keyword(s):

Pressure Distribution ◽

Plantar Pressure ◽

Center Of Pressure ◽

Lower Limbs ◽

Quiet Standing ◽

Medial Longitudinal Arch ◽

Longitudinal Arch ◽

Plantar Pressure Distribution ◽

Flexible Flatfoot ◽

Fresh Frozen

This study quantified and compared the efficacy of in-shoe orthoses and ankle braces in stabilizing the hindfoot and medial longitudinal arch in a cadaveric model of acquired flexible flatfoot deformity. This was addressed by combining measurement of hindfoot and arch kinematics with plantar pressure distribution, produced in response to axial loads simulating quiet standing. Experiments were conducted on six fresh-frozen cadaveric lower limbs. Three conditions were tested: intact-unbraced; flatfoot-unbraced; and flatfoot-braced. Flatfoot deformity was created by sectioning the main support structures of the medial longitudinal arch. Six different braces were tested including two in-shoe orthoses, three ankle braces and one molded ankle-foot orthosis. Our model of flexible flatfoot deformity caused the calcaneus to evert, the talus to plantarflex and the height of the talus and medial cuneiform to decrease. Flexible flatfoot deformity caused a pattern of medial shift in plantar pressure distribution, but minimal change in the location of the center of pressure. Furthermore, in-shoe orthoses stabilized both the hindfoot and the medial longitudinal arch, while ankle braces did not. Semi-rigid foot and ankle orthoses acted to stabilize the medial longitudinal arch. Based on these results, it was concluded that treatment of flatfoot deformity should at least include use of in-shoe orthoses to partially restore the arch and stabilize the hindfoot.

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Biomechanical Evaluation of Tarsometatarsal Fusion Comparing Crossing Lag Screws and Lag Screw With Locking Plate

Foot & Ankle International ◽

10.1177/10711007211033541 ◽

2021 ◽

pp. 107110072110335

Author(s):

Sarah Ettinger ◽

Lisa-Christin Hemmersbach ◽

Michael Schwarze ◽

Christina Stukenborg-Colsman ◽

Daiwei Yao ◽

...

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Operative Procedure ◽

Fixation Technique ◽

Lag Screw ◽

Group 15 ◽

Fresh Frozen ◽

Biomechanical Evaluation ◽

The Stability ◽

End Stage

Background: Tarsometatarsal (TMT) arthrodesis is a common operative procedure for end-stage arthritis of the TMT joints. To date, there is no consensus on the best fixation technique for TMT arthrodesis and which joints should be included. Methods: Thirty fresh-frozen feet were divided into one group (15 feet) in which TMT joints I-III were fused with a lag screw and locking plate and a second group (15 feet) in which TMT joints I-III were fused with 2 crossing lag screws. The arthrodesis was performed stepwise with evaluation of mobility between the metatarsal and cuneiform bones after every application or removal of a lag screw or locking plate. Results: Isolated lag-screw arthrodesis of the TMT I-III joints led to significantly increased stability in every joint ( P < .05). Additional application of a locking plate caused further stability in every TMT joint ( P < .05). An additional crossed lag screw did not significantly increase rigidity of the TMT II and III joints ( P > .05). An IM screw did not influence the stability of the fused TMT joints. For TMT III arthrodesis, lag-screw and locking plate constructs were superior to crossed lag-screw fixation ( P < .05). TMT I fusion does not support stability after TMT II and III arthrodesis. Conclusion: Each fixation technique provided sufficient stabilization of the TMT joints. Use of a lag screw plus locking plate might be superior to crossed screw fixation. An additional TMT I and/or III arthrodesis did not increase stability of an isolated TMT II arthrodesis. Clinical Relevance: We report the first biomechanical evaluation of TMT I-III arthrodesis. Our results may help surgeons to choose among osteosynthesis techniques and which joints to include in performing arthrodesis of TMT I-III joints.

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Is subtalar extra articular screw arthroereisis (SESA) reducing pain and restoring medial longitudinal arch in children with flexible flat foot?

Journal of Orthopaedics ◽

10.1016/j.jor.2020.01.038 ◽

2020 ◽

Vol 20 ◽

pp. 147-153

Author(s):

Mohammed Elmarghany ◽

Tarek M. Abd El-Ghaffar ◽

Ahmed Elgeushy ◽

Ehab Elzahed ◽

Yehia Hasanin ◽

...

Keyword(s):

Medial Longitudinal Arch ◽

Flat Foot ◽

Longitudinal Arch

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Why heel spurs are traction spurs after all

Scientific Reports ◽

10.1038/s41598-021-92664-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Johann Zwirner ◽

Aqeeda Singh ◽

Francesca Templer ◽

Benjamin Ondruschka ◽

Niels Hammer

Keyword(s):

Achilles Tendon ◽

Soft Tissues ◽

Plantar Fascia ◽

Trabecular Architecture ◽

Pathological Findings ◽

Traction Forces ◽

X Ray ◽

Developmental Mechanism ◽

Common Features ◽

Compressive Loads

AbstractIt is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces. Previous histological investigations focused on either one of the two spur locations, thereby potentially overlooking common features that refer to a uniform developmental mechanism. In this study, 19 feet from 16 cadavers were X-ray scanned to preselect calcanei with either plantar or posterior spurs. Subsequently, seven plantar and posterior spurs were histologically assessed. Five spur-free Achilles tendon and three plantar fascia entheses served as controls. Plantar spurs were located either intra- or supra-fascial whereas all Achilles spurs were intra-fascial. Both spur types consistently presented a trabecular architecture without a particular pattern, fibrocartilage at the tendinous entheses and the orientation of the spur tips was in line with the course of the attached soft tissues. Spurs of both entities revealed tapered areas close to their bases with bulky tips. Achilles and plantar heel spurs seem to be non-pathological calcaneal exostoses, which are likely results of traction forces. Both spur types revealed commonalities such as their trabecular architecture or the tip direction in relation to the attached soft tissues. Morphologically, heel spurs seem poorly adapted to compressive loads.

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