Kidner Procedure for Symptomatic Accessory Navicular and Its Relation to Pes Planus

1995 ◽  
Vol 16 (8) ◽  
pp. 500-503 ◽  
Author(s):  
Somchai Prichasuk ◽  
Opas Sinphurmsukskul
Keyword(s):  
Pitch Angle ◽  
Normal Subjects ◽  
Tibialis Posterior ◽  
Medial Longitudinal Arch ◽  
Pes Planus ◽  
Tibialis Posterior Tendon ◽  
Accessory Navicular ◽  
Tendon Insertion

The role of relocation of tibialis posterior tendon insertion in the treatment of symptomatic accessory navicular and its relation to the pes planus was studied in 28 patients with symptomatic accessory navicular. Two hundred non-affected individuals were used as control. The calcaneal pitch angle measured radiographically, was used as an indicator of pes planus. All patients had had an excision of the accessory navicular and relocation of the tibialis posterior tendon insertion (Kidner procedure). The average follow-up was 3.2 years. The results were good in 27 patients, and fair in 1 patient, and there were no poor results. Most of the patients demonstrated that the pain and the fatigue signs of the foot and the leg have been improved. Only 3 of 25 patients clinically showed an improvement of the medial longitudinal arch. The calcaneal pitch angle in patients with symptomatic accessory navicular was significantly (14.8°) lower than that in normal subjects (21.4°). An association of pes planus and symptomatic accessory navicular was shown. The Kidner procedure gave good results in the relief of pain and fatigue in patients with symptomatic accessory navicular. The procedure did not significantly restore the height of the medial arch.

An Anatomic Study of the Naviculocuneiform Ligament and Its Possible Role Maintaining the Medial Longitudinal Arch

2018 ◽  
Vol 40 (3) ◽  
pp. 352-355 ◽  
Author(s):  
Eric Swanton ◽  
Lauren Fisher ◽  
Andrew Fisher ◽  
Andrew Molloy ◽  
Lyndon Mason
Keyword(s):  
Weight Bearing ◽  
Lower Limbs ◽  
Tibialis Posterior ◽  
Medial Longitudinal Arch ◽  
Pes Planus ◽  
Average Width ◽  
Tibialis Posterior Tendon ◽  
Longitudinal Arch ◽  
Medial Cuneiform ◽  
Distal Aspect

Background: Weight-bearing radiographic analysis of pes planus deformities show, with varying degree of severity, a break in the Meary line. The break in the Meary line occurs not only at the talonavicular joint but also distal to the spring ligament and reported tibialis posterior insertion. Our aim in this study was to investigate the distal plantar ligaments of the medial longitudinal arch, to try to identify other areas where deformity correction could be affected. Methods: We examined 11 cadaveric lower limbs that had been preserved for dissection 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 tibialis posterior tendon inserted into the plantar medial aspect of the navicular with separate slips to the intermediate and lateral cuneiform. The navicular cuneiform ligament extended from the navicular to medial cuneiform. This structure was statically inserted between the navicular and medial cuneiform, which would allow the pull of the tibialis posterior to act on the navicular and medial cuneiform in tandem. The average width of the naviculocuneiform ligament was 15.2 mm (range 12.4-18.0) compared to 9.5 mm (range 7.6-11.4) for the tibialis posterior tendon. Conclusion: The tibialis posterior tendon inserted into the navicular and continued onto the medial cuneiform to provide a static restraint between 2 bony insertions, thus supporting the distal aspect of the medial longitudinal arch. Clinical Relevance: We are confident that it is a structure of importance in maintaining the distal aspect of the medial longitudinal arch and may therefore have significant clinical and surgical implications when treating the pes planus deformity.

Role of Tendoscopy in Treating Stage II Posterior Tibial Tendon Dysfunction

2018 ◽  
Vol 39 (4) ◽  
pp. 433-442 ◽  
Author(s):  
Alessio Bernasconi ◽  
Francesco Sadile ◽  
Matthew Welck ◽  
Nazim Mehdi ◽  
Julien Laborde ◽  
...  
Keyword(s):  
Invasive Surgery ◽  
Stage Ii ◽  
Preoperative Imaging ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial ◽  
Spring Ligament ◽  
Sf 36

Background: Stage II tibialis posterior tendon dysfunction (PTTD) resistant to conservative therapies is usually treated with invasive surgery. Posterior tibial tendoscopy is a novel technique being used in the assessment and treatment of posterior tibial pathology. The aims of this study were (1) to clarify the role of posterior tibial tendon tendoscopy in treating stage II PTTD, (2) to arthroscopically classify spring ligament lesions, and (3) to compare the arthroscopic assessment of spring ligament lesions with magnetic resonance imaging (MRI) and ultrasonographic (US) data. Methods: We reviewed prospectively collected data on 16 patients affected by stage II PTTD and treated by tendoscopy. We report the reoperation rate and functional outcomes evaluated by comparing pre- and postoperative visual analogic scale for pain (VAS-pain) and the Short-Form Health Survey (SF-36; with its physical [PCS] and mental [MCS] components). Postoperative satisfaction was assessed using a VAS-satisfaction scale. One patient was lost to follow-up. Spring ligament lesions were arthroscopically classified in 3 stages. Discrepancies between preoperative imaging and intraoperative findings were evaluated. Results: At a mean of 25.6 months’ follow-up, VAS-pain ( P < .001), SF-36 PCS ( P = .039), and SF-36 MCS ( P < .001) significantly improved. The mean VAS-satisfaction score was 75.3/100. Patients were relieved from symptoms in 80% of cases, while 3 patients required further surgery. MRI and US were in agreement with intraoperative data in 92% and 67%, respectively, for the tendon assessment and in 78% and 42%, respectively, for the spring ligament. Conclusions: Tendoscopy may be considered a valid therapeutic tool in the treatment of stage II PTTD resistant to conservative treatment. It provided objective and subjective encouraging results that could allow continued conservative therapy while avoiding more invasive surgery in most cases. MRI and US were proven more useful in detecting PT lesions than spring ligament tears. Further studies on PT could use this tendoscopic classification to standardize its description. Level of Evidence: Level IV, therapeutic study, case series.

Orthotics

2013 ◽  
Author(s):  
Sharon Dixon ◽  
Sophie Roberts
Keyword(s):  
Lower Limb ◽  
Movement Pattern ◽  
Fundamental Principle ◽  
Tibialis Posterior ◽  
Medial Longitudinal Arch ◽  
Firing Patterns ◽  
Tibialis Posterior Tendon ◽  
Longitudinal Arch ◽  
Custom Made ◽  
Dynamic Gait

An orthotic is a custom-made insole which fits inside a shoe with the purpose of changing the way in which the foot functions during both standing and dynamic gait. There are many theories regarding the influence of these devices on the foot and lower limb. It is widely accepted that the fundamental principle is that an orthotic encourages a change in the movement pattern of the foot, aiming to alleviate stress to musculoskeletal structures, and produce changes in muscle firing patterns. An example of how an orthotic works is when one is used to change the functioning position of the medial longitudinal arch of the foot by altering the orientation of the calcaneus and potentially reducing the demand on the tibialis posterior tendon....

Long-term follow-up of patients undergoing tibialis posterior transfer: Is acquired pes planus a complication?

The Foot ◽  
2018 ◽  
Vol 34 ◽  
pp. 83-89 ◽  
Author(s):  
Mira Pecheva ◽  
Adam Devany ◽  
Basil Nourallah ◽  
Steven Cutts ◽  
Chandra Pasapula
Keyword(s):  
Tibialis Posterior ◽  
Pes Planus ◽  
Long Term Follow Up ◽  
Tibialis Posterior Transfer

Role of prolactin in age-related change in serum dehydroepiandrosterone sulphate concentrations

1989 ◽  
Vol 120 (5) ◽  
pp. 655-660 ◽  
Author(s):  
Tohru Yamaji ◽  
Miyuki Ishibashi ◽  
Fumimaro Takaku ◽  
Akira Teramoto ◽  
Kintomo Takakura ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Normal Subjects ◽  
Significant Negative Correlation ◽  
Adrenocortical Function ◽  
Dehydroepiandrosterone Sulphate ◽  
Age Related ◽  
Number Of Patients ◽  
Normal Women

Abstract. Serum dehydroepiandrosterone sulphate concentrations were measured in 70 patients with prolactinoma and in 54 patients with acromegaly with normal adrenocortical function. Compared with values in normal subjects of corresponding age, serum dehydroepiandrosterone sulphate levels were increased in 22 patients with prolactinoma (31%) and in 5 patients with acromegaly (9%). The four acromegalic patients who had elevated serum dehydroepiandrosterone sulphate levels had hyperprolactinemia. The mean serum dehydroepiandrosterone sulphate concentrations in patients with prolactinoma in each decade decreased with advancing age. There was a significant negative correlation between serum dehydroepiandrosterone sulphate concentrations and ages of the patients with prolactinoma. In all 8 women with prolactinoma as in 6 normal women, serum dehydroepiandrosterone sulphate levels declined definitely during the 9 years of follow-up despite persistent hyperprolactinemia. These results indicate that serum dehydroepiandrosterone sulphate levels are increased in a substantial number of patients with hyperprolactinemia, however, PRL per se may not play a significant role in the age-related change in serum dehydroepiandrosterone sulphate levels.

scholarly journals POS1333 ANKLE ARTHRITIS IN JUVENILE IDIOPATHIC ARTHRITIS: DON’T MISS TENOSYNOVITIS. CLINICAL AND SONOGRAPHIC FEATURES OF ANKLE TENOSYNOVITIS IN JIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 948.3-949
Author(s):  
S. Pastore ◽  
S. Della Paolera ◽  
A. Zabotti ◽  
A. Tommasini ◽  
A. Taddio
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Clinical Characteristics ◽  
Color Doppler ◽  
Tendon Sheath ◽  
Response To Treatment ◽  
Tibialis Posterior ◽  
Ultrasound Guided ◽  
Sonographic Examination

Background:Tenosynovitis can occur in patients with Juvenile Idiopathic Arthritis (JIA) and may be clinically difficult to distinguish from joint synovitis. The role of musculoskeletal ultrasound (msk-US) is still discussed in the management of JIA but recent studies supported the utility of msk-US especially in detection of tenosynovitis. There is no consensus treatment for tenosynovitis in children with JIA and almost all studies focused on tendon sheath injection with glucocorticoids.Objectives:The aims of the study were: i) to define the prevalence of tenosynovitis of the ankle in JIA patients and ankle swelling; ii) to describe the clinical characteristics of patient with tenosynovitis and to analyze different response to treatment.Methods:We conducted an observational cross-sectional study of a group of patients with JIA followed at the Rheumatology Service of the Maternal and Child Institute “Burlo Garofolo” of Trieste. We enrolled all the patients who reported a swelling of the ankle at least once during the follow-up period and, among these patients, we included only those who underwent msk-US. Based on both clinical and sonographic examination, we identified patients with tenosynovitis and we described their demographical and clinical characteristics as well as the therapeutic approach undertaken in this group of patients.Results:On December 31st 2019, 56 swollen ankles of 48 patients were assessed with msk-US: 22 ankles showed sonographic signs of synovitis (39%), 16 ankles of both synovitis and tenosynovitis (28%), 14 ankles of tenosynovitis only (25%). Overall, tenosynovitis was detected on twenty-seven (56%) out of 48 children with at least a swollen ankle. The majority of patient were females (70%) and the most affected tendon was the tibialis posterior (66%). Twenty-five patients with tenosynovitis (92%) achieved clinical and radiological remission: seven out of 26 patients (26%) treated with methotrexate achieved clinical and radiological remission without the addition of other therapies; fifteen out of seventeen patients (88%) treated with a biological drug responded to the therapy, of which eleven (73%) were in combination therapy with methotrexate.Conclusion:We observed that more than 50% of the patients with a swelling of the ankle presented a tenosynovitis and among these patients about 50% did not show sonographic sign of synovitis. Msk-US was decisive in order to identify tenosynovitis and to characterize ankle swelling in JIA patients. Among patients with tenosynovitis biological therapy alone or in association with immunomodulating therapy showed effectiveness in inducing disease remission.References:[1]Peters SE, Laxer RM et al. Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study. Pediatr Rheumatol Online J. 2017 Apr 11;15(1):22.[2]Lanni S, Bovis F et al. Delineating the Application of Ultrasound in Detecting Synovial Abnormalities of the Subtalar Joint in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1346-53.[3]Cimaz R, Giani T et al. What is the real role of ultrasound in the management of juvenile idiopathic arthritis? Ann Rheum Dis. 2020 Apr;79(4):437-439. doi: 10.1136/annrheumdis-2019-216358[4]Lanni S, Marafon DP et al. Comparison between clinical and ultrasound assessment of the ankle region in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2020 Apr 27.[5]Laurell L, Court-Payen M et al. Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study. Pediatr Rheumatol Online J. 2011 Jan 29;9(1):4.Disclosure of Interests:None declared

scholarly journals A New Anatomical Classification for Tibialis Posterior Tendon Insertion and Its Clinical Implications: A Cadaveric Study

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1619
Author(s):  
Jeong-Hyun Park ◽  
Digud Kim ◽  
Hyung-Wook Kwon ◽  
Mijeong Lee ◽  
Yu-Jin Choi ◽  
...  
Keyword(s):  
Morphological Variability ◽  
Morphological Characteristics ◽  
Common Type ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Tibialis Posterior Tendon ◽  
Race And Gender ◽  
And Gender ◽  
Tendon Insertion

The variations in the tibialis posterior tendon (TPT) could not be defined by previous classification; thus, this study used a larger-scale cadaver with the aim to classify the types of TPT insertion based on the combination of the number and location of TPT insertions. A total of 118 feet from adult formalin-fixed cadavers were dissected (68 males, 50 females). The morphological characteristics and measurements of TPT insertion were evaluated. Four types of TPT insertions were classified, wherein the most common type was type 4 (quadruple insertions, 78 feet, 66.1%), which was divided into four new subtypes that were not defined in the previous classification. The second most common type was type 3 (triple insertions, 25 feet, 21.2%) with three subtypes, including the new subtype. Type 2 was found in 13 feet (11%), and the rarest type was type 1 (2 feet, 1.7%), wherein the main tendon was only attached to the navicular bone and the medial cuneiform bone. We suggest high morphological variability of the TPT in relation to the insertion location, along with the possibility of significant differences according to race and gender. Moreover, this classification will help clinicians understand adult flatfoot deformity-related posterior tibial tendon dysfunction (PTTD).

scholarly journals Association between ADAMTS13 deficiency and cardiovascular events in chronic hemodialysis patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shih-Yuan Hung ◽  
Tsun-Mei Lin ◽  
Hung-Hsiang Liou ◽  
Ching-Yang Chen ◽  
Wei-Ting Liao ◽  
...  
Keyword(s):  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Cardiovascular Events ◽  
Density Lipoprotein ◽  
Normal Subjects ◽  
Adamts13 Activity ◽  
Cholesterol Levels ◽  
Adamts13 Deficiency

AbstractA mild decrease of ADAMTS13 (a disintegrin and metalloprotease with thrombospodin type 1 motif 13) could attribute to stroke and coronary heart disease in general population. However, the role of ADAMTS13 in hemodialysis (HD) patients remains to be explored. This cross-sectional and observational cohort study enrolled 98 chronic HD patients and 100 normal subjects with the aims to compare the ADAMTS13 activity between chronic HD patients and normal subjects, and to discover the role of ADAMTS13 on the newly developed cardiovascular events for HD patients in a 2-year follow-up. Our HD patients had a significantly lower ADAMTS13 activity than normal subjects, 41.0 ± 22.8% versus 102.3 ± 17.7%, p < 0.001. ADAMTS13 activity was positively correlated with diabetes, triglyceride and hemoglobin A1c, and negatively with high-density lipoprotein cholesterol levels in HD patients. With a follow-up of 20.3 ± 7.3 months, the Cox proportional hazards model revealed that low ADAMTS13, comorbid diabetes, and coronary heart diseases have independent correlations with the development of cardiovascular events. Our study demonstrated that chronic HD patients have a markedly decreased ADAMTS13 activity than normal subjects. Although ADAMTS13 seems to correlate well with diabetes, high triglyceride and low high-density lipoprotein cholesterol levels, ADAMTS13 deficiency still carries an independent risk for cardiovascular events in chronic HD patients.

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