scholarly journals The Plantar Support of the Navicular-Cunieform Joint

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.

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.

Morphometric Dimensions of the Calcaneonavicular (Spring) Ligament

2007 ◽  
Vol 28 (8) ◽  
pp. 927-932 ◽  
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.

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.

Posterior Tibial Tendon and Spring Ligament Lesions in Rheumatoid Arthritis

2019 ◽  
Vol 35 (4) ◽  
pp. 65-69
Author(s):  
M. Bouysset ◽  
T. Tavernier ◽  
E. Decullier ◽  
C. Confavreux ◽  
J.G. Tebib ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Treatment Intensification ◽  
Flat Foot ◽  
Biologic Treatment ◽  
Posterior Tibial ◽  
Spring Ligament ◽  
Number Of Patients ◽  
Tendon Lesion

In rheumatoid arthritis, a significant number of patients have hindfoot pain while they are considered in low disease activity. Then the rheumatoid hindfoot may evolve in valgus flat foot with disability. The aim of our study was to observe the lesions of the main stabilizers of the hindfoot in rheumatoid arthritis to improve the followup and the treatment of the disease. Thirty-three feet (from 21 patients) with rheumatoid arthritis and pain of the hindfoot were consecutively observed. The patients have had no biologic treatment. Every foot had Magnetic Resonance Imaging (MRI) of the hindfoot with gadolinium injection. The tendon of the tibialis posterior muscle, the spring ligament and the inter-osseous talocalcaneal ligament were considered. All the feet presented tenosynovitis of the posterior tibial tendon. Structural lesions of the posterior tibial tendon (23/33 feet, 69.7%) were more frequent than lesions of the spring ligament (12/33 feet, 36.4%). There was no inferior spring ligament lesion without superior spring ligament lesion. No interosseous talocalcaneal ligament lesion was observed. In rheumatoid arthritis, the hindfoot, and particularly the posterior tibial tendon, should be evaluated during patient follow-up to detect a possible lesion. Posterior tibial tendon lesion arises at the same time as the spring ligament lesion, before interosseous talocalcaneal ligament lesion. Imaging, especially MRI, may complete clinical examination. If rheumatoid involvement of the posterior tibial tendon is observed, treatment intensification is required.

scholarly journals POSTERIOR TIBIAL TENDON INJURY - IS MISSED DIAGNOSIS, A POSSIBILITY? SHOULD IT BE SUSPECTED IN ALLANKLE EVERSION SPRAINS? - A CASE REPORT

2020 ◽  
pp. 1-2
Author(s):  
Chavda Sumant ◽  
Garg Chaitanya ◽  
George, Biji Thomas ◽  
Jad Allah, Bader
Keyword(s):  
Physical Examination ◽  
Ankle Sprain ◽  
Weight Bearing ◽  
Ankle Injuries ◽  
Radiographic Evaluation ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Persistent Symptoms ◽  
Posterior Tibial ◽  
Ankle Brace

Ankle sprains are one of the most common injuries that occur among people of all ages and accounts for 75% of ankle injuries and for 10 to 30 percent of sports-related injuries in young athletes. Inversion sprain is more common than eversion ankle sprain, to result in injury to the lateral ligament complex. Though injury to the posterior tibial tendon is not a very common injury associated with eversion ankle sprain, it often can be overlooked and missed in the initial physical examination. We present a case of a college student who sustained a twisting injury to his left ankle while playing football. After initial history, physical examination and plain radiographic evaluation, a diagnosis of eversion ankle sprain was made by a general practitioner and treated conservatively. Due to persistent symptoms and local signs, subsequent evaluation with an MRI study revealed tibialis posterior (TP) tendon strain with diffuse soft tissue swelling extending up to lower third of the leg and associated Grade I osteochondral injury to the posterolateral aspect of talus. The injury was successfully treated with medial arch support ankle brace, analgesics, guarded weight bearing and physiotherapy with full functional recovery in 12 weeks.

scholarly journals Efek Injeksi Plasma Kaya Platelet Terhadap Tenosinovitis Tendon Tibialis Posterior: Sebuah Studi Kasus

2019 ◽  
Vol 5 (1) ◽  
pp. 60-65
Author(s):  
Henry Ricardo Handoyo ◽  
Andryan Hanafi Bakri ◽  
Andri Primadhi Primadhi
Keyword(s):  
Platelet Rich Plasma ◽  
Tibialis Posterior ◽  
Medial Malleolus ◽  
Posterior Tibial Tendon ◽  
Foot And Ankle ◽  
Posterior Tibial Tendon Dysfunction ◽  
Flat Foot ◽  
Posterior Tibial ◽  
Left Ankle ◽  
History Of

Introduction: Posterior tibial tendon dysfunction is one of the most common, problems of the foot and ankle. Tenosynovitis of the posterior tibial tendon (PTT) is an often unrecognized form of PTT dysfunction. Case: A 54-year-old woman presented with left ankle pain that began while morning walk three days prior. She noted that the left ankle hurt with even light touch and the pain was unrelieved with sodium diclofenac. She denied any history of trauma. She was seen in the outpatient clinic for this condition. On examination, a three centimeter area of pain was found posterior to the medial malleolus and parallel to the PTT. She also had a stage I flat foot and mild soft tissue swelling around medial malleolus region on her radiograph examination. Ultrasound examination was done with the result of anechoic fluid visible in the peritendinous space around the PTT. The patient received diagnosis of PTT tenosynovitis, with the foot and ankle disability index (FADI) score was 58.7. Platelet rich plasma (PRP) injection was done twice with an interlude of two weeks. The pain subsided and the following FADI score was 84.6. Outcome: Patient showed improvement in her left ankle PTT tenosynovitis after two PRP injection. Conclusion: This case report highlights the efficacy of PRP as a modality in managing PTT tenosynovitis.

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....

Proximal Medial Longitudinal Arch Incision for Plantar Fascia Release

Foot & Ankle ◽  
1987 ◽  
Vol 8 (3) ◽  
pp. 152-155 ◽  
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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