Calcaneocuboid joint | ScienceGate

Category: Hindfoot Introduction/Purpose: There has been considerable interest in recent years in performing a combined talonavicular and subtalar arthrodesis instead of a standard triple arthrodesis for a rigid hindfoot deformity. The ”medial double” (diple) avoids fusing the calcaneocuboid joint with its lateral incision, common bone block graft and high rate of complications. Although the results of the “medial double” are generally satisfactory, there are no reports of late midfoot abduction deformity, although it was predicted by Evans in 1975. Methods: A 79 year-old-male with long-standing skin psoriasis with joint involvement presented with severe bilateral flatfoot deformities. The left hindfoot was arthritic, deformed and painful. Despite a conservative course of orthotics and ankle braces, the pain persisted. Because there was a psoriatic plaque over the lateral side of the foot, it was decided to perform a ”medial double” arthrodesis with screw fixation, a plantarflexing 1st tarsometatarsal joint fusion for medial column stabilization, and a heel cord lengthening Results: Skin and bony healing were uneventful. Over the subsequent three years a progressive abduction deformity developed through the naviculocuneiform joints and the unfused calcaneocuboid joint. The patient had only occasional pain in the midfoot and wore wide shoewear to accommodate the deformity. Conclusion: A late abduction deformity can develop through the midfoot in patients who have the ‘medial double” procedure for hindfoot valgus. The cuboid settles proximally against the short distal calcaneus, and the naviculocuneiform joints sublux laterally. In patients with hindfoot valgus with severe lateral column shortening secondary to calcaneocuboid joint remodeling, it may be better to perform an actual triple arthrodesis with a bone graft in the calcaneocuboid joint instead of a “medial double.” Alternatively, one could add a naviculocuneiform arthrodesis to the ”medial double” arthrodesis to prevent this complication.

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Radiographic Union of Evans Osteotomy Without Fixation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00358 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0035

Author(s):

Megan R. Miles ◽

Brian P. Gallagher ◽

Katherine L. Mistretta ◽

Nigel N. Hsu ◽

Haijun Wang ◽

...

Keyword(s):

Allogenic Bone ◽

Lateral Column ◽

First Metatarsal ◽

Calcaneocuboid Joint ◽

Calcaneal Osteotomy ◽

Metatarsal Angle ◽

Flexible Flatfoot ◽

Lateral Column Lengthening ◽

Allogenic Bone Graft

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a lateral column lengthening procedure of the calcaneus that is commonly used to correct flexible flatfoot deformities. There is no consensus on whether fixation is needed to avoid nonunion and calcaneocuboid subluxation when performing this osteotomy. We assessed the nonunion rate and correlated extent of subluxation with graft size in an unfixed Evans osteotomy with an allograft wedge and no pinning of the calcaneocuboid joint at any point in the largest series of the procedure to date. Surgeries were performed in patients undergoing flexible flatfoot reconstruction. Methods: We retrospectively reviewed 120 consecutive patients who had undergone 145 unfixed Evans osteotomies by a single surgeon with allogenic bone graft for flatfoot reconstruction between January 2013 and October 2017, with a mean follow-up of 62.5 (range 9.4-266.7) weeks. The calcaneocuboid joint was not pinned during the procedure. Data were collected using clinical and radiographical examination during regular follow-up. Results: A total of 137 feet (94.5%) underwent a double calcaneal osteotomy with an associated medial displacement calcaneal osteotomy (MDCO). There was one nonunion (0.69%). The mean time to union was 10.8 (range, 6.7-17.9) weeks. There was significant improvement in all radiographic parameters postoperatively, including calcaneal pitch, talonavicular uncoverage, anteroposterior and lateral talo-first metatarsal angle, lateral column length, and naviculocuboid overlap (p<0.05). Minor postoperative calcaneocuboid joint subluxation (1.51 +- 2.3 mm) occurred in 72 of 118 feet (61.0%) and had no correlation with wedge size (r=0.06; 95% CI, -0.13, 0.24; p=0.6). Conclusion: An unfixed Evans osteotomy for symptomatic flatfoot deformity resulted in a significant improvement in the radiographic alignment of the foot with an exceptionally rare nonunion rate. Detectable calcaneocuboid subluxation was common but minimal in extent and was not correlated with wedge size in this series in which wedges were less than 12 mm in the maximum dimension. This report represents the largest series of the Evans procedure to date.

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COMPARATIVE ANATOMICAL STUDY AND INCIDENCE OF OS PERONEUM IN PERONEUS LONGUS TENDON AND ITS CLINICAL SIGNIFICANCE. Estudio anatómico comparativo e incidencia del os peroneum en el tendón de peroneo largo y su significación clínica

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v6.n1.14093 ◽

2016 ◽

Vol 6 (1) ◽

pp. 15-19

Author(s):

Poonam Verma ◽

Anterpeet Arora

Keyword(s):

Incidence Rate ◽

Clinical Significance ◽

Anatomical Study ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Calcaneocuboid Joint ◽

Cuboid Bone ◽

Os Peroneum ◽

High Incidence Rate

Introducción: El objetivo de nuestro estudio fue evaluar la tasa de incidencia del os peroneo (OP) en el tendón del peroneo lateral largo (PLT) y su importancia clínica. Métodos: La disección de 60 cadáveres embalsamados (56 hombres y 4 mujeres) del grupo de mediana edad se hizo para tener acceso a la tasa de incidencia del os peroneo en PLT. Resultados: En nuestro estudio se observó que la tasa de incidencia del os peroneo fue de 86,6% (52 extremidades). La ubicación del os peroneo es también un tema de controversia. La mayoría de los autores afirman que se relaciona con el hueso cuboides y de vez en cuando se ve inferior al calcáneo distal a la articulación calcáneo-cuboidea. Pero en el presente estudio el os- peroneo estuvo en relación al hueso cuboides en 40 extremidades (76.9%) y distal a articulación calcaneocuboidea en el resto de las 12 extremidades (23.1%). Conclusión: Este estudio sugiere que existe una alta tasa de incidencia de un OP en cadaveres. Esto puede ser como consecuencia de la técnica utilizada para localizar el mismo. La importancia clínica ha sido mencionada en relación con la ubicación del os peroneo, que puede ser confundido con fracturas estiloides y de Jones. Introduction: The aim of our study was to assess the incidence rate of the os peroneum (OP) in the peroneus longus tendon (PLT) and its clinical significance. Methods: Dissection of 60 embalmed cadavers (56 male and 4 female) of middle age group was done to access the incidence rate of os peroneum in peroneus longus tendon. Results: In our study the incidence rate of os peroneum was 86.6% (52 limbs). The location of os peroneum is also a subject of dispute. Most authors stated that it is related to the cuboid bone and occasionally it is seen inferior to the calcaneum distal to the calcaneocuboid joint. But in the present study os peroneum was in relation to cuboid bone in 40 limbs (76.9%) and distal to calcaneocuboid joint in 12 limbs (23.1%). Conclusion: This study suggests that there is a high incidence rate of the os peroneum in the peroneus longus tendon in cadavers. This may be a consequence of the technique used to locate it. The os peroneum can be mistaken for a styloid or Jones fractures.

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