[Some aspects of the tumoral pathology of the calcaneum. Cases of solitary cyst of the calcaneum, of aneurysmal cyst, of reticulosarcoma of the calcaneum].
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Adult↗
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The participation of cartilage canals in the ossification of the human fetal calcaneum.
The relationship of cartilage canals to the developing ossification centres in the human calcaneum was investigated. The cartilage canals were always present in the calcaneum by 78 mm CR length. The calcaneum has two primary ossification centres. The main centre was identified in the deep part of the calcaneum as a spherical zone of cartilage cells in the proliferative phase between 82 and 120 mm CR length and in the hypertrophic phase between 130-156 mm. Numerous cartilage canals entered the calcaneum from its dorsal and ventral surfaces and, between 106 and 156 mm CR length, they formed vascular arcades around this centre. Between 165 and 175 mm, calcification and marrow space formation were noted involving branches from the adjoining cartilage canals within these areas, which provided vascular osteogenic tissue to the early spaces. The inconstant parachondral centre, when present, may appear first during the fourth month as a periosteal reaction on the inferolateral side in the anterior wall of a deep groove in front of the posterior tuberosity of the calcaneum. By 120 mm CR length, a thin layer of subperiosteal bone was present along with a zone of early hypertrophic cartilage cells deep to it. Calcification and marrow space formation occurred by 165 mm and these marrow spaces were supplied by periosteal buds. Osteoid tissue was formed in them between 186 and 206 mm CR length. The main centre was oval in shape due to its posterolateral extension irrespective of the presence or absence of the parachondral centre.(ABSTRACT TRUNCATED AT 250 WORDS)
Calcaneus↗
Relationship of triceps surae torques to photographed tibia-calcaneum angles in man (II).
A previous paper described an apparatus and method for giving the relationship between triceps surae torque and the tibia-calcaneum angle. As a first approximation we took the angle between the calcaneum and the foot-plate as being invariable in all subjects, when the torque was zero. The aim of the present work is to measure the inter-individual variations of the angle. 1. Guide-marks are selected on the skin; showing the axes of the calcaneum and of the leg. Metal rods indicate the axes thus defined and the true angle between the leg and the calcaneum is measured by photography. The curves drawn from these true angles differ from the preceding curves by 0 degrees to 10 degrees for normal children and +12 degrees to -15 degrees for cerebral palsied children. 2. The photographic method verifies the exactitude of the trigonometrical method of correcting angles that we proposed in the previous paper.
Ankle Joint↗
Estimation of length of calcaneum and talus from their bony markers.
Since hardly a report is available on estimation of length of calcaneum and talus from a fragment of them, a fresh study was made on a present day south Indian population. A total of 110 calcanei (55 right and 55 left), and 70 tali (35 right and 35 left), all unpaired, dry, and devoid of gross pathology, were used. Maximum anteroposterior length of the bone was measured in millimeter using an anthropometric board, and linear measurements of the other bony markers were measured in millimeter using a sliding caliper. Bony markers of calcaneum were maximum anteroposterior length, maximum transverse width, length, width and depth of groove on the sustentaculum tali, and length, width, and depth of the sulcus calcanei. Bony markers of talus were maximum anteroposterior length, maximum transverse width, length and width of articular surface for the lateral malleolus, length and width of articular surface for the medial malleolus, vertical width and transverse width of articular surface of the head, width and depth of groove for tendon of the flexor hallucis longus, and length, width, and depth of the sulcus tali. Simple regression suggested that maximum length of the calcaneum regressed significantly with maximum transverse width, length, width and depth of groove on the sustentaculum tali, and length, width, and depth of the sulcus calcanei and that maximum length of the talus regressed significantly with maximum transverse width, length and width of the lateral articular surface, length of the medial articular surface, vertical and transverse diameters of the head, and depth of the sulcus tali. Maximum length of calcaneum and talus is derived from the regression values, to predict the stature of the person from available stature equations in the literature.
Anthropometry↗
"T"-osteotomy of the calcaneum.
The relative length and height of the lateral and medial walls of the calcaneum probably govern the production and persistence of structural hindfoot deformity, forefoot supination and adduction, and pronation and abduction. Anatomical restoration of the proportions of the calcaneal walls forms the basis of the T-osteotomy of the calcaneum. We have undertaken this operation on 72 feet in 60 patients for cavovarus deformity with forefoot adduction. The calcaneum is approached from the lateral side and the T-shaped osteotomy is performed through the body, the vertical limb being 1 to 1.5 cm behind and parallel to the calcaneo-cuboid joint. The horizontal limb starts from the centre of the vertical cut and ends above the attachment of the tendo achillis. The postero-inferior segment is pushed out correcting the heel varus and at the same time broadening the heel. The forefoot is manipulated downwards and outwards to correct the residual cavus and the adduction and supination of the forefoot. The over-all results, with an average follow-up of 3.7 years, have been satisfactory.
Adolescent↗
To what extent is the tibia-calcaneum angle a reliable measurement of the triceps surae length? Radiological correction of the torque-angle curve (III).
Previous papers gave some methods for the reliable measurement of the tibia-calcaneum angle. It is of common use to evaluate the physical properties of triceps surae on the basis of torque-angle curves. However this method is reliable only if each tibia-calcaneum angle corresponds to a defined distance between the insertions of the muscle in subjects of the same height. Evidence is given by radiological measurements that this correspondance is correct in normal children. However, this is no longer true in certain cerebral palsied children because of abnormal translation of the calcaneum and/or abnormal ratio of bone sizes. In this case the torque-angle curves do not define properly the torque-length curves. A method of correction is given. This correction may be as high as 15 degrees.
Ankle Joint↗
Calcaneum broadband ultrasound attenuation relates to vegetarian and omnivorous diets differently in men and women: an observation from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study.
Vegetarian diets have been suggested to be beneficial for bone health due to increased consumption of plant foods, including soya, or reduced consumption of meat. However, meat may also be beneficial for bone health. The evidence relating diet to bone health is based largely on studies of women, often in those at high risk of osteoporosis. Few studies have investigated dietary inter-relationships in men as well as women from general populations. We examined broadband ultrasound attenuation (BUA) of the calcaneum, using a CUBA clinical instrument, in 6,369 men and 5,379 postmenopausal women. The population was divided into four groups according to vegetarian status and frequency of soya consumption, which was defined by response to a food frequency questionnaire that estimates frequency of consumption of food types over the year prior to completion. Regular soya consumers were defined as those who ate soya products with a frequency of between once a day and once a week. Calcaneum BUA in vegetarian men was significantly lower than omnivores by approximately 6% (5 dB/MHz) and was 15% (13.6 dB/MHz) lower in those who were also regular soya consumers. This difference remained after adjustment for age, height, weight, smoking habit, physical activity, selected foods and nutrients and exclusion of those with a prior history of osteoporosis, fractures or cancer. Calcaneum BUA in omnivorous men with regular soya consumption was not lower than the remaining population. In women, there were no significant differences by usual dietary pattern. This surprising finding indicates that regular soya intake is not associated with better bone indices in vegetarian men. The difference in BUA was not explained by the known common covariates; however, it is possible that other aspects of lifestyle associated with these eating behaviors might explain this observation. Plausible mechanisms exist for our findings; soya contains phytoestrogens, likened to naturally occurring estrogens, and meat has been shown to influence levels of IGF-1 and sex hormone binding globulin, which may be related to bone health. Our findings emphasize the need for further research and investigation into dietary inter-relationships and bone health and the effects of vegetarian status, including consumption of soya-based foods, in men as well as women.
Adult↗
Fractures of the calcaneum.
Sixty-seven patients with 86 fractures of the calcaneum were re-examined 2 to 6 years after their injury. These fractures of the calcaneum were of two types: thalamic, involving the posterior subtalar joint (85%); and nonthalamic, confined to the extra-articular area (15%). Treatment had been by functional therapy, plaster fixation, pin reduction, or open reduction. At followup, only 28 of the 86 heels were entirely painless. Pain was most common posterolaterally along the peroneal tendons; reduction of the tuber (Böhler) angle correlated significantly (p less than 0.001) with an abutment of the peroneal tendons. Motion in the subtalar joint was restricted in two thirds of the series, and in the talocrural joint in one third; a reduction of the tuber angle correlated significantly (p less than 0.001) with reduced mobility of these joints. The duration of sick leave was significantly (p less than 0.05) shorter after functional treatment of displaced thalamic fractures than after treatment with pin reduction and immobilization in plaster. Results were the same with both modes of treatment. The results of treatment of nonthalamic fractures were rewarding, whereas a common consequence of thalamic fractures was considerable impairment of ankle function. The significant correlation between a depressed tuber angle and unsatisfactory functional results suggests that closer attention should be paid to the accurate alignment of the posterior subtalar joint in the treatment of thalamic fractures of the calcaneum.
Adolescent↗
[Dual-photon absorptiometry of the calcaneum in osteoporosis. Preliminary results].
Anteroposterior views of the lumbar spine are commonly used for the measurement of bone mineral density (BMD) by diphoton absorptiometry (DPA). Values in lumbar vertebral BMD can be increased by the existence of a compression fracture, osteoarthrosis, scoliosis or aortic calcifications. Evaluation of bone loss at a peripheral site, such as the calcaneum (essentially trabecular site), could compensate for the principal causes of error associated with vertebral measurement. Calcaneal BMD in 195 control women was used to establish reference values closely correlated with lumbar BMD (p less than 0.001). The same study was undertaken in osteoporotic women. Preliminary results based upon 38 cases are reported here. Measurement of BMD of the calcaneum was correlated with vertebral trabecular bone density measured by double energy CT scan, indicating that this peripheral site offers a good reflection of what is happening at vertebral trabecular level. In contrast, calcaneal BMD was not correlated with spinal BMD, except if patients with osteoarthrosis and/or scoliosis were eliminated. Measurement of the BMD of the calcaneum by DPA is thus a simple, rapid and reproducible method for evaluation of a trabecular bone site which could be complementary to the measurement of lumbar BMD when the latter is falsified by artefacts.
Absorptiometry, Photon↗
[Evaluation of bone density of the calcaneum using ultrasound attenuation in menopausal women].
The results of bone density of the calcaneum measured with ultrasound in 107 menopaused women were compared with reference values provided by the manufacturer of the Walker Sonics machine and with the results of quantitative densitometry obtained with computed tomography of the calcaneum and lumbar vertebrae. The coefficient of correlation was 0.57 for the calcaneum and 0.45 for the vertebrae and was confirmed by the kappa index which was 0.58 and 0.54 respectively, indicating that bone density measurement with ultrasound attenuation is a simple non-invasive non-radiating technique which is a promising method for exploring osteoporosis in menopaused women.
Adult↗
Trabecular patterns of the calcaneum as an index of osteoporosis. A comparison using gamma-absorptiometry.
Measurements of bone mineral content in the calcaneum were made by gamma-absorptiometry in 77 patients with ankle fractures treated by operation, and compared with the calcaneal osteoporosis index. The index was calculated from plain lateral radiographs of the calcaneum. The bone mineral measurements showed a wide range, but there was only a narrow range of the index with exclusively high values. There was a weak correlation between the calcaneal index and the bone mineral content in the injured ankles, but no or only a very poor correlation in the uninjured ankles. We also found no correlation between the decline in index and loss of mineral content in the injured ankles.
Absorptiometry, Photon↗
A technique of dynamic reduction for displaced fractures of the thalamus of the calcaneum.
A new technique of reduction based on the anatomical structure of the calcaneum was first described in 1974. Two pins were inserted, one into the posterior surface and the other into the plantar surface of the bone. This allowed early mobilisation of the foot. The method can be used in all types of fractures including comminuted fractures of the tuberosity, the tongue type, the central depression type, the severe tongue type, the severe depression type and unclassified severe crush fractures. Complete anatomical reduction was obtained in 58 out of 72 fractures (77%) and 56 out of 64 patients (87.5%) were classified as "very good" by the Maxfield assessment. In this paper the authors discuss their method of management of displaced fractures of the thalamic part of the calcaneum.
Adult↗
Histological abnormalities of the calcaneum in congenital talipes equinovarus.
Six calcaneal fragments from patients aged 2, 3, 4, and 5 years with relapsed talipes, and two normal feet from a 40-week-old stillborn fetus were studied. All tissue was sectioned in the sagittal or coronal plane and stained using alcian blue and sirius red to distinguish cartilage and bone. Immunocytochemistry was performed to illustrate collagen types I and II. Within the clubfoot calcaneum, there were fewer chondrocytes and a diminished number of cartilage canals. Although a growth plate was present, the zones of differentiated chondrocytes were not apparent and the chondrocytes were smaller and flatter. The alcian blue staining within the spherical physis was paler than normal, suggesting that the amount of extracellular proteoglycans was reduced. Overall, the growth plate region of the talipes calcaneum resembled that of a permanent cartilage, like articular cartilage. Abnormalities were also seen in the ossification center. Cartilage spicules were rare, and developing bone frequently abutted directly onto the growth plate cartilage. The relative absence of a primary spongiosa suggested that the physis was virtually inactive and endochondral bone formation was retarded. These findings are consistent with the hypothesis that an intrinsic primary growth disorder causes the formation of a small hypoplastic bone and, subsequently, a smaller foot.
Calcaneus↗
Dislocation of the calcaneum.
Dislocation of the tarsal bones is uncommon; isolated dislocation of the calcaneum has been reported only four times. This paper presents a case of dislocated calcaneum and reviews the literature.
Adult↗
The effect of ongoing litigation on outcome scores following open reduction and internal fixation of the calcaneum.
All sixteen patients who had undergone open reduction and internal fixation (ORIF) of the calcaneum by the senior author between April 1993 and August 1996 were included in the study. Two had died from unrelated illnesses and one had failed to attend any follow-up following discharge. The remaining 13 were reviewed by the main author. As part of a complete clinical, radiological and functional assessment, Buckley and Meek (B&M) and Kerr and Atkins (K&A) outcome scores were calculated as well as a satisfaction score obtained by a visual analogue scale (VAS). Statistical analysis of the results using Wilcoxen's paired and unpaired ranking scores showed that the initial grade of the fracture, degree of operative reduction, correction of width of the heel and post-operative ranges of motion had no significant correlation to either B&M or K&A outcome scores or to the VAS score. However, the presence of ongoing litigation was significantly correlated to the scores (VAS < 0.01, B&M < 0.05, K&A < 0.05). These findings cast doubt on the validity of post operative scoring for fracture of the calcaneum in the presence of ongoing litigation.
Calcaneus↗
Intra-articular fractures of the calcaneum. Part I: Pathological anatomy and classification.
We have studied the radiographic and CT features of 120 displaced intra-articular fractures of the calcaneum in order to define the pathological anatomy. In 96% of cases, the CT scans identified three main fragments: sustentacular, lateral joint and body. The sustentacular fragment was often rotated into varus, the lateral joint fragment into valgus and the body fragment impacted upwards, in varus and displaced laterally. The displacement of these fragments varied according to which of three fracture types was present, as defined by the composition of the fractured lateral wall of the calcaneum. In type 1 it was formed by the lateral joint fragment alone; in type 2 by both body and lateral joint fragments; and in type 3 by the body fragment alone. Fracture fragment displacement differs from that previously described, in that true uniform depression of the lateral joint fragment is rare.
Adolescent↗
Operative treatment of displaced intra-articular fractures of the calcaneum. Medium-term results.
Since 1986, we have treated displaced intra-articular fractures of the calcaneum by open reduction through a lateral approach, stable internal fixation and bone grafting. We assessed the results at a mean follow-up of 2.92 years in 44 patients, comparing them with those for 19 patients treated non-operatively. Clinical assessment used the scoring system of Crosby and Fitzgibbons (1990) and radiological measurements were made from lateral, axial and internal oblique views. The articular congruity of the subtalar joint and any arthritic changes were also assessed. We found significantly better results in the operated group with respect to pain, activity, range of movement, return to work and swelling of the hind foot. Radiologically, the operated group showed significantly better scores for articular congruity and arthritic changes. We conclude that the operative treatment of displaced intra-articular fractures of the calcaneum gives better medium-term results than conservative management.
Adult↗
Minimally-invasive treatment of intra-articular fractures of the calcaneum.
We describe the results of 287 intra-articular fractures of the calcaneum in 247 patients treated by minimally-invasive reduction and K-wire fixation between 1994 and 2003. There were 210 men (85%) and 37 women (15%). The most common cause of injury was a fall from a height in 237 patients (96%). Fracture classification was based on the method described by Sanders and Essex-Lopresti. All patients were operated on within 21 days of injury and 89% (220) within 48 hours. The reduction was graded as nearly anatomical (less than 2 mm residual articular displacement and satisfactory overall alignment) in 212 (73.9%) fractures. There were 20 cases (7%) of superficial pin-track infection and five (1.7%) of deep infection. All healed at a mean of 6 weeks (3 to 19). Loss of reduction was observed in 13 fractures (4.5%) and a musculocutaneous flap was needed in three (1%). The results were evaluated in 176 patients (205 fractures) with a mean age of 44.3 years (13 to 67), available for follow-up at a mean of 43.4 months (25 to 87) using the Creighton-Nebraska Health Foundation Assessment score. The mean score was 83.9 points (63 to 100). There were 29 (16.5%) excellent, 98 (55.7%) good, 26 (14.8%) fair and 23 (13%) poor results. A total of 130 patients (73.9%) were able to return to their original occupation at a mean of 5.6 months (3.2 to 12.5) after the injury. Semi-open reduction and percutaneous fixation is an effective treatment for displaced intra-articular fractures of the calcaneum.
Adolescent↗