The os intermetatarseum is located between the medial cuneiform and the base of the first and second metatarsals. Literature reviews have found few symptomatic cases of this condition since the 19th century. We report the case of a young female athlete, 20 years old, with sudden pain in the back of the midfoot after a jump. The os intermetatarseum is the rarest accessory bone in the foot and is typically asymptomatic. The presence of this bone should be considered when patients, especially young athletes, present with pain in the dorsum of the foot and compressive symptoms of the deep fibular nerve. Level of Evidence V; Therapeutic Studies; Expert Opinion.

RESUMOO calcâneo é o osso do tarso mais fraturado, contudo a fratura-luxação bloqueda do calcâneo é uma condição rara, devido à estabilidade óssea e ligamentar entre o calcâneo, o tálus e o cuboide. Relatamos o caso de uma paciente com fratura-luxação bilateral do calcâneo, com características únicas na literatura: ambas expostas, com luxação bilateral dos fibulares, além de apresentar a interposição bilateral do tendão flexor longo do hálux nos focos de fratura. Uma revisão da literatura identificou apenas 19 casos dessa fratura-luxação já descritos, nenhum deles com a combinação de lesões encontradas neste relato. A fratura do calcâneo pode exibir ampla variedade de lesões associadas que requerem um diagnóstico e um tratamento adequado. Nível de Evidência V; Estudos Terapêuticos; Opinião de Especialista.Descritores: Fratura-luxação; Calcâneo/cirurgia; Articulação talocalcânea; Procedimentos cirúrgicos minimamente invasivos. AbStRActThe calcaneus is the most commonly fractured tarsal bone. However, locked fracture-dislocation of the calcaneus is a rare condition because of the bone and ligament stability between the calcaneus, talus, and cuboid. We report the unique features of a case of bilateral fracture-dislocation of the calcaneus, including open fractures, bilateral fibular dislocation, and bilateral interposition of the flexor hallucis longus tendon at the fracture site. A literature review identified only 19 cases of locked fracture-dislocation, but none of these cases involved the combination of injuries observed in this case. Fracture of the calcaneus may be associated with a variety of injuries requiring proper diagnosis and treatment. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Checkrein deformity is characterized by flexible plantar flexion contracture of the interphalangeal joint and flexible extension contracture of the metatarsophalangeal joint of the hallux. It occurs due to entrapment of the flexor hallucis longus in the callus formation at the fracture site or within scar tissue on lower limb. Currently, there is still no consensus about the best surgical treatment for this deformity. The aim of this study is to report a case of a patient that was treated with a novel approach for the treatment of checkrein deformity of the hallux located in the forefoot, with satisfactory functional outcomes. Level of Evidence V; Therapeutics Studies; Expert Opinion.A deformidade em flexão do hálux é caracterizada pela contractura em flexão da articulação interfalângica e em extensão da articulação metatarsofalângica do hálux. Ocorre devido ao encarceramento do flexor longo do hálux na formação do calo no local da fratura ou no tecido cicatricial do membro inferior. Ainda não há consenso sobre o melhor tratamento cirúrgico para essa deformidade. O objetivo deste estudo é relatar um caso de um paciente que foi tratado com uma nova abordagem para o tratamento da deformidade em flexão do hálux localizado no antepé, com resultados funcionais satisfatórios. Nível de Evidência V; Estudos Terapêuticos; Opinião do Especialista.Palavras-chave: Deformidades articulares adquiridas/cirurgia; Deformidades nos pés; Articulação metatarsofalângica; Traumatismos dos tendões.How to cite this article: Miranda BR, Barroco RS, Nishikawa DRC, Oliveira LZP, Ghani MBA. Checkrein deformity treated through a forefoot approach: a case report. Sci J Foot Ankle. 2019;13(4):259-63.

Objective: To investigate the association between talus fracture-dislocation and the occurrence of pre-operative vascular injuries identified via echo-colour Doppler examination of the lower limbs and to assess whether these injuries directly affect talar necrosis. Methods: Retrospective study with data collection on 26 patients with a diagnosis of talus fracture-dislocation who were evaluated by pre-operative arterial and venous echo-colour Doppler from 2004 to 2015. Results: The sample included 26 patients (26 feet), ranging in age from 16 to 62 years, with a mean follow-up time of 2 years and 9 months. A total of six (23.07%) changes were diagnosed via echo-colour Doppler, of which five (83.33%) were due to arterial injury of the ‘segmental occlusion of the posterior tibial artery’ type and one (16.67%) was due to venous injury of the ‘recent deep venous thrombosis of the popliteal-distal segment’ type, with no arterial injury. No significant association was found between the vascular injuries diagnosed by Doppler and progression to necrosis. Conclusion: A significant portion of the patients with talus fracture-dislocation presented with vascular injury diagnosed by echo-colour Doppler, although no association was found between vascular injury and outcomes of osteonecrosis. Level of Evidence IV; Diagnostic studies.

Introduction: The McBride test was created to assess hallux valgus reduction and is also used to assess capsular and lateral soft-tissue tension indicating the need for lateral capsular release after the bone procedure in the first metatarsal bone. The flowcharts for lateral soft-tissue release remain unclear and lack consensus among surgeons. Objective: To propose a modified version of the test for the complementary preoperative assessment of hallux valgus reduction. Methods: We describe a method in which the examiner supinates the first metatarsal head medially to manually correct the pronation of the first metatarsal and then applies varus force to the hallux to test the lateral capsular tension of the metatarsophalangeal joint. Results: A significant reduction in lateral capsular tension was observed in the metatarsal head lifting and rotating maneuver compared with the conventional McBride test. Discussion: Hallux valgus reduction is greater with manual correction of the deformity than with the classic McBride test, most likely because of the resulting rotational bone repositioning and soft-tissue balancing. These changes seem to decrease the lateral tension that limits the correction of the deformity in the metatarsophalangeal angular plane. Conclusion: We believe that this modified version of the McBride test can be used as a more reliable predictor of the need for lateral metatarsophalangeal release after the metatarsal position is corrected through osteotomy or cuneometatarsal arthrodesis.