Acquired adult flat foot due to isolated plantar calcaneonavicular (spring) ligament insufficiency with a normal tibialis posterior tendon

Tryfonidis, M.; Jackson, Wayne; Mansour, Ramy; Cooke, Paul; Teh, James; Ostlere, S; Sharp, Robert

doi:10.1016/j.fas.2007.11.005

Cited by 95 publications

(70 citation statements)

References 14 publications

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“…10 Therefore, early diagnosis and treatment of such ligament injuries may Ultrasonography is a relatively inexpensive and valid method to assess ankle ligaments, and there are several studies regarding its accuracy. In a study published in 2010 using arthroscopy as the gold standard, ultrasound with a 8-MHz probe showed a 91% diagnostic accuracy for an acute ATFL injury where MRI gave a 97% accuracy.…”

Section: Discussionmentioning

confidence: 99%

Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function

Dea

Loizou

Allen

et al. 2017

The British Journal of Radiology

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Objective: To assess the prevalence of injury of the talonavicular ligament (TNL) in ankle sprains, its anatomy and the stability of the talonavicular joint (TNJ) before and after dividing the TNL in a cadaver. Methods: During a prospective study of 100 patients to assess the outcome of ankle injuries, we noted high incidence of TNL injuries; we will discuss here the TNL findings. Each patient had undergone ultrasound and cone beam CT examination of the ankle. Six TNLs were dissected off fresh-frozen cadaveric feet for histological analysis. In further six cadaveric feet, the stability of the TNJ was assessed by mechanical stress before and after division of the TNL; movement at the joint was assessed by measuring the distance between the talus and navicular bone [talonavicular distance (TD)] using ultrasound. The TD was measured on ten randomly selected ultrasound images by three independent observers and repeated twice by a single observer to determine the inter-and intraobserver reliability. Results: 21% of the patients had an injury to the TNL. Histological examination demonstrated a dense connective tissue composed of bundles of collagen in parallel arrangement along the ligament length. The interobserver and intraobserver reliability of the TD showed almost perfect agreement. Displacement at the TNJ after stress with the TNL intact measured 0.18 6 0.08 cm and 0.29 6 0.07 cm (p , 0.005) when divided. Conclusion: The TNL is surprisingly commonly injured in ankle sprains. Its anatomy and histology suggest a role in tensile force transmission during the windlass mechanism in gait. Advances in knowledge: Injury to the TNL is common and has not been described. Its anatomy suggests resistance to tensile forces and its injury allows excessive movement at the TNJ. INTRODUCTIONAcute ankle injuries account for approximately 10% of all emergency department attendances.1 Several publications cover the incidence of ligament injuries, especially the lateral ligamentous complex and deltoid ligament (DL). In one study, there were anterior talofibular ligament (ATFL) injuries in 75% of patients after acute inversion ankle sprain with a combined ATFL and calcaneofibular ligament (CFL) in 41%. 2 In another study, the prevalence of DL injury in patients with chronic lateral ankle instability was 36%.3 There are no studies to our knowledge investigating injury of the talonavicular ligament (TNL) in patients presenting with an ankle sprain.

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Section: Discussionmentioning

confidence: 99%

Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function

Dea

Loizou

Allen

et al. 2017

The British Journal of Radiology

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“…Repair of the ligament can be risky to the medial plantar nerve because the nerve passes under the ligament in around 70% of cases. 5 A slotted cannula (Wright Medical Technology, Arlington, TN) can be inserted underneath the ligament and an arthroscope introduced to confirm that the nerve is not sandwiched between the ligament and the cannula. Then, the arthroscope is removed, a Micro SutureLasso (Arthrex) is introduced, and suture is passed through the ligament under arthroscopic guidance through anterior subtalar arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although injury to the spring ligament is commonly due to the failure of the tibialis posterior tendon in adult-acquired flatfoot deformity, isolated injury to the ligament with a normal tibialis posterior tendon has been reported. [4][5][6] Repair of the spring ligament is indicated in case of a torn ligament with or without tibialis posterior tendon deficiency. However, an open approach to the ligament requires extensive soft-tissue dissection.…”

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confidence: 99%

Endoscopic Repair of the Superficial Deltoid Ligament and Spring Ligament

Lui¹

2016

Arthroscopy Techniques

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The plantar calcaneonavicular ligament, also known as the spring ligament, is an important static stabilizer of the medial longitudinal foot arch. Compromise of this ligament is a primary causative factor of peritalar subluxation, and it should be repaired in addition to treatment of tibialis posterior tendon abnormalities. Open repair of the ligament requires extensive soft-tissue dissection. The development of the high distal portal for posterior tibial tendoscopy allows repair of the ligament endoscopically. This, together with endoscopically assisted reconstruction of the tibialis posterior tendon, allows complete endoscopic treatment of stage 2 posterior tibial tendon deficiency. The major structure at risk is the medial plantar nerve. This technique is technically demanding and should be reserved for experienced foot and ankle arthroscopists.

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“…calcaneonaviculare plantare trägt erheblich zur Stabilisierung des Fußgewölbes bei. Bei Ruptur kommt es zur Abflachung des medialen Fußgewöl-bes und zur Ausbildung eines Pes planus, daher auch das Synonym Plattfußband [38].…”

Section: Lateraler Bandapparatunclassified

Das instabile Sprunggelenk

Klein¹

2015

Arthroskopie

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Acquired adult flat foot due to isolated plantar calcaneonavicular (spring) ligament insufficiency with a normal tibialis posterior tendon

Cited by 95 publications

References 14 publications

Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function

Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function

Endoscopic Repair of the Superficial Deltoid Ligament and Spring Ligament

Das instabile Sprunggelenk

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