Clinics in Podiatric Medicine and Surgery最新文献

This article provides an overview of the soft tissue contributions to the normal structures that surround the talo-calcaneal-navicular (TCN) joint of the human arch. The TCN joint has a multiplanar range of motion that makes it essential to the kinetic coupling that links the forefoot and hindfoot. The soft tissue connection surrounding this joint is known as the spring ligament complex. More accurate knowledge of the anatomy of this complex will enhance the understanding of its role in the support of the head of the talus and, potentially, its critical interactions with the normal or abnormal function of the arch.

The fibrocartilaginous component of the plantar plate offers stability at the metatarsophalangeal joint. In conjunction with the attachments of the deep transverse metatarsal ligaments and collateral ligaments, the plantar plate complex resists tensile forces anchored by the plantar fascia and compression forces under the metatarsal heads.

Pes planovalgus is a multiplanar deformity consisting of a combination of hindfoot valgus, collapse of the medial longitudinal arch, forefoot varus, and forefoot abduction. This deformity is often associated with posterior tibial tendon dysfunction. Collapse of the medial longitudinal arch increases stress to the static stabilizers of the medial column including the deltoid ligament, spring ligament, plantar fascia, plantar and talocalcaneal interosseous ligaments, as well as the talonavicular and naviculocuneiform capsules. There is a higher incidence of concomitant spring ligament pathology in pes planovalgus deformity and posterior tibial tendon dysfunction based on magnetic resonance imaging and intraoperative observation than in other static stabilizers.

Insertional Achilles tendinopathy can be a very challenging clinical syndrome with various nonoperative measures typically attempted before surgical intervention. Associated complications are known with surgical repair and can be limb altering. Owing to the longevity of clinical symptoms before clinical presentation, changing the pathophysiologic process and halting the inflammatory changes becomes paramount. Here we discuss nonoperative techniques and updates in the foot and ankle literature.

The plantar plate is a critical structure involved in stabilizing the metatarsophalangeal joint. Its disruption can not only be painful for the patient but also may lead to subsequent structural deformities. There are several conservative treatment modalities available to help mitigate symptoms including splinting, offloading, and intraarticular injections. That being said, once the pathology progresses to advanced stages, these treatments are not efficacious. Reported success with conservative treatment modalities is limited to case studies and series with a low level of clinical evidence. As such, this represents an area where further investigation is needed to evaluate the true efficacy of conservative treatment and to allow for development of a more standardized approach.

The Achilles tendon is well known as the strongest tendon within the body. Its anatomic composition is unique to allow absorption of extreme loads. Historically, there has been a longstanding belief that rupture of the Achilles tendon occurs within a "watershed" region of ischemia. However, experimental data have demonstrated uniform hemodynamic flow throughout the tendon to challenge this widespread notion.

The objective of this article is to review the biomechanical stresses that occur during normal physiologic function of lower extremity soft tissue anatomic structures and to use this as a baseline for a critical analysis of the medical literature because it relates to surgical reconstruction following injury. The Achilles tendon, anterior talofibular ligament, plantar plate, and spring ligament are specifically evaluated.