Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cases of acute tarsal tunnel syndrome are rare. To the best of our knowledge, we describe the only reported case of acute posterior tibial nerve compression resulting from adjacent haemotogenous pyogenic calcaneal osteomyelitis.</p> <p>Case presentation</p> <p>A previously healthy 38-year-old Caucasian woman developed symptoms of acute tarsal tunnel syndrome in her right foot over a six-day period. No antecedent trauma or systemic symptoms were noted. Magnetic resonance imaging and bone scan imaging, followed by surgical decompression and bone biopsy confirmed a diagnosis of <it>Staphylococcus aureus </it>calcaneal osteomyelitis. Her pain and paraesthesia disappeared after the operation, while her inflammatory markers normalised during a 12-week course of antibiotics. After four years she has remained asymptomatic without any indication of recurrence.</p> <p>Conclusion</p> <p>This case is not just unique in describing osteomyelitis as a cause of tarsal tunnel syndrome, because haemotogenous calcaneal osteomyelitis is in itself a rare pathology. We recommend considering infection as a differential diagnosis in patients presenting with acute tarsal tunnel syndrome.</p

Chronic sinus formation using non absorbable braided suture following open repair of Achilles tendon

This study reports a case of a 34 year old man who sustained an Achilles tendon rupture which was surgically repaired using a non-absorbable suture that was complicated by a deep sinus and chronic infection. Despite antibiotics, surgical debridement and skin grafting, his condition did not resolve. Further imaging revealed a sinus leading to the core suture knot that was eccentrically placed but not buried within the healed tendon repair, and the offending suture was subsequently removed. This case highlights the importance of meticulous surgical technique when performing Achilles tendon repair and a high index of suspicion for early imaging when patients present with chronic wound infection post-operatively. The authors urge surgeons to use routinely use an absorbable non-braided suture, which remains buried within the core when performing Achilles tendon repair.</p

Access to the talar dome surface with different surgical approaches

Background: Access to the talar dome for the treatment of osteochondral lesions (OCLs) can be achieved via several different approaches to the ankle joint. The recent description of an anatomical nine-grid scheme of the talus has proven useful to localise OCLs but no studies have demonstrated which approaches are indicated to access each of these zones. The aim of this study is to demonstrate the access afforded to each zone by each approach. Methods: Four standard soft tissue ankle approaches were performed simultaneously in ten fresh-frozen cadavers (anterolateral - AL, anteromedial - AM, posterolateral - PL, posteromedial - PM). The area of the talus, which was accessible with an instrument perpendicular to the surface was documented for each of the approaches. Using ImageJ software the surface area exposed with each approach was calculated. The talar dome was then divided using a nine-grid scheme and exposure to each zone was documented. Results: The AL, AM, PL and PM approaches allow for exposure of 24%, 25%, 5%, 7% of the talar dome respectively. The AL gives access to zones 3 (completely) and 2, 5, 6 (partially); the AM to zones 1 (completely) and 2, 4, 5 (partially); the PL to zones 9 and 8 (partially); and the PM to zones 7 and 8 (partially). Conclusions: A large area of the talar dome cannot be easily accessed with the use of standard soft tissue approaches (39%). Minimal or no access is achieved for grid zones 4-6 and 8. In those instances careful preoperative planning is necessary and extended exposure can be achieved with the use of osteotomies, section of the ATFL or through modified approaches

Transient osteoporosis of the foot

Transient osteoporosis is a rare cause of pain in the foot. There is a broad differential diagnosis. A multidisciplinary assessment by both an orthopaedic surgeon and rheumatologist with review of the imaging by a radiologist is useful, as this condition is a diagnosis of exclusion. </jats:p

A Novel Use of Arthroereisis in the Adult Flat Foot

Category: Hindfoot Introduction/Purpose: The use of an arthroereisis screw is well described in the paediatric population for the correction of flexible flat feet. Here we present a case comparison series involving the use of an arthroereisis screw to augment reconstruction in adult patients with Tibialis Posterior Insufficiency. Methods: All patients (36 feet in 34 patients) underwent flexor digitorum longus transfer, reefing of the spring ligament and a translational medialising calcaneal osteotomy. In 23 cases the reconstruction was augmented with an arthroereisis screw (Kalix, Integra), which was removed 6 months later in all cases. The mean age was 58 years and most patients were female. Weight bearing radiographs were taken after removal of the implant and assessed using previously published parameters. Patients were evaluated at follow up using validated functional outcome questionnaires (MOXFQ, EQ-5D and a health VAS). Results: One patient in the group without augmentation went on to have a triple fusion 13 months after reconstruction. In both cohorts the calcaneal pitch was raised, Meary’s angle decreased, the medial cuneiform height increased and the talonavicular coverage angle improved post-operatively compared to pre-operative measurements (p < 0.05, Wilcoxon Signed Rank tests). There was a trend towards better radiographic correction in the augmented group and the difference in correction of the talonavicular coverage angle was statistically significant (p < 0.05, Students T test). There was however no difference between the MOXFQ, EQ-5D and heath VAS scores between the two groups at mean follow up of 4 years. Conclusion: We conclude that the use of an arthroereisis screw is a promising adjunct to conventional reconstruction in tibialis posterior insufficiency