Three-plane kinesiology of hindfoot instability was studied after lesions to the ligamentous structures in the sinus and canalis tarsi in 20 amputation specimens. Neither a lesion of the cervical ligament nor of the interosseous talocalcaneal ligament resulted in an increase in the total range of movements above 2.6 degrees in any of the three planes. However, the percentage increase in the total range of movements after cutting of the ligaments was generally largest in the talocalcaneal joint compared to the increase in the total hindfoot joint complex. The largest percentage increase (43%) in the talocalcaneal joint occurred at dorsiflexion after cutting the interosseous talocalcaneal ligament. The demonstrated minor instability after experimental lesions of the ligamentous structures in the sinus and canalis tarsi may have a clinical identity in the sinus tarsi syndrome. Patients with that syndrome rarely present an objective hindfoot instability, although a major complaint is a feeling of hindfoot instability.
In the evaluation of the role of the calcaneofibular ligament in stabilizing the talocalcaneal joint, an experimental set-up was prepared. In 10 osteoligamentous specimens, the talocalcaneal motion was measured under a constant well defined moment by using a specially constructed apparatus. By using a moment of 1.5 Nm, increment in adduction in the talocalcaneal joint after section of the calcaneofibular ligament was found between 3.1 degrees and 4.6 degrees, still increasing with dorsiflexion. This increment, shown to constitute 61 to 77% of the total increment in adduction in the hindfoot after section of the calcaneofibular ligament, was found to increase gradually with dorsiflexion. The study has shown the calcaneofibular ligament as an important structure in stabilizing the talocalcaneal joint. Increment in adduction in the hindfoot after section of the calcaneofibular ligament was shown primarily to take place in the talocalcaneal joint.
Two hundred consecutive patients with arthrographically verified rupture of one or both of the lateral ankle ligaments were allocated to treatment with either an operation and a walking cast, walking cast alone, or strapping with an inelastic tape - all for 5 weeks. Eighty-seven percent of the patients attended follow-up after 1 year. Only 5 percent in each treatment group were unsatisfied with the result. There were no differences between the treatment groups in ankle stability or symptoms during different activities, regardless of rupture of the anterior talofibular ligament alone or combined with rupture of the calcaneofibular ligament. However, the patients treated with tape had fewer symptoms, fewer complaints when running, and more ankles recovered to the preinjury state. Therefore, in lateral ankle ligament rupture, tape bandages seem preferable.
A kinesiologic study of the range of rotation in the hindfoot after cutting of the calcaneofibular ligament was performed in amputation specimens. Cutting of. the calcaneofibular ligament results in a significant increment in the external rotation of the tibial-talocalcaneal joint complex and the talocalcaneal joint, maximum 5.4" and 2.9", respectively. The total range of rotation in the tibial-talocalcaneal joint complex and the talocalcaneal joint increased 32 and 20 per cent, respectively. The calcaneofibular ligament is an important structure in the rotatory stabilization of the hindfoot.
The tibiocalcaneal fascicle of the deltoid ligament was studied in 10 lower leg amputation specimens to evaluate its stabilizing effect on movement in the tibiotalocalcaneal joint complex and the talocalcaneal joint complex. Cutting of the fascicle resulted in minor numerical increases in movement in all three planes in the tibiotalocalcaneal joint complex as well as in the talocalcaneal joint complex. The maximum median increase in the tibiotalocalcaneal joint complex was 6.1 degrees in abduction, whereas the maximum median increase in the talocalcaneal joint complex was 3.6 degrees in abduction. However, the percentage of increase in the total range of movement in a single plane was large for abduction-addition in both the tibiotalocalcaneal joint complex and the talocalcaneal joint complex, at 28% and 31%, respectively. The largest percentage of increase, 40%, was found in the total range of plantarflexion-dorsiflexion in the talocalcaneal joint complex. Our data suggest that the tibiocalcaneal fascicle is an important stabilizing structure of abduction, external rotation, and plantarflexion movements in the tibiotalocalcaneal joint complex, especially in the talocalcaneal joint complex.
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