Influence of tibialis posterior muscle activation on foot anatomy under axial loading: A biomechanical CT human cadaveric study

Dullaert, Koen; Hagen, Jennifer; Simons, Paul; Gras, Florian; Gueorguiev, Boyko; Richards, R. Geoff; Klos, Kajetan

doi:10.1016/j.fas.2016.07.003

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…The frame was designed to perform pneumatic static axial loading in the range from 0 to 750 N. The distal end of the frame was radiolucent to avoid scattering [11][12][13]. The specimens were positioned plantigrade on a carbon fiber plate.…”

Section: Methodsmentioning

confidence: 99%

“…CT scans of 0.63 mm slice thickness were performed using a SOMATOM Emotion CT scanner (Siemens, Munich, Germany). Each specimen was scanned under 700 N single-legged stance loading while placing the foot in neutral, 15 degree inversion, or 15 degree eversion position [11][12][13]. The width of each intact talus perpendicular to its long axis at the level of the lateral process was measured using CT scanning.…”

Section: Methodsmentioning

confidence: 99%

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Medial talar resection: how much remains stable?

Hagen

Sands

Swords

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Pathologies of the medial talus (e.g., fractures, tarsal coalitions) can lead to symptomatic problems such as pain and nonunion. Bony resection may be a good solution for both. It is unclear how much of the medial talus can be taken before the subtalar joint becomes unstable. The aim of this study was to evaluate the effect a limited resection of the medial talar facet and the anteromedial portion of the posterior talar facet has on subtalar stability. Methods Eight fresh-frozen human cadaveric lower limbs were mounted in a frame for simulated weight-bearing. Computed tomography scans were obtained under 700 N single-legged stance loading, with the foot in neutral, 15° inversion, and 15° eversion positions. A sequential resection of 10, 20, and 30% of the medial facet and the anteromedial portion of the posterior talar facet to the calcaneus, based on the intact talus width, was performed. Measurements of subtalar vertical angulation, talar subluxation, coronal posterior facet angle and talocalcaneal (Kite) angle in the anteroposterior and lateral view were performed. Results Gross clinical instability was not observed in any of the specimens. No significant differences were detected in the measurements between the resected and intact states (P ≥ 0.10) as well as among the resected states (P ≥ 0.11). Conclusion In a biomechanical setting, resecting up to 30% of the medial facet and anteromedial portion of the posterior facet based on the intact talus width—does not result in any measurable instability of the subtalar joint in presence of intact ligamentous structures. Level of evidence V.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Medial talar resection: how much remains stable?

Hagen

Sands

Swords

et al. 2022

Eur J Trauma Emerg Surg

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“…Por su parte Kitaoka 21 simuló experimentalmente cargas durante la fase unipodal de la marcha, llegó a la conclusión de que la relajación en la presión ejercida sobre el tendón tibial posterior provoca cambios posicionales de las estructuras del pie tendentes a restaurar el alineamiento del arco plantar interno; infiere que «es un estabilizador importante del arco plantar». Dullaert 22 analiza mediante un estudio biomecánico experimental del tendón tibial posterior en pies de cadáveres sometidos a carga axial, analizados con tomografía axial, el colapso del arco medial y la subluxación de la articulación subastragalina como hallazgos habituales del pie plano. Concluyen contrariamente que el tibial posterior bajo carga no restaura el arco plantar medial ni corrige la subluxación subastragalina ni el ángulo astrágalo metatarsal.…”

Section: Concluimos Que En El Pie Normalunclassified

“…La modificación de las fuerzas equilibrantes de la musculatura extrínseca causa déficit en la cinética de las articu-laciones de medio y retropié, llevando a máxima contención las estructuras capsuloligamentarias de la articulación de Chopart y subastragalina, que sumadas a la fuerza del tendón de Aquiles durante la marcha someten a mayor tensión el complejo capsuloligamentario medial lesionando el ligamento en hamaca y de forma secundaria causando inflamación y ruptura del tibial posterior y alteraciones en su inserción. 22,45 Dullaert 22 demostró que la tensión aislada del tendón tibial posterior no corrige la deformidad del plano en bipedestación, al contrario la aumenta y sólo la activación simultánea de los estabilizadores activos y pasivos logrará un pie plantígrado.…”

Section: Transferencias Tendinosasunclassified

Pie plano adquirido del adulto por disfunción del tibial posterior. Opciones para el tratamiento quirúrgico

Núñez-Samper¹,

Llanos-Alcázar²,

Viladot-Pericé³

et al. 2021

Acta Ortopédica Mexicana

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RESUMEN.Presentamos la posible causa etiopatogénica de la disfunción del tibial posterior o pie plano doloroso del adulto y la relación causa-efecto que puede existir. También exponemos la clasificación de la lesión y las diferentes opciones para el tratamiento quirúrgico de la deformidad. Desde 1939, múltiples artículos han sido publicados, avalados por la clínica, así como por estudios experimentales, electromiográficos y biomecánicos; publicaciones consultadas y evaluadas para el desarrollo de esta revisión, según nuestro criterio: el primum movens de la disfunción del tibial posterior es ocasionado por un fallo del ligamento en hamaca o calcáneo navicular plantar (spring ligament), principal estabilizador pasivo del arco plantar interno. Este fallo supondría en el tiempo un aumento de trabajo del tendón tibial posterior, de por sí «insuficiente», que entraría en fatiga hasta llegar a la rotura parcial o total. Los trabajos publicados en relación con los procedimientos de partes blandas que actúan sobre el tendón tibial posterior en el estadio II no han tenido el resultado esperado en la historia natural de la deformidad. La artrodesis por el contrario, ha sido efectiva en otros estadios, pero está asociada a una pérdida de la dinámica del movimiento en el retropié y a un aumento de la presión en las articulaciones adyacentes.Palabras clave: Disfunción del tibial posterior, ligamento en hamaca, pie plano doloroso del adulto. ABSTRACT.We present the possible etiopatogenic causes of posterior tibial dysfunction or painful flat foot of the adult and the cause-and-effect relationship that may exist. We also expose the gradation of the lesion and the different therapeutic options for the surgical treatment of the deformity. Since 1939, multiple articles have been published, which have been endorsed by clinical, experimental, electromyographic and biomechanical studies; publications that have been consulted and evaluated for the development of this review. In our opinion: the dysfunction of the posterior tibial is caused in principle by a failure of the plantar navicular calcaneus ligament (spring ligament), the main passive stabilizer of the internal plantar arch. This failure would, in time, mean an increase in work of the posterior tibial tendon, in itself «insufficient», which would go into fatigue, until it reached a partial or total rupture. Published work on soft-part procedures acting on the posterior tibial tendon in stage II has not had the expected result in the natural history of deformity. Arthrodesis, on the other hand, has been effective in other stages, but is associated with a loss of movement dynamics in the back foot and increased pressure on adjacent joints.

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“…The CT scans were performed as earlier described in detail by [11,19], in short form. A non-weightbearing CT scan was first performed whilst feet were placed in neutral position on the loading device with the lower limbs extended and the ankle joint in a neutral position, followed by a simulated weight-bearing CT scan in unaltered position, with a load equal to body weight applied to the loading device (Fig.…”

Section: Clinical and Radiologic Testingmentioning

confidence: 99%

A novel method of clinical first tarsometatarsal joint hypermobility testing and radiologic verification

Ornig

Tschauner

Holweg

et al. 2020

Wien Klin Wochenschr

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Summary Background First tarsometatarsal joint (TMT-1) hypermobility might cause hallux valgus deformity (HV), and recurrence following surgical correction. Anatomic findings, indicating tibialis anterior tendon (TAT) involvement in TMT‑1 stabilization, led to the development of cross-glide test allowing clinical TMT‑1 stability testing. Cross-glide test function was evaluated in anatomical specimens and in the clinical setting, compared to simulated weight-bearing computer tomography (CT) analysis. Methods Cross-glide test was evaluated in 6 healthy lower leg specimens before and after TAT transection. Clinical testing was performed prospectively in 36 feet (6 controls, 21 HV, 9 recurrent HV); consecutive weight-bearing CT analysis was performed. Results from clinical testing were compared to CT analysis. Results TMT‑1 instability significantly increased in anatomic specimens following TAT transection (p = 0.009). In the clinical setting, all healthy feet were cross-glide test negative, 62% of HV cases and all recurrent HV feet were positive. In the CT analysis- Compared to controls the HV cases revealed significantly increased MT‑1 internal rotation (p = 0.003) and decreased dorsal angle (p = 0.002), considered as collapsing forefoot signs; HV recurrent cases revealed similar results. Positive cross-glide tested cases revealed increased MT‑1 internal rotation values (p < 0.001) and dorsal angle values (p < 0.001) in CT analysis. Strikingly, cross-glide test positive HV cases revealed significantly increased internal TMT‑1 rotation (p = 0.043) in CT analysis, and HV and IMT (intermetatarsal) angle were significantly higher (p = 0.005, p = 0.006). 15 HV recurrence cases, treated with TMT‑1 arthrodesis, revealed no recurrence during follow-up. Conclusion Cross-glide test allows reliable clinical TMT‑1 instability testing, via TAT tension, and is less laborious than CT analysis. We recommend TMT‑1 arthrodesis in cases with instability in clinical testing, to avoid HV recurrence.

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Influence of tibialis posterior muscle activation on foot anatomy under axial loading: A biomechanical CT human cadaveric study

Cited by 9 publications

References 24 publications

Medial talar resection: how much remains stable?

Medial talar resection: how much remains stable?

Pie plano adquirido del adulto por disfunción del tibial posterior. Opciones para el tratamiento quirúrgico

A novel method of clinical first tarsometatarsal joint hypermobility testing and radiologic verification

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