Acute and Chronic Subtalar Joint Instability: Does It Really Exist?

Acute and chronic subtalar instability and commonly coexistent with other hindfoot pathology but can be difficult to diagnose. A high degree of clinical suspicion is required as most imaging modalities and clinical maneuvers are poor at detecting isolated subtalar instability. The initial treatment is similar to ankle instability, and a wide variety of operative interventions have been presented in the literature for persistent instability. Outcomes are variable and limited

Isolated medial column stabilization improves alignment in adult-acquired flatfoot

In some patients with painful flatfoot, realignment and arthrodesis of the medial naviculocuneiform and first tarsometatarsal joints can be done to correct alignment and relieve symptoms. The primary purpose of this radiographic study was to assess the ability of isolated medial column arthrodesis to improve hindfoot alignment. We also assessed the ability of the procedure to correct radiographic parameters of overall foot structure in acquired flatfoot. Preoperative and postoperative radiographs of 19 patients who had naviculocuneiform and/or tarsometatarsal realignment and arthrodesis for adult-acquired flatfoot were examined by two reviewers. All parameters improved, with the lateral talometatarsal angle approaching normal. A decrease in talonavicular subluxation in the axial plane suggests passive improvement in hindfoot position without direct manipulation of any hindfoot bones or joints. These observations provide evidence for a link between stability of the midfoot and alignment of the hindfoot. In carefully selected patients, medial column realignment may restore normal anatomy without fusing essential joints. Modern clinical outcome studies are the next step in the objective evaluation of this procedure

Assessment of an electronic goniometer designed to measure equinus contracture

To achieve more objective and repeatable measurements of equinus contracture, we developed the equinometer, a device that allows the measurement of ankle range of motion under controlled torque conditions. This study assessed its accuracy across different subjects and examiners. Two examiners used the equinometer to measure the angle of ankle dorsiflexion at 15 N x m torque on five subjects. Accounting for variation in measurements because of subjects, examiners, and placement of device, we used linear mixed-effects models. Accounting for the variation because of subject, different placements of the equinometer within each subject and the adjustment for the effects of examiner and trial sequence, the standard deviation was 0.94 degrees, 95% confidence interval (0.79 degrees, 1.13 degrees). An upper standard deviation of 1.36 degrees is felt to be acceptable for clinical investigation