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Abstract The foot is an uncommon location for osseous tumors, comprising ~ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Resumo O pé é um local incomum para tumores ósseos, e compreende cerca de 3% de todos os tumores esqueléticos, em especial ao redor do calcâneo. A cirurgia radical cria um vazio no pé, o que afeta de forma negativa a capacidade de resgate do membro. As cirurgias de reconstrução do calcâneo não são comumente realizadas por causa da instabilidade da prótese, defeito de partes moles, e consequente possibilidade de insucesso pósoperatório. Assim, apresentamos aqui um caso raro de sarcoma sinovial originário da bainha do tendão tibial posterior com acometimento secundário do osso calcâneo. Considerando as experiências prévias de diferentes cirurgiões, projetamos uma prótese sob medida com modificações relevantes.

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SUMMARY: Sex estimation is an important aspect of skeletal identification. In addition, previous studies have found that the sex estimation of each race is different. Thus, it is necessary to develop discriminant function equations for the estimation of sex for the Thai population. This study aims to investigate the relationship between width, length and height of the calcaneus and talus with regards to sex and compare the effectiveness of sex estimation between the calcaneus alone, the talus alone, and between both the calcaneus and talus. A total of 200 individuals (100 males and 100 females) were used in this study; ages ranged from 19 to 94 years. Thirteen variables of calcaneus and ten variables of talus were measured. The authors created discriminant function equations for the estimation of sex and tested the efficiency of the equations obtained by using a test group of 40 individuals (20 males and 20 females). By analyzing the mean values of the variables in the calcaneus and the talus, it was shown that males were significantly different from females (p0.05). A stepwise method was used to create 6 equations for sex estimation. The equations were categorized from between the calcaneus alone, the talus alone, and between both the calcaneus and the talus, providing a sex estimation accuracy of between 88.5 and 93.0 %. Using the test group, it was shown that discriminant function equations from the calcaneus alone, the talus alone, and the calcaneus and the talus together, can estimate sex at a high level of accuracy. Sex estimation accuracy was greater than 85 % in all equations. Therefore, the discriminant function equations from the calcaneus alone, the talus alone, and between both the calcaneus and the talus, from this study can be applied to the Thai population.

La estimación del sexo es un aspecto importante de la identificación esquelética. Estudios previos han encontrado que la estimación del sexo de cada raza es diferente. Por lo tanto, es necesario desarrollar ecuaciones de funciones discriminantes para la estimación del sexo de la población tailandesa. Este estudio tuvo como objetivo investigar la relación entre el ancho, el largo y la altura de los huesos calcáneo y talus con respecto al sexo y comparar la efectividad de la estimación del sexo entre el calcáneo solo, el talus solo y entre el calcáneo y el talus. Se utilizaron un total de 200 huesos de individuos adultos (100 hombres y 100 mujeres), cuyas edades oscilaron entre 19 y 94 años. Se midieron trece variables del calcáneo y diez variables del talus. Los autores crearon ecuaciones de funciones discriminantes para la estimación del sexo y probaron la eficiencia de ellas usando un grupo de prueba de huesos de 40 individuos (20 hombres y 20 mujeres). Al analizar los valores medios de las variables en el calcáneo y el talus, se demostró que los huesos de los hombres eran significativamente diferentes al de las mujeres (p0.05). Se utilizó un método paso a paso para crear 6 ecuaciones para la estimación del sexo. Las ecuaciones se clasificaron entre el calcáneo solo, el talus solo y entre el calcáneo y el talus, lo que proporcionó una precisión de estimación del sexo de entre 88,5 y 93,0 %. Usando el grupo de prueba, se demostró que las ecuaciones de funciones discriminantes del calcáneo solo, el talus solo y el calcáneo y el talus juntos pueden estimar el sexo con un alto nivel de precisión. La precisión de la estimación del sexo fue superior al 85 % en todas las ecuaciones. Por lo tanto, las ecuaciones de la función discriminante del calcáneo solo, el talus solo y entre el calcáneo y el talus de este estudio se pueden aplicar a la población tailandesa.

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We investigated the potential of exogenous hyaluronic acid (HA) associated with corticosteroid injections to improve pain and function for the treatment of post-traumatic subtalar osteoarthritis, in comparison with isolated intra-articular corticosteroid. Twenty-five symptomatic participants (50 ± 8 years) with a minimum follow-up of 1 year after surgery for calcaneus fractures were enrolled. Participants were randomly assigned into a therapeutic group that underwent isolated corticosteroid intra-articular subtalar injection (Corticosteroid Group, n = 12) or a combination of HA plus corticosteroid (HA+C Group, n = 13). All participants underwent three repeated injections with intervals of 1 week. We assessed the visual analog scale of pain (VAS) and the AOFAS scores at 4 moments: before treatment (pre), 4-, 12-, and 24-weeks following the last injection. HA+C Group showed lower VAS at the 12th (p = .003) and 24th weeks (p = .003) and greater AOFAS at the 4th (p = 0.040), 12th (p = .014), and 24th weeks (p = .021), in comparison to Corticosteroid Group. We observed a reduction in VAS in the Corticosteroid Group only at the 4th week (p = .007), compared with pretreatment values. In the HA+C Group, VAS presented lower levels at the 4- (p < .001), 12- (p < .001), and 24 weeks (p < .001). In the Corticosteroid Group, participants presented higher AOFAS score only at the 4th week (p < .001), while in the HA+C Group, the AOFAS scores were greater at the 4th, 12th, and 24th weeks compared to baseline (p < .001). The combination of exogenous HA and corticosteroid showed greater and longer analgesic effects and function improvement in comparison with isolated intra-articular corticosteroids.

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SUMMARY: The weight of the body is transmitted to the foot through the subtalar joint and talus. Considering the important location of the talus and calcaneus, the morphological structures of these bones may affect the biomechanics of the subtalar joint. At the same time, the morphological structure of these bones is important in some common foot deformities. We aimed to investigate whether the various measurements of the talus and calcaneus are associated with different foot deformities in this study. In this study, radiography images of 158 (72 male and 86 female) patients within the mean age of 44 years were retrospectively examined. Eleven different measurements of the talus and calcaneus were obtained from the lateral and antero-posterior radiographs of the patients. A total of 158 patient's routine clinic radiographs were retrospectively assessed, which have calcaneal spur (n=63), hallux valgus (n=32) and control group (n=63). We determined that the body height of the calcaneus, maximum width of the head of the talus, minimum anterior width of the calcaneus were significantly different between calcaneal spur group and control group. Maximum length fibular malleolar facet of the talus was significantly different between age groups. And we determined that the calcaneal index was significantly different between hallux valgus group and control groups. Also all measurements were significantly different between males and females. As a result, some measurements that significantly determine the morphology of the talus and calcaneus were found to be significant between deformity groups and control groups. We think that our study will contribute to the literature as it is the first study in which the measurements obtained from the radiographic images of the talus and calcaneus are associated with foot deformities.

El peso del cuerpo se transmite al pie a través de la articulación subtalar y el talo. Teniendo en cuenta la importante ubicación del talo y el calcáneo, las estructuras morfológicas de estos huesos pueden afectar la biomecánica de la articulación subtalar. Al mismo tiempo, la estructura morfológica de estos huesos es importante en algunas deformidades comunes del pie. Nuestro objetivo fue investigar si las diversas medidas del talo y el calcáneo están asociadas con diferentes deformidades del pie en este estudio. Se examinaron retrospectivamente imágenes radiográficas de 158 pacientes (72 hombres y 86 mujeres) con una edad promedio de 44 años. Se obtuvieron once medidas diferentes del talo y el calcáneo a partir de las radiografías lateral y anteroposterior de los pacientes. Se evaluaron retrospectivamente un total de 158 radiografías clínicas de rutina de los pacientes, los cuales tenían espolón de calcáneo (n=63), hallux valgus (n=32) y grupo control (n=63). Determinamos que la altura del cuerpo del calcáneo, el ancho máximo de la cabeza del talo, el ancho anterior mínimo del calcáneo fueron significativamente diferentes entre el grupo con espolón calcáneo y el grupo control. La longitud máxima de la faceta maleolar fíbular del talo era significativamente diferente entre los grupos de edad. También determinamos que el índice calcáneo fue significativamente diferente entre el grupo de hallux valgus y los grupos controles. Además, todas las medidas fueron significativamente diferentes entre hombres y mujeres. Como resultado, algunas medidas que determinan la morfología del talo y el calcáneo resultaron significativas entre los grupos de deformidad y los grupos controles. Estimamos que nuestro estudio contribuirá a la literatura debido a que es el primer reporte en el que las medidas obtenidas de las imágenes radiográficas del talo y el calcáneo se asocian con deformidades del pie.

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INTRODUCTION: The deforming condition of the navicular bone known as Müller-Weiss disease (MWD) is a rare disease. Patients present with chronic pain in the talonavicular joint and a paradoxical flat foot with a varo hindfoot. OBJECTIVE: To analyze the clinical results of a lateral osteotomy of calcaneus applied to patients with MWD. MATERIAL AND METHODS: Retrospective observational study carried out in two hospitals. The series consists of nine cases in eight patients, all of them with symptomatic Müller-Weiss disease, treated by lateral osteotomy of the calcaneus between 2012 and 2017, obtaining an average follow-up of 4 years (2-6). The mean age was 62 years (50-75). In all patients, Costa-Bartani angles (CB), Kite angle and Calcaneal Inclination (CI) were measured. In addition, the Manchester Oxford Scale (MO) to measure the post-surgical satisfaction of patients. RESULTS: All patients report having improved their pain by obtaining a postoperative score on the mean Manchester Oxford scale of 32.54 points (15.62-53.75). In 66% of patients the CB angle improves, the Kite angle in 89% and the CI in 33%. CONCLUSION: The improvement in the pain of the patients in our series is not accompanied by radiological changes in the same proportion, it is a simple and uncomplicated technique in our follow-up.

INTRODUCCIÓN: La afección deformante del hueso navicular conocida como enfermedad de Müller-Weiss (EMW) es una enfermedad rara. Los pacientes presentan dolor crónico en la articulación talonavicular y un pie plano paradójico con retropié varo. OBJETIVO: Analizar los resultados clínicos de la osteotomía valguizante de calcáneo aplicada a pacientes con EMW. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo, realizado en dos centros hospitalarios. La serie consta de nueve casos en ocho pacientes, todos ellos con enfermedad de Müller-Weiss sintomática, fueron tratados mediante osteotomía valguizante de calcáneo entre 2012 y 2017, con un seguimiento medio de cuatro años (dos a seis). La edad media fue de 62 años (50-75). En todos los pacientes se midieron los ángulos de Costa-Bartani (CB), el ángulo de Kite y la inclinación calcánea (IC). Además, se utilizó la escala Manchester Oxford (MO) para medir la satisfacción postquirúrgica de los pacientes. RESULTADOS: Todos los pacientes refieren haber mejorado en su dolor, obteniendo una puntuación postoperatoria media de 32.54 puntos (15.62-53.75) en la escala Manchester Oxford. En 66% de los pacientes el ángulo CB mejoró, al igual que en el ángulo de Kite en 89% y la IC en 33%. CONCLUSIÓN: La mejoría en el dolor de los pacientes de nuestra serie no está acompañada por cambios radiológicos en la misma proporción, es una técnica sencilla y sin complicaciones en nuestro seguimiento.

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BACKROUND: Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression. OBJECTIVE: Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur. METHODS: Design: A single-blinded, randomized and controlled trial. SETTING: Biomechanics laboratory. PARTICIPANTS: Forty-three women, 29 with calcaneal spur and 14 control. INTERVENTION: Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 ± 9.4, height: 1.61 ± 0.1, BMI: 32.1 ± 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 ± 5.8, height: 1.62 ± 0.1, BMI: 32.2 ± 4.3) and control (CG n = 14, age: 47.8 ± 8.6, height: 1.63 ± 0.1, BMI: 27.5 ± 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI). STATISTICAL ANALYSIS: analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (α = 5%). Effect size with D Cohen's also was used between T0 and after six (T6) months of intervention. RESULTS: The MFG and COIG were effective at reducing pain after six months (MFG: 2.5-4.5 CI, p = 0.001; COIG: 1.5-3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7-15.4 CI, p = 0.010; COIG: 11.3-15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3-622.7 CI) and COIG (401.3-644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2-5.4 CI; Left: 3.6-5.4 CI) COIG (FPI Right: 3.4-6.8 CI; Left: 3.3-5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG. CONCLUSIONS: The mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects. TRIAL REGISTRATION: ClinicalTrials.gov NCT03040557 (date of first registration: 02/02/2017).

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BACKGROUND: Subtalar pain following intra-articular calcaneus fractures may be associated with disability, pain, and a negative impact on the quality of life. Salvage procedures as subtalar fusion are associated with further consequences as stiffness, altered ankle biomechanics, and adjacent articular overloading with degenerative changes. The objective of the present study is to evaluate the short-term effects of viscosupplementation with intra-articular hyaluronic acid (HA) on function and pain, in patients with painful subtalar joint after calcaneus fracture. METHODS: We searched for patients who underwent osteosynthesis of intra-articular calcaneus fracture between January 2011 and July 2015 and were diagnosed during the follow-up with pain and subtalar osteoarthritis. Between January and December of 2018, 13 patients (50 ± 10 years) accepted to participate in this study and received intra-articular HA injections. Three consecutive doses of 20 mg of HA were administered within a week interval, through anterolateral injections into the subtalar joint. We prospectively evaluated the function using the ankle/hindfoot American Orthopaedic Foot & Ankle Society score (AOFAS) and level of pain using the visual analog scale (VAS) before the intervention and 4, 12, and 24 weeks after the first injection. RESULTS: Hindfoot function improved with an increase of AOFAS from 55 ± 19 before the intervention to 88 ± 20 at the 24th week (P = .001). Similarly, we observed relief of pain during the 24 weeks following intra-articular hyaluronic acid injection, with a decrease in VAS from 8.3 ± 1.3 before treatment to 2.2 ± 3.0 at the 24th week (P = .001). CONCLUSION: For patients experiencing pain and dysfunction with subtalar osteoarthritis after intra-articular calcaneus fracture, viscosupplementation with intra-articular HA may be associated with improvement in function and pain in the short term. Furthermore, patients with higher grades of osteoarthritis may have limited benefit in pain relief and function improvement. LEVEL OF EVIDENCE: IV, Case series.

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Resumen: Introducción: La afección deformante del hueso navicular conocida como enfermedad de Müller-Weiss (EMW) es una enfermedad rara. Los pacientes presentan dolor crónico en la articulación talonavicular y un pie plano paradójico con retropié varo. Objetivo: Analizar los resultados clínicos de la osteotomía valguizante de calcáneo aplicada a pacientes con EMW. Material y métodos: Estudio observacional, retrospectivo, realizado en dos centros hospitalarios. La serie consta de nueve casos en ocho pacientes, todos ellos con enfermedad de Müller-Weiss sintomática, fueron tratados mediante osteotomía valguizante de calcáneo entre 2012 y 2017, con un seguimiento medio de cuatro años (dos a seis). La edad media fue de 62 años (50-75). En todos los pacientes se midieron los ángulos de Costa-Bartani (CB), el ángulo de Kite y la inclinación calcánea (IC). Además, se utilizó la escala Manchester Oxford (MO) para medir la satisfacción postquirúrgica de los pacientes. Resultados: Todos los pacientes refieren haber mejorado en su dolor, obteniendo una puntuación postoperatoria media de 32.54 puntos (15.62-53.75) en la escala Manchester Oxford. En 66% de los pacientes el ángulo CB mejoró, al igual que en el ángulo de Kite en 89% y la IC en 33%. Conclusión: La mejoría en el dolor de los pacientes de nuestra serie no está acompañada por cambios radiológicos en la misma proporción, es una técnica sencilla y sin complicaciones en nuestro seguimiento.

Abstract: Introduction: The deforming condition of the navicular bone known as Müller-Weiss disease (MWD) is a rare disease. Patients present with chronic pain in the talonavicular joint and a paradoxical flat foot with a varo hindfoot. Objective: To analyze the clinical results of a lateral osteotomy of calcaneus applied to patients with MWD. Material and methods: Retrospective observational study carried out in two hospitals. The series consists of nine cases in eight patients, all of them with symptomatic Müller-Weiss disease, treated by lateral osteotomy of the calcaneus between 2012 and 2017, obtaining an average follow-up of 4 years (2-6). The mean age was 62 years (50-75). In all patients, Costa-Bartani angles (CB), Kite angle and Calcaneal Inclination (CI) were measured. In addition, the Manchester Oxford Scale (MO) to measure the post-surgical satisfaction of patients. Results: All patients report having improved their pain by obtaining a postoperative score on the mean Manchester Oxford scale of 32.54 points (15.62-53.75). In 66% of patients the CB angle improves, the Kite angle in 89% and the CI in 33%. Conclusion: The improvement in the pain of the patients in our series is not accompanied by radiological changes in the same proportion, it is a simple and uncomplicated technique in our follow-up.

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The present study aimed to evaluate the new heterologous fibrin biopolymer associated, or not, with photobiomodulation therapy for application in tendon injuries, considered a serious and common orthopedic problem. Thus, 84 Rattus norvegicus had partial transection of the calcaneus tendon (PTCT) and were randomly divided into: control (CG); heterologous fibrin biopolymer (HFB); photobiomodulation (PBM); heterologous fibrin biopolymer + photobiomodulation (HFB + PBM). The animals received HFB immediately after PTCT, while PBM (660 nm, 40 mW, 0.23 J) started 24 h post injury and followed every 24 h for 7, 14, and 21 days. The results of the edema volume showed that after 24 h of PTCT, there was no statistical difference among the groups. After 7, 14, and 21 days, it was observed that the treatment groups were effective in reducing edema when compared to the control. The HFB had the highest edema volume reduction after 21 days of treatment. The treatment groups did not induce tissue necrosis or infections on the histopathological analysis. Tenocyte proliferation, granulation tissue, and collagen formation were observed in the PTCT area in the HFB and HFB + PBM groups, which culminated a better repair process when compared to the CG in the 3 experimental periods. Interestingly, the PBM group revealed, in histological analysis, major tendon injury after 7 days; however, in the periods of 14 and 21 days, the PBM had a better repair process compared to the CG. In the quantification of collagen, there was no statistical difference between the groups in the 3 experimental periods. The findings suggest that the HFB and PBM treatments, isolated or associated, were effective in reducing the volume of the edema, stimulating the repair process. However, the use of HFB alone was more effective in promoting the tendon repair process. Thus, the present study consolidates previous studies of tendon repair with this new HFB. Future clinical trials will be needed to validate this proposal.

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BACKGROUND: Autologous grafting is widely used in orthopaedic surgery because of its high osteogenic capacity, immunologic compatibility, for the absence of risk of disease transmission, and for not requiring a bone bank. The posterior-superior calcaneal tuberosity is an option for obtaining a cortical and cancellous structural bone. This study aims to describe the operative technique and complications observed at the donor site of the posterior-superior calcaneal tuberosity. METHODS: Patients who underwent graft harvesting from the posterior-superior calcaneal tuberosity were retrospectively evaluated by pain outcomes, imaging tests, and intra- and postoperative complications. RESULTS: Twenty patients with a median age of 69 years (range 48-77) and follow-up of 16 months (12-26) were assessed. Median postoperative pain at the donor site was 0 (0-6), with 2 patients reporting persistent local pain. No case of Achilles tendon rupture or intra- or postoperative calcaneal fracture were identified. One patient developed a superficial infection that was quickly resolved using oral antibiotic therapy. CONCLUSION: The posterior-superior calcaneal tuberosity is an alternative source of autologous graft with low donor site morbidity. LEVEL OF EVIDENCE: Level IV, case series.

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SUMMARY: Heel spur is an osteophytic protrusion larger than 2 mm that lies just anterior to the tuberosity of the calcaneus. Heel spur can be of two types: plantar heel spur and dorsal heel spur. The aim of this study was to evaluate the relationship between the heel spurs incidence with age, sex and side. A total of 2000 bilateral radiographs of 1000 patients (518 men and 482 women) aged 20-93 years who applied to Terme state hospital, Samsun, Turkey due to trauma were examined. Patients were grouped into 10 year age ranges (20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years and over 70 years). The incidences of plantar heel spur, dorsal heel spur, and both were evaluated according to age, sex and side relations. Plantar or dorsal heel spurs were detected in 32.6 % (326 patients) of the patients. The incidences of plantar heel spur, dorsal heel spur, plantar and dorsal heel spur were 26.0 %, 16.9 %, and 10.3 % respectively. According to sex, the incidence of plantar heel spur was higher in women in all age groups. Although the incidence of dorsal heel spur was higher in men in the 6th decade, it was more common in women in other age groups. The incidence of plantar heel spur was 2.615 times higher in the right foot and 2.810 times higher in the left foot in women. As the age increased, the risk of plantar heel spur increased 1.060 times in the right foot and 1.061 times in the left foot. The incidence of dorsal heel spur was 1.510 times higher in the right foot and 1.715 times higher in the left foot in women. As the age increased, the incidence of dorsal heel spur increased in both feet and this increase was 1.055 times in both feet.

RESUMEN: El espolón calcáneo es una protuberancia osteofítica de más de 2 mm que se encuentra por delante de la tuberosidad del calcáneo. El espolón calcáneo puede ser de dos tipos: espolón calcáneo plantar y espolón calcáneo dorsal. El objetivo de este estudio fue evaluar la relación entre la incidencia de espolón calcáneo con la edad, el sexo y el lado. Se examinaron un total de 2000 radiografías bilaterales de 1000 pacientes (518 hombres y 482 mujeres) de 20 a 93 años de edad que fueron solicitadas en el hospital estatal de Terme, Samsun, Turquía debido a un traumatismo. Los pacientes se agruparon en rangos de edad de 10 años (20-29 años; 30-39 años; 40-49 años; 50-59 años; 60-69 años y mayores de 70 años). Las incidencias de espolón calcáneo plantar, espolón calcáneo dorsal y ambos se evaluaron de acuerdo con la edad, el sexo y lados. Se detectaron espolones calcáneos plantares o dorsales en el 32,6 % (326 pacientes) de los pacientes. Las incidencias de espolón calcáneo plantar, espolón calcáneo dorsal, espolón calcáneo plantar y dorsal fueron del 26 %, 16,9 % y 10,3 %, respectivamente. Según el sexo, la incidencia de espolón calcáneo plantar fue mayor en mujeres en todos los grupos de edad. Aunque la incidencia del espolón calcáneo dorsal fue mayor en hombres en la sexta década, era más común en mujeres en otros grupos de edad. La incidencia de espolón calcáneo plantar fue 2,6 veces mayor en el pie derecho y 2,8 veces mayor en el pie izquierdo en mujeres. A medida que aumentaba la edad, el riesgo de espolón calcáneo plantar aumentaba 1,06 veces en el pie derecho y 1,061 veces en el pie izquierdo. La incidencia de espolón calcáneo dorsal fue 1,510 veces mayor en el pie derecho y 1,715 veces mayor en el pie izquierdo en mujeres. A medida que aumentaba la edad, la incidencia de espolón calcáneo dorsal aumentaba en ambos pies y este aumento era de 1,055 veces en ambos pies.

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Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.

La fractura de calcáneo es poco frecuente y tiene altos costos asociados a largo plazo por su morbilidad asociada. El tratamiento quirúrgico de estas fracturas mediante la vía de abordaje lateral extendido tiene riesgos de complicación de herida quirúrgica que pueden superar 20%. Dentro de las causas del dolor secuelar, la más frecuente es la artropatía subtalar, pero se deben descartar otras como la infección asociada al implante. El objetivo de este estudio es determinar la presencia de gérmenes en el implante mediante su extracción, sonicación y cultivo. Se excluyeron los casos con clínica de infección, artropatía subtalar, seudoartrosis y cirugía de artrodesis subastragalina concomitante. Se registró antecedente de fractura expuesta, complicación de herida operatoria, tiempo entre cirugías, motivo de la ablación del implante y resultados de cultivos con los gérmenes identificados. Se obtuvo una tasa de cultivos positivos de 33.3%. Consideramos que es importante tener en cuenta la infección asociada al implante como causa del dolor en este tipo de pacientes, con el fin de estudiar microbiológicamente los casos y entregar el tratamiento adecuado cuando corresponda.

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Cryptococcus neoformans is an encapsulated, yeast-like fungus that can cause a systemic mycosis, particularly in immunocompromised patients. Disseminated infections typically affect the central nervous system, and osseous lesions are infrequent. Only 5%-10% of disseminated cryptococcosis involves bones. A 69-year-old female presented pain, swelling, and a soft tissue mass in her right lateral hindfoot. Her medical history included a kidney transplant (10 years earlier) secondary to chronic disease due to IgA nephropathy. The patient underwent an excisional biopsy, surgical debridement, and secondarily negative pressure wound therapy to achieve skin closure. Biopsy revealed a rare Cryptococcus neoformans osteomyelitis of the calcaneus. The patient then received IV treatment with liposomal amphotericin B at 3 mg/kg/d for 25 days. In conclusion, we present a case of cryptococcal osteomyelitis which, although not a frequent disease, must be considered as one of the differential diagnoses of osteolytic osseous lesions in patients with chronic osteomyelitis. Cryptococcus neoformans may be a potential cause of below-knee infection, mainly in immunocompromised patients.

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Calcaneus fractures are scarcely reported in archaeological assemblages worldwide. The main goal of this paper is to present a study case related to a calcaneus fracture and a set of bone lesions recorded in an adult individual dated in the Middle Holocene (ca. 6000-3000 years BP). This individual was part of a hunter-gatherer society that inhabited the eastern Pampa-Patagonian transition (lower basin of Colorado river, Argentina). The individual was recovered at Tres Bonetes 1 site (TB1-E1). The causes of the injury and the stress it could have had generated in the individual are discussed. Macroscopic analysis and radiographic images were carried out and several bone alterations were detected (27.1%; 19/70). The lesions were located in the right ankle joint linked to an intra-articular calcaneus fracture. The main cause may have been a fall from height. The remodeled new bone formation indicates that the individual survived the stress event, but several sectors of the skeleton (e.g., spine, shoulders) were affected. The original morphological structure of the calcaneus was not restored and probably caused joint instability that affected the biomechanical behavior of the ankle. The individual must have suffered acute and severe pain and need help, care and assistance from other people.

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Resumen: La fractura de calcáneo es poco frecuente y tiene altos costos asociados a largo plazo por su morbilidad asociada. El tratamiento quirúrgico de estas fracturas mediante la vía de abordaje lateral extendido tiene riesgos de complicación de herida quirúrgica que pueden superar 20%. Dentro de las causas del dolor secuelar, la más frecuente es la artropatía subtalar, pero se deben descartar otras como la infección asociada al implante. El objetivo de este estudio es determinar la presencia de gérmenes en el implante mediante su extracción, sonicación y cultivo. Se excluyeron los casos con clínica de infección, artropatía subtalar, seudoartrosis y cirugía de artrodesis subastragalina concomitante. Se registró antecedente de fractura expuesta, complicación de herida operatoria, tiempo entre cirugías, motivo de la ablación del implante y resultados de cultivos con los gérmenes identificados. Se obtuvo una tasa de cultivos positivos de 33.3%. Consideramos que es importante tener en cuenta la infección asociada al implante como causa del dolor en este tipo de pacientes, con el fin de estudiar microbiológicamente los casos y entregar el tratamiento adecuado cuando corresponda.

Abstract: Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.

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Abstract Objective: a) Establish reference values for bone parameters by using the speed of sound (SOS, m/s) of broadband ultrasound attenuation (BUA, dB/MHz) and establish a bone quality index (BQI = αSOS + βBUA) for children and adolescents living in a region of moderate altitude, b) compare bone parameters with an international standard (with different ethnic, socio-economic, and lifestyle backgrounds) by using ultrasound of the calcaneus (heel bone) (QUS). Methods: A descriptive cross-sectional study was carried out with children and adolescents between the ages of 6.0 and 16.9 years old. The sample was selected randomly. A total of 1322 subjects were studied. Weight, height, and bone parameters, using ultrasound of the calcaneus, were evaluated SOS, BUA, and BQI. Body Mass Index BMI was calculated. Results: The average age of males was 11.44 ± 0.35 years old, and for females, it was 11.43 ± 0.35 years old. The students in this research showed slightly higher values of SOS, BUA, and BQI for both sexes when compared with the international reference (the 50th percentile). Percentiles were generated (P3, P10, P25, P50, P75, P90, and P97) using the LMS method [median (M), standard deviation (S), and power of the Box-Cox transformation (L)] by age and sex. Conclusion: The students living at a moderate altitude showed slightly higher values in bone parameters in relation to the international reference. This pattern depicted a population with a better state of bone health. The proposed percentiles may be used to categorize adequate to at risk bone parameters based on age and sex.

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OBJECTIVE: a) Establish reference values for bone parameters by using the speed of sound (SOS, m/s) of broadband ultrasound attenuation (BUA, dB/MHz) and establish a bone quality index (BQI=αSOS+ßBUA) for children and adolescents living in a region of moderate altitude, b) compare bone parameters with an international standard (with different ethnic, socio-economic, and lifestyle backgrounds) by using ultrasound of the calcaneus (heel bone) (QUS). METHODS: A descriptive cross-sectional study was carried out with children and adolescents between the ages of 6.0 and 16.9 years old. The sample was selected randomly. A total of 1322 subjects were studied. Weight, height, and bone parameters, using ultrasound of the calcaneus, were evaluated SOS, BUA, and BQI. Body Mass Index BMI was calculated. RESULTS: The average age of males was 11.44±0.35 years old, and for females, it was 11.43±0.35 years old. The students in this research showed slightly higher values of SOS, BUA, and BQI for both sexes when compared with the international reference (the 50th percentile). Percentiles were generated (P3, P10, P25, P50, P75, P90, and P97) using the LMS method [median (M), standard deviation (S), and power of the Box-Cox transformation (L)] by age and sex. CONCLUSION: The students living at a moderate altitude showed slightly higher values in bone parameters in relation to the international reference. This pattern depicted a population with a better state of bone health. The proposed percentiles may be used to categorize adequate to at risk bone parameters based on age and sex.

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Calcaneal tendon injuries are extremely common in the general population and in orthopedics routine care. Its increasing incidence, which is motivated by an aging population, improved access to the health care system, increased prescription of continuous-use medication, erratic participation in sports and other factors, has had a direct impact on society. Consolidated treatment options for tendinopathies lack quality scientific support for many modalities. New therapies have emerged to enhance nonsurgical approach outcomes and to reduce the number of patients requiring surgery. Although these operative procedures provide good pain relief and functional outcomes, they are costly and may lead to complications.

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The increasing incidence of calcaneal tendon ruptures has substantially impacted orthopedic care and costs related to its treatment and prevention. Primarily motivated by the increasing of life expectancy, the growing use of tenotoxic drugs and erratic access to physical activity, this injury accounts for considerable morbidity regardless of its outcome. In recent years, the evolution of surgical and rehabilitation techniques gave orthopedists better conditions to decide the most appropriate conduct in acute tendon rupture. Although still frequent due to their high neglect rate, Achilles chronic ruptures currently find simpler and more biological surgical options, being supported by a new specialty-focused paradigm.

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Abstract Calcaneal tendon injuries are extremely common in the general population and in orthopedics routine care. Its increasing incidence, which is motivated by an aging population, improved access to the health care system, increased prescription of continuous-use medication, erratic participation in sports and other factors, has had a direct impact on society. Consolidated treatment options for tendinopathies lack quality scientific support for many modalities. New therapies have emerged to enhance nonsurgical approach outcomes and to reduce the number of patients requiring surgery. Although these operative procedures provide good pain relief and functional outcomes, they are costly and may lead to complications.

Resumo As afecções que acometem o tendão calcâneo são extremamente comuns na população geral e no cotidiano da atenção ortopédica. Sua crescente incidência, motivada pelo envelhecimento da população, pela melhora no acesso à saúde, pelo aumento na utilização de drogas de uso contínuo, pela errática participação esportiva e outros fatores, tem causado impacto direto na sociedade. As tendinopatias, ainda que hoje respaldadas por tratamentos consolidados, carecem de suporte científico de qualidade para muitas das suas recomendações. Novas terapêuticas têm surgido com o objetivo de potencializar o resultado da abordagem não-operatória e diminuir a quantidade de pacientes que necessitam de uma cirurgia. Esses procedimentos operatórios apresentam uma boa resposta álgica e funcional dos pacientes, no entanto não são livres de complicações e dos altos custos que os cercam.

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