UNASSIGNED: A case of chronic osteomyelitis with Brodie\'s abscess of the cuboid caused by a wooden foreign body penetrating the plantar foot. Total cuboidectomy was carried out with implantation of an anatomically molded antibiotic-impregnated cement spacer with culture-specific postoperative intravenous antibiotics. At six months of follow-up, the patient was completely asymptomatic without evidence of a recurrence of infection. Final radiographs also didn\'t show spacer migration or surrounding bone erosions. The spacer obviated the need for any foot fusion which preserved foot biomechanics. The patient didn\'t need to use any braces or insoles.
UNASSIGNED: Osteomyelitis should always be on the differential list of lytic lesions of the tarsal bones, especially if there is a history of prior foot trauma. In this case, cuboid excision and placement of an antibiotic-impregnated cement spacer provided sustained relief of symptoms without evidence of recurrence or complications for six months.Level of Evidence: V.

OBJECTIVE: To compare the effects of anchor reconstruction of posterior tibial tendon with the traditional Kidner\'s procedure for accessory navicular bone syndrome.
METHODS: A retrospective analysis was conducted on 40 young athletes diagnosed with accessory navicular bone syndrome who were admitted to our hospital from 2018 to 2021. Among them, 20 patients underwent the modified Kidner procedure for the anchor reconstruction of the posterior tibial tendon (Experimental group), while the remaining 20 patients were treated with the traditional Kidner\'s procedure (Control group). Regular follow-ups were conducted to evaluate the degree of relief of foot symptoms and functional recovery.
RESULTS: All patients were followed up for 12 to 24 months (mean duration: 18.6±3.7) after the operation. At the last follow-up, significant differences were observed in the function and symptom relief of the affected foot compared to the preoperative state. The experimental group had a mean operation time of 52.10 ± 3.41 minutes, significantly shorter than the control group\'s 61.25 ± 2.75 minutes. The mean time to return to normal activity was 12.65 ± 1.23 weeks for the experimental group, compared to 15.25 ± 1.16 weeks for the control group.
CONCLUSIONS: The modified Kidner procedure demonstrates a higher patient satisfaction rate compared to the traditional Kidner procedure. This is attributed to its shorter duration, reduced trauma, and quicker recovery of normal activity.

BACKGROUND: The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.
BACKGROUND: Das Ziel dieser retrospektiven Studie ist, die konservative und chirurgische Therapie von Strahlbein-Frakturen beim Pferd zu beschreiben und zu vergleichen. Es wird versucht, kritische Punkte zu identifizieren, welche die Prognose dieser orthopädischen Erkrankung günstig beeinflussen können. Es wurden alle Pferde in die Studie eingeschlossen, die zwischen 2005 und 2017 an der Pferdeklinik der Vetsuisse-Fakultät der Universität Zürich aufgrund einer Strahlbein-Fraktur behandelt worden waren. Der Schweregrad der Lahmheit bei der Erstuntersuchung, die röntgenologische Beurteilung, die Hufkonformation, die Behandlung (konservativ oder chirurgisch), die Komplikationen und der Outcome wurden anhand der Krankengeschichten ermittelt. Konservative und chirurgische Therapie bestanden aus Boxenruhe, kontrolliertem Bewegungsprogramm und einem therapeutischen orthopädischen Hufbeschlag. Bei der chirurgischen Therapie wurde zusätzlich eine Frakturreduktion mit einer Corticalisschraube durchgeführt. Dabei wurden fünf Pferde mit Computer Assisted Surgery operiert und drei mit Hilfe der Computertomographie. Die Nachuntersuchungen umfassten klinische und röntgenologische Untersuchungen. Der Outcome wurde in drei Kategorien unterteilt: 1 = Sehr gut; 2 = Gut; 3 = Schlecht. Zwölf Pferde erfüllten die Einschlusskriterien; vier Pferde wurden konservativ und acht chirurgisch behandelt. Nach konservativer Therapie hatten zwei Pferde (50 %) einen sehr guten und zwei (50 %) einen guten Outcome. Nach chirurgischer Therapie hatten vier Pferde (50 %) einen sehr guten und vier (50 %) einen schlechten Outcome. Insgesamt zeigten 67 % der Pferde einen sehr guten oder guten Outcome, obwohl in keinem dieser Fälle röntgenologische Anzeichen einer Knochenheilung beobachtet werden konnten. Verschiedene Komplikationen konnten identifiziert werden, wie der Bruch einer Schraube, die Fragmentierung des kleinen Strahlbeinfragmentes, die Entwicklung von Osteoarthrose im Hufgelenk sowie eine fortschreitende Podotrochlose. Diese Studie zeigt, dass die Prognose von Strahlbein-Frakturen grundsätzlich vorsichtig ist und dass degenerative Veränderungen vom Strahlbeinapparat die Prognose verschlechtern. In der vorliegenden Studie verbesserte die chirurgische Behandlung die Prognose von Strahlbeinfrakturen trotz der intraoperativen Verwendung der dreidimensionalen Bildgebung nicht. Der technische Fortschritt könnte jedoch die Komplikationsrate in Zukunft verringern.
BACKGROUND: Le but de cette étude rétrospective était de décrire et de comparer le traitement conservateur et chirurgical des fractures de l’os naviculaires chez le cheval. Une tentative est faite pour identifier les points critiques qui peuvent influencer favorablement le pronostic de cette maladie orthopédique. Tous les chevaux traités pour une fracture de l’os naviculaire à la Clinique équine de la Faculté Vetsuisse de l’Université de Zurich entre 2005 et 2017 ont été inclus dans cette étude. La gravité de la boiterie lors de l’examen initial, l’évaluation radiographique, la conformation du sabot, le traitement (conservateur ou chirurgical), les complications et le résultat ont été déterminés à partir des dossiers médicaux. Le traitement conservateur et chirurgical consistait en un repos au box, un programme d’exercice contrôlé et un ferrage orthopédique thérapeutique. Au cours du traitement chirurgical, une réduction de la fracture a également été effectuée à l’aide d’une vis corticale. La chirurgie assistée par ordinateur a été utilisée sur cinq chevaux et la tomographie assistée par ordinateur sur trois chevaux. Les examens de suivi comprenaient des examens cliniques et radiographiques. Les résultats ont été divisés en trois catégories: 1 = très bon; 2 = bon; 3 = mauvais. Douze chevaux répondaient aux critères d’inclusion ; quatre chevaux ont été traités de manière conservatrice et huit ont été traités chirurgicalement. Après un traitement conservateur, deux chevaux (50 %) ont eu un très bon résultat et deux (50 %) un bon résultat. Après le traitement chirurgical, quatre chevaux (50 %) ont eu un très bon résultat et quatre (50 %) un mauvais résultat. Dans l’ensemble, 67 % des chevaux ont eu un très bon ou un bon résultat, bien que les signes radiographiques de guérison osseuse n’aient été présents dans aucun de ces cas. Diverses complications ont été identifiées, telles que la fracture d’une vis, la fragmentation du petit fragment de l’os naviculaire, le développement d’une arthrose dans l’articulation interphalangienne distale et une podotrochlose progressive. Cette étude montre que le pronostic des fractures de l’os naviculaire est généralement réservé et que les modifications dégénératives de l’appareil naviculaire aggravent le pronostic. Dans la présente étude, le traitement chirurgical n’a pas amélioré le pronostic des fractures du naviculaire malgré l’utilisation intra-chirurgicale de l’imagerie tridimensionnelle. Cependant, les progrès techniques pourraient réduire le taux de complications dans le futur.
BACKGROUND: Lo scopo di questo studio retrospettivo è di descrivere e confrontare il trattamento conservativo e chirurgico delle fratture del navicolare nei cavalli e di conseguenza individuare i punti critici che possono influenzare favorevolmente la prognosi di questa malattia ortopedica. In questo studio sono stati inclusi tutti i cavalli trattati per una frattura del navicolare tra il 2005 e il 2017 presso la Pferdeklinik, Vetsuisse-Fakultät, Universität Zürich (Clinica Equina, della Facoltà di Medicina Veterinaria, dell‘Università di Zurigo). La gravità della zoppia all’esame iniziale, la valutazione radiografica, la conformazione dello zoccolo, il trattamento (conservativo o chirurgico), le complicazioni e l’esito sono stati determinati dalle cartelle cliniche. Il trattamento conservativo e chirurgico consisteva in riposo nel box, un programma di esercizi controllati e una ferratura ortopedica terapeutica. Durante il trattamento chirurgico, è stata anche eseguita la riduzione della frattura con una vite corticale. La chirurgia assistita da computer è stata utilizzata in cinque cavalli e la tomografia computerizzata in tre cavalli. Gli esami di follow-up includevano esami clinici e radiografici. L’esito è stato diviso in tre categorie: 1 = molto buono; 2 = buono; 3 = scadente. Dodici cavalli soddisfacevano i criteri di inclusione; quattro cavalli sono stati trattati in modo conservativo e otto sono stati trattati chirurgicamente. Dopo il trattamento conservativo, due cavalli (50 %) hanno avuto un esito molto buono e due (50 %) hanno avuto un buon esito. Dopo il trattamento chirurgico, quattro cavalli (50 %) hanno avuto un esito molto buono e quattro (50 %) hanno avuto un esito scadente. Complessivamente, il 67 % dei cavalli ha avuto un esito molto buono o buono, anche se segni radiografici di guarigione ossea non erano presenti in nessuno di questi casi. Diverse complicazioni sono state identificate, come la rottura di una vite, la frammentazione del piccolo frammento osseo del navicolare, lo sviluppo di osteoartrosi nell’articolazione interfalangea distale e la progressione della navicolite. Questo studio dimostra come la prognosi delle fratture del navicolare è generalmente cauta e che i cambiamenti degenerativi dell’apparato navicolare peggiorano la prognosi. Nel presente studio, il trattamento chirurgico non ha migliorato la prognosi delle fratture del navicolare nonostante l’uso intrachirurgico dell’immagine tridimensionale. Tuttavia, progressi tecnici potrebbero ridurre il tasso di complicazioni in futuro.

Navicular and cuboid fractures can be complex and difficult to treat. Depending on the mechanism of injury, diagnosis of such fractures is not always possible with conventional radiographs due to the irregularity and overlap of the midfoot bones. Advanced imaging is indicated if a fracture is of high suspicion or to further characterize a displaced fracture. Cuboid and navicular fractures can occur in isolation but are often associated with other midfoot injuries due to their anatomic relationships. Typically, nondisplaced fractures can be treated conservatively, whereas displaced fractures require surgical intervention to prevent future complications.

OBJECTIVE: The purpose of this study was to present the classification of navicular bones and the anatomical basis for the diagnosis and treatment of navicular fractures of the foot.
METHODS: 351 computed tomographic (CT) images of the navicular bone were analyzed and classified. The navicular bone\'s anatomical morphology was measured by three independent researchers in each type. Analysis and recording of the measurement results followed.
RESULTS: Navicular bones were assorted into three types: I shape(37.04%), II shape(54.41%), and III shape(8.55%). The left and right sides did not differ in any appreciable ways, except ab, bc, and ∠abc (P < 0.05); And all data were statistically different between men and women except for ∠abc (p > 0.05).
CONCLUSIONS: The classification of the navicular bone in this study may be helpful in making the treatment decision for navicular fracture.
METHODS: 4.

Mueller-Weiss Syndrome (MWS), characterized by spontaneous adult-onset tarsal navicular osteonecrosis, is an uncommon cause of chronic midfoot pain that can lead to functional impairment and progressive deformities. This study aimed to present clinical and radiological outcomes of talonavicular-cuneiform (TNC) arthrodesis in the treatment of patients with MWS. A retrospective study was performed on 8 consecutive patients (6 female, 2 male; mean age = 50 years; range = 33-64) who underwent TNC arthrodesis using plate fixation with autologous bone grafting for the treatment of MWS. To evaluate clinical status, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Midfoot Score was performed immediately preoperatively and at the final follow-up. In radiographic evaluation, talus-first metatarsal angle (Meary\'s angle) was measured preoperatively and at the final follow-up. Solid fusion was also examined on postoperative radiographs and computerised tomography. The mean follow-up was 35 months (range = 24-52). The mean AOFAS improved from 37 (range = 24-53) preoperatively to 85 (range = 80-93) at the final follow-up (p < 0.001). No major intra- operative complications were observed in any of the patients. According to the Maceira and Rochera radiological staging system, 5 feet was stage 3, and 3 feet was stage 4. The mean union time was 10 months (range = 5-15). Radiographic solid fusion was achieved in all but one foot that developed talonavicular non-union. TNC arthrodesis using plate fixation with autologous bone grafting seems to be an effective surgical method for reconstruction of MWS.

OBJECTIVE: Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA).
METHODS: A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6-17). Mean follow-up was 7 ± 2.9 years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01.
RESULTS: Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing.
CONCLUSIONS: SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications.
METHODS: IV.

The paper deals with the torques of external muscles acting on the upper ankle joint under weight-bearing conditions and their importance in diagnosing and treating the human foot. Experimental data were collected and calculations were performed. Based on the experiments with the biomechanical model of the foot and upper ankle joint, it was shown how the changes in the force arms of the external muscles of the foot under weight-bearing conditions, change the torque. The real values of muscle forces and torques of the external muscles of the foot were calculated. Taking into account the distance of the lines of muscle action from the axis of rotation of the upper ankle joint the rotational force of the muscles was calculated. The influence of changing the force arm on the rotational efficiency of the muscle balancing the moment of gravity was shown. Knowledge of muscle torque under weight-bearing conditions is crucial for correctly assessing foot biomechanics. It has been shown that torque (gravitational and muscular), not pure force, is crucial when assessing the rotational capacity of the analyzed joint. A change in the approach to diagnostics and treating paresis or weakness of extrinsic foot muscles was proposed through the manipulation of the distance of their action line from the axis of joint rotation.

UNASSIGNED: Although the incidence of os supranaviculare (OSSN) is generally low, symptomatic OSSN affects athletes. The aim of this study was to assess the variations of OSSN and the results of osteosynthesis between the OSSN and the navicular bone.
UNASSIGNED: Eleven feet of 10 elite athletes with symptomatic OSSN were treated. There were 3 male and 7 female patients with an average age of 19 years. Eight feet exhibited navicular stress fracture (NSF). Operative treatment was performed in 9 feet of 8 patients and 2 conservatively. Seven OSSNs were fixed with 1 or 2 screw(s) according to their size, using an autologous bone graft. The accompanying NSF was also treated surgically in 4 feet. Foot condition was evaluated using the Japanese Society for Surgery of the Foot (JSSF) midfoot rating scale and sports activity score of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q).
UNASSIGNED: The median OSSN was 12.7 mm in width, 5.6 mm in length, and 6.6 mm in height. The dorsal surface of the OSSN required at least 70 mm2 to be fixed using 2 screws. Seven OSSNs of 6 patients treated surgically successfully fused with the navicular. Two small OSSNs that were not stabilized with screws also fused after surgical treatment for NSF. However, one of the 2 OSSNs with NSF treated nonoperatively did not achieve fusion. The patients were followed up for 24-161 months. The median JSSF score improved from 87 to 97.7 postoperatively (P = .00312). The median postoperative SAFE-Q sports score was 84.8. All patients returned to their original activities.
UNASSIGNED: Our results suggest that osteosynthesis with autologous bone graft was effective for symptomatic OSSNs. Even when the OSSN was small and not suitable for internal fixation, treatment of NSF was effective for union of OSSNs. The OSSN possibly belongs to a part or subtype of NSF.

The conservative treatment for Kohler\'s disease will take several months, but some patients still have flatfoot and persistent pain. From October 2013 to July 2015, 3 children with Kohler\'s disease underwent navicular decompression and micro-circulation reconstruction surgery in our hospital. All the patients have received conservative treatment for more than 3 months and the effect was poor. X-ray showed the bone density of navicular increased significantly. All patients were followed up over 1 year. The 3 patients recovered well. VAS score decreased from 7.0 to 2.6 at 1 month after the operation. The pain symptom disappeared completely on 3 months after surgery. The density of navicular bone recovered to normal. Navicular decompression and micro-circulation reconstruction surgery may quickly improve the ischemic status of navicular bone, alleviate pain symptom and enable patients to resume normal activity as soon as possible.