1/12. Intercuneiform instability and the "gap" sign.We describe three cases of low-energy injuries to the midfoot resulting in rupture of Lisfranc's ligament without tarsometatarsal injury. Examination of the feet revealed an obvious physical sign only on weightbearing, and all three patients were noted at surgery to have intercuneiform instability in association with a rupture of Lisfranc's ligament.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/12. Traumatic hallux valgus following rupture of the medial collateral ligament of the first metatarsophalangeal joint: a case report.Metatarsophalangealjoint injuries of the great toe are receiving increasing attention in athletes. Significant disability and long-term morbidity can result from these focal injuries. The entity known as turf-toe is widely recognized. rupture of the medial collateral ligament of the first metatarsophalangeal joint is less common. A case of traumatic rupture of the medial collateral ligament in the great toe of a soccer player, which progressed to hallux valgus deformity, is presented.- - - - - - - - - - ranking = 3keywords = ligament (Clic here for more details about this article) |
3/12. Calcaneocuboid joint instability: a novel operative technique for anatomic reconstruction.A case history of a 13-year-old female national top-level gymnast, suffering from calcaneocuboid joint instability, is presented. The procedure was done as an anatomic repair by capsular reefing, which was augmented using a local periosteal flap. Initially, the athlete twisted her ankle. Clinical investigation revealed no sign of a lateral ankle ligament injury, but following this initial examination, recurrent giving-way of the foot occurred. She additionally felt significant but diffuse pain on the lateral side of the foot during loading in training and competition. For 2 months she was unable to run and conservative treatment failed. diagnosis of a calcaneocuboid instability was established 4 months after the initial lesion by clinical and x-ray stress examination of the calcaneocuboid joint. Open surgery was successfully performed. Early functional posttreatment was done and the patient returned to full high-level gymnastics ability 16 weeks after surgery. Two years later, a similar injury occurred to the opposite calcaneocuboid joint and the same operative procedure again led to full sports ability.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
4/12. Turf toe: ligamentous injury of the first metatarsophalangeal joint.Injuries to the metatarsophalangeal (MTP) joint of the great toe have increased in incidence over the past thirty years following the introduction of artificial playing surfaces and the accompanying use of lighter footwear. Although most common in American football players, similar injuries can also occur in other sporting activities including soccer and dance, or following trauma to the great toe. The mechanism of injury is typically hyperextension of the MTP joint, but injuries have also been reported secondary to valgus or varus stress, or rarely as a result of hyperflexion injury. The abnormal forces applied to the first MTP joint at the time of injury, result in varying degrees of sprain or disruption of the supporting soft tissue structures, leading to the injury commonly referred to as turf toe. The extent of soft tissue disruption is influential in treatment planning and can be used to determine the prognosis for recovery. This report will review the anatomy of the first MTP join, followed by a discussion of the mechanism of injury and the typical clinical presentation of an individual with turf toe. Finally, the role of imaging including radiography and magnetic resonance imaging, and standard treatment options for turf toe will be discussed.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
5/12. Your diagnosis? Midfoot sprain: Lisfranc ligament disruption.Suspected midfoot sprains can be a challenge to evaluate when the initial weight-bearing views are normal. In this case, MRI allowed prompt confirmation of the suspected unstable Lisfranc ligament injury and contributed to prompt management with rigid fixation.- - - - - - - - - - ranking = 2.5keywords = ligament (Clic here for more details about this article) |
6/12. Conservative management of subtle Lisfranc joint injury: a case report.STUDY DESIGN: Case report. BACKGROUND: Athletic Lisfranc injuries are characterized by disruption of the soft tissues about the tarsometatarsal joint complex. They are frequently missed on initial consultation due to a paucity of demonstrable physical signs, yet often result in significant disability. This case illustrates the 2 great challenges in managing these injuries: firstly, arriving at an accurate diagnosis and, secondly determining whether the injury is stable and, therefore, appropriate for conservative management CASE DESCRIPTION: The athlete was a 21-year-old professional basketball player with a recurrent ligamentous injury of the Lisfranc joint. A global approach to evaluation and treatment of the entire lower extremity and pelvis in managing this injury is emphasized. OUTCOMES: The athlete in this case report made a successful return to his previous level of competition 12 weeks postinjury. At 2-year follow-up he continues to play professionally without any symptoms. DISCUSSION: In selected cases for which patients have no osseous displacement and the ability to run on the toes soon after injury, conservative management of Lisfranc injury may be appropriate Key features of a conservative approach include recognition of a prolonged recovery time adequate rest for soft tissue healing, restoration of a normal gait pattern to prevent chronic overstress of injured tissues, appropriate orthotic prescription, and proprioceptive retraining.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
7/12. Rapidly progressive Charcot arthropathy following minor joint trauma in patients with diabetic neuropathy.Neuropathic (Charcot) arthropathy is a slowly progressive, chronic, destructive form of joint degeneration seen in patients with a neurosensory deficit. Attempts to produce neuropathic joint disease experimentally with a variety of deafferentation procedures have generally been unsuccessful. However, if the knee is rendered unstable by anterior cruciate ligament transection (ACLT), breakdown of the joint occurs rapidly in dogs that have previously undergone dorsal root ganglionectomy (DRG) for deafferentation of the ipsilateral limb. In contrast, ACLT in neurologically intact dogs produces not only nonprogressive changes that are characteristic of mild osteoarthritis. This report describes 3 patients with longstanding insulin-dependent diabetes mellitus in whom neuropathic arthropathy developed within weeks after minor trauma to the foot or ankle. In these patients, diabetic neuropathy served as the functional equivalent of dorsal root ganglionectomy, and the minor trauma served as the functional equivalent of ACLT. Together, they illustrate the phenomenon of neurogenic acceleration of joint degeneration in humans.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
8/12. Irreducible dislocation of the metatarsophalangeal joints of the foot.An unusual dislocation of the metatarsophalangeal joints of the third, fourth, and fifth toes with fractures of the neck of the second metatarsal bone occurred in a 23-year-old man. Hyperextension of the metatarsophalangeal joints is the mechanism of injury and is substantiated by the anatomic investigation. The metatarsal head is trapped between the fibrocartilaginous plate on the plantar surface of the foot, the dorsal capsule and deep transverse metatarsal ligament on the dorsal surface, the flexor tendons on the lateral aspect and the lumbrical tendons on the medial aspect. Division of the fibrocartilaginous plate, the deep transverse ligament and the dorsal capsule facilitates reduction of dislocation.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
9/12. Plantar ecchymosis sign: a clinical aid to diagnosis of occult Lisfranc tarsometatarsal injuries.diagnosis of subtle Lisfranc injuries can be difficult for the examining clinician. Radiographs do not always reveal the full extent of tarsometatarsal injuries. We describe a clinical sign found in significant Lisfranc injuries that consists of a mid-foot ecchymotic area on the plantar aspect. This implies the potential for significant injury to the plantar tarsometatarsal ligaments. We call this the plantar ecchymosis sign. patients with this injury and sign should be aggressively evaluated, with early consideration for stress radiographs and ORIF if indicated, as the prognosis of the undertreated Lisfranc injury is poor.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
10/12. MR diagnosis of traumatic tear of the spring ligament in a pole vaulter.The spring ligament is a significant contributor to the stability of the talar head and longitudinal arch of the foot, lending importance to accurate radiologic diagnosis of injury. Using MR, we diagnosed a spring ligament tear with associated navicular dorsal subluxation, confirmed intraoperatively. To our knowledge, there are no previous reports of MR diagnosis of tear of the spring ligament.- - - - - - - - - - ranking = 3.5keywords = ligament (Clic here for more details about this article) |
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