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Orthopaedic Surgery Foot
Degenerative Pathology of the Coxa Pedis – A New Pathological Entity
a report by
Giacomo Pisani,
1
Pier Carlo Pisani
2
and Enrico Parino
3
1. Founder and First President, European Society of Foot and Ankle Surgery (ESFAS); 2. Specialist, Orthopaedics and Traumatology, Professor G Pisani
Foot Surgery Centre; 3. Specialist in Orthopaedics and Traumatology, Foot Surgery Centre, Fornaca di Sessant Clinic
When a patient – most often a post-menopausal woman – complains of presence of the glenoid ligamentous component; this allows talar head axis
worsening medial tarsalgia with progressive evolution to pes planus, the variations while opening and closing the foot’s kinetic chain.
15,17,18
instant diagnosis is of so-called posterior tibial tendon dysfunction.
1
Generally defined as posterior tibial tendon dysfunction syndrome in the The role played by the sole glenoid component in maintaining the plantar
framework of degenerative pes planus in the adult, the literature has arch is hard to establish due to the significant interaction between muscular
reported extensively on this disease by focusing on clinical symptoms and function, especially of the posterior tibial muscle, the congruence of skeletal
proposing aetiopathogenetic theories and various therapeutic options since parts and capsuloligamentous constraint.
19–21
In experimental conditions,
22
the late 1980s.
2–5
The clinical pictures described progressively evolve the sole section of the posterior tibial muscle does not modify the plantar
towards the collapse of the plantar arch, deformity with eversion of the arch of a foot that bears an axial load, hence the need to perform large
foot and the onset of degenerative arthropathy of the subtalar and sections of the medial capsuloligamentous structures of the talonavicular
talonavicular joints. Surgical investigations for suspected posterior tibial joint to generate deformities that are comparable to the everted pes planus.
7
muscle tendinopathy intra-operatively found that the anatomical continuity Other experimental studies
20,21
have shown that the major mechanical
of the tendon was preserved, and documented the presence of regressive contribution to the stability of the longitudinal plantar arch is provided by
aspects in the fibrocartilaginous component of the acetabulum pedis the plantar fascia, followed by the short and long plantar ligaments and by
(spring ligament), with anatomical and pathological pictures ranging from the spring ligament. While the ligamentous structures guarantee plantar
malacia to tearing along the entire thickness. The literature has reported arch stability with a silent electromiograph during double limb support, the
similar lesions in the same ligament in cases of pathological tearing of the muscular structures act when the foot is loaded.
18
Posterior tibial tendon
posterior tibial tendon.
6–8
They have also been found experimentally
9
in tearing or dysfunction causes a loss of active stabilisation during inversion of
acquired pes planus in the adult with a deformed talonavicular joint. Balen the mid-foot joint with subsequent inability to turn the foot into the rigid
and Elms
10
considered the frequent magnetic resonance imaging (MRI) lever needed for the push-off. The medial tarsal capsuloligamentous
findings (92%) of spring ligament lesions associated with posterior tibial structures (deltoid ligament, superomedial and plantar branches of the
lesions, and also reported
11
finding a possible spring ligament lesion in spring ligament) carry a greater load induced by destabilisation caused by
patients with a normal posterior tibial tendon. calcaneal valgism and increased talar pronation. During the push-off phase,
Our previous paper (2003)
12
reported 13 cases of patients who,
Giacomo Pisani is Past President of the Italian Foot and Ankle
appearing for surgery with a clinical diagnosis of degenerative posterior
Society, Founder of the Professor G Pisani Foot Surgery Centre
tibial tendonopathy, were surgically found to have either minor or major in Turin and Founder and First President of the European
structural degenerative involvement of the spring ligament with
Society of Foot and Ankle Surgery (ESFAS). He was Head of
the Department of Orthopaedic Surgery at the San Lazzaro
macroscopic evidence of tendon integrity, besides moderate and most
Hospital for 20 years, and has instructed 57 orthopaedic
likely secondary tenosynovitis. A case record study revealed a frequent
training courses in Italy. Professor Pisani graduated from Turin
University in 1953.
and interesting association between the accessory navicular bone and
glenoid structure lesions, thus theorising a direct microtraumatic process.
E: info@chirurgiapiede-pisani.it
Pier Carlo Pisani is a Specialist in Orthopaedics and
Anatomical References
Traumatology at the Professor G Pisani Foot Surgery Centre.
The acetabulum pedis
13
is the acetabulum component of the coxa pedis.
14
It He was previously Tenured Chief Physician of the Foot Surgery
presents a mosaic-like structure
15,16
with a panniculus adiposus in the centre
Operating Unit at Giovanni Bosco Hospital in Turin. Dr Pisani
has authored or co-authored 60 scientific publications and
and a skeletal component (navicular, anterior subtalar joint) with interposed
two monographs and is an Honorary Member of the French
glenoid fibrocartilage (see Figure 1) on which the superomedial and plantar
Society of Medicine and Foot Surgery (SFMPC).
branches of the spring ligament converge (spring ligament). The
superomedial calcaneonavicular ligament has a triangular cartilaginous
articular facet that is articulated with the corresponding medial articular
Enrico Parino is a Specialist in Orthopaedics and Traumatology
at the Foot Surgery Centre of the Fornaca di Sessant Clinic in
surface of the talar head. Elastin fibres can be found in the spring ligament.
14
Turin. He is Editor of Chirurgia del Piede and the author of 40
The glenoid’s strengthening elements are the superficial deltoid ligament
scientific publications and numerous reports for national and
international congresses. Professor Parino is a Council
fibres that are attached to the sustentaculum and the recurrent tract of the
Member of the Italian Foot and Ankle Society and a member
posterior tibial tendon.
12
The glenoid is laterally completed by the of the Editorial Board of Clinics in Pediatric Medicine and
calcaneonavicular branch of the bifurcate ligament (or Chopart’s ligament).
Surgery. He graduated from Turin University in 1985.
The acetabulum of the coxa pedis is functionally modular owing to the
© TOUCH BRIEFINGS 2008 71
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