Bone and Joint Disorders of the Foot and Ankle A Rheumatological Approach

Springer-Verlag Berlin Heidelberg GmbH

Bone and Joint Disorders of the Foot and Ankle A Rheumatological Approach

Editor Maurice Bouysset

Preface by Jean-Charles Gerster

Foreword by Karl Tillmann

Springer

Dr Maurice Bouysset Rhumatologist Attache des H6pitaux de Lyon 138, rue Philippe Heron 69400 Villefranche-sur-Sa6ne France

Original French edition Le pied en rhumatologie © Springer-Verlag France, Paris, 1998

Coordinators of «Le pied en rhumatologie»: Andre Bardot, Michel Bonnin, Maurice Bouvier, Bernard Daum, Francois Eulry, Christophe Piat

Library of Congress Cataloging-in-Publication Data Pied en rhumatologie. English.

Bone and joint disorders of the foot and ankle I editor, Maurice Bouysset ; with the collaboration of Andre Bardot ... [et al.l·

p. cm. ISBN 978-3-662-06134-3 ISBN 978-3-662-06132-9 (eBook) DOI 10.1007/978-3-662-06132-9

1. Podiatry. I. Bouysset, Maurice, 1946- . II. Bardot, Andre. III. Title. [DNLM: 1. Foot--pathology. 2. Ankle--pathology. 3. Bone Diseases. 4. Joint Diseases. RDS63.PS313 1997 617.S'8S--dc21 DNLM/DLC for Library of Congress

WE 880 P613b 1997al

97-427So CIP

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© Springer-Verlag Berlin Heidelberg 1998 Originally published by Springer-Verlag Berlin Heidelberg New York in 1998 Softcover reprint of the hardcover 1St edition 1998

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The authors

Dr Didier Acker, Certifie de Podologie de l'Universite Rene Descartes, Attache a l'H6pital Lariboisiere (Chirurgie ortho­pedique), a l'H6pital Saint-Louis (Diabetologie), ala poly­clinique de l'H6pital Corentin Celton, 15-17 avenue Simon Bolivar, 75019 Paris

Pr Andre Bardot, Professeur h.onoraire des Universites, Chirurgien orthopediste, 17 A boulevard de l' Avenir, 13012 Marseille

Dr Abdelssamad Belmouhoub, Centre Hospitalier d'Aubenas, Service de Mefdecine interne, 07205 Aubenas

Dr Jacques Bernard, Medecin en Chef, Medecin des H6pitaux, Chef de Service, Service de Medecine Interne, CHA H. Larrey, 24 Chemin de Pouvourville, 31998 Toulouse Armees

Dr Monique Bonjean, Centre des Massues, 92 rue E. Locard, 69322 Lyon Cedex 05

Pr Fran~ois Bonnel, Professeur a la faculte, Chirurgien des H6pitaux, Service d'Orthopedie, H6pital Lapeyronie, Avenue Gaston Giraud, 34000 Montpellier

Dr Michel Bonnin, Chirurgien Orthopediste, Clinique Charcot, 51-53 rue du Commandant Charcot, 69110 Sainte­Foy-Les-Lyon

Pr Maurice Bouvier, Professeur a la Faculte Lyon-Sud, 165 chemin du Grand Revoyet, 69310 Pierre Benite

Dr Maurice Bouysset, Rhumatologue, 138 rue Philippe Heron, 69400 Villefranche-sur-Sa6ne. Attache des H6pitaux de Lyon, H6pital Edouard Herriot, Service du Pr Meunier, 69003 Lyon

Dr Eric Butin, Praticien Hospitalier, Service de Chirurgie A, Centre Hospitalier, Avenue Winston Churchill, 62000 Arras

Dr Fran~ois Canovas, Praticien Hospitalier, Laboratoire d'Anatomie, Faculte de Medecine, H6pital Lapeyronie, Avenue Gaston Giroud, 34000 Montpellier

Dr Moussa Chamoun, Chirurgie Orthopedique et Traumatologique, CHU Lapeyronie, 34059 Montpellier

Dr Paul Chauvot, Chef de Service, Centre Regional Leon Berard, Departement de Medecine Nucleaire, 28 rue Laennec, 69373 Lyon Cedex 08

Dr Thierry Conrozier, Praticien hospitalier, Rhuma­tologue,8 place Bellecour, 69002 Lyon

Dr Arnaud Constantin, Medecin Aspirant, Interne des H6pitaux, Service de Medecine Interne, CHA H. Larrey, 24 Chemin de Pouvourville, 31998 Toulouse Armees

Pr Georges Curvale, Professeur des Universites, Chirurgien orthopediste des H6pitaux, Service de Chirurgie orthope-

dique et Traumatologique, H6pital de la conception, 130005 Marseille

Pr Dr Jean Dequeker, Rhumatologue, Chef de Service, Rhumatologie Universitaire Ziekenhuizen, Katholieke Universiteit Leuven, Weligerveld 1, 3212 Pellenberg, Belgium

Dr Patrice Fran~ois Diebold, Chirurgie Orthopedique, 34 rue Gambetta, 54000 Nancy

Dr Isabelle Durieu, Chef de Clinique, Service de Neurologie C, CHRU, H6pital Roger Salengro, Boulevard du Pr Leclercq, 59037 Lille Cedex

Pr Fran~ois Eulry, Professeur au Val de Grace, Medecin des H6pitaux des Armees, Chef du Service de Rhumatologie, H6pital d'instruction des Armees Begin, 69 avenue de Paris, 94163 Saint-Mande Cedex

Carol Frey, MD, Orthopaedic Foot and Ankle Center, 1200 Rosecrans, Suite 208, Manhattan Beach, CA 90266, USA

Dr Fran~ois Gaillard, Ancien Chef de Clinique Assistant, Rhumatologue, 22 rue Simon, 51100 Reims

Dr Francisco Giammarile, Centre Leon Berard, 28 rue Laennec, Service de medecine nucleaire, 69373 Lyon cedex 08

Pr Daniel Goutallier, Professeur des Universites, Chirurgien des H6pitaux, H6pital Henri Mondor, 94000 Creteil

Pr Pierre Groulier, Professeur des Universites, Chirurgien des H6pitaux, Service de Chirurgie Orthopedique et Traumatologie, H6pital de la Conception, 147 boulevard Baille, 13385 Marseille Cedex 5

Dr Genevieve Guaydier-Souquieres, Rhumatologue, Praticien Hospitalier, Service de Rhumatologie, CHU, ave­nue de la C6te de Nacre, 14033 Caen Cedex

Pr William G. Hamilton, 345 West 58th street, New-York, NY 10019, USA

Dr Claudine Huber-Levernieux, Rhumatologue, 31 ave­nue des Etats-Unis, 78000 Versailles. H6pital Lariboisiere, Paris. H6pital Henri Mondor, Creteil

Dr Fran~oise Lapeyre-Gros, Specialiste en Reeducation Fonctionnelle, Centre d' Appareillage de Lyon, 53 rue de Crequi, 69412 Lyon Cedex 06

Dr Carlos Maynou, Praticien Hospitalier, Service d'Orthopedie Traumatologique, CHRU, 59037 Lille Cedex

Pr Henri Mestdagh, Professeur a la Faculte de Medecine de Lille, Chef du Service d'Orthopedie Traumatologie D, CHRU, 59037 Lille Cedex

VI THE AUTHORS

Dr Raoul Meyer, Rhumatologue, 22 avenue de la Paix, 67000 Strasbourg

Dr Eric Noel, Praticien Hospitalier, Service de Rhumatologie, H6pital Edouard Herriot, place d'Arsonval, 69003 Lyon

Dr Christophe Piat, Ancien Chirurgien des H6pitaux. H6pital Henri Mondor, 51 avenue De Lattre de Tassigny, 94000 Creteil

Dr Frederic Picard, Chirurgien Orthopediste, Chirurgien des H6pitaux, CHU de Grenoble, H6pital Sud, 38042 Grenoble Cedex 09

Pr Gerard Remy, Professeur de Maladies Infectieuses, H6pital Robert Debre, CHU Reims, rue Alexis Carrel, 51100 Reims

Dr Alexandre Rochwerger, Chirurgien orthopediste, Service de Chirurgie Orthopedique et Traumatologie, H6pital de la Conception, 147 bd Baille, 13385 Marseille Cedex 5

Pr Jacques Rodineau, H6pital National de Saint-Maurice, Service de Reeducation et Traumatologique du Sport, 14 rue du Val d'Osne, 94410 Saint-Maurice

Pr Dominique Saragaglia, Professeur des Universites, Service de Chirurgie Orthopedique et de Traumatologie du Sport, CHU de Grenoble, H6pital Sud, 38042 Grenoble Cedex09

Thierry Serpollet, Technicien au Centre de grand appa­reillage, Ministere des anciens combattants, 53 rue de Crequi, 69412 Lyon Cedex 06

Dr Thierry Tavernier, Radiologue, Clinique de la Sauvegarde, Avenue Ben Gourion 69261 Lyon Cedex 09

Dr Alain Thomas, Medecin Aspirant, Service de Medecine Interne, CHA H. Larrey, 24 Chemin de Pouvourville, 31998 Toulouse Armees

Dr Patricia Thoreux, Chirurgien orthopediste, H6pital Avicenne, 125 rue de Stalingrad, 93000 Bobigny

Prof. Dr Karl Tillmann, Facharzt fUr Orthopiidie, Rheumaklinik Bad Bramstedt, Postfach 1448, 24572 Bad Bramstedt, Germany

Dr Yves Tourne, Chirurgien Orthopediste, Chirurgien des H6pitaux, CHU de Grenoble, H6pital Sud, 38042 Grenoble Cedex09

Pr Patrick Vexiau, Service de Diabetologie, Endocrinologie, Nutrition, H6pital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10

Dr Denis Vial, Centre de Reeducation et Readaptation Fonctionnelles, Villa Richelieu, rue Philippe Vincent, 17028 La Rochelle Cedex

Anthony B. Ward, BSc, MD, FRCP (Ed), FRCP (Lond), North Stafforrdshire Rehabilitation Centre, The Haywood, High Lane, Burslem, Stoke-on-Trent, Staffordshire, ST6 7AG

Dr Rene Westhovens, Rhumatologue, Chef de Service, Rhumatologie Universitaire Ziekenhuizen, Katholieke Universiteit Leuven, Weligerveld I, 3212 Pellenberg, Belgique

Dr Laurent Zabraniecki, Medecin Aspirant, Interne des H6pitaux, Service de Medecine Interne, CHA H. Larrey, 24 Chemin de Pouvourville, 31998 Toulouse Armees

Preface

This encyclopedia on the pathology of the foot is to some extent a response to the wishes expressed in 1978 by the organizers of the "Premieres Journees Europeennes de Podologie" in Paris; in effect, they advocated a close collaboration between the diverse specialities of medicine and orthopedics in the field of the study and treatment of affections of the foot with a view to an ever closer collaboration for the well-being of the patients. An increasing number of patients seek the help of the rheumatologist or orthopedist for disorders of the feet, the clinician is then confronted either with a diagnostic problem when the foot is the organ primarily affected, or a therapeutic problem when a sufferer from a well­defined rheumatic disease is led to consult him for persistent pain.

Even if the pathology of the feet has often been neglected by the medical profession, whereas the hands have received every attention, many European rheumatologists and orthopedic surgeons have for long addressed this problem. The names of some of the pioneers in this subject during the 1950S and 60S will be familiar: EGL Bywaters and A St Dixon in Great Britain, WS Vainio in Finland, K Tillmann in Germany, AS Denis and S Braun in France. Further, one should not ignore the considerable contribution to our knowledge of podology provided by the Monographies de podologie published by Masson under the supervision of Lucien Simon and his team at Montpellier: some ten volumes in all.·

Medicine advances rapidly and its practitioners are increasingly urged to act not only effectively but also economically, The concept of "evidence-based medicine" has a particular application to the locomotor system. Can there be any better method of succeeding than to provide a manual that is encyclopedic to the point of being up-to-date while discussing the diverse disorders of the foot in detail? Is not this organ the meeting-place of various clinicians: rheumatologists, neurologists, angiolo­gists and their orthopedic surgical colleagues? Before planning treatment to relieve a fore- or hind-foot condition, the diagnosis must be based primarily on the clinical experience that the practitioner can refresh as required by an attentive reading of the various chapters of this book. The methods of auxi­liary investigation, especially imaging, which are many, should, as pointed out by M Bouysset and M Bonnin in Chapter 6, be judiciously and economically selected with the aim of resolving the relevant problem.

It is clear that this work covers the field of the pathology of the adult foot, and that it studiously avoids the pediatric field; similarly, it does not deal with traumatic fractures, a subject that is the province of a very distinct speciality.

The clarity of the subjects discussed in each of the 34 sections and the quality of the illustrations contained in this book lead me quite naturally to congratulate Maurice Bouysset and his collaborators; they have understood that "obscurity is the kingdom of error" as Vauvenargues, a moralist of the 18th century wrote; they cast a new and original light on a large chapter in the pathology of the locomotor system.

This volume, written mostly by European authors, and published in the English language, will become without any doubt a reference work for many doctors, physiotherapists, occupational thera­pists and podologists at the dawn of the year 2000 and for many years to come

Professor Jean-Charles Gerster Professor of Rhumatology,

Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

Foreword

At the moment, there is growing, worldwide, medical interest in the subject of the foot and its disor­ders. This is reflected in the increasing number of scientific magazines and specialized scientific socie­ties. Since the specialized literature concerning the medical aspects of the foot is growing, one has to have very good reasons to add a new publication to the list of the good and up-to-date books which are already available.

This book is indeed special and unique. It reflects the most recent knowledge of foot pathology, clinical and imaging diagnosis, present possibilities of conservative as well as surgical therapy, and it includes the rheumatological view. This is what gives it practical significance and special character.

Maurice Bouysset is the most competent person I know to succeed in this demanding mission, because of his outstanding knowledge and experience and his special gift to co-operate and stimulate co-operation from others. His clear organization of the book and his selection of authors are the best preconditions for the success of this work.

This book is written to inform those rheumatologists who are more interested in patients than in theory or laboratory investigations. But, because of its balance of authors: rheumatologists, surgeons and co-disciplinary members, it is also relevant to a wide orthopaedic audience, not only to arthritic surgeons.

When I read the proofs, the approach from the standpoint of rheumatologists, unusual as it was for me, was fascinating. The more detailed information of basic research in conservative treatment (inclu­ding ortheses and shoes) was most enjoyable. There was also sufficient additional surgical information. I believe this new experience will be extremely useful for any orthopaedic surgeon engaged in foot problems, at least it was for me.

The more marginal subject matters such as neuropathies, septic arthritis, diabetes, metabolic diseases and traumatological disorders and their sequelae are essential with respect to differential diagnosis and furthermore these "excursions" make the book attractive for anyone who has to manage foot problems at all.

Last but not least, one can recognize the French origin of this book in spite of its respect for the international "state of the art". France has indeed a great tradition in foot medicine that shines through this substantial work.

Thanks and congratulations to the editor. Best wishes for the book!

Prof. Dr. Karl Tillmann

Acknowledgements

To Claudine, Cecile, Raphael and Claire.

With specific aknowledgements to Professor M Bouvier, Professor PJ Meunier and Doctor E Noel; without their help this book would not have been possible.

And for their help, a special gratitude to . Corinne Gauthier, secretary . Professor Jacques Tebib, Professor PD Delmas, Professor P. Miossec

David LeVay, Mark Gelpke, Michel Bonnin, Nina Crowte, Rachid Belmouhoub and Heidi Schell gave extra help with the translation in English.

Editors of the book "Le pied en rhumatologie" : Andre Bardot, Michel Bonnin, Maurice Bouvier, Bernard Daum, Francois Eulry, Christophe Piat.

The following people are also thanked for their direct or indirect participation in the making of this book:

Didier Acker, Cecile Aloin, Nadine Biffy, Paule Bonnevie, Richard Bonnevie, Helene Bonnin, Michel Bochu, Alain Bouysset, Celine Bouysset, Yves Bouysset, Roland Chapard, Jean-Pierre Duivon, Alain Fraisier, Kitty Guglielmi, Jocelyne Jalby, Fred Jouhaud, Fran<;:oise Jouhaud, Andre-Louis Lanier, Bernard Lanier, Gabrielle Lanier, Fran<;:oise Lapeyre, Linda Lee, Guy Lorca, Philippe Magnin, Alain Marcot, Marcel Pacaud, Raymond Paulat, Solange Perret, Michelle Pradel, Patricia Sibaud, Catherine Tavernier, Karl Tillmann, Jeanne Tovar, Claire Vasseur, Elisabeth Vianey, Jean-Claude Vianey, Eric Vignon, Nicole Walch.

Contents

1 Anatomy of the foot and ankle ............... 1

F. Bonnel, F. Canovas, M. Bonnin, M. Chamoun and M. Bouysset Bones, ligaments, joints ...................... 1

Talocrural joint ......................... 2

Subtalar joint (talocalcaneal joint) .......... 5 Talonavicular joint ....................... 5 Calcaneocuboid joint ..................... 5 Tarsometatarsal joint .................... 6

Metatarsophalangeal joints ................ 6 Interphalangeal joints .................... 6 Metatarsosesamoid joint .................. 6 Accessory bones ........................ 6

Muscles .................................. 7 Extrinsic muscles ........................ 7

Muscles of the anterior compartment ..... 7 Tibialis anterior muscle ............. 7 Fibularis tertius muscle ............. 7 Extensor hallucis longus muscle ...... 7 Extensor digitorum longus muscle .... 8

Lateral compartment muscles ........... 8 Fibularis brevis muscle ............. 8 Fibularis longus muscle ............. 8

Muscles of the posterior compartment .... 8 Tibialis posterior muscle ............ 8

Flexor digitorum longus muscle ...... 8 Flexor hallucis longus muscle ........ 9 Triceps surae muscle ............... 9

Intrinsic muscles ........................ 9 Extensor digitorum brevis muscle ........ 9 Flexor digitorum brevis muscle ......... 9 Flexor hallucis brevis muscle ............ 9 Quadratus plantae muscle .............. 9 Abductor hallucis muscle .............. 9 Abductor digiti minimi muscle ......... 10

Adductor hallucis muscle .............. 10

Dorsal interosseous muscles ........... 10

Plantar interosseous muscles ........... 10

Plantar aponeurosis ........................ 10

Innervation .............................. 11

Vascularization ............................ 11

Bursae and synovial tendon sheaths ........... 12

Calcaneal area .......................... 12

Retromalleolar area ..................... 12

The instep ............................. 12

Intercapito-metatarsal spaces ............. 12

Adhesion function to the ground .......... 12

Topographic areas ......................... 13 Medial part: tibio-talo-calcaneal

or tarsal tunnel ................. 13 Lateral part: fibular tunnel ................ 13 Intercapito-metatarsal space .............. 14

2 Clinical examination ofthe foot and ankle ... 15

C. Frey

3 Radiography of the foot ................... 21

M. Bouysset and T. Tavernier Radiographic views of the foot ............... 21

Angular and axial relationships of the foot ...... 21

Dorsoplantar view in weight-bearing ....... 22

Lateral view in weight-bearing ............ 22

Frontal view of the ankle, calcaneal deviation in the frontal plane: measurement ................... 24

Load-bearing bifocal radiography of the entire foot ................ 24

4 Sectional imaging of the foot and ankle: CT and MRI ............................. 27

T. Tavernier Techniques and processing ................. 27

CT ................................... 27

MRI ................................. 30 Normal CT and MR images of the foot and ankle 32

Advantages and disadvantages of both techniques ................ 46

CT and MRI performances related to the pathology ................ 46

Bone pathology ........................ 46 Fractures ........................... 46 Occult fractures, micro fractures,

stress fractures ................. 47 Osteochondral injuries of the talar dome . 49 Osteonecrosis ....................... 50 Algodystrophy ...................... 50 Loose bodies ........................ 50 Synostosis and synchondrosis .......... 50

Osteitis, osteomyelitis, arthritis ......... 50

Bone tumors ........................ 51

Soft tissue pathology .................... 51

Calcaneal tendon (Achilles tendon) ...... 51

XII CONTENTS

Other tendons ....................... 51 Muscle imbalance in Tenosynovitis .................... 51 the frontal plane ................ 69 Tendinopathies .................. 52 Muscle imbalance in Ruptures ........................ 52 the horizontal plane ............. 69 Longitudinal fissures .............. 52 Deformities of the neuropathic foot ..... 69 Subluxation and dislocation ......... 52 Hindfoot deformities .............. 69

Ligamentous lesions .................. 52 Midfoot deformities ............... 69 Plantar aponeurosis .................. 54 Forefoot deformities .............. 69 Morton's neuroma ................... 54 Equinus and calcaneocavus foot ..... 70

Accessory muscles ................... 54 Clawed toes ...................... 70

Soft tissue tumors .................... 54 A general guide to the examination ............ 70 Past history and etiologic enquiry

5 Nuclear medicine in foot pathology ......... 57 at the first consultation .......... 70

P. Chauvot and F. Giammarile General assessment ..................... 71

Tracers .................................. 57 Neurologic examination .................. 71

Techniques ............................... 57 Peripheral nerve pathology ............ 71

"Normal scintigraphy" ...................... 57 CNS pathology ...................... 71

Indications ............................... 58 Orthopedic examination ................. 71

Infectious ............................. 58 Trophic and vascular assessment .......... 71

Injuries and stress fractures .............. 58 Functional assessment ................... 71

Vascular disorders, necrosis Therapeutic measures ...................... 72

and osteochondritis .............. 58 Medication ............................ 72

Neoplastic or degenerative diseases, Physical medicine ...................... 72

dysplasia ...................... 59 Neuroablative procedures ................ 74 Particular orthopedic problems ........... 59 Chemical neurolysis or blockade ........ 74

Neuroablative surgical procedures ...... 74 6 Correct use of auxiliary investigations in foot Orthopedic surgery ..................... 74

and ankle disorders ....................... 61 Clinical forms and principles of treatment ...... 75 M. Bouysset, M. Bonnin and T. Tavernier The peripheral neuropathic foot ........... 75 In current practice ......................... 61 Clinical pictures ..................... 75

Clinical assessement ..................... 61 Principles of treatment ................ 76 When these first investigational stages Flail foot ........................ 76

are negative .................... 62 Foot drop. Equinus foot ............ 76 Auxiliary investigations ..................... 63 Paralytic valgus foot ............... 77

Bone scintigraphy ...................... 63 Paralytic varus foot ................ 77 Computed tomography .................. 63 Paralytic calcaneocavus foot ........ 77 Arthrography with CT ................... 63 Pes cavus ........................ 78 Tenography with CT .................... 63 The neurodegenerative foot ............... 78 MRI ................................. 63 Clinical features ..................... 78 Ultrasonography ....................... 63 Charcot-Marie-Tooth disease ........ 78 Electromyography ...................... 65 Friedreich's ataxia ................ 79 Other procedures ....................... 65 Principles of treatment ................ 79 Biopsy-arthroscopy of the ankle ........... 65 The central neuropathic foot .............. 79

The procedure varies with every Clinical features and treatment ......... 79 diagnostic possibility ............ 65 The paraplegic foot ............... 79

Cerebral palsy foot ................ 80 7 The neuropathic foot ..................... 67 The foot in adult cerebral lesions ..... 81 A. Bardot, A. B. Ward and G. Curvale The hemiplegic foot ............... 81 Pathophysiology .......................... 67

Neurological ........................... 67 8 Septic arthritis of the foot and ankle ........ 85 Biomechanical ......................... 68 F. Gaillard and G. Rimy

Kinetics ............................ 68 Frequency ............................. 85 Muscle imbalance in the sagittal plane 68 Diagnosis ............................. 85

Bacteriologic diagnosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 85

Several factors explain the particular features of foot lesions 0 0 0 0 0 0 0 0 0 0 0 86

The anatomy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 86

The origin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 86

The history 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 86

The infected joint 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87

Particular diagnostic problems in septic arthritis of the foot 0 0 0 0 0 0 0 87

Treatment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 88

Antibiotics 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 88

Immobilization 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 88

Drainage 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 88

Particular problems 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 88

The criteria for stopping the treatment 0 0 0 0 0 89

Course and prognosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 89

9 The diabetic foot ......................... 91

Po Vexiau, Do Acker and Ao Belmouhoub Epidemiology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91

Generalities 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91

Complications 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 91

Trophic risks in diabetics 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • 0 92

Physiopathology . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 92

Arteriopathy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 92

Neuropathy 000000000000.0000000000000092

Infections 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0 0 0 0 0 0 0 93

Mycoses 00000.00000000000000000000093

Bacterial infections 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 93

Clinical examination 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 93

Clinical examination of the foot 0 0 0 0 0 • 0 0 0 0 0 93

General examination . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 95

Auxiliary examinations 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 95

X-rays without preparation 0 0 0 0 0 0 • 0 0 • 0 0 • 0 0 95

Vascular examination 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0096

Additional examinations searching for infective lesions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 96

Treatment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 97

Preventive treatment 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 97

Treatment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 97

Treatment of lesions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 98

Surgery 0000.00.00.00.0000000000000000098

Plantar orthoses 0 0 0 0 0 0 0 0 • 0 0 • 0 0 0 0 0 • 0 0 • 0 0 0 99

Toe orthoses 00 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 • 0 0 • 0 0 0 0 0 99

Shoes 0.00.00.00.00.000.0000000000000099

The role of rehabilitation. 0 0 • 0 0 0 • 0 0 • 0 0 • 0 0 100

Treatment of mycosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 100

Treatment of diabetes 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100

Antibiotherapy . 0 0 • 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 101

Anticoagulant treatment o. 0 0 0 0 0 0 0 0 0 • 0 •• 0 101

Treatment of neuropathy 0 0 0 • 0 0 0 0 0 • 0 0 0 0 0 0 101

Treatment of arteriopathy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 101

Treatment of other risk factors 0 0 • 0 0 • 0 0 • 0 0 101

CONTENTS XIII

10 Metabolic arthropathies of the foot ........ 105

Ro Westhovens, Tho Conrozier, and Jo Dequeker Gout 00000000000000000000000000000000000105

Hydroxyapatite crystal arthropathy 0 0 0 0 • 0 0 0 0 0 107

Chondrocalcinosis 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 107

Other crystal arthropathies o. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 107

Hyperlipidemia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 108

Hemochromatosis and Wilson's disease 00 0 0 0 0 0 108

Thyroid acropachy 0 0 0 0 0 0 • 0 0 • 0 0 • 0 0 0 0 0 0 0 0 0 • 0 108

Acromegaly 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 108

Hereditary storage disorders . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108

11 The rheumatoid foot ..................... III

Mo Bouysset General remarks 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 111

Pathomechanics 0 0 0 0 0 0 0 • 0 0 0 • 0 0 • 0 0 • 0 0 0 0 0 0 0 0 III

Hindfoot deformities 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 112

Forefoot deformities 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 113

Deformities of the toes 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 113

Clinical features 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 U5

At the onset 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0 0 • 0 0 0 0 U5

The established state 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 116

Radiography 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 u8

Additional imaging techniques 0 0 0 0 0 0 0 • 0 0 • U9

Other rheumatoid features 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • l20

Course 0000000000.000000.00.00000000.0121

Treatment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 121

Nonoperative treatment 00. 0 0 • 0 0 • 0 0 0 0 0 0 0 0 121

Therapeutic indications 0 0 0 • 0 0 • 0 0 • 0 0 0 0 0 0 0 123

General indications . 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 • 0 123

12 Surgery of the rheumatoid foot: indications . 129

Ko Tillmann General considerations 0 0 • 0 0 0 • 0 0 0 0 0 0 0 0 0 0 • 0 0 129

Preventive surgery 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0 • 0 0 0 0 0 0 129

Reconstructive procedures 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 130

Tendon repair 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 130

Osteotomy 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 130

Arthrodesis 0 0 0 0 • 0 0 • 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 131

Arthroplasty 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 131

Endoprosthetic replacement 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 132

13 Foot involvement in spondylarthropathies .. 135 Fo Eulry General pathophysiology . 0 0 • 0 0 • 0 0 • 0 0 • 0 0 •• 0 • 135

Pathology 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 135

Pathogenesis 0 0 0 0 0 • 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 •• 136

Diagnostic criteria of spondylarthropathies 0 0 0 0 136

Involvement of the foot joints in the spondylarthropathies 0 0 0 0 0 0 137

Hindfoot involvement 0 0 • 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 137

Forefoot involvement 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 139

Other joint disorders in the foot 0 0 0 0 0 0 0 0 0 0 140

XIV SoMMAIRE

Skin involvement in spondylarthropathies ..... 140

Keratoderma palmaris and plantaris of Vidal-Jacquet ................ 141

Pustulosis palmaris et plantaris ........... 141

Psoriasis ............................. 141 Diagnostic difficulties ..................... 142

Problems of prognosis and treatment ......... 143

The treatment of local inflammation ....... 143

Prevention of the deformities ............ 144 Obtaining normal walking ............... 144

Treatment of local complications ......... 144

14 Algodystrophies of the foot and ankle .••.•. 149

F. Eulry Physiopathology .......................... 149 Etiology ................................. 150

Clinical study ............................ 150 Articular features ...................... 150 Vasomotor disturbances and

trophic symptoms .............. 150

Clinical syndromes ..... , ... ,', ... , ..... 151

Complementary investigations ............... 151 Radiologic features ... ,., ... ,', ... , ..... 151

99mTc bone scan .. , ... , ..... , ...... , ... 152

Magnetic resonance imaging, ..... , ..... ,152

Diagnostic difficulties ... , .......... , , ... , . , 152

Clinical course ........ , .......... " ... ,., 153

Treatment .......... , ................. , 154

Systemic drugs against vasomotor disturbances, .. , . , , .. , , , ... , , , . 154

General analgesics ...... , ..... , ... " ... 154 Local and loco-regional treatment ......... 154

Management of treatment " ..... , .. ,.". 154 Does a preventive treatment exist? ......... 155

15 Valgus flat foot and tarsal fusions .....••..• 157 Ch. Piat and D. Goutallier Definition ...... , ... ,',.,.,.,',., .. ,', ... 157

Characteristics .............. , ... ,., ... ," 157

Pathomechanics .. , ..... , .... " .... , .... ,' 159

Clinical examination .............. , ..... ,' 160

Radiographic investigation. , , ... , , , ... , .... , 161

Functional signs , , . , , , , . , , , , , , , , , , . , , , .. , , 164

Medial pain syndrome . , , , , . , , , ... , , .... 164

The painful contracted flat foot , , , , .. , .... 165

Pain of the subtalar and midtarsal center of rotation ... , .. 165

Failure of compensatory mechanisms in the forefoot ........ " .... ," 165

Evolution of symptoms with age , , , . , , .... 166

Treatment .............. , .... , , , . , . , , . 166

Conservative treatment , ... ,', ... ,." ... ,., 166

Plantar orthoses , ... ,., ... ,., ..... , .... 166

Functional rehabilitation .... , .... , . , .... 166

Tarsal fusions ........ , .... , ..... , ..... 166

Surgical treatment .. , ..... , ..... , ..... " .. 167

Soft tissue procedures .............. , ... 167 Bone and joint procedures ..... , ..... , , .. 167

Indications " .... , .......... , ...... , .. 168

16 Pes cavus in the adult .................... 173 H. Mestdagh, C. Maynou, E. Butin and 1. Durieu Pathologic anatomy ....................... 173 Pathophysiology, , ... , ..... , , .... , . , . , .. , . 174

Muscle dysfunction ........ , ........... 174

Dysfunction of the long plantar flexor muscles .,', .... ,." .. ,.,174

Loss of balance between the anterior and posterior muscles, .... , ..... 174

Dysfunction of the intrinsic muscles of the foot .. , .... ,., .... " .... 174

Capsular and ligamentous contracture ,.,.,174 Etiology , . , , , . , , , ... , . , .. , , , , .. , . , . , .. , . , 175

Muscular conditions .. , ..... , ...... , .... 175

Peripheral neuron diseases ........... , ... 175 Trunk lesions, ..... , .... , ..... , ..... 175

Polyneuropathies ........ , ..... , ..... 175

Hereditary motor and sensory neuropathy ..... , .... , . , 175

Cauda equina root lesions ., .... , .... , 176 Anterior horn lesions of the

spinal cord .................... 176 Hereditary spinocerebellar

degenerative diseases .. , . , , .. , . , . 176 Acquired non-hereditary pyramidal conditions

of the central nervous system ..... 176 Primary pes cavus ,., .... , ... ,., ... " .. 176

Clinical diagnosis ... , ..................... 176

Reasons for consultation .......... , ..... 176

Clinical examination ",.,., .. ,.,',.,.,' 176

Radiology , ..... , ...................... 177

Treatment ... , ..... , .......... , .... , , ... , 178

Treatment with orthoses (insoles) , .... , ... 178

Surgical treatment " ... " .............. 178

Operations on the soft tissues .,.".,., 178

Lengthening of the achilles-plantar system .,', ... " .............. 178

Tendon transplantation ""',.,'" 179 Bone operations .................... 179

Anterior pes cavus ............... 179

Posterior pes cavus ... , .... , , , .. , . 179 Therapeutic indications , ... , , .. , . , , , ... , 180

17 Pathology of the first ray .••...•..••...••. 183 A. Hallux valgus Y. Tourne, F. Picard and D. Saragaglia Anatomy of the first ray .................... 183

Descriptive anatomy .................... 183 The metatarsophalangeal joint

of the hallux ................... 183 The cuneiform-metatarsal joint ........ 183 Intrinsic muscles of the first ray ........ 183 Extrinsic muscles of the first ray ....... 184

Functional anatomy .................... 184 Morphotypes of the foot ................ 184

Anatomy and pathology of hallux valgus ...... 184 The osteo-articular lesions ............... 184 Muscular dysfunction ................... 185 Associated lesions ...................... 185

Etiology and pathogenesis of hallux valgus .... 186 The role of shoes ...................... 186 Predisposing anatomic factors ............ 186

Clinical considerations ..................... 187 Reasons for consultation ................ 187

Exostosis .......................... 187 Pain .............................. 187 Problems with footwear .............. 187

Anatomic and radiographic studies ........ 187 Osteo-articular axial deviation ......... 188 Morphotypes of the foot .............. 190 Associated lesions ................... 190

Overloading of the middle rays ..... 190 Foot statics ..................... 190

Reducing deformities of the first ray ....... 191 Treatment ............................. 191

Objectives ............................ 191 Conservative treatment ................. 191 Surgical treatment ..................... 192

Bunionectomy ...................... 192 Conservative methods ............... 192

Recentering the sesamoid sling ..... 192 McBride's procedure .............. 192 Shortening the proximal phalanx .... 192 Metatarsal osteotomies ............ 192 Osteotomy of the base of

the metatarsal ................. 193 Distal osteotomies ................ 193 Bipolar osteotomy ................ 193 Diaphysial osteotomies ............ 193 Operations on the

cuneo-metatarsal joint .......... 194 Radical methods .................... 194

Implanted prostheses: the Swanson prosthesis ......... 194

Interposition prostheses ........... 194 Resurfacing prostheses ............ 194

CONTENTS XV

Metatarsophalangeal arthrodesis .... 194 Surgical indications .................. 195

Congenital static hallux valgus ...... 195 Acquired static hallux valgus with

healthy articular cartilage ........ 195 Cartilaginous lesions .............. 195

Treating surgical complications ........ 195 Trophic disturbances ............. 195 Metatarsophalangeal joint stiffness

of the hallux ................... 195 Complications linked to osteotomy .. 195 Relapses ........................ 196 Overcorrection .................. 196 Postoperative metatarsalgia ........ 196

Treatment of associated lesions ........ 196

17 Pathology of the first ray ..••...•..•...... 199 B. Hallux rigidus

D. Saragaglia, Y. Tourne and F. Picard Physiopathology .......................... 199 Pathogenesis ............................. 199 Clinical observations ...................... 200 Treatment .............................. 200

18 Disorders of the sesamoid bones •..••..••. 203 F. Gaillard Anatomy and physiology ................... 203 Clinical features .......................... 203

Static or microtraumatic pathology ....... 203 Necrosis of the sesamoids .............. 204 Reflex sympathic algodystrophy (RSD) .... 204 Fractures of the sesamoids .............. 204 Arthritis ............................. 205 Microcrystalline pathology .............. 205 Septic pathology ....................... 205 Other pathologies ...................... 205

19 Some reflections on the first ray .••..•...• 207 P. Groulier and A. Rochwerger

20 Static pathology of the forefoot .••..•..••. 209

(Morton syndrome excluded) P. Diebold, R. Meyer and M. Bonjean Biomechanical considerations ............... 209 Clinical examination ....................... 211

Etiology ................................. 211

First ray insufficiency ................... 212 Second ray syndrome ................... 212

Course ............................ 213 Treatment ......................... 213

Freiberg's disease ...................... 214 Clinical features .................... 214 Course ............................ 214

XVI SOMMAIRE

Radiographic signs .................. 215 Diagnosis .......................... 215 Treatment ......................... 216

The round forefoot or anterior round foot .. 216 Mechanism ........................ 216 Clinical features .................... 216 Treatment ......................... 217 Surgical Treatment .................. 217

Insufficiency of a middle metatarsal ....... 218 Congenital shortness of the metatarsals .. 218 Iatrogenic metatarsal insufficiency ..... 218 Metatarsal insufficiency of

neurologic origin ............... 219 Treatment of metatarsal insufficiency ... 219

Intractable plantar hyperkeratosis ......... 219 Lateral plantar overloading with

secondary pathology ............ 219 Lateral bursitis of the 5th metatarsal head .. 220

Clinical features .................... 220 Radiographic features ............... 220 Conservative treatment .............. 220 Surgical treatment ................... 221 Metatarsalgia: conclusion ............. 221

Toe disorders (excluding the first ray) ..... 221 Pathogenesis of clawed toes ........... 221 Clinical features .................... 222 General treatment of clawed toes ....... 223 Total clawing ....................... 223 Clinodactyly ....................... 224 Suppradductus of the second toe ....... 224 Quintus varus supradductus .......... 224

21 Morton's metatarsalgia .................. 227 C. Huber-Levernieux Pathologic anatomy ....................... 228 Diagnosis ............................... 228 Treatment ............................... 229

Conservative treatment ................. 229 Surgical treatment ..................... 230

22 Painful heel syndromes of mechanical origin 233 G. Guaydier-Souquieres Anatomic review ......................... 233 Physiologic review ........................ 234 Clinical presentation ...................... 234

Clinical examination ................... 234 Supplementary investigations ............ 235

Clinical forms ............................ 236 Acute form ........................... 236 Forms related to a specific terrain ......... 236

Etiologies ............................... 236

Differential diagnosis ...................... 237 Inflammatory rheumatic diseases ......... 237 Other systemic disorders ................ 237 Bone lesions .......................... 237 Soft tissue lesions ...................... 238 Nerve lesions ......................... 238 Arterial lesions ........................ 238

Treatment ............................... 238 Rest ................................. 238 Heel supports ......................... 238 Advice on footwear .................... 238 Other therapeutic measures .............. 239 Surgery .............................. 239

23 Tendinopathy of the calcaneal tendon ...... 241 M. Bouysset Pathology ............................... 241 Predisposing and precipitating factors ........ 241 Clinical features and supplementary tests ..... 242 Anatomo-clinical types .................... 243

Peritendinitis ......................... 243 Tendinopathy of the tendon itself ......... 243 Tendinopathies secondary to inflammatory,

infectious or metabolic diseases ... 243 Rupture of the calcaneal tendon .......... 243 Differential diagnosis ................... 244

Treatment .............................. 244 Surgical treatment ..................... 244 Treatment of tendon rupture ............. 245

24 Ankle tendon pathology ................. 247 (excluding calcaneal tendon disorders)

M. Bonnin Tibialis posterior tendon pathology .......... 247

Anatomy ............................. 247 Biomechanics ......................... 248 Ruptures of the tibialis posterior tendon ... 248

Pathogenesis ....................... 248 Clinical features .................... 249 Treatment ......................... 251

Dislocation of the tibialis posterior tendon .. 252 Fibular tendon pathology .................. 252

Anatomy ............................. 252 Split lesions of the fibularis

brevis tendon .................. 253 Pathology of the fibularis longus tendon .... 253 Extrinsic pain in the fibular tendons ....... 255 Dislocation of the fibular tendons ......... 255

Pathology of the tendon of the flexor hallucis longus muscle (FHL) ............ 256

Pathology of the tendon of the tibialis anterior muscle ................ 256

25 Entrapment neuropathies ................ 259 (excluding Morton's neuroma)

G. Guaydier-Souquieres Tarsal tunnel syndrome .................... 259

Anatomic and physiologic review ......... 259 Clinical features ....................... 260

Physical examination ................... 260

Supplementary investigations ............ 261

Etiology .............................. 261

Differential diagnosis ................... 261

Treatment ............................ 262 Nerve branch entrapment distal to

the tarsal tunnel ............... 262

Nerve to the abductor digiti minimi muscle. 262

Lateral plantar nerve ................... 263 Medial plantar nerve ................... 263

Superficial fibular nerve entrapment ......... 263

Symptoms ........................... 264 Etiology ............................. 264

Differential diagnosis ................... 264 Treatment ............................ 265

Deep fibular nerve entrapment .............. 265

Symptoms ............................ 265

Etiology ............................. 265 Differential diagnosis ................... 266

Treatment ........................... 266 Sural nerve entrapment .................... 266

Symptoms ........................... 266

Etiology ............................. 266

Differential diagnosis ................... 267

26 Stress fractures of the foot and ankle ...... 269 J. Bernard, L. Zabraniecki, A. Constantin and A. Thomas Pathophysiology ......................... 269

Risk factors ............................. 269 Circumstances of occurrence ............... 270

Increased physical activity ............... 270 Changes in load distribution ............. 270

Clinical features .......................... 270

Methods of diagnosis ...................... 270

Clinical ............................. 270

Conventional radiology. . . . . . . . . . . . . . . .. 271

Bone scintigraphy ...................... 271

Modern imaging techniques .............. 271

Bone densitometry ..................... 271

Frequency and distribution of stress fractures .. 272

Fracture sites and characteristics ............ 273

Clinical forms ............................ 274

Differential diagnosis ...................... 274

Clinical course ........................... 274

CONTENTS XVII

Treatment ............................... 276 Prevention .............................. 276

27 Sprains of the ankle ..................... 279 J. Rodineau and P. Thoreux Lateral ankle sprains ...................... 280

Interrogational data .................... 280 Physical examination ................... 281 Imaging .............................. 281

Standard films ...................... 281 Films in forced positions ............. 282 Ultrasound ........................ 282

Treatment ............................ 282 Anterior ankle sprains ..................... 284

Pathologic anatomy .................... 284 Clinical assessment .................... 284 Radiographic assessment ................ 284 Treatment ............................ 284

Medial ankle sprains ...................... 284 Pathologic anatomy .................... 284 Clinical assessment .................... 285 Radiographic assessment ................ 285 Treatment ............................ 285

Rehabilitation of ankle sprains .............. 285 Countering residual edema .............. 285 Countering painful phenomena .......... 286 Improving the range of movement ........ 286 Restoration of full function .............. 286

28 Ankle sprain sequelae ................•.. 287 (excluding reflex sympathetic algodystrophy)

M. Bonnin Laxity of the talocrural joint ................ 288

Biomechanics ......................... 288 Diagnosis ............................ 289 Treatment ............................ 291

Subtalar laxity ........................... 291 Biomechanics ......................... 291 Clinical features ....................... 292 Treatment ............................ 293

Anterolateral impingement ................. 293 Osteochondral lesions of the talar dome .... 293

Treatment ............................ 295 Tibiofibular syndesmosis injuries ............ 295

Anatomy and biomechanics ............. 295 Clinical features ....................... 296

Sinus tarsi syndrome ...................... 297 Occult fractures .......................... 297 Anterior impingement syndrome ............ 298 Pathology of the posterolateral

talar tuberosity ................ 298

XVIII SOMMAIRE

29 Current concepts in the treatment of acute and chronic lateral ankle instability ....... 303

W. G. Hamilton The modified Brostrom procedure for

symptomatic lateral ankle instability .... 306

30 Bone tumors, dystrophies and rare bone lesions of the foot ....•..... 309

M. Bouvier Bone Tumors ............................ 309

Cystic lesions which simulate tumors ......... 309

Idiopathic cyst ........................ 309

Aneurysmal cyst ....................... 310 Tumors with exclusive or predominant

bone differentiation ............. 311 Osteoid osteoma ....................... 311 Osteoblastoma ........................ 312

Osteosarcoma ......................... 312

Tumors with exclusive or predominant cartilaginous differentiation ...... 313

Exostoses ............................. 313

Chondromas .......................... 313

Solitary chondroma .................. 313

Enchondroma ................... 314

Juxtacortical chondroma ........... 314

Multiple chondromas or enchondromatosis .............. 314

Chondrosarcoma ...................... 314

Benign chondroblastoma ................ 315

Chondromyxoid fibroma ................ 315

Giant-cell tumor .......................... 315

Vascular tumors .......................... 316 Angioma or hemangioma ................ 316

Angiosarcoma or hemangioendothelioma ... 316

Lipoma ................................. 316

Bone marrow tumors ...................... 316

Ewing's sarcoma .................... 316 Solitary plasmocytoma of the bone ..... 317

Distal metastases ......................... 318

Bone dystrophies ......................... 319

Paget's disease ........................ 319

Fibrous dysplasia ...................... 319

Rare bone lesions ...................... 319

Constitutional osteopetroses .......... 319

Genetic bone diseases with excessive bone transparency ...... 320

31 Overuse syndromes of the foot during running ......................... 323

M. Bouysset, E. Noel and M. Bonnin Etiology ................................. 323

Intrinsic factors ....................... 323

Malalignment syndromes ............. 323

Limb-length discrepancy ............. 324

Muscle weakness .................... 325

Other factors ....................... 325

Extrinsic factors ....................... 325

32 Foot orthoses .......................... 329 D. Acker, M. Bouysset, G. Guaydier-Souquieres, D. Vial and F. Lapeyre-Gros with the help in making the orthoses of Mr Kieffert, Mr Lavigne, Mr Menou and Mr Gerard Different types of orthoses ................. 329

Materials ............................. 330

Composition of the orthosis ............. 330

Clinical assessment before prescribing foot orthoses .................. 331

Examples offoot orthoses .................. 332

Metatarsalgia ......................... 332

Varus pes cavus ....................... 334

Hallux rigidus ......................... 334

Hallux valgus ......................... 335

Flatfoot ............................. 335

Static flatfoot in adults ............... 335

Hypermobile flatfoot in children ....... 335

Talalgia .............................. 336

Rheumatoid arthritis . . . . . . . . . . . . . . . . . .. 337

Neurotrophic feet ...................... 338

Toe orthoses ............................. 338

Legislation regarding foot orthoses in France .. 338

33 General ideas about footwear ............. 341

F. Lapeyre-Gros and T. Serpollet History ................................. 341

The shoe ................................ 341

Basic requirements of proper shoes ....... 343

The last ............................. 344

The different units of measurement ....... 344

Different types of shoes: advantages and drawbacks ................. 344

34 The orthopedic shoe •.................... 347

F. Lapeyre-Gros and F. Gaillard With the technical support of P. Vernay, technician at the Centre d'Appareillage de Lyon The different parts of the orthopedic shoe

and manufacturing principles ..... 347 The inner orthosis (or orthotic cork sole) ... 347

The upper and support pieces ............ 347

The sole ............................. 348

Indications .............................. 348

Rheumatologists and the orthopedic shoe ..... 350

Index .•.................................•. 351