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Tarsal & Ankle Bones

Talar and ankle bone pathology: fracture patterns, osteochondral lesions, and management of AVN risk & post-traumatic arthritis.

Overview

Ankle arthroscopy is a low-morbidity procedure that permits exact localization and complete excision of the nidus in osteoid osteoma of the talus neck [1]. It allows concurrent treatment of accompanying synovitis and facilitates an early return to full activity following excision [1]. Subtalar arthroscopy serves as a viable option for the evaluation and management of syndesmotic injuries, as well as for addressing persistent pain following definitive treatment of ankle fractures [2].

For displaced or unstable ankle fractures in adults, both surgical and conservative care result in similar functional outcomes, making either approach appropriate [8]. In cases of comminuted articular fractures of the distal tibia, combined dual-pin fixation and limited open reduction can yield satisfactory results, even when preservation of ankle function seemed unlikely [9]. Operative treatment of unusual fracture-dislocations, such as those of the tarsal navicular, has also demonstrated excellent results [7].

Arthroscopic management of osteochondral lesions of the talar head offers less pain, reduced surgical trauma, and better cosmetic results compared to open approaches, though it remains technically demanding and should be reserved for experienced foot and ankle arthroscopists [73]. Similarly, arthroscopic management of osteochondral lesions of the plantar medial talar head is technically demanding and should be limited to experienced practitioners [30]. For severe ankle pathology with marked deformity, calcaneotalotibial arthrodesis using a retrograde posterior-to-anterior locked nail can achieve union, maintain hindfoot alignment, limit complications, and provide overall patient satisfaction [71]. In pediatric cases requiring one-stage bone and soft-tissue ankle reconstruction, isolated metatarsal epiphysis transfer is a valuable option [77].

Anatomy & Pathophysiology

Osseous & Articular Integrity

Accurate diagnosis of anatomy, biomechanics, and soft tissue structures is fundamental to correctly identify patients requiring conservative or surgical treatment to prevent chronic ankle instability [5]. The dynamic congruency of the joint, influenced by ligamentous integrity, remains the main anatomical component in mechanical ankle instability [25]. Three-dimensional talar shape is not a factor in chronic mechanical ankle instability [25].

For Hawkins II/III talus fractures, anteromedial cannulated screw fixation does not affect the stability of the ankle joint [26], but is conducive to the recovery of ankle function [26]. In pediatric ankle fractures, therapeutic objectives include achieving an adequate functional axis of the ankle without articular gaps [27] and protecting the physis to avoid growth alterations [27].

The effect of talus osteochondral defect area size on ankle biomechanics is evident in the midstance and push-off phases [34]. Passive dorsiflexion of the ankle significantly increases pressure in all four compartments of the leg [49]. Hallux valgus deformity and its severity are positively associated with the magnitude of anteroposterior postural sway [51].

Kinematics & Arthrodesis Outcomes

The subtalar joint plays a small but essential role in the motion occurring between the foot and the leg during the stance phase of normal walking [36]. Spatiotemporal parameters are not affected by hindfoot alignment resulting from subtalar compensation [33].

A sound knowledge of midfoot anatomy facilitates understanding of its function, recognition of deviation from normal in terms of injury or pathology, and guides treatment [39]. Regarding surgical stabilization:

Triple Arthrodesis: Proper alignment can give predictable improvement in patient symptoms [40], but results in a loss of hindfoot motion [40].

Talonavicular vs. Double Arthrodesis: Both procedures lead to equal residual tarsal bone motion postoperatively [54]. Both also provide the midtarsal and subtalar joints with comparable biomechanical stability [54].

Classification

Anomalous Tarsal Variants: Anomalous tarsal bones, such as the 'os talocalcaneus', represent unique anatomical variants that may require surgical removal [6].

Ball-and-Socket Ankle: The ball-and-socket ankle is primarily a congenital abnormality of the talus and the ankle, rather than part of a specific congenital short-limb syndrome or a reactive change to a subtalar coalition [29].

Rigid Valgus Foot: Rigid valgus foot is primarily caused by congenital fusions of the tarsal bones, specifically talocalcaneal bridge, rather than peroneal spasm [66].

Associated Tarsal Coalitions: Associated tarsal coalitions are classified into dual, threefold, massive, and total types based on the number and sites of involved joints [35]. Dual coalitions are the most common configuration among associated tarsal coalitions [35].

Talocalcaneal Coalition (CT-Based): A new classification system of talocalcaneal coalition based on computed tomography was developed to facilitate operative planning [41].

Cuboid Fractures: A classification system for cuboid fractures is proposed in relation to the mechanism of injury [63].

Calcaneal Fractures: Calcaneal fracture severity is classified according to the Sanders classification [14].

Clinical Presentation

History and Mechanism: Patients may present with persistent pain following definitive treatment of ankle fractures [2]. Chronic lateral ankle instability is frequently associated with intra-articular pathology, as one in three patients has a cartilage lesion [20]. The most common location for these lesions is the talus (85%), with the majority situated on the medial talar dome (68%) [20]. Congenital diastasis of the inferior tibiofibular joint presents as a developmental anomaly secondary to congenital hypoplasia of the tibia, talus, and medial ray of the foot [22].

Inspection and Palpation: Swollen feet require careful examination and radiological evaluation to rule out occult talar fractures, particularly in patients with ipsilateral femoral shaft fractures [4]. Process and tubercle fractures of the hindfoot are frequently misdiagnosed as ankle sprains, necessitating a high degree of clinical suspicion and specialized imaging for accurate diagnosis [10]. Patients with isolated anterolateral calcaneal dislocations require urgent diagnosis to ensure acceptable outcomes [42].

Special Tests and Imaging: Subtalar arthroscopy serves as a diagnostic and therapeutic tool for evaluating syndesmotic injuries [2] and managing persistent pain after ankle fracture fixation [2]. High-field magnetic-resonance imaging provides a useful diagnostic adjunct for evaluating persistent ankle symptoms after trauma [18]. Accurate diagnosis of anatomy, biomechanics, and soft tissue structures is fundamental to identify patients requiring conservative or surgical treatment for subtalar instability to prevent chronic ankle instability [5].

Red-Flag Patterns and Differential Diagnosis: Anomalous tarsal bones, such as 'os talocalcaneus', and unusual fracture-dislocations of the tarsal navicular represent rare anatomical variants or injuries [6, 7]. Massive tarsal synostosis appearing bilaterally in successive generations is an unusual familial occurrence [12]. Metatarsal coalition can present as an uncommon mimic of bone neoplasms [19]. Most accessory ossicles of the foot and ankle are incidental findings managed nonsurgically [17].

Chronic and Post-Traumatic Sequelae: Nonsurgical treatment is effective in many patients with symptomatic calcaneal malunion [21]. Postoperative prognosis for primary synovial chondromatosis of the ankle depends on the stage of disease at surgery, with potential for minimum impairment and normal ankle roentgenograms long-term [3]. Complete surgical excision of a space-occupying structure is suggested to effectively relieve symptoms and prevent recurrence in tarsal tunnel syndrome secondary to an identifiable cause [38].

Interventional Capabilities: Ankle arthroscopy permits exact localization and complete excision of the nidus in osteoid osteoma of the talus neck [1]. Posterior arthroscopy with the ankle in dorsiflexion is an excellent alternative approach for posterior pathology [24]. International consensus terminology exists for osteochondral lesions of the ankle to standardize diagnosis and management [11].

Investigations

Plain radiography: Ankle stress radiographic measurements are reliable [23]. Computed tomography plays a key role in planning operative treatment for unstable trimalleolar ankle fractures [59]. Careful examination and radiological evaluation of swollen feet are essential to rule out occult talar fractures in patients with ipsilateral femoral shaft fractures [4]. Process and tubercle fractures of the hindfoot are frequently misdiagnosed as ankle sprains, requiring a high degree of clinical suspicion and specialized imaging for accurate diagnosis [10]. Advanced imaging should be considered to rule out occult fracture in athletes with significant capsular distention or those who do not respond to nonoperative management after a suspected ankle sprain [67]. Stress inversion ankle roentgenograms should be considered in cases of talar osteochondritis dissecans [78].

MRI: Magnetic resonance imaging is reliable and accurate in demonstrating arteries in the lower extremities of young patients for vascularized fibular grafting planning, without the morbidity associated with angiography [52]. High-field magnetic-resonance imaging may provide a useful diagnostic adjunct in evaluating persistent symptoms in the ankle after trauma [18].

Other Considerations: Accurate diagnosis of anatomy, biomechanics, and soft tissue structures is fundamental to correctly identify patients requiring conservative or surgical treatment for subtalar instability [5]. An international consensus on terminology for osteochondral lesions of the ankle has been established to assist clinicians [11]. In patients with chronic lateral ankle instability, 20% have a cartilage lesion, with the most common location being the talus (85%) and most lesions located on the medial talar dome (68%) [20]. Repeated inversion stress in ankles with lax lateral ligaments can result in osteochondral lesions of the medial part of the talus [78]. Osteochondral lesions of the talus can be treated using anterior and posterior portals with the patient in the supine position, emphasizing visualization of the central and posterior ankle to avoid missing pathology [64]. Ankle arthroscopy permits exact localization and complete excision of the nidus in osteoid osteoma of the talus neck [1]. Arthroscopic treatment of osteoid osteoma allows for treatment of accompanying synovitis and early return to full activity [1]. Metatarsal coalition can present as an uncommon mimic of bone neoplasms [19]. Non-fibular non-ossifying fibromas with typical radiographic features that are less than thirty-three millimeters long and less than 50 per cent of the width of the involved bone are not likely to fracture and need only be observed [60].

Treatment

Non-Operative

Conservative management is appropriate for displaced or unstable ankle fractures in adults, yielding functional outcomes similar to surgical care [8]. Nonsurgical treatment is also effective for many patients with symptomatic calcaneal malunion [21]. Most accessory ossicles of the foot and ankle are incidental findings managed nonsurgically [17]. Nonoperative treatment involving early mobilization and protected weight-bearing yields better results than radical surgical methods for calcaneal fractures, as surgical restoration of impacted calcaneal bone is considered hopeless in this context [58]. Nonoperative treatment may allow neonatal leg fractures to heal but requires close monitoring of limb vascularisation [68].

Operative

Indications: Ankle arthroscopy is indicated for exact localization and complete excision of the nidus in osteoid osteoma of the talus neck [1]. Subtalar arthroscopy is indicated for the evaluation and management of syndesmotic injury and for persistent pain following definitive treatment of ankle fractures [2]. Symptomatic coalition of the middle facet of the talocalcaneal joint should be treated with resection when non-operative methods fail to relieve symptoms [61]. A more aggressive approach using talectomy and tibial calcaneal arthrodesis is suggested for dislocation of the first cuneiform in tarsometatarsal fracture-dislocation [16]. Removal of the fore part of the foot with preservation of the tibial epiphysis is recommended for congenital absence of the fibula to allow for end-bearing and better prosthetic function [76].

Surgical Approach / Technique: Ankle arthroscopy permits complete excision of the osteoid osteoma nidus and treatment of accompanying synovitis, facilitating an early return to full activity with little morbidity [1]. Arthroscopic management of osteochondral lesions of the plantar medial talar head is technically demanding and should be reserved for experienced foot and ankle arthroscopists [30]. A one-step technique using bone marrow aspirate concentrate and scaffold is utilized for osteochondral lesions of the talus in ankle osteoarthritis [46]. Local shockwave therapy combined with arthroscopic surgery is employed for osteochondritis of the talus [55]. A self-designed combined plate through a sinus tarsi approach may be used for type II and type III calcaneal fractures [45].

Implant Selection: Internal fixation is used for osteochondral lesions of the talus involving a large bone fragment [13]. Bone marrow aspirate concentrate and scaffold are selected for osteochondral lesions of the talus in the setting of osteoarthritis [46].

Adjuncts: Local shockwave therapy combined with arthroscopic surgery serves as an adjunct for osteochondritis of the talus [55].

Other Considerations: Operative treatment of an unusual fracture-dislocation of the tarsal navicular gave an excellent result [7]. Subtalar arthrodesis will rarely be required in the treatment of resistant congenital club foot using gradual correction with leverage-wire correction and wire-traction cast, as conservative and unionist treatment methods yield encouraging results [79]. Careful examination and radiological evaluation of swollen feet are essential to rule out occult talar fractures in patients with ipsilateral femoral shaft fractures [4]. Patients with problems at the ankle, subtalar, and foot joints in addition to varus deformity of the knee are recommended to undergo knee joint correction first [65]. Current literature does not support the interchangeability of treatments for primary osteochondral defects of the talus, as different techniques have different indications based on lesion size, depth, and cartilage integrity [70].

Evidence Levels: Arthroscopic removal of osteoid osteoma on the neck of the talus is supported by Level 4 evidence [1]. Subtalar arthroscopy is supported by Level 5 evidence [2]. Operative treatment of tarsal navicular fracture-dislocation is supported by Level 4 evidence [7]. Internal fixation of osteochondral lesions of the talus is supported by Level 4 evidence [13]. Arthroscopic management of plantar medial talar head osteochondral lesions is supported by Paper-level evidence [30]. Bone marrow aspirate concentrate and scaffold for osteochondral lesions of the talus in osteoarthritis is supported by Level 4 evidence [46]. Patients with end-stage osteoarthritis presented a high revision rate at 10 years when treated with bone marrow aspirate concentrate and scaffold for osteochondral lesions of the talus [46]. Combination of arthroscopic surgery and radial extracorporeal shockwave therapy for osteochondritis of the talus is supported by Level 1 evidence [55]. Minimally invasive sinus tarsi approach for calcaneal fractures is supported by Level 4 evidence [45]. Resection for symptomatic talocalcaneal coalition is supported by Level 4 evidence [61]. Talectomy and tibial calcaneal arthrodesis for tarsometatarsal fracture-dislocation is supported by Level 4 evidence [16]. Amputation and prosthesis for congenital absence of the fibula is supported by Level 4 evidence [76]. Conservative and unionist treatment methods for resistant congenital club foot are supported by Level 5 evidence [79]. Surgical and conservative care for displaced or unstable ankle fractures are both appropriate treatment methods supported by Level 1 evidence [8]. Nonsurgical treatment for calcaneal malunion is supported by Level 5 evidence [21]. Nonsurgical management of accessory ossicles is supported by Level 5 evidence [17]. Nonoperative treatment of calcaneal fractures is supported by Level 5 evidence [58]. Nonoperative treatment for neonatal leg fracture is supported by Case Report evidence [68]. Pediatric ankle fracture management is supported by Level 5 evidence [27]. Pediatric fracture management is supported by Textbook evidence [57]. Evaluation for occult talar fractures in ipsilateral femoral shaft fractures is supported by Level 5 evidence [4]. Management of compensatory changes after knee arthroplasty is supported by Level 2 evidence [65]. Need for future high-level controlled studies to explore advantages and disadvantages of specific treatments for primary osteochondral defects of the talus is supported by Letter evidence [70].

Complications

General Morbidity: Ankle arthroscopy is associated with little morbidity [1]. Subtalar arthroscopy serves as a viable modality for the evaluation and management of syndesmotic injuries [2] and for addressing persistent pain following the definitive treatment of ankle fractures [2].

Talar Fractures: Talar fractures typically result from high-energy trauma accompanied by concomitant lower extremity injuries [69]. These injuries lead to fair to poor long-term functional outcomes [69]. In patients with ipsilateral femoral shaft fractures, careful examination and radiological evaluation of swollen feet are essential to rule out occult talar fractures [4].

Growth Disturbance: Failure of fibular regeneration after graft harvest in growing children results in progressive elevation of the lateral malleolus and valgus instability of the ankle [75].

Other Considerations: The postoperative prognosis for primary synovial chondromatosis is dependent on the stage of the disease at the time of surgery [3]. Massive familial tarsal synostosis is an unusual occurrence [12]. Some patients experience increased ankle pain after total knee arthroplasty for knee osteoarthritis with varus, particularly if there is residual knee varus deformity, a stiff hindfoot with varus deformity, or ankle arthritis [80].

Recovery

Light activity (weeks): Ankle arthroscopy for osteoid osteoma of the talus is associated with early return to full activity [1]. For displaced or unstable ankle fractures in adults, surgical and conservative care result in similar functional outcomes, allowing for comparable timelines in light activity [8].

Full activity (months): Patients with osteoid osteoma of the talus treated via ankle arthroscopy achieve early return to full activity [1]. In children with Hawkins II/III talus fractures, anteromedial cannulated screw fixation is conducive to the recovery of ankle function [26]. Patients with skeletally immature and mature ankles attain healing at comparable rates after internal fixation of large-bone-fragment osteochondral lesions of the talus [13].

Complete recovery / outcome plateau (months): Total ankle arthroplasty and ankle arthrodesis show no differences in patient-reported function at 1 year for end-stage ankle arthritis [31]. The Chrisman-Snook operation restores good long-term function in a high percentage of patients with ankle instability due to unhealed or neglected lateral ligament tears [56]. Satisfactory immediate correction was obtained in 48 of 52 feet using gradual correction with leverage-wire correction and wire-traction cast for resistant congenital club foot in infants [15].

Rehabilitation protocol: Primary closure of external fixator pin sites is a reasonable alternative to secondary healing due to faster wound-healing time [31]. Satisfactory results were obtained in comminuted articular fractures of the distal tibia using combined dual-pin fixation and limited open reduction [9]. Approaching calcaneus fractures through the sinus tarsi provides satisfactory mid- to long-term radiographic and clinical outcomes, independent of fracture severity according to Sanders classification [14].

Functional milestones: Postoperative prognosis for primary synovial chondromatosis of the ankle depends on the stage of disease at surgery, with potential for minimum impairment and normal ankle roentgenograms long-term [3]. Satisfactory results were obtained in approximately 75% of 21 patients undergoing tibiotalocalcaneal arthrodesis for arthritis and deformity of the hind part of the foot [85]. Osseous union was radiographically evident in all but three patients undergoing tibiotalocalcaneal arthrodesis [85]. A patient with fracture of the anterior extremity of the calcaneus together with calcaneocuboid joint dislocation achieved a good functional outcome with no arthropathic changes at 2.5 years follow-up [72].

Other Considerations: Subtalar arthroscopy can be performed for the evaluation and management of syndesmotic injury [2] and for the management of persistent pain following definitive treatment of ankle fractures [2]. A 42% reduction in tibiotalar contact area occurs with one millimeter of lateral talar displacement, emphasizing the importance of restoring normal roentgenographic relationship after ankle injuries to prevent poor clinical results [84]. Long-term clinical and radiographic follow-up is necessary to determine the natural history of asymptomatic talar bone marrow edema in professional ballet dancers [81]. Paget's disease of the tibia can progress as a purely lytic lesion, with faster longitudinal growth occurring during the first six years before slowing as the disease extends to involve the entire bone [82]. Patients with ankle varus are older and have prolonged symptom duration compared to those with chronic lateral ankle instability alone [83]. Myositis ossificans in the newborn underwent extensive remodeling with almost normal bone morphology at follow-up despite the atypical anatomical site and rapid course [86].

Key Evidence

  • [L4] Ankle arthroscopy has little morbidity, permits exact localization and complete excision of the nidus, and allows treatment of accompanying synovitis with an early return to full activity. (10.1007/s00167-003-0413-4)
  • [L5] It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures. (10.1177/2325967119s00451)
  • [Case_report] Postoperative prognosis is dependent on the stage of the disease at the time of surgery, with this patient showing minimum impairment and normal ankle roentgenograms twenty years after surgery. (10.2106/00004623-197658060-00024)
  • [L5] Careful examination and radiological evaluation of swollen feet are essential to rule out occult talar fractures in these patients. (10.1007/s00402-004-0783-1)
  • [L5] Accurate diagnosis of anatomy, biomechanics, and soft tissue structures is fundamental to correctly identify patients requiring conservative or surgical treatment to prevent chronic ankle instability. (10.1177/23259671211021352)
  • [L4] The paper describes a unique case of an anomalous tarsal bone, termed 'os talocalcaneus', which was surgically removed from a five-year-old boy. (10.2106/00004623-195133040-00010)
  • [L4] An unusual fracture-dislocation of the tarsal navicular is reported where operative treatment gave an excellent result. (10.2106/00004623-196951030-00019)
  • [L1] Both surgical and conservative care of displaced or unstable ankle fractures in adults result in similar functional outcomes and are both appropriate treatment methods. (10.1177/2325967121s00892)
  • [L5] Process and tubercle fractures of the hindfoot are frequently misdiagnosed as ankle sprains; a high degree of clinical suspicion and specialized imaging are required for accurate diagnosis. (10.5435/00124635-200512000-00002)
  • [L5] This international consensus derived from leaders in the field will assist clinicians with the appropriate terminology for osteochondral lesions of the ankle. (10.1016/j.jisako.2021.12.001)
  • [L4] Massive tarsal synostosis appearing bilaterally in two successive generations of one family is an occurrence unusual enough to report, with no similar cases found in the literature review. (10.2106/00004623-195739050-00017)
  • [L4] We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT. (10.1177/0363546520988739)
  • [L4] Approaching calcaneus fractures through the sinus tarsi provides satisfactory mid- to long-term radiographic and clinical outcomes, independent of the severity of the fractures according to the Sanders classification. (10.1007/s00402-020-03530-3)
  • [L4] Satisfactory immediate correction was obtained in forty-eight of fifty-two feet. (10.2106/00004623-196244010-00012)
  • [L4] A more aggressive approach using talectomy and some type of tibial calcaneal arthrodesis as part of the initial treatment is suggested. (10.2106/00004623-195032020-00022)
  • [L5] Most accessory ossicles of the foot and ankle are incidental findings managed nonsurgically. (10.5435/jaaos-d-20-00218)
  • [Case_report] High-field magnetic-resonance imaging may provide a useful diagnostic adjunct in evaluating persistent symptoms in the ankle after trauma. (10.2106/00004623-198668060-00017)
  • [L4] These cases highlight an uncommon presentation of metatarsal coalition mimicking bone neoplasms. (10.1186/s12891-025-09279-3)
  • [L4] The most common location was the talus (85%), with most lesions located on the medial talar dome (68%). (10.1177/03635465221084365)
  • [L5] Nonsurgical treatment is effective in many patients with symptomatic calcaneal malunion. (10.5435/00124635-201101000-00004)
  • [L5] The condition is secondary to congenital hypoplasia of the tibia, talus, and medial ray of the foot. (10.2106/00004623-197658060-00028)
  • [L4] Ankle stress radiographic measurements were proven to be reliable. (10.1177/0363546507313091)
  • [Commentary] Posterior arthroscopy with the ankle in dorsiflexion is an excellent alternative in other cases. (10.1016/j.arthro.2021.01.020)
  • [L3] This supports the interpretation that the dynamic congruency of the joint, which is influenced by ligamentous integrity remains the main anatomical component in mechanical ankle instability. (10.1186/s12891-025-09458-2)
  • [L4] It does not affect the stability of the ankle joint and is conducive to the recovery of ankle function. (10.1186/s13018-023-04253-y)
  • [L5] Therapeutic objectives should be to achieve an adequate functional axis of the ankle without articular gaps, and to protect the physis in order to avoid growth alterations. (10.1302/2058-5241.6.200042)
  • [L4] The ball-and-socket ankle is primarily a congenital abnormality of the talus and the ankle rather than part of a specific congenital short-limb syndrome or a reactive change to a subtalar coalition. (10.2106/00004623-198365030-00029)
  • [Paper] This technique is technically demanding and should be reserved for experienced foot and ankle arthroscists. (10.1016/j.eats.2018.09.001)
  • [L5] This article provides a summary of orthopaedic foot and ankle research from September 2022 to September 2023, highlighting that both total ankle arthroplasty and ankle arthrodesis are good options for treating end-stage ankle arthritis with no differences in patient-reported function at 1 year, and that primary closure of external fixator pin sites is a reasonable alternative to secondary healing due to faster wound-healing time. (10.2106/jbjs.23.01482)
  • [L3] The spatiotemporal parameters were not affected by the hindfoot alignment resulting from subtalar compensation. (10.1186/s13018-024-04615-0)
  • [L5] The effect of the defect area of the ankle talus cartilage on the ankle biomechanics is evident in the midstance and push-off phases. (10.1186/s12891-022-05450-2)
  • [L4] Associated tarsal coalitions are classified into dual, threefold, massive, and total types based on the number and sites of involved joints, with dual coalitions being the most common configuration. (10.5435/jaaos-d-24-01191)
  • [L5] The subtalar joint plays a small but essential role in the motion occurring between the foot and the leg during the stance phase of normal walking. (10.2106/00004623-196446020-00010)
  • [Case_report] For tarsal tunnel syndrome secondary to an identifiable space-occupying structure with distinct neurologic symptoms, complete surgical excision of the causative structure is suggested to effectively relieve symptoms and prevent recurrence. (10.1186/s12891-020-03530-9)
  • [L5] A sound knowledge of the anatomy of the midfoot facilitates an understanding of its function, recognition of a deviation from the normal, in terms of injury or pathology and guides treatment. (10.1007/s00167-010-1101-9)
  • [L5] When proper alignment is obtained, it can give predictable improvement in patient symptoms, but the resultant loss of hindfoot motion is not without consequences. (10.5435/00124635-199805000-00007)
  • [L4] A new classification system of the talocalcaneal coalition to facilitate operative planning was developed. (10.1186/s12891-021-04567-0)
  • [Case_report] Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed. (10.1186/s12891-022-05506-3)
  • [L4] Treatment with our self-designed combined plate through a sinus tarsi approach may be safe and effective for type II and type III calcaneal fractures. (10.1186/s13018-016-0497-4)
  • [L4] This one-step technique for the treatment of OLT in OA ankles showed to be safe and to provide a satisfactory outcome, even if patients with end stage OA presented a high revision rate at 10 years. (10.1007/s00167-021-06494-y)
  • [L4] Passive dorsiflexion of the ankle significantly increased pressure in all four compartments of the leg. (10.2106/00004623-198567050-00028)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L4] Magnetic resonance imaging was reliable and accurate in demonstrating the arteries in the lower extremities of young patients and, unlike angiography, was not associated with morbidity. (10.2106/00004623-199072030-00014)
  • [L5] Both fusions lead to equal residual tarsal bone motion postoperatively, providing the midtarsal and subtalar joints with comparable biomechanical stability. (10.1007/s00402-009-0878-9)
  • [L1] Local shockwave therapy was safe and effective in patients with osteochondritis of the talus treated with a combination of arthroscopic surgery and rESWT. (10.1302/0301-620x.105b10.bjj-2023-0152.r2)
  • [L4] Based on the findings in this study, we concluded that this procedure will restore good long-term function in a high percentage of patients who are disabled by ankle instability due to unhealed or neglected tears of the lateral ligaments. (10.2106/00004623-198567010-00001)
  • [L5] The author concludes that surgical restoration of impacted calcaneal bone is hopeless and that non-operative treatment involving early mobilization and protected weight-bearing yields better results than radical surgical methods. (10.2106/00004623-196345040-00022)
  • [L4] Trimalleolar ankle fractures are considered unstable and generally treated operatively, with computed tomography playing a key role in planning. (10.1302/2058-5241.6.200138)
  • [L4] Non-fibular lesions with typical radiographic features that are less than thirty-three millimeters long and less than 50 per cent of the width of the involved bone are not likely to fracture and need only be observed. (10.2106/00004623-198163060-00016)
  • [L4] Symptomatic coalition of the middle facet of the talocalcaneal joint should be treated with resection when non-operative methods fail to relieve symptoms. (10.2106/00004623-199274040-00008)
  • [L4] A classification system for fractures of the cuboid is proposed in relation to the mechanism of injury. (10.1302/0301-620x.98b7.36639)
  • [L5] This editorial commentary argues that most osteochondral lesions of the talus can be well treated using both anterior and posterior portals with the patient in the supine position, emphasizing the importance of visualizing the central and posterior ankle to avoid missing pathology. (10.1016/j.arthro.2017.09.007)
  • [L2] Patients who have problems at the ankle, subtalar, and foot joints in addition to varus deformity of the knee are recommended to undergo knee joint correction first. (10.1007/s00167-018-4840-7)
  • [L4] Rigid valgus foot is primarily caused by congenital fusions of the tarsal bones, specifically talocalcaneal bridge, rather than peroneal spasm. (10.2106/00004623-195537010-00018)
  • [L4] Clinicians should consider advanced imaging to rule out occult fracture in athletes with significant capsular distention or those who do not respond to nonoperative management after a suspected ankle sprain. (10.1177/0363546508324965)
  • [Case_report] Nonoperative treatment may allow the fracture to heal but requires close monitoring of limb vascularisation. (10.1016/j.otsr.2016.07.008)
  • [L4] Talar fractures typically result from high-energy trauma with concomitant lower extremity injuries, leading to fair to poor long-term functional outcomes. (10.1186/s12891-021-04572-3)
  • [Letter] Current literature does not support the interchangeability of treatments for primary osteochondral defects of the talus, as different techniques have different indications based on lesion size, depth, and cartilage integrity; future high-level controlled studies are needed to explore advantages and disadvantages for specific indications. (10.1007/s00167-017-4700-x)
  • [L4] With use of a retrograde locking nail, the accepted goals of calcaneotalotibial arthrodesis (union, maintenance of hindfoot alignment, limitation of complications, and overall patient satisfaction) can be achieved even in limbs with marked deformity. (10.2106/00004623-200300004-00016)
  • [L5] The patient achieved a good functional outcome with no arthropathic changes at 2.5 years follow-up. (10.1007/s00402-009-0834-8)
  • [Paper] Arthroscopic management of osteochondral lesions of the talar head offers advantages of better cosmetic results, less pain, and less surgical trauma, though the technique is technically demanding and should be reserved for experienced foot and ankle arthroscopists. (10.1016/j.eats.2019.05.006)
  • [L4] In growing children, failure of fibular regeneration after graft harvest results in progressive elevation of the lateral malleolus and valgus instability of the ankle. (10.2106/00004623-197254030-00012)
  • [L4] They recommend removing the fore part of the foot with preservation of the tibial epiphysis to allow for end-bearing and better prosthetic function. (10.2106/00004623-196143050-00001)
  • [L5] According to our findings, isolated metatarsal epiphysis transfer appears a valuable option in one-stage bone and soft-tissue ankle reconstructions in children. (10.1016/j.injury.2015.07.011)
  • [L4] The case demonstrates that repeated inversion stress in ankles with lax lateral ligaments can result in osteochondral lesions of the medial part of the talus, and stress inversion ankle roentgenograms should be considered in cases of talar osteochondritis dissecans. (10.2106/00004623-197052010-00018)
  • [L2] However, some patients experience increased ankle pain, especially if there is residual knee varus deformity, a stiff hindfoot with varus deformity, or ankle arthritis. (10.3389/fsurg.2021.713055)
  • [L4] Long-term clinical and radiographic follow-up is necessary to determine the natural history of these lesions. (10.1177/23259671231159910)
  • [Case_report] The report documents the progression of a purely lytic lesion in Paget's disease of the tibia over twelve years, noting that faster longitudinal growth occurred during the first six years before slowing as the disease extended to involve the entire bone. (10.2106/00004623-197658060-00023)
  • [L3] Patients with ankle varus were older and had prolonged symptom duration compared to those with CLAI alone. (10.1186/s13018-025-06232-x)
  • [L5] A 42 per cent reduction in tibiotalar contact area occurs with one millimeter of lateral talar displacement, emphasizing the importance of restoring normal roentgenographic relationship after ankle injuries to prevent poor clinical results. (10.2106/00004623-197658030-00010)
  • [L4] Satisfactory results were obtained in approximately 75 per cent of twenty-one patients; osseous union was radiographically evident in all but three patients. (10.2106/00004623-198870090-00004)
  • [Case_report] Despite the atypical anatomical site and rapid course, the lesion underwent extensive remodeling with almost normal bone morphology at follow-up. (10.2106/00004623-198668030-00023)

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