Plantar bulge

Introduction Patients with congenital vertical talus often show that the arch of the foot disappears or the sole of the foot protrudes. The medial and temporal sides of the foot are prominent because the talus is prominent here.

Cause

Cause:

First, the cause

It is generally believed that this malformation has formed within the first three months of the embryo. Clinically, there are two types of arc type and hair style. The latter is a malformation of congenital diseases such as meningeal spinal bulging, multiple joint contracture, neurofibromatosis, and trisomy 13 to 15,18. The cause of the arc-shaped vertical talus is still unclear. It has been suggested that the development of foot embryos is blocked. Bitsila experimented with young rabbits, and cut the long extensor digitorum, tibialis anterior and transverse leg ligaments, and caused the gastrocnemius muscle to shrink. As a result, an animal model of vertical talus was successfully established. Therefore, he proposed that primary soft tissue lesions are the main cause of this deformity. Other scholars have found that the incidence of certain families and twins is significantly higher than that of the general population and is believed to be related to genetic factors.

Second, pathological changes

Pathological changes can be divided into bony deformities and soft tissue lesions. The skeletal deformity mainly forms a joint between the scaphoid and the dorsal aspect of the talar neck, and locks the talus in a vertical state. The talus is flat or ovoid above the skeletal head, and the talar neck is poorly developed and shortened, and the dorsal side forms the articular surface. The proximal joint of the scaphoid is inclined to the temporal side. The calcaneus is displaced to the posterolateral side. The anterior portion of the calcaneus is deflected to the outside and flexed to the temporal side. The load is poorly developed and loses the role of supporting the talus. The lateral column of the foot is concave, and the inner column is relatively long.

There are also significant changes in soft tissue. The sacral ligament and the ligament contracture from the dorsal ligament of the boat are the main factors affecting the reduction. Bifurcation of the lateral ligament ligament causes foot abduction. With the talus ligament and the ligament of the Achilles tendon, it hinders the repositioning of the posterior lateral aspect of the calcaneus. The ligament of the scapula, the scapular side and the medial joint capsule were elongated. The tibialis anterior muscle, toe length, long extensor muscle, tibialis brevis and calf triceps are increased in tension due to contracture. The longus and posterior tibial tendons move to the front of the ankle and act as an extensor muscle (Fig. 1).

Figure 1 Abnormal changes in congenital vertical talus and tendon (1. toe extensor tendon 2. deltoid ligament 3. tibia 4. anterior tibialis 5. gastrocnemius 6. soleus muscle 7. toe long flexor 8. posterior tibial muscle 9. long Flexor 10. Achilles tendon 11. Long extensor muscle 12. First metatarsal 13. Anterior tendon 14. Cruciate ligament 15. First wedge bone 16. Scaphoid 17. With scapular ligament 18. Astragalus 19. Tendon 20. Toe long flexor tendon 21. Long flexor tendon 22. Calcaneal)

Third, the pathogenesis

Dislocation of the scaphoid joint may occur in the uterus within 3 months of pregnancy, while adjacent subtalar joints, interphalangeal joints, and ankle joint subluxation are secondary. The disease can be single or a part of multiple body malformations.

The scaphoid forms a joint with the dorsal aspect of the talus neck, making the talus vertical. The talus is deformed, the talus neck is shortened, and the talus is displaced to the posterior lateral side, showing a drooping state. The talus is convex on the sole of the foot. Other interphalangeal joints have also changed accordingly. The anterior bundle of the triangular ligament, the dorsal lateral ligament, the Achilles tendon ligament, the talus ligament and the Achilles tendon ligament have different degrees of contracture, while the posterior joint capsule of the ankle joint and the subtalar joint are shortened, and the ligament of the ligament is pulled. Stretching. The calf muscles (pre-extension of the tibialis anterior muscle, long extensor muscles, long extensor muscles, triceps, etc.) have contractions; the posterior tibial muscles and the long bones of the tibia are displaced forward and become dorsiflexors.

an examination

Related inspection

General radiography examination joint examination

I. Symptoms

Patients often show that the arch of the foot disappears or the sole of the foot is raised. The medial and temporal sides of the foot are very prominent because the talus is prominent here. There are dorsal extensions and abductions in the anterior part of the foot. The dorsal muscles of the foot, the ligaments of the scaphoid and the ligaments of the scaphoid often cause tension and contracture, which affects the plantar flexion and varus of the anterior part of the foot. The calcaneus valgus deformity causes the posterior muscle of the foot. Tendons and ligaments are shortened. Because the ankle joint is stiff and the activity is limited, the deformity of the foot is heavier. When the patient stands or walks, the heel cannot reach the ground, the gait is unstable, the walking is slow, and the foot is prone to fatigue and pain.

Second, diagnosis

Early treatment of this disease is expected to correct deformity, so early diagnosis is more important for prognosis. Congenital vertical talus is not very difficult to diagnose based on medical history, clinical manifestations and X-ray examination.

Some scholars have proposed three-point X-ray signs as a reference for clinical diagnosis:

1 The angle of the axis is too large, and the difference from the normal group is significant;

2 does not extend from the axis;

3 Displacement at the intersection with the axis of the axis.

Differential diagnosis

Heel kyphosis: The heel protrudes backwards and is common in trisomy 13 syndrome. Trisomy 13 is also known as Patau syndrome and is caused by chromosomal abnormalities.

Flat foot: Flat foot (Orthopedics), flat foot disease is mainly due to some reasons such as abnormal foot shape, muscle atrophy, ligament contracture or chronic strain caused by foot arch collapse or elastic loss caused by foot pain, also known as flat foot.

The foot can not be bent and varus: the posterior tibial nerve injury manifests as the foot can not be bent and varus.

Smooth rounded mass of the ankle: The symptoms of the ganglion cyst are characterized by smooth rounded masses in the ankle.

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