Foot and Ankle Instability : A Clinical Guide to Diagnosis and Surgical Management

This book comprehensively discusses the basic and practical aspects of foot and ankle surgery applied to all pathologies resulting from instabilities of these joints, a condition that remains underestimated. Uniquely, it not only addresses injuries to the lateral ankle ligaments, but also examines injuries to the deltoid-spring ligament complex, the syndesmotic and chopart joint ligaments, as well as peritalar instability – all pathologies that have often been neglected in the past. For each type of instability, it describes the anatomical basics and the biomechanical features, allowing readers to understand the injury pattern, the subsequent symptoms and clinical findings. Further, it offers guidance on selecting the most appropriate imaging tool for diagnosis and planning surgical reconstruction. Written by world-renowned pioneers in the field, and featuring a wealth of high-quality, intraoperative pictures, the book guides readers step-by-step through the latest, innovative technical surgical solutions for each condition. With its consistent structure, from the basics to the solution, its problem-oriented approach as well as its meticulously selected iconography, this book is a must-read for all orthopedic surgeons with an interest in foot and ankle surgery whishing to explore this promising field. Further, it is a valuable resource for residents, researchers and physiotherapists wishing to gain insights into foot and ankle instability and reconstructive surgery. Foreword Preface Contents About the Authors Abbreviations 1: Introduction 2: Lateral Ankle Instability 2.1 Anatomy of the Lateral Ligaments of the Ankle 2.1.1 Anterior Talofibular Ligament 2.1.2 Calcaneofibular Ligament 2.1.3 Lateral Talocalcaneal Ligament 2.1.4 Posterior Talofibular Ligament 2.2 Biomechanics of Lateral Ankle Instability 2.2.1 Stabilizing Function 2.2.2 Mechanical Changes with Loss of Ligamentous Support 2.2.3 Rotational Instability 2.3 Conclusions and Clinical Implications 2.4 Injury Pattern of Lateral Ankle Ligaments 2.5 History and Clinical Presentation 2.6 Imaging 2.7 Arthroscopy 2.8 Conservative Treatment and Rehabilitation 2.8.1 Acute Ankle Sprains 2.8.2 Chronic Ankle Instability 2.8.3 Rehabilitation 2.9 Surgical Management of Lateral Ankle Instability 2.9.1 Acute Ankle Sprain 2.9.2 Avulsion Fractures of the Fibula 2.9.3 Chronic Lateral Ankle Instability 2.9.4 Concomitant Injuries and Pathologies 2.9.4.1 Peroneal Tendon Injuries 2.9.4.2 Osteochondral Lesions (OCL) 2.9.4.3 Inframalleolar Misalignment 2.9.4.4 Supramalleolar Misalignment 2.9.5 Postoperative Management 2.10 Outcome 2.11 Complications 2.12 Conclusions and Future Evolution References 3: Lateral Ankle Instability Including Chopart Joint 3.1 Anatomy of the Chopart Joint Ligaments 3.1.1 The Calcaneocuboid Joint 3.1.2 The Talocalcaneonavicular Joint 3.2 Biomechanics of the Chopart joint 3.3 Injuries to the Midtarsal Joints 3.3.1 Inversion Midtarsal Sprains 3.3.2 Eversion Midtarsal Sprains 3.3.3 High-Energy Midtarsal Injuries 3.4 History and Clinical Presentation 3.5 Imaging 3.6 Treatment 3.7 Outcome 3.8 Complications 3.9 Conclusions References 4: The Unstable Syndesmosis 4.1 Anatomy of Syndesmosis 4.1.1 Bony Configuration 4.1.2 The Syndesmotic Ligaments 4.1.2.1 The Anterior Inferior Tibiofibular Ligament 4.1.2.2 The Posterior Inferior Tibiofibular Ligament 4.1.2.3 The Transverse Tibiofibular Ligament 4.1.2.4 The Intermalleolar Ligament 4.1.2.5 The Interosseous Membrane 4.2 Biomechanics of Syndesmotic Instability 4.3 Conclusions and Clinical Implications 4.4 Injury Mechanism 4.5 History and Clinical Findings 4.6 Imaging 4.6.1 Conclusion 4.7 Arthroscopy 4.7.1 Acute Injuries 4.7.2 Chronic Injuries 4.8 Conservative Treatment and Rehabilitation 4.8.1 Conservative Treatment 4.8.2 Rehabilitation 4.9 Surgical Management 4.9.1 Acute Injuries 4.9.2 Chronic Injuries 4.9.3 Postoperative Management 4.10 Outcome 4.11 Complications 4.12 Conclusions References 5: Medial Ankle Instability (Including Spring Ligament) 5.1 Anatomy of the Deltoid-Spring Ligament Complex 5.1.1 Superficial Components of the Deltoid Ligament 5.1.1.1 The Tibionavicular Ligament 5.1.1.2 The Tibiospring Ligament 5.1.1.3 The Tibiocalcaneal Ligament 5.1.1.4 The Superficial Posterior Tibiotalar Ligament 5.1.2 Deep Components of the Deltoid Ligament 5.1.2.1 The Deep Posterior Tibiotalar Ligament 5.1.2.2 The Deep Anterior Tibiotalar Ligament 5.1.3 The Spring Ligament Complex 5.1.3.1 The Superomedial Calcaneonavicular Ligament 5.1.3.2 The Medioplantar Oblique Calcaneonavicular Ligament 5.1.3.3 The Inferior Calcaneonavicular Ligament 5.2 Biomechanics of Medial Ankle Instability (Including Spring Ligament) 5.3 Conclusions and Clinical Implications 5.4 Injury Pattern of the Deltoid-Spring Ligament Complex and Classification 5.4.1 Type I-Injury (Table 5.1) 5.4.1.1 Type I A-Injury 5.4.1.2 Type I B-Injury 5.4.1.3 Type I C-Injury 5.4.2 Type II-Injury (Table 5.1) 5.4.2.1 Type II A-Injury 5.4.2.2 Type II B-Injury 5.4.2.3 Type II C-Injury 5.4.3 Type III-Injury (Table 5.1) 5.4.3.1 Type III A-Injury 5.4.3.2 Type III B-Injury 5.4.3.3 Type III C-Injury 5.4.4 Type IV-Injury (Table 5.1) 5.4.4.1 Type IV A-Injury 5.4.4.2 Type IV B-Injury 5.4.4.3 Type IV C-Injury 5.5 Injury Mechanism 5.5.1 Injuries to the Superficial Deltoid Ligament 5.5.2 Injuries to the Deep Deltoid Ligament 5.5.3 Injuries to the Spring Ligament 5.6 Clinical Findings 5.7 Imaging 5.8 Arthroscopy 5.8.1 Acute Injury 5.8.2 Chronic Injury 5.9 Conservative Treatment and Rehabilitation 5.9.1 Type I and Type II-Injuries 5.9.2 Type III-Injuries 5.9.3 Type IV-Injuries 5.10 Surgical Management of Medial Ankle Instability 5.10.1 Proximal Tear of Deltoid Ligament (Type I-Injury) 5.10.1.1 Injury to TNL and TSL (Type I A) 5.10.1.2 Injury to the TNL, TSL and a Partial Injury to the TCT (Type I B) 5.10.1.3 Injury to the TNL, TSL, and TCT (Type I C) 5.10.2 Intermediate Tear of Deltoid Ligament (Type II-Injury) 5.10.2.1 Incomplete Tear (Type II A) 5.10.2.2 Complete Tear without Defect (Type II B) 5.10.2.3 Complete Tear with Defect (Type II C) 5.10.3 Spring Ligament Tear (Type III-Injury) 5.10.3.1 Tear of Spring Ligament with Intact PT Tendon (Type III A) 5.10.3.2 Tear of Spring Ligament Involving the PT Tendon (Type III B) 5.10.3.3 Bony Avulsion of PT Tendon with Spring Ligament Tear (Type III C) 5.10.4 Deep Deltoid Ligament Tear (Type IV-Injury) 5.10.4.1 Incomplete Tear of the Deep Deltoid with a Talar Tilt