0:00

This is a 38-year-old woman,

0:02

another person who fell down steps.

0:04

There seems to be a lot of that in foot and ankle injuries.

0:07

Um, starting again with the bones.

0:11

So here we can see edema

0:13

with a little fracture at the anterior process

0:16

of the calcaneus.

0:17

There's also a little bit of edema

0:20

with an undisplaced fracture at the navicular tuberosity

0:24

and some edema at the medial Alis.

0:28

So these fractures

0:29

and contusions involve our show part joint, which, um,

0:33

consists of that talo calcan navicular joint

0:36

and the calcan cuboid joints.

0:38

So it just, as I did on the prior, um, cases,

0:42

we thought about the bones.

0:43

Now let's think about the ligaments

0:45

that attach to these bones.

0:47

So, um, the ligaments that stabilize the show part joint.

0:50

Let's start by thinking about the calcaneal cuboid joint.

0:54

So that is stabilized principally

0:56

by the dorsal calcan cuboid, um, ligament,

1:01

and then the short and long plantar ligaments, as well

1:04

as the calcan cuboid component of the bifurcate ligament.

1:08

So our little fracture at the anterior process

1:11

of the calcaneus is at the expected attachment

1:13

of the bifurcate ligament.

1:16

Uh, further laterally we have the calcaneal

1:18

cuboid component.

1:20

And then, uh,

1:21

more medially you have the calcan navicular component.

1:25

So those are both attaching on our fracture fragment.

1:29

And then as we look at the long axis images, um,

1:32

at the dorsal calcaneal cuboid ligament, you can see that

1:36

that's also a little bit thickened

1:38

and emus compatible with injury.

1:42

Um, the talo navicular

1:44

or taal calcan navicular joint is stabilized

1:47

by your dorsal talo navicular ligaments

1:49

and spring ligaments, as well

1:51

as the calcan cuboid component.

1:54

Sorry, CALCAN navicular component of the bifurcate ligament.

1:58

So here, tail navicular joint capsule,

2:02

dorsal tail navicular ligament looks EMT irregular, um,

2:06

compatible with injury.

2:10

We already talked about that Calcan navicular component

2:13

of the bifurcate ligament.

2:15

And then we'll talk more about the spring

2:17

ligaments in the next case.

2:20

Um, but there are three major components, um,

2:24

the most important being your, um, s medial, um,

2:29

component of the spring ligament

2:32

that looks like it's intact here.

2:34

Um, and then we have our medial plantar

2:38

and infra plantar longitudinal components

2:42

of the spring ligamentous complex.

2:44

That medial plantar oblique component looks like it's

2:46

attaching in the region of that navicular fracture.

2:50

Um, altogether, um, these findings are compatible

2:54

with a midtarsal sprain injury.

2:57

This is a common injury pattern

2:58

that's gonna result from ankle inversion

3:01

commonly clinically, it can get confused

3:03

for your typical ankle sprains.

3:06

Um, treatment of these injuries is usually conservative,

3:09

but it's important to, to identify and,

3:11

and know these structures so that you can look for the

3:14

other injuries that you might expect, um, when you see one

3:18

of the, the ligaments or, or fractures, um,

3:23

and, uh, important for the patient to know, I think,

3:27

why exactly they're hurting, even though most

3:29

of these injuries are treated conservatively.