Radiographic Evidence of TaloTarsal Dislocation<br />Michael E. Graham, DPM, FACFAS, FASPS, FAENS<br />
TaloTarsal Mechanism<br />Relationship of the articular facets of the talus on the calcaneus and navicular.<br />3 bones, ...
Normal <br />Articular facets are in constant contact<br />Forces are balanced on the articular facets<br />“Normal” amoun...
Abnormal – TaloTarsal Mechanism<br />Articular facets are displaced, one on the other.<br />Excessive amount of joint moti...
Degrees of deformity<br />There are various grading levels of deformities from  mild to severe.  <br />Regardless of its s...
TaloTarsal Dislocation<br />Following the same thought process, there are various stages of talotarsal dislocation from mi...
Normal to abnormal talotarsal alignment<br />www.HyProCure.com<br />
TaloTarsal Dislocation<br />Incomplete – partial displacement<br />Most common type of TTD<br />Usually dynamic, recurrent...
Complete TaloTarsal Dislocation<br />Total displacement of articular facets. <br />Patients are unable to bear weight<br /...
TaloTarsal Dislocation Partial<br />This is not normal<br />There is partial displacement of one articular facet to its co...
Is this normal?<br />Yes<br />Talus is fully articulated with the tarsal mechanism<br />Weight/force of the body is anatom...
Is this normal?<br />NO<br />Talus is displaced on the tarsal mechanism.<br />Pathologic event.<br />Deformity is above th...
Is this normal?<br />NO<br />Talus is displaced on the tarsal mechanism<br />Not anatomically aligned (triplane deformity)...
Is this normal?<br />No<br />Pathologic alignment<br />Notice that this is not a “flat foot” take a look at the calcaneal ...
Is this normal?<br />Yes<br />Articular facets of the talus are anatomically aligned with their counterparts on the tarsal...
Is this foot normal?<br />Yes<br />Talus is properly aligned on the tarsal mechanism.<br />Articular facets are aligned an...
Is this normal?<br />NO<br />Medial displacement of the head of the talus on the navicular.<br />Displacement of one of th...
Is this Normal?<br />Yes<br />No Transverse plane deformity<br />No displacement of the talus on the tarsal mechanism<br /...
Point of Observation-<br />Notice the displacement of the talus on the tarsal mechanism.  This particular case has a sagit...
Cardinal Planes of Deformity<br />www.HyProCure.com<br />
TaloTarsal Dislocation- Sagittal Plane<br />Plantarflexion of the talus on the tarsal mechanism indicates a sagittal plane...
Medial displacement of the head of the talus with the navicular.<br />This leads to excessive strain on the knee and hip. ...
What is the easiest way to see a frontal plane deformity on a lateral view?<br />
Sustentaculumtali is a great indicator of frontal plane deformity. <br />Normal TaloTarsal Mechanism sustentaculum is angl...
TaloTarsal Dislocation<br />There can be a single dominant plane of deformity:<br />Sagittal > Transverse/Frontal<br />Tra...
TaloTarsal Dislocation<br />Two dominate planes of deformity:<br />Sagittal & Transverse > Frontal<br />Sagittal & Frontal...
TaloTarsal Dislocation<br />All three planes are involved.<br />www.HyProCure.com<br />
TaloTarsal Dislocation before/after<br />“Broken” TaloTarsal Mechanism<br />(718.27)<br />“Fixed” TaloTarsal Mechanism<br ...
“Changing Lives, One Step at a Time”<br />www.hyprocure.com<br />View our on-line training<br />www.hyprocuredoctors.com<b...
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
TaloTarsal Dislocation - Radiographic Evidence
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TaloTarsal Dislocation - Radiographic Evidence

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Talotarsal displacement is a rather common deformity leading to many secondary conditions. This lecture guides radiographic clues leading to an accurate diagnosis.

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TaloTarsal Dislocation - Radiographic Evidence

  1. 1. Radiographic Evidence of TaloTarsal Dislocation<br />Michael E. Graham, DPM, FACFAS, FASPS, FAENS<br />
  2. 2. TaloTarsal Mechanism<br />Relationship of the articular facets of the talus on the calcaneus and navicular.<br />3 bones, 4 articulations<br />Triplane helicoidal motion<br />Function is to transfer vertical from above into horizontal forces below.<br />www.HyProCure.com<br />
  3. 3. Normal <br />Articular facets are in constant contact<br />Forces are balanced on the articular facets<br />“Normal” amount of joint mechanism motion is available (no more, no less)<br />www.HyProCure.com<br />
  4. 4. Abnormal – TaloTarsal Mechanism<br />Articular facets are displaced, one on the other.<br />Excessive amount of joint motion is present<br />Excessive forces are placed on supporting tissues<br />Pathologic condition<br />www.HyProCure.com<br />
  5. 5. Degrees of deformity<br />There are various grading levels of deformities from mild to severe. <br />Regardless of its severity- this is still a pathologic condition that will not resolve on its own, is progressive, and will only get worse with time. <br />Wouldn’t it be better/easier to fix this “sooner than later”?<br />www.HyProCure.com<br />
  6. 6. TaloTarsal Dislocation<br />Following the same thought process, there are various stages of talotarsal dislocation from mild to severe. This is also a dynamic, progressive deformity that if left undiagnosed or undertreated it will lead to many other secondary pathologic conditions within the foot and also the proximal musculoskeletal chain.<br />www.HyProCure.com<br />
  7. 7. Normal to abnormal talotarsal alignment<br />www.HyProCure.com<br />
  8. 8. TaloTarsal Dislocation<br />Incomplete – partial displacement<br />Most common type of TTD<br />Usually dynamic, recurrent<br />No associated fractures <br />Complete – total displacement<br />Least common type of TTD<br />Traumatic etiology<br />Associated with concomitant fractures.<br />www.HyProCure.com<br />
  9. 9. Complete TaloTarsal Dislocation<br />Total displacement of articular facets. <br />Patients are unable to bear weight<br />Associated fractures<br />Traumatically induced<br />www.HyProCure.com<br />
  10. 10. TaloTarsal Dislocation Partial<br />This is not normal<br />There is partial displacement of one articular facet to its counter-facet<br />Pathologic condition<br />Results in excessive abnormal motion and excessive abnormal forces acting on the supporting soft tissues<br />Sagittal plane deformity<br />Plantarflexed talus<br />Anterior deviation of Cyma<br />Obliterated Sinus tarsi<br />Increased Talar Declination Angle<br />Diagnosis- TaloTarsal Dislocation (718.37)<br />www.HyProCure.com<br />
  11. 11. Is this normal?<br />Yes<br />Talus is fully articulated with the tarsal mechanism<br />Weight/force of the body is anatomically & biomechanically correct.<br />No talotarsal displacement<br />Open Sinus Tarsi<br />Normal Cyma<br />www.HyProCure.com<br />
  12. 12. Is this normal?<br />NO<br />Talus is displaced on the tarsal mechanism.<br />Pathologic event.<br />Deformity is above the bottom of the foot.<br />Sagittal plane deformity (Increased Talar Declination Angle) Plantarflexed Talus<br />Anterior deviation of Cyma<br />Obliterated Sinus Tarsi<br />Diagnosis: TaloTarsal Dislocation (718.37)<br />www.HyProCure.com<br />
  13. 13. Is this normal?<br />NO<br />Talus is displaced on the tarsal mechanism<br />Not anatomically aligned (triplane deformity)<br />Pathologic biomechanical mechanism<br />Plantarflexed talus (sagittal plane deformity)<br />Anterior Cyma deviation<br />Fully obliterated sinus tarsi<br />ICD-9: TaloTarsal Dislocation (718.37)<br />www.HyProCure.com<br />
  14. 14. Is this normal?<br />No<br />Pathologic alignment<br />Notice that this is not a “flat foot” take a look at the calcaneal inclination angle.<br />Obliterated sinus tarsi<br />Sagittal plane deformity<br />Anterior deviation of Cyma<br />ICD-9 TaloTarsal Dislocation (718.37)<br />www.HyProCure.com<br />
  15. 15. Is this normal?<br />Yes<br />Articular facets of the talus are anatomically aligned with their counterparts on the tarsal mechanism.<br />No sagittal plane deformity<br />Normal Cyma<br />“Open” sinus tarsi<br />CPT: 28585 with HyProCure.<br />www.HyProCure.com<br />
  16. 16. Is this foot normal?<br />Yes<br />Talus is properly aligned on the tarsal mechanism.<br />Articular facets are aligned and in constant contact.<br />Normal Cyma<br />Normal TaloNavicular facet alignment<br />No transverse plane deformity<br />Assumed open sinus tarsi on lateral<br />Normal TaloTarsal Alignment<br />www.HyProCure.com<br />
  17. 17. Is this normal?<br />NO<br />Medial displacement of the head of the talus on the navicular.<br />Displacement of one of the 4 articular facets results in partial displacement of the remaining 3 facets.<br />Transverse plane deformity<br />Anterior deviation Cyma<br />TaloNavicular displacement<br />Assumed obliterated sinus tarsi <br /> on lateral radiograph. <br />Diagnosis- TaloTarsal Dislocation (718.37) <br />www.HyProCure.com<br />
  18. 18. Is this Normal?<br />Yes<br />No Transverse plane deformity<br />No displacement of the talus on the tarsal mechanism<br />Normal Cyma<br />Normal TaloNavicular Articulation<br />No transverse plane deformity<br />S/p TaloTarsal Stabilization with Internal Fixation- HyProCure (CPT- 28585)<br />www.HyProCure.com<br />
  19. 19. Point of Observation-<br />Notice the displacement of the talus on the tarsal mechanism. This particular case has a sagittal and transverse plane deformity with minimal anterior displacement.<br />www.HyProCure.com<br />
  20. 20. Cardinal Planes of Deformity<br />www.HyProCure.com<br />
  21. 21. TaloTarsal Dislocation- Sagittal Plane<br />Plantarflexion of the talus on the tarsal mechanism indicates a sagittal plane deformity.<br />This leads to an anterior pelvic tilt.<br />www.HyProCure.com<br />
  22. 22. Medial displacement of the head of the talus with the navicular.<br />This leads to excessive strain on the knee and hip. <br />Compare the bisection of the talus to the 2nd metatarsal (Talar Second Metatarsal Angle)<br />TaloTarsal Dislocation- Transverse Plane<br />www.HyProCure.com<br />
  23. 23. What is the easiest way to see a frontal plane deformity on a lateral view?<br />
  24. 24. Sustentaculumtali is a great indicator of frontal plane deformity. <br />Normal TaloTarsal Mechanism sustentaculum is angled superiorly.<br />In a frontal plane TTD deformity it drops plantarly.<br />TaloTarsal Dislocation- Frontal Plane<br />www.HyProCure.com<br />
  25. 25. TaloTarsal Dislocation<br />There can be a single dominant plane of deformity:<br />Sagittal > Transverse/Frontal<br />Transverse > Sagittal/Frontal<br />Frontal > Transverse/Sagittal<br />Single Transverse Plane Deformity<br />Single Transverse Plane Deformity<br />www.HyProCure.com<br />
  26. 26. TaloTarsal Dislocation<br />Two dominate planes of deformity:<br />Sagittal & Transverse > Frontal<br />Sagittal & Frontal > Transverse<br />Frontal & Transverse > Sagittal<br />Transverse & Sagittal<br />www.HyProCure.com<br />
  27. 27. TaloTarsal Dislocation<br />All three planes are involved.<br />www.HyProCure.com<br />
  28. 28. TaloTarsal Dislocation before/after<br />“Broken” TaloTarsal Mechanism<br />(718.27)<br />“Fixed” TaloTarsal Mechanism<br />(28585 with HyProCure)<br />www.HyProCure.com<br />
  29. 29. “Changing Lives, One Step at a Time”<br />www.hyprocure.com<br />View our on-line training<br />www.hyprocuredoctors.com<br />

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