The tarsus

Rob Pettitt; Gareth Arthurs; Brian Beale; Don Hulse

doi:10.22233/9781910443286.24

The tarsus

British Small Animal Veterinary Association , 447 (2018); https://doi.org/10.22233/9781910443286.24

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The tarsus

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Authors: Rob Pettitt, Gareth Arthurs, Brian Beale and Don Hulse
From: BSAVA Manual of Canine and Feline Musculoskeletal Disorders
Item: Chapter 24, pp 447 - 471
DOI: 10.22233/9781910443286.24
Copyright: © 2018 British Small Animal Veterinary Association
Publication Date: November 2018

This chapter covers surgical anatomy, examination of the tarsus, diagnostic tools, surgical approaches, congenital conditions of the tarsus, developmental conditions of the tarsus and acquired conditions of the tarsus. Quick Reference Guide to Imaging Techniques by Thomas W. Maddox. Operative Techniques: Medial malleolar osteotomy and repair; Medial arthrotomy for osteochondritis dissecans of the medial ridge of the talus; Partial tarsal arthrodesis; Pantarsal arthrodesis; Repair of Achilles tendon rupture.

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Figures

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24.1

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24.1 The bones and joints of the canine tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.2

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24.2 The ligaments of the canine tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.3

(a) Hyperextension of the proximal intertarsal joint in the left hindlimb of a Shetland Sheepdog. Note the abnormal dropped posture of the hock, the mid-tarsal angulation and the absence of a visible calcaneus projecting caudally (arrowed). (b) A mediolateral radiograph of a tarsus showing the same pathology. Note the severe subluxation with loss of plantar support at the proximal intertarsal joint (arrowed). (Courtesy of Gareth Arthurs) © 2018 British Small Animal Veterinary Association

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24.3 (a) Hyperextension of the proximal intertarsal joint in the left hindlimb of a Shetland Sheepdog. Note the abnormal dropped posture of the hock, the mid-tarsal angulation and the absence of a visible calcaneus projecting caudally (arrowed). (b) A mediolateral radiograph of a tarsus showing the same pathology. Note the severe subluxation with loss of plantar support at the proximal intertarsal joint (arrowed). (Courtesy of Gareth Arthurs)

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24.4

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24.4 Swelling of the caudomedial aspect of the right tarsocrural joint in a dog with osteochondritis dissecans (OCD) of the medial ridge of the talus.

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24.5

Palpation of the distal Achilles tendon. The tendon should be examined for thickness, tautness and any pain on palpation. This is best done during weight-bearing. © 2018 British Small Animal Veterinary Association

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24.5 Palpation of the distal Achilles tendon. The tendon should be examined for thickness, tautness and any pain on palpation. This is best done during weight-bearing.

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24.6

(a) Dorsoplantar radiograph of the normal canine tarsus. Note the uniformly narrow tarsocrural joint space and the superimposition of the calcaneus over the lateral tarsocrural joint space. (b) Mediolateral radiograph of the normal canine tarsus. Note the limits of the calcaneoquartal joint (arrowed). © 2018 British Small Animal Veterinary Association

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24.6 (a) Dorsoplantar radiograph of the normal canine tarsus. Note the uniformly narrow tarsocrural joint space and the superimposition of the calcaneus over the lateral tarsocrural joint space. (b) Mediolateral radiograph of the normal canine tarsus. Note the limits of the calcaneoquartal joint (arrowed).

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24.7

Flexed dorsoplantar radiograph of the normal canine tarsus. Note the increased visibility of the lateral aspect of the tarsocrural joint space. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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24.7 Flexed dorsoplantar radiograph of the normal canine tarsus. Note the increased visibility of the lateral aspect of the tarsocrural joint space. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.8

Dorsal plane CT image of the hock at the level of the trochlear ridges of the talus. The lateral trochlear ridge (red circle) is normal but the medial trochlear ridge (yellow circle) is almost completely missing secondary to osteochondrosis. This is much easier to appreciate on a CT image than it would be on the equivalent radiographs. (Courtesy of Gareth Arthurs) © 2018 British Small Animal Veterinary Association

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24.8 Dorsal plane CT image of the hock at the level of the trochlear ridges of the talus. The lateral trochlear ridge (red circle) is normal but the medial trochlear ridge (yellow circle) is almost completely missing secondary to osteochondrosis. This is much easier to appreciate on a CT image than it would be on the equivalent radiographs. (Courtesy of Gareth Arthurs)

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24.9

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24.9 Arthroscopic view of the normal tarsal joint. PM = plantaromedial.

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24.10

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24.10 Positioning of the plantarolateral portal for arthroscopy of the tarsus.

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24.11

(a) Performing an arthroscopic mini-arthrotomy through a plantaromedial approach to remove (b) an osteochondritis dissecans (OCD) fragment of the medial ridge of the talus. © 2018 British Small Animal Veterinary Association

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24.11 (a) Performing an arthroscopic mini-arthrotomy through a plantaromedial approach to remove (b) an osteochondritis dissecans (OCD) fragment of the medial ridge of the talus.

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24.12

Dorsoplantar radiograph of a Newfoundland with congenital medial ‘spur’ formation affecting the central tarsal bone (arrowed). There is also marked rotation of the tarsus and metatarsus in relation to the distal tibia and fibula. There was no lameness related to these abnormalities. © 2018 British Small Animal Veterinary Association

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24.12 Dorsoplantar radiograph of a Newfoundland with congenital medial ‘spur’ formation affecting the central tarsal bone (arrowed). There is also marked rotation of the tarsus and metatarsus in relation to the distal tibia and fibula. There was no lameness related to these abnormalities.

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24.13

Valgus deviation of the tarsus and foot (pes valgus) in a juvenile Newfoundland. This deviation was causing lameness and was corrected by a medially based closing wedge osteotomy. The opposite limb was less severely affected. © 2018 British Small Animal Veterinary Association

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24.13 Valgus deviation of the tarsus and foot (pes valgus) in a juvenile Newfoundland. This deviation was causing lameness and was corrected by a medially based closing wedge osteotomy. The opposite limb was less severely affected.

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24.14

(a) Mediolateral radiograph of OCD of the hock. There is periarticular soft tissue swelling (white arrows) and the tarsocrural joint space is widened caudally. Flattening of the trochlear ridge is evident (black arrows) and the caudal edge of the distal tibia appears extended by marginal osteophyte formation. There is a free mineralized body (the OCD lesion) caudal to the trochlear ridge. (b) Plantarodorsal radiograph of OCD of the medial trochlear ridge. The medial joint space is abnormally widened (compare with Figure 24.6a ). OCD = osteochondritis dissecans. © 2018 British Small Animal Veterinary Association

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24.14 (a) Mediolateral radiograph of OCD of the hock. There is periarticular soft tissue swelling (white arrows) and the tarsocrural joint space is widened caudally. Flattening of the trochlear ridge is evident (black arrows) and the caudal edge of the distal tibia appears extended by marginal osteophyte formation. There is a free mineralized body (the OCD lesion) caudal to the trochlear ridge. (b) Plantarodorsal radiograph of OCD of the medial trochlear ridge. The medial joint space is abnormally widened (compare with Figure 24.6a ). OCD = osteochondritis dissecans.

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24.15

Arthroscopic diagnosis of OCD of the tarsus. (a) OCD of the medial ridge of the talus. (b) Raised OCD lesion of the medial ridge of the talus. OCD = osteochondritis dissecans. © 2018 British Small Animal Veterinary Association

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24.15 Arthroscopic diagnosis of OCD of the tarsus. (a) OCD of the medial ridge of the talus. (b) Raised OCD lesion of the medial ridge of the talus. OCD = osteochondritis dissecans.

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24.16

Positioning of anchorage points for prosthetic tarsocrural collateral ligaments. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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24.16 Positioning of anchorage points for prosthetic tarsocrural collateral ligaments. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.17

(a) Dorsoplantar and (b) mediolateral radiographs of a partial tarsal arthrodesis performed in a dog 6 months previously using a contoured 2.7 mm dynamic compression plate on the lateral aspect of the tarsus. Note that only the ‘ghost’ outline of the proximal and distal rows of intertarsal joints are visible, consistent with progressive arthrodesis. (Courtesy of Gareth Arthurs) © 2018 British Small Animal Veterinary Association

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24.17 (a) Dorsoplantar and (b) mediolateral radiographs of a partial tarsal arthrodesis performed in a dog 6 months previously using a contoured 2.7 mm dynamic compression plate on the lateral aspect of the tarsus. Note that only the ‘ghost’ outline of the proximal and distal rows of intertarsal joints are visible, consistent with progressive arthrodesis. (Courtesy of Gareth Arthurs)

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24.18

Stressed radiograph showing hyperextension of the proximal intertarsal joint due to plantar ligament degeneration in a Shetland Sheepdog. There is enthesophyte formation on the plantar aspect of the calcaneoquartal joint (arrowed) and new bone formation dorsal to the centrodistal joint. © 2018 British Small Animal Veterinary Association

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24.18 Stressed radiograph showing hyperextension of the proximal intertarsal joint due to plantar ligament degeneration in a Shetland Sheepdog. There is enthesophyte formation on the plantar aspect of the calcaneoquartal joint (arrowed) and new bone formation dorsal to the centrodistal joint.

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24.19

Mediolateral radiograph of the contralateral, apparently normal, limb of a dog with subluxation of the proximal intertarsal joint. There is periarticular soft tissue swelling and plantar enthesophyte formation adjacent to the calcaneoquartal joint. These changes signify ongoing degenerative changes that may lead to failure of plantar ligament support. © 2018 British Small Animal Veterinary Association

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24.19 Mediolateral radiograph of the contralateral, apparently normal, limb of a dog with subluxation of the proximal intertarsal joint. There is periarticular soft tissue swelling and plantar enthesophyte formation adjacent to the calcaneoquartal joint. These changes signify ongoing degenerative changes that may lead to failure of plantar ligament support.

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24.20

(a–b) Stressed views of the tarsus demonstrating fracture of the first tarsal bone with resulting medial and dorsal instabilities originating at the centrodistal joint. (c–d) Selective stabilization of the affected centrodistal joint using two screws, washers and a figure-of-eight wire. Management in this case was successful. (Courtesy of Gareth Arthurs) © 2018 British Small Animal Veterinary Association

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24.20 (a–b) Stressed views of the tarsus demonstrating fracture of the first tarsal bone with resulting medial and dorsal instabilities originating at the centrodistal joint. (c–d) Selective stabilization of the affected centrodistal joint using two screws, washers and a figure-of-eight wire. Management in this case was successful. (Courtesy of Gareth Arthurs)

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24.21

Adult Rottweiler with chronic complete Achilles tendon rupture. There is a pressure sore on the plantar aspect of the calcaneus and thickening of the distal Achilles tendon. The hock is hyperflexed. © 2018 British Small Animal Veterinary Association

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24.21 Adult Rottweiler with chronic complete Achilles tendon rupture. There is a pressure sore on the plantar aspect of the calcaneus and thickening of the distal Achilles tendon. The hock is hyperflexed.

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24.22

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24.22 Gastrocnemius avulsion in a Labrador Retriever. Note the partially ‘dropped’ hock posture with hyperflexion (‘clenching’) of the digits.

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24.23

Mediolateral radiograph of gastrocnemius avulsion. Note the small areas of mineralization proximal to the calcaneus and the ‘capping’ of the tip of calcaneus by new bone formation (arrowed). © 2018 British Small Animal Veterinary Association

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24.23 Mediolateral radiograph of gastrocnemius avulsion. Note the small areas of mineralization proximal to the calcaneus and the ‘capping’ of the tip of calcaneus by new bone formation (arrowed).

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24.24

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24.24 Ultrasonogram of an injured Achilles tendon. Note injury of the gastrocnemius insertion at the calcaneus. The superficial flexor tendon is intact.

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24.25

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24.25 Patient positioning for a mediolateral view of the tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.26

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24.26 Patient positioning for a plantardorsal view of the tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.27

Patient positioning for a flexed dorsoplantar view of the tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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24.27 Patient positioning for a flexed dorsoplantar view of the tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.28

Patient positioned for mediolateral extended view of the canine tarsus. Adhesive tape is used to stabilize the hock in the extended position. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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24.28 Patient positioned for mediolateral extended view of the canine tarsus. Adhesive tape is used to stabilize the hock in the extended position. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.29

Patient positioning for a mediolateral flexed view of the canine hock. Adhesive tape is used to hold the tarsocrural joint in a fully flexed position. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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24.29 Patient positioning for a mediolateral flexed view of the canine hock. Adhesive tape is used to hold the tarsocrural joint in a fully flexed position. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.30

Set-up for the application of stressed tarsal views. The tarsus is stabilized by adhesive tape. (a) Maximum stress is applied to the medial (M) aspect of the tarsus. (b) Maximum stress is applied to the lateral (L) aspect of the tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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24.30 Set-up for the application of stressed tarsal views. The tarsus is stabilized by adhesive tape. (a) Maximum stress is applied to the medial (M) aspect of the tarsus. (b) Maximum stress is applied to the lateral (L) aspect of the tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.31

Medial tarsocrural arthrotomy by osteotomy of the medial malleolus. (a) Exposure of the medial aspect of the tarsus. (b) Retraction of caudal tendons prior to osteotomy. (c) Position of osteotomy. (d) Distal reflection of medial malleolus to expose the medial trochlear ridge. Designed and drawn by Vicki Martin Design and printed with their permission. © 2018 British Small Animal Veterinary Association

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24.31 Medial tarsocrural arthrotomy by osteotomy of the medial malleolus. (a) Exposure of the medial aspect of the tarsus. (b) Retraction of caudal tendons prior to osteotomy. (c) Position of osteotomy. (d) Distal reflection of medial malleolus to expose the medial trochlear ridge. Designed and drawn by Vicki Martin Design and printed with their permission.

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24.32

(a) Vertical arthrotomy between tendons. (b) Exposure of the medial ridge of the talus. OCD = osteochondritis dissecans. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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24.32 (a) Vertical arthrotomy between tendons. (b) Exposure of the medial ridge of the talus. OCD = osteochondritis dissecans. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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24.33

Partial tarsal arthrodesis. (a) Typical lateral plate placement (see also Figure 24.17 ). The twist in the plate is usually necessary in order to apply it flush to the bone, to ensure that the screws engage the metatarsal bones correctly and to avoid causing a rotational deformity of the metatarsal bones relative to the proximal tarsus. (b) Contoured medial bone plate placement. The use of a medial plate is unusual as much more contouring is required and it is difficult to place the plate as proximal on the talus as is possible on the calcaneus when the plate is placed laterally. (a, Courtesy of Gareth Arthurs) © 2018 British Small Animal Veterinary Association

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24.33 Partial tarsal arthrodesis. (a) Typical lateral plate placement (see also Figure 24.17 ). The twist in the plate is usually necessary in order to apply it flush to the bone, to ensure that the screws engage the metatarsal bones correctly and to avoid causing a rotational deformity of the metatarsal bones relative to the proximal tarsus. (b) Contoured medial bone plate placement. The use of a medial plate is unusual as much more contouring is required and it is difficult to place the plate as proximal on the talus as is possible on the calcaneus when the plate is placed laterally. (a, Courtesy of Gareth Arthurs)

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24.34

(a) Mediolateral and (b) dorsoplantar views immediately postoperatively following pantarsal arthrodesis surgery in a 40 kg Labrador Retriever. A minimally contoured 3.5/2.7 mm hybrid pantarsal arthrodesis plate (Veterinary Instrumentation) has been placed on the medial aspect of the tibia and a 4.5 mm calcaneotibial positional screw has been placed to augment the strength of the repair. (Courtesy of Gareth Arthurs) © 2018 British Small Animal Veterinary Association

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24.34 (a) Mediolateral and (b) dorsoplantar views immediately postoperatively following pantarsal arthrodesis surgery in a 40 kg Labrador Retriever. A minimally contoured 3.5/2.7 mm hybrid pantarsal arthrodesis plate (Veterinary Instrumentation) has been placed on the medial aspect of the tibia and a 4.5 mm calcaneotibial positional screw has been placed to augment the strength of the repair. (Courtesy of Gareth Arthurs)

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24.35

Positioning of a calcaneotibial screw. The screw tip should protrude sufficiently from the cranial cortex of the tibia so that each part can be removed if the screw breaks. © 2018 British Small Animal Veterinary Association

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24.35 Positioning of a calcaneotibial screw. The screw tip should protrude sufficiently from the cranial cortex of the tibia so that each part can be removed if the screw breaks.