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Comparative anatomy helps to define among surgical procedures, those that are able to restore early walking function using really useful structures, without necessarily respecting the normal anatomy. This book proposes an original vision based on the following ideas : ? The cure is complete only if it occurs quickly, which is vital for vulnerable patients. ? The surgical goal isn?t the anatomical restitution ad integrum, but to resore the fonction, that of the permanent terrestrial human bipedalism. To identify it, put it back into its evolutionary context and compare it to the anatomo-functional models of our closest relatives, the great apes. ? Achieving this dual objective through new surgical techniques (percutaneous and minimally invaseve), associated with biomechanical data for immediate and total support.
List of contents
Foreword ix
Introduction xiii
Chapter 1. Comparison: The Key to Understanding Human Specificity 1
1.1. Comparison, a source of clarity 1
1.2. Different models of the foot and ankle throughout evolution 1
1.2.1. Evolution of the chiridial limb 2
1.2.2. The human model 6
1.2.3. Comparative functional anatomy 9
1.3. Different functional anatomy models of bipedalism, from turkeys to humans and great apes 10
1.3.1. Challenges in terms of phylogeny 10
1.3.2. Definition of bipedalism 11
1.3.3. Different bipeds 12
1.3.4. Conclusion 23
1.4. Permanent terrestrial human bipedalism, explained through the model of the bi-articular muscles 23
1.4.1. Introduction 23
1.4.2. Kinematic analysis 24
1.4.3. Dynamic analysis (Figure 1.22) 26
1.4.4. Electromyography 28
1.4.5. Surgical treatment 31
1.4.6. Conclusion 32
1.5. Alternating dorsal/plantar flexion of the ankle; comparison with the great ape 32
1.5.1. Kinematic analysis 33
1.5.2. Dynamic analysis 36
1.5.3. Conclusion 36
1.6. Dorsiflexion location (Figure 1.15) 37
Chapter 2. The Aim of Surgery: Restore Function 39
2.1. Introduction 39
2.1.1. The notion of sacrifice 39
2.1.2. Normal 39
2.1.3. Useful 40
2.1.4. Direct surgical implications 41
2.2. Hallux valgus 42
2.2.1. Pathophysiology 42
2.2.2. Normality/utility balance 45
2.3. Arthrodesis 48
2.3.1. The first cuneometatarsal joint (C1M1) 48
2.3.2. First metatarsophalangeal joint (MTP1) 52
2.4. Excessive mechanical pressure under the forefoot (second, third and fourth metatarsals - M2, M3 and M4, respectively) 55
2.4.1. Biomechanics and evolution 55
2.4.2. Pathophysiology 57
2.4.3. Surgical treatment 58
2.5. Plantar plate 60
2.5.1. Introduction 60
2.5.2. Plantar plate in primates 60
2.5.3. Anatomy 61
2.5.4. Biomechanics 64
2.5.5. Mechanical balance 66
2.5.6. Treatment 66
2.6. Release of gastrocnemius muscles 66
2.7. Claw toes (Figure 2.34) 67
2.7.1. Surgical alternatives 67
2.7.2. Anatomy reminder 69
2.7.3. Extension function 71
2.7.4. Flexor tendons: which priorities? 74
2.7.5. Unusual anastomose 78
2.7.6. Conclusion 79
2.8. Second ray syndrome 80
2.8.1. Medical and surgical considerations 80
2.8.2. Second metatarsal in human primates, non-human primates and fossil hominids 83
2.8.3. Treatment 94
2.8.4. Conclusion 95
2.9. Morton's neuroma 95
2.9.1. Introduction 95
2.9.2. Pathological anatomy review 95
2.9.3. Clinical consequence 97
2.9.4. Surgical options 97
2.9.5. Choosing between utility and normality 98
2.10. Appendix: anatomy and function of tendons 98
Chapter 3. Rapid Healing Through Immediate Use of the Operated Foot: A Purpose 101
3.1. Introduction 101
3.2. The need for a concept 102
3.3. New percutaneous and minimally invasive techniques 102
3.3.1. Development of percutaneous surgery 102
3.3.2. Principles of percutaneous surgery 103
3.3.3. Biomechanical translation of this new conceptual approach 105
3.3.4. Absence of pain 109
3.3.5. Immediate full weight bearing 110
3.3.6. Manipulations 111
3.3.7. Technological innovation 111
About the author
Cyrille CAZEAU, M.D. : Foot and ankle surgeon
Summary
Comparative anatomy helps to define among surgical procedures, those that are able to restore early walking function using really useful structures, without necessarily respecting the normal anatomy. This book proposes an original vision based on the following ideas : ? The cure is complete only if it occurs quickly, which is vital for vulnerable patients. ? The surgical goal isn?t the anatomical restitution ad integrum, but to resore the fonction, that of the permanent terrestrial human bipedalism. To identify it, put it back into its evolutionary context and compare it to the anatomo-functional models of our closest relatives, the great apes. ? Achieving this dual objective through new surgical techniques (percutaneous and minimally invaseve), associated with biomechanical data for immediate and total support.
