Search Results (53)

The aim of this study was to assess bone health in individuals over 60 years of age in Kazakhstan, focusing on the relationship between osteoporosis, body mass index (BMI), body composition, and nutritional factors. This study included 1961 participants, consisting of 1620 women and 341 men, aged 60 to 89. Bone strength was assessed using quantitative ultrasound of the calcaneus, while fracture risk was assessed with the FRAX tool. Osteoporosis was detected in 20.2% of women and 15.2% of men, and osteopenia affected 59.8% of women and 58.4% of men. A total of 73.7% of the participants were overweight, 38.2% were pre-obese, and 35.5% were obese. The results of the study emphasise that, in addition to classic nutrients (calcium, vitamin D, protein), a number of trace elements and vitamins (selenium, iodine, zinc, vitamin B6, phytosterols) also play a significant, possibly indirect, role in bone metabolism. An inverse correlation was observed between BMI and osteoporosis prevalence; with a decrease in BMI, the incidence of osteoporosis increased (women: χ² = 26.0, df = 2, p < 0.001; men: χ² = 4.29, df = 2, p < 0.014; total sample: χ² = 32.3, df = 2, p < 0.001), thus confirming that excess body fat exerts a protective effect on bone health. Significant risk factors for osteoporosis included age, height, and weight. A link was found between the age of first osteoporosis onset and BMI (from 65 to 72.14 years). This confirms the value of FRAX for accurately assessing fracture risk and developing personalised recommendations based on anthropometric and dietary characteristics. Future longitudinal research is warranted to validate these results and further elucidate the underlying mechanisms, including the predictive power of novel anthropometric parameters such as the Body Roundness Index and Body Shape Index. Full article

Osteochondroses of the foot represent a unique and less frequently discussed topic. This narrative review aims to provide a comprehensive overview of foot osteochondroses, highlighting their definition, pathophysiology, clinical features, diagnosis, and treatment. Historical sources, including early case reports, were included along with the current literature to picture the current knowledge on the subject. Anatomical mapping of pain locations and associated ossification centers was employed as a framework to present the various forms of foot osteochondroses. Multiple types of foot osteochondrosis were identified. The calcaneus, navicular and lesser metatarsal are among the more common involved bones. Most forms share a multifactorial etiology involving mechanical stress, vascular insufficiency, and delayed ossification. The pain is localized and common to all forms. Diagnosis relies on clinical assessment supported by radiographic and sometimes magnetic resonance imaging findings. During the acute phase, joint rest is essential. Despite the potential for spontaneous resolution, some cases can lead to structural deformities or persistent symptoms. Foot osteochondroses, although rare, require careful clinical evaluation due to their impact on pediatric patients. Increased awareness and standardized treatment approaches may improve early recognition and management, potentially reducing long-term sequelae. Full article

Background/Objectives: The calcaneus is the most commonly injured tarsal bone, potentially resulting in long-term functional deficiencies and disability. The type of treatment mainly depends on fracture type and morphology. Treatment of these fractures can be challenging due to a limited soft tissue envelope and is frequently associated with complications. The aim of this study was to classify fracture types and identify factors associated with in-hospital complications. Methods: Patients with calcaneal fractures treated at our level I trauma center between 1997 and 2017 were included. Demographic data, comorbidities, fracture characteristics, type of treatment, complications and revisions, compliance and accompanying injuries were evaluated. Results: A total of 238 patients (m = 163, f = 75) at a mean age of 40 years sustaining either uni- or bilateral calcaneal fracture resulting in a total of 288 calcaneal fractures. Concomitant injuries were present in 103 patients (35.9%). Traumatic spine lesions were present in 21.9%. Complications were recorded in 59 fractures (20.5%). Open fractures were more likely to develop complications (76.0% vs. 15.2%, p < 0.001). Significant complication (33% vs. 14%, p < 0.001) and wound complication rates (29% vs. 10%, p < 0.001) were found in multiple-injured patients. All open fractures were surgically treated on the day of admission. In calcaneal fractures with a Böhler angle below 0 degrees, more complications were seen (33% vs. 17%, p < 0.05). Conclusions: High complication rates following calcaneal fractures were detected, with an increased likelihood in open fractures and in patients with multiple injuries. A negative Böhler angle was associated with worse outcomes. Full article

The calcaneus is very useful in archaeological contexts where human remains may be commingled. When DNA is impossible and the context is commingled, non-metric traits of the calcaneus may be used to identify phenotypical differences between human remains. Background/Objectives: We compared the prevalence of several calcaneal non-metric traits of pre-Hispanic and modern inhabitants of the Canary islands in order to (1) test the skeletal variation between pre-Hispanic and modern (17–18th century) Canarian samples and (2) gather information on biological and lifestyle differences between the samples using the calcaneal bone. Methods: We used a total of 364 calcanei (164 modern Canarian [72 left and 92 right] and 200 pre-Hispanic Canarian [92 left and 108 right] calcanei) and available non-metric traits to show differences between modern and pre-Hispanic Canarian population samples. Results: Our results highlight that some particular activity traits were common among the pre-Hispanic sample, while other traits, such as articular facet type Ib and the medial root of the inferior extensor retinaculum, show similar frequencies between pre-Hispanic and modern samples, which may indicate a genetic proponent influencing these similarities. Conclusions: Our results suggest that at least two traits, facet type Ib and the medial root of the inferior extensor retinaculum, may be influenced by genetics due to the persistence in modern samples despite the change of lifestyle between pre-Hispanic and modern Canarians. Full article

Background: Monitoring bone mineral density (BMD) in adults is critical for early detection of osteoporosis and prevention of fracture, for which quantitative ultrasound (QUS) is a good non-invasive tool. We examined the associations of QUS measures, including stiffness index (SI) and T-score, with socio-demographic, lifestyle, and anthropometric correlates and risk of subsequent fracture. Methods: Calcaneal QUS was performed using GE’s Lunar Achilles EXPII among 24,651 adults (mean age 59.5 years, 61.7% women) from the China Kadoorie Biobank study. Socio-demographic and lifestyle information was collected using an interviewer-administered electronic questionnaire, and anthropometrics were measured following standard protocols. Incidence of fracture and osteoporosis was recorded via linkage with nationwide health insurance database. Linear and Cox regression analyses were conducted, adjusting for potential confounders. Results: On average, men had higher SI (92.8 vs. 86.0) but lower T-score (−0.85 vs. −0.64) than women. In both men and women, advanced age and smoking were inversely associated with SI and T-score, while physical activity and tea drinking were positively so (p < 0.0001 for all). Except for height, all other anthropometric measures were significantly and positively associated with both BMD measures. With each SD lower SI, the risk of subsequent fracture was 26% (95% confidence interval: 10–44%) and 40% (25–57%) higher in men and women, and the corresponding associations of T-score were identical. Conclusions: Among Chinese adults, the SI and T-score provided by Achilles EXPII had similar patterns and predictive values for subsequent fracture, despite the T-score for men and women not being directly comparable because of gender-specific references used. Future studies are needed to confirm or refute the causality of relationship between lifestyle and anthropometric factors and BMD. Full article

Background: Identifying the optimal bone regions for DNA analysis is critical, as DNA preservation and quality vary significantly across bone types and structures and is defined as intra-bone variability. This study aimed to evaluate the correlation between computed tomography (CT)-measured bone density and DNA preservation in small skeletal elements to identify optimal regions for DNA analysis. Methods: 137 bones from six skeletal elements excavated from a single burial site were analysed using Dual-Source CT (DSCT) to map compact and cancellous regions. DNA was extracted using a demineralisation method and quantified via real-time PCR to assess DNA quantity and degradation. Results: Among 461 bone regions analysed (137 bones; patellae, calcaneus, talus, the navicular bones, the cuboid bone, and the medial cuneiform bone), a significant difference in DNA quantity was observed only in the calcaneus, where the sulcus contained more DNA than the body. No significant differences in the degradation index were detected among bone segments or skeletal elements. Correlations between CT-measured bone density and DNA quantity or degradation index were region-specific. Higher bone density correlated positively with DNA quantity in compact regions of the calcaneus and talus. Regarding degradation, a positive correlation (higher bone density → higher degradation) was observed in the patella’s anterior surface, while a negative correlation (higher bone density → lower degradation) was found in the talus’s sulcus, the opposite side of the talar sulcus, the posterior calcaneal articular facet, and the cuboid’s tuberosity. No significant correlations were found in other bone segments. Conclusions: Our study identified small skeletal elements, particularly the patella and the navicular bone, as promising sources for DNA analysis. While bone density correlated with DNA preservation in some cases, the relationship was inconsistent. Our findings support the use of small bones in forensic and archaeological research and warrant further investigation. Full article

The calcaneus plays a critical role in balance, locomotion, and muscle attachment, making it a key structure for biomechanical adaptations. This study examined interspecies differences between sheep and goats, as well as intraspecies variations among different sheep breeds, in calcaneus morphology. A total of 128 right calcanei were analyzed using 3D geometric morphometric methods to allow detailed assessments of calcaneus shape and size. Among sheep, the Hamdani sheep displayed the largest calcaneus among the breeds, distinguishing them significantly from the others. In contrast, goats had a bilaterally narrower calcaneal body, while sheep featured a more pronounced distal portion that articulates with the talus and a deeper articular surface. Additionally, the sustentaculum tali were more developed in sheep. The bilaterally compressed calcaneal body in goats likely reflects their agility and ability to navigate steep, rocky terrains. In contrast, sheep’s broader and more robust calcaneus may support their grazing lifestyle on flatter terrains, emphasizing their stability and weight-bearing capacity. These findings highlight the functional significance of calcaneal morphology in the locomotor strategies and physical capabilities of goats and sheep, providing valuable insights for comparative anatomy and veterinary science. Full article

The paper presents a detailed gross anatomical description of the elements of the pelvic limb in the African green monkey and provides comparative and differential elements on pelvic limb monkey osteology. The osteometric investigation adds value to the gross morphological and radiological investigation, adjoining metric data to the gross descriptive data set. The main methodology used was the gross morphological investigation, doubled by regular osteometrical and radiographical assessments. For each of the elements, several morphological aspects are described, pointing to the specific and differential aspects that might serve as landmarks in the specific diagnosis of different adaptative changes, related to the type of locomotion. For the pelvis, the aspect of the symphysis, the overall shape of the pelvic inlet, the iliac wing aspect and the acetabular shape are listed as significant elements. The femur has a spherical head with an inferior position of the femoral fovea and a well-developed (tall) greater trochanter, lacking the third trochanter. The medial condyle of the femur is better developed than the lateral one and an evident extensor’s fossa is noted at the level of the distal shaft. The proximal lateral condyloid surface in the tibia is slightly larger than the medial one, with noticeable intercondilar eminences. The fibula is long and unfused with the tibia. Some specific anatomical features are listed only for the talus and calcaneus from tarsals. The study revealed the presence of the gastrocnemius sesamoid bones and the proximal sesamoidi bones as well. Investigation presents a series of osteometrical data with an attempt to show some basic metrical differences among the investigated specimens. Full article

Background/Objectives: Facial bone density, including the jawbone, declines earlier than that of the lumbar spine and calcaneus. Calcium maltobionate is reported to mitigate bone resorption and maintain bone density of the lumbar spine in post-menopausal women, but its effects on facial bone density remain understudied. Therefore, this study compared variations in facial bone mineral density with variations in calcaneal bone mineral density and bone resorption markers among healthy women, examining differences between pre- and post-menopause and the effects of continuous calcium maltobionate intake. Methods: This randomized, double-blind, placebo-controlled, parallel-group trial involved 48 healthy Japanese women aged 30–69 years, divided into two groups. The test food group received tablets containing calcium maltobionate, while the placebo group received tablets containing a maltose and calcium carbonate mixture for 24 weeks. Calcaneal and facial bone densities were measured pre- and post-intervention in both groups. Results: Post-intervention calcaneal bone mineral density and bone resorption marker deoxypyridinoline (DPD) showed no statistical difference between groups in pre-menopausal women. However, in post-menopausal women, the test food group exhibited significantly higher calcaneal bone density and lower DPD levels compared with the placebo group. Facial bone mineral density increased significantly in the test food group compared with the placebo group in post-menopausal participants, with similar trends observed in pre-menopausal participants. Conclusions: Facial bone mineral density could serve as a useful indicator for monitoring bone health from middle age onward. Moreover, continuous calcium maltobionate intake appears to mitigate bone density decline in pre- and post-menopausal women, contributing to osteoporosis prevention (UMIN-CTR ID: 000046391). Full article

Severe adult-acquired flatfoot deformity is widely addressed surgically via the Grice–Green subtalar arthrodesis. Standard radiographic measurements have been reported, but these are limited to planar views. These complex deformities and the relevant corrections after surgery should be assessed in weight-bearing using 3D analyses now enabled by modern cone-beam CT scans. The present study is aimed at reporting these 3D radiographical foot bone alignments and the clinical results for this surgery. Ten patients were treated with the Grice–Green procedure. This implies inserting an autologous bone graft from the proximal tibial into the extra-articular sinus-tarsi to perform a subtalar arthrodesis. Before and after surgery, the patients were assessed based on the clinical range-of-motion and Foot-Function and Posture Indexes. Three-dimensional models of the tibia, calcaneus, talus, navicular, and 1st metatarsus were reconstructed from cone-beam CT scans in a single-leg up-right posture. Relevant longitudinal axes were defined to calculate ten spatial angles. Post-operatively, a significant realignment was observed for seven angles, including corrections lift-up of the talus (on average by 15°) and subtalar joint (13° in 3D), as well as the Meary’s angle (21°). Only few correlations were found between traditional clinical and novel 3D radiographical measurements, suggesting the former only limitedly represent the corresponding real skeletal status, and the latter thus offer the physician a more comprehensive evaluation. The present original analysis from modern cone-beam CT scans shows precisely the correction of foot and ankle bone alignments achieved using the Grice–Green surgical procedure, finally in 3D and in weight-bearing. For the first time, traditional clinical and score system evaluations are reported together with bone orientation and joint angles in the three anatomical planes. Full article

Background/Objectives: Physical activity is widely recognized for its beneficial effects on bone density during adolescence, which could lead to enhanced bone density in later life, thus acting as a health-promoting activity with long-lasting implications. However, not all studies are conclusive regarding the type, intensity, duration, and frequency of the most effective physical activities. This study focuses on combat sports athletes and examines the relationship between their somatic build and heel bone parameters using ultrasound (USG) and their vitamin D3 levels. Methods: The study included 40 male athletes specializing in various combat sports. The measurements of body height, body mass, skinfold thickness, and bone widths at multiple sites were performed to estimate the somatic build. The USG parameters of the heel bone and the blood levels of vitamin D3 were also recorded. Statistical significance was determined using one-way ANOVA, with differences among sports disciplines also examined. Results: The study found significant differences in the body composition and USG bone parameters among athletes from different combat sports (p ≤ 0.05). The calcaneus stiffness index (SI) and speed of sound (SOS) were significantly higher in athletes with normal vitamin D3 levels compared to those with below-normal levels (p = 0.0015 and p = 0.001, respectively). These findings suggest that vitamin D3 may influence bone stiffness and density. Conclusions: The study underscores the importance of maintaining adequate vitamin D3 levels to support bone mineralization in athletes, particularly those training indoors with limited exposure to sunlight. It also highlights the potential of using USG as a non-invasive method to assess bone health, aiding in the optimization of training programs to prevent injuries and improve performance. Full article

Background: Heel pain in children is a common condition. The aetiology can be ascribed to fractures, osteochondrosis, tendinitis, calcaneal-navicular or talo-calcaneal coalition, osteomyelitis, rheumatic diseases, anatomic variants, malignant tumours (osteosarcoma, Ewing’s sarcoma), and benign lesions (bone cyst, aneurismal bone cyst, osteoid osteoma, or exostosis). In particular, this manuscript focuses on a case of calcaneal exostosis in the paediatric age, aiming to highlight its rarity. Osteochondromas are benign tumours of the surface of the bone and the overlying cartilage. They grow until skeletal maturity and can cause stiffness, pain, cosmetic alterations, tendinitis, and neuro-vascular compression. The calcaneus is an extremely rare site for these tumours. Only two case reports of paediatric exostosis of the calcaneus bone are available. Methods: We describe a case of a girl of 16 years of age, affected by multiple cartilaginous exostosis, who presented with a painful mass on the inferior margin of the foot in the calcaneal region, which was diagnosed as an exostosis. The neoformation was excised, and the girl underwent clinical follow-up. Results: The patient was promptly discharged in good condition, and on the 25th postoperative day, she was completely pain-free and allowed weight bearing. Conclusions: In the case of heel pain resistant to conservative treatment, the presence of an osteochondroma should be considered after excluding more common causes. If symptomatic, calcaneal osteochondromas could require surgical excision. Full article

Background: Chondroblastoma (CB), a rare benign bone tumor that produces chondrocytes, often develops in the epiphysis or apophysis of children and young adults. The treatment of these rare tumors is complex. The standard treatment protocol involves curettage with local adjuvants and bone graft or cement application. The authors examined 38 CBs to determine risk factors for local recurrence, complications, and functional outcomes following epiphyseal curettage. Methods: Twenty-two girls and sixteen boys aged 10 to 17 years with histologically confirmed chondroblastoma who arrived at our hospital between January 2000 and June 2021 were reviewed retrospectively. Clinical data, radiographic images, histological results, treatment, functional outcomes, and the local recurrence rate were examined—surgical treatment involved total tumor curettage, followed by bone grafting and adjuvant techniques. Local recurrences have also been reported. Results: The most frequently affected site was the proximal femur. Sites of involvement included the proximal femur in 10 (26.3%) cases, the proximal tibia in 8 (20.8%), the humerus in 5 cases (13.2%), the distal tibia in 4 cases (10.5%), the distal femur in 3 cases (7.9%), the supracetabular region in 3 cases (7.9%), the talus in 1 case (2.6%), the calcaneus in 1 case (2.6%), the scapula in 1 case (2.6%), the lumbar spine in 1 case (2.6%), and the iliac bone in 1 (2.6%) patient. The mean follow-up was 144.2 months (24 to 276). The local recurrence rate was 7.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 28.3 points (17 to 30). The mean duration of symptoms at presentation was 5.8 (range, 1 to 28) months. Conclusion: Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. In a relatively small proportion of cases, long-term complications and recurrence can occur due to growth plate damage and late diagnosis. In patients admitted to the pediatric clinic with pain, which is often accompanied by localized edema and joint effusion, early detection via advanced radiological scans (X-ray, CT, or MRI) may prevent delays in diagnosis. Full article

Background: There is a growing interest in bone tissue MRI and an even greater interest in using low-cost MR scanners. However, the characteristics of bone MRI remain to be fully defined, especially at low field strength. This study aimed to characterize the signal-to-noise ratio (SNR), T₂, and T₂* in spongy bone at 0.3 T, 1.5 T, and 3.0 T. Furthermore, relaxation times were characterized as a function of bone-marrow lipid/water ratio content and trabecular bone density. Methods: Thirty-two women in total underwent an MR-imaging investigation of the calcaneus at 0.3 T, 1.5 T, and 3.0 T. MR-spectroscopy was performed at 3.0 T to assess the fat/water ratio. SNR, T₂, and T₂* were quantified in distinct calcaneal regions (ST, TC, and CC). ANOVA and Pearson correlation statistics were used. Results: SNR increase depends on the magnetic field strength, acquisition sequence, and calcaneal location. T₂* was different at 3.0 T and 1.5 T in ST, TC, and CC. Relaxation times decrease as much as the magnetic field strength increases. The significant linear correlation between relaxation times and fat/water found in healthy young is lost in osteoporotic subjects. Conclusion: The results have implications for the possible use of relaxation vs. lipid/water marrow content for bone quality assessment and the development of quantitative MRI diagnostics at low field strength. Full article

Introduction: Flatfoot is a condition commonly seen in children; however, there is general disagreement over its incidence, characterization and correction. Painful flatfoot accompanied with musculoskeletal and soft tissue problems requires surgery to avoid arthritis in adulthood, the most common surgical approach being two osteotomies to the calcaneus and medial cuneiform bones of the foot. Objectives: This study focuses on the parametrization of these two bones to understand their bone morphology differences in a population sample among 23 normal subjects. Population differences could help in understanding whether bone shape may be an important factor in aiding surgical planning and outcomes. Methods: A total of 45 sets of CT scans of these subjects were used to generate surface meshes of the two bones and converted to be iso-topological meshes, simplifying the application of Generalized Procrustes Analysis and Principal Component Analysis, allowing the main sources of variation between the subjects to be quantified. Results: For the calcaneus, 16 Principal Components (PCs) and, for the medial cuneiform, 12 PCs were sufficient to describe 90% of the dataset variability. The quantitative and qualitative analyses confirm that for the calcaneus PC1 describes the Achilles attachment location and PC2 largely describes the anterior part of the bone. For the medial cuneiform, PC1 describes the medial part of the bone, while PC2 mainly describes the superior part. Conclusion: Most importantly, the PCs did not seem to describe the osteotomy sites for both bones, suggesting low population variability at the bone cutting points. Further studies are needed to evaluate how shape variability impacts surgical outcomes. Future implications could include better surgical planning and may pave the way for complex robotic surgeries to become a reality. Full article