|Year : 2022 | Volume
| Issue : 4 | Page : 211-216
A morphological and morphometric study of talus in relation to ankle implant
Archana Singh1, Arun Singh2
1 Associate Professor, Department of Anatomy, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
2 Professor and Head, Department of Community Medicine, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
|Date of Submission||10-Aug-2022|
|Date of Decision||07-Sep-2022|
|Date of Acceptance||16-Sep-2022|
|Date of Web Publication||29-Oct-2022|
Department of Anatomy, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: The talus is the second-largest tarsal bone. Morphometric analysis of both sides of the talus is necessary to know the right–left symmetry for implant design and for mechanical testing for surgeons and orthopedicians. Hence, this study was done to observe the facets of the inferior surface of the talus and to measure the morphometric parameters of the talus. Methodology: This cross-sectional study was carried out on a total of 66 dry adult human tali (33 of the right side and 33 of the left side). Morphologically, the types of articular facets on the head of the talus were assessed and classified as done by Boyan et al. as -Type A1, Type A2, Type A3, Type A4, Type B, and Type C. Morphometric evaluation of talus was done with the help of digital vernier caliper, and anteroposterior distance (length), maximum transverse width, vertical height of talus, length of sulcus tali, width of sulcus tali, depth of sulcus tali, and head–neck length (HNL) of talus were measures. Neck-body angle of the talus was also measured. Statistical analysis was performed, and data were expressed as mean, minimum, maximum values, and standard deviation. Results: In the present study, Type A1 facet was found in 51.5% of the talus, in 28.8% of Type A2, in 12.1% of Type A3, in 1.5% of Type A4, in 6.5% of Type B, and none of Type C facet found. The mean length, width, and height of the talus were 52.74 ± 4.39 mm, 31.45 ± 2.74 mm, and 25.93 ± 2.64 mm, respectively. The width, length, and depth of sulcus tali were 5.9 ± 1.02 mm, 21.88 ± 3.07 mm, and 5.52 ± 1.25 mm, respectively. HNL of talus was 15.72 ± 2.73 mm, and neck-body angle of the talus was 153.88° ±4.64°, respectively. No statistically significant difference was found on both sides except neck-body angle, where P = 0.031 (P < 0.05). Conclusion: The values of neck-body angle of the right side talus were higher than the left side, and the difference was statistically significant. Hence, the measurement of this study may help the surgeons to choose the appropriate size of the prosthesis for talus implantation surgeries.
Keywords: Articular facets of the talus, head-body angle, sinus tarsi, sulcus tali
|How to cite this article:|
Singh A, Singh A. A morphological and morphometric study of talus in relation to ankle implant. Natl J Clin Anat 2022;11:211-6
|How to cite this URL:|
Singh A, Singh A. A morphological and morphometric study of talus in relation to ankle implant. Natl J Clin Anat [serial online] 2022 [cited 2023 Feb 6];11:211-6. Available from: http://www.njca.info/text.asp?2022/11/4/211/359872
| Introduction|| |
The skeleton of the foot has seven bones, and the talus is one of the largest tarsal bones after calcaneum. It looks like a tortoise. It has three parts: head, neck, and body. It forms joint between the foot and leg. Above, it articulates with the inferior surface of the lower part of the tibia and on sides by medial and lateral malleolus and forms the ankle joint. Below, it forms the subtalar joint with the calcaneum, and anteriorly it forms talonavicular joint with the navicular bone. The talus forms the keystone of the medial longitudinal arch of the foot, which helps in the distribution and transmission of weight to the plantar arch.
Three articular facets are present on the inferior surface of the head of the talus which are separated from each other with smooth ridges. The posterior facet is oval in shape and the largest one is which articulates with the facet on sustentaculum tali of the calcaneum. The anterolateral facet articulates with the anterior articular facet of the calcaneum, and a medial articular facet is related to the spring ligament.
The neck of talus lies between the head and body. The long axis of the neck is inclined medially. The inferior surface of the neck has a deep sulcus on its medial side known as sulcus tali. These sulcus tali form a tunnel known as sinus tarsi, with the sulcus calcanei present on the calcaneum. The angle between the long axis of the neck and the long axis of body of the talus is called as neck-body angle, which is about 150° in adults and it is about 130°–140° at birth.
Talus forms an axis for the movement at the ankle joint. During locomotion, several different forces applied over the talus. Hence, the patterns of stress over the talus influence the morphometric dimensions and articular surface areas. That is why the morphometric analysis of both sides of the talus is necessary to know the right–left symmetry and may help in prosthesis design and also help the surgeons to choose the appropriate size of the prosthesis for talus implantation surgeries.
| Materials and Methods|| |
The present cross-sectional study was done on 66 dry human tali in the Department of Anatomy, Rohilkhand Medical College and Hospital, Bareilly, UP (India), from September to December, 2020. The sample size was calculated as 66 with reference of the study of Arora et al., with a prevalence of 79%, with a 95% confidence interval (Z = 1.96), and a precision of 10%. After excluding the damaged bones or showing some pathological deformities, a total of 66 tali were selected for the study from the museum of anatomy department. The Institutional Ethical Committee Approval was sought for the study (IEC/IRB No. IEC/11/2020).
Articular facets on the inferior surface of the head of the talus were assessed and classified as done by Boyan et al. Anterior and middle articular facets were observed in Type A, and according to the extent of their separation, it was classified into four subtypes – If the distance is <2 mm: Type A1, if the distance is between 2 and 5 mm: Type A2, if the distance is >5 mm: Type A3, if only one facet is there: Type A4, if there is no separation in between two facets: Type B, and in Type C anterior, middle and posterior facets were not separated.
Morphometric evaluation of talus was done with digital Vernier caliper with an accuracy of 0.01 mm. Following measurements were taken in the study by Sumati and Phatak in Gujarati population in India.,
Anteroposterior distance (talus length-TL) - was measured from the most anterior point to the most posterior point of the talus. The maximum transverse width (talus width-TW) - was measured from the most medial point to the most lateral point of the body of the talus. The vertical height of talus (talus height-TH) was measured from the most superior to the most inferior points of the talus body [Figure 1].
|Figure 1: Various measurement of talus. (a) Anteroposterior TL, (b) TW, (c) Vertical TH. TL: Length of talus, TW: Width of Talus, TH: Height of talus|
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The length of sulcus tali (STL) was measured from its medial margin to the lateral margin. The width of sulcus tali (STW)was measured from anterior margin to posterior margin. The width of sulcus tali (STW) was measured from the margin of the sulcus to its floor [Figure 2].
Head–neck length (HNL) was taken from the most anterior point of the head to the midpoint on the anterior margin of the trochlear surface. Neck body angle was measured between long axis of the neck and long axis of the body of talus with the help of goniometer. [Figure 3].
The collected data were tabulated in Microsoft Excel worksheet, and analysis was performed using software SPSS version 22 (IBM Corp., Armonk, NY). All data were expressed in mean, minimum, maximum values, and standard deviation. Student's t-test was applied to know the significant differences exist, if any, in between the right and left mean measurements, and P < 0.05 was taken as significant.
| Results|| |
Of 66 tali, 33 tali were of the right side and 33 tali were of the left side. In this study, according to the distance of facets present on the inferior surface of the head of the talus, 51.5% of talus had Type A1, 28.8% had Type A2, 12.1% had Type A3, 1.5% had Type A4, and 6.5% had Type B facets. None of the talus had Type C facet [Figure 4] and [Table 1].
|Figure 4: The types of articular facets present on the inferior surface of head of talus|
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|Table 1: Types of facets present on the inferior surface of the head of the talus|
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In the present study, the mean anteroposterior length [TL] of the talus was 52.74 ± 4.39 mm (right - 52.81 ± 4.67 mm, left - 52.67 ± 4.17 mm), width of the talus was 31.45 ± 2.74 mm, height was 25.93 ± 2.64 mm, the width of sulcus tali was 5.9 ± 1.02 mm, length of sulcus tali was 21.88 ± 3.07 mm, depth of sulcus tali was 5.52 ± 1.25 mm, HNL of talus was 15.72 ± 2.73 mm, and neck-body angle of the talus was 153.88° ±4.64° [Table 2]. The mean, minimum, and maximum values of the right and left sides of the talus are given in [Table 3].
|Table 2: Minimum, maximum, and mean values of measured parameters of the talus|
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|Table 3: Minimum, maximum, and mean values of various morphometric parameters of both the sides of the talus and t-value and P value (n=33)|
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The values of morphometric measurements of both sides were compared using t-test. t-value and P values are given in [Table 3]. No statistically significant difference was found on both sides' measured values except neck-body angle, where P = 0.031 (P < 0.05).
| Discussion|| |
The knowledge of the anatomical features of the talus is very important, because restoration of the normal anatomy is very important during injuries of the talus to prevent the development of secondary pathology and morbidity.
In 51.5% of the talus, Type A1 facet was found; in 28.8% of talus, Type A2 facet was present; in 12.1% of cases, Type A3 facet was found; in 1.5% of talus, Type A4 facet was noted; and type B was found in 6.1% of the talus in the present study. Bilodi reported Type A1 in 5%, Type A4 in 10%, Type B in 66.6%, and Type C in 18.4% of talus; Lee et al. in the Korean population reported Type A1 facet in 9.2%, Type A4 in 30.3%, and Type B in 60.5% of the talus. Boyan et al. in the Turkish population observed Type A2 facet in 1.7% and Type B in 98.3% of talus. In the present study, Type A1 facet was observed in a very high percentage, while other researchers reported Type B facet as more common in their studies,,,, [Table 4].
|Table 4: Percentage of type of articular facets on the inferior surface of the head of the talus reported by different authors|
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In the present study, the length of the right talus was 52.81 ± 4.67 mm and the left talus was 52.67 ± 4.17 mm. There was no significant difference in the length of talus of the right and left sides. Almost similar values were reported by Koshy et al., Lee et al., Boyan et al., Omar et al., Aparna et al., and Gautham et al. whereas Kavya et al. (radiological study) and Otag reported higher values for talar length [Table 5].
|Table 5: Mean length, width, and height of the talus measured by different authors|
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In the present study, the mean width of the right talus was 31.19 ± 2.79 mm and of left side width was 31.7 ± 2.7 mm, and the total mean width was 31.45 ± 2.74 mm, which was smaller than the values reported by other authors.,,,,,, Kavya et al. reported that the mean width of the talus of the right side was 30.83 ± 4.08 mm and on the left side was 30.99 ± 4.23 mm (in the radiological study), which was almost similar to the present study [Table 5].
In the present study, the mean height of the talus on the right side was 26.15 ± 2.81 mm, and of the left side, it was 25.72 ± 2.47 mm. Higher values for height were reported by Kavya et al., Otag, Omar et al.,and Aparna et al. [Table 5].
In the present study, the mean value of the width of sulcus tali was 5.9 ± 1.02 mm, the length of sulcus tali was 21.88 ± 3.07 mm, and the mean depth of sulcus tali was 5.52 ± 1.25 mm [Table 2]. Various measurements of sulcus tali of the present study were almost similar to the values of studies conducted by Koshy et al., Boyan et al., Gautham et al.,and Jung et al. [Table 6].
|Table 6: Various measurements of sulcus tali and neck-body angle of the talus reported by different studies|
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The mean value of HNL of talus was measured as 15.72 ± 2.73 mm in the present study, which was smaller than the measured value of Bidmos and Dayal et al. in south African talus, Sakaue in Japanese, Lee et al. in Korean, and Sumati and Phatak [Table 7] in Indian talus.
On the right side, neck-body angle of talus was 154.94°, and on the left, it was 152.81° in the present study, which was similar to values reported by Gautham et al. [Table 6]. There was significant difference between the right and left side angles. It was higher on the right side, which may be due to different walking habits and lifestyle patterns.
| Conclusion|| |
In the present study, the incidence of Type A articular facets present on the inferior surface of the head of the talus was more, and there was no Type C articular facet observed, but other authors reported Type B facet with a higher incidence. This may be due to racial, genetic, climatic, environmental, and nutritional differences. In morphometry of talus, there were no significant differences found between the parameters of both the right and left sides except neck-body angle, which was higher on the right side. Hence, this may help orthopedic surgeons to choose the correct size for the talus during constructive surgeries and prosthetic surgeries. The other side of the talus of the same person can be taken into account for choosing the right size of the talus during such kind of procedures.
The sample size was small, and this kind of study can be done with the radiological study.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]