Introduction
A synovial joint (a joint that allows bones to move in opposition to one another) in the foot is called the talocalcaneonavicular joint. The talocalcaneonavicular joint, which also includes the anterior portion of the talocalcaneal joint, may share the same joint space with the talonavicular joint. It is created between the talus, navicular bone, and calcaneus, three of the foot's tarsal (short-angulated) bones. This joint belongs to a kind of articulation known as the intertarsal ball and socket.
What Is the Anatomy of the Talocalcaneonavicular Joint?
Together with the plantar calcaneonavicular and calcaneonavicular parts of the bifurcate ligament, the calcaneus and navicular bone form a "socket" that articulates with the convex head and plantar surface of the talus. The calcaneocuboid portion of the bifurcate ligament, the plantar calcaneonavicular ligament, and the dorsal talonavicular ligament are the three main ligaments that are connected to this joint.
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Articulating Surfaces: The talocalcaneonavicular joint, as its name implies, is a ball-and-socket joint made of three tarsal bones (the talus, calcaneus, and navicular) and the surrounding ligamentous tissues. The talus has five articular facets (surfaces) that work together to create this joint. They consist of the following:
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On the talar neck is the middle facet of the calcaneus.
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On the talar head is the anterior facet of the calcaneus.
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Navicular articular facet.
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Facet for the plantar calcaneonavicular ligament.
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Facet for the bifurcate ligament's calcaneonavicular portion.
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The socket created by the navicular bone, calcaneus, plantar calcaneonavicular ligaments, and the calcaneonavicular portion of the bifurcate ligament serves as the point of articulation for the articular facets. The term "acetabulum pedis" is also used to describe this foot socket. The anterior part of the acetabulum is made up of the navicular bone's concave proximal articular facet. The middle and anterior talar articular facets, which are located on the anterior (front) portion of the calcaneus, make up the posterior (rear) part. The central regions consist of the bifurcate ligament's calcaneonavicular fibers and the plantar calcaneonavicular ligament. They are situated laterally and medially, respectively.
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Ligaments and Joint Capsules: The dorsal (part away from the trunk) and proximal (part towards the trunk) portions of the articulation contain the talocalcaneonavicular joint capsule. The dorsal component of the capsule fuses laterally with the calcaneonavicular portion of the bifurcate ligament and medially with the medial collateral and plantar calcaneonavicular ligaments as it extends from the neck of the talus to the dorsal margin of the proximal articular surface of the navicular bone. The tarsal sinus contains the proximal, more developed portion of the joint capsule. Along with the anterior portion of the talocalcaneal joint capsule, this portion (sometimes referred to as the "real" joint capsule) creates the powerful talocalcaneal interosseous ligament. The synovial membrane lines the joint capsule, which helps lubricate the joint to enable bone movements. Three ligaments support this joint:
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Dorsal Talonavicular Ligament - The talonavicular ligament, also known as the dorsal talonavicular ligament, is a wide band that spans the dorsal portion of the talus neck and the navicular bone. The tendons of the muscles that extend the foot are positioned inferior to this ligament. According to some authors, this ligament has distinct superficial and deep sections, with the former being the longer and broader of the two.
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Plantar Calcaneonavicular Ligament - The anterior portion of the sustentaculum tali connects to the plantar surface of the navicular bone along with the plantar calcaneonavicular ligament, also referred to as the spring ligament. Several writers claim that this ligament is divided into an inferior component and a superomedial part. The medial longitudinal foot arch's stability is also maintained in part by the spring ligament. This ligament is crucial in the emergence of acquired "flat foot" deformity, which is characterized by the absence of the longitudinal arch of the foot.
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Calcaneonavicular Part of a Bifurcate Ligament - The calcaneocuboid and the calcaneonavicular sections are formed by the bifurcate ligament, a Y-shaped structure that extends from the dorsolateral surface of the calcaneus. The calcaneocuboid part attaches to the medial aspect of the cuboid, as suggested by its name, while the calcaneonavicular part attaches to the lateral aspect of the navicular. Since its dorsal surface contributes to the creation of the middle half of the acetabulum pedis, the calcaneonavicular portion of this ligament is important for the talocalcaneonavicular joint.
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What Are the Nerve and Blood Supply to the Talocalcaneonavicular Joint?
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Nerve Supply - The medial plantar nerve supplies innervation to the inferomedial portion of the talocalcaneonavicular joint, whereas the dorsomedial, dorsal, and lateral aspects are supplied by branches of the deep (peroneal) fibular nerve. A branch of the tibial nerve is the medial plantar nerve, while the deep fibular nerve is a branch of the common fibular (peroneal) nerve.
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Blood Supply - The following articular branches of arteries supply the subtalar joint with blood the posterior tibial artery and the fibular (peroneal) artery.
What Are the Movements Facilitated in the Talocalcaneonavicular Joint?
This joint moves in sync with the subtalar joint, which provides the motions. The following motions are possible due to this articulation:
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Foot adduction (inward movement) and supination (inadequate inward roll of the foot after landing).
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Foot pronation (a typical and natural foot movement that takes place during foot landing during running or walking) and foot abduction (movement of rotation of the lateral or away from the midline).
What Are Talocalcaneonavicular Joint Abnormalities?
Among the disorders that could result in talonavicular arthritis are inflammatory diseases, a septic talonavicular joint, primary osteoarthritis, injury and trauma like a navicular fracture, and avascular necrosis (the lack of blood causing bone tissue to die) of the navicular or talus. Talonavicular dislocations are very uncommon injuries that are brought on by the forefoot being pressed into severe abduction or adduction. They frequently go hand in hand with calcaneocuboid dislocation (often temporary) and calcaneal fractures (and are then called trans calcaneal talonavicular dislocations).
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Arthritis (inflammation of joints), with its accompanying pain and functional dysfunction, can develop when the articular cartilage in the joint is damaged. Rheumatoid arthritis, posttraumatic arthritis, and osteoarthritis of the joint are other types of arthritis that can affect the talonavicular joint and cause pain and functional dysfunction.
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Due to the forces put on the midfoot, the joint is prone to strains and sprains, especially when engaging in high-impact sports like running on hard surfaces while wearing inappropriate footwear.
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Collagen vascular disorders (an autoimmune disease where the body’s immune system attacks its own tissues), infection, villonodular synovitis (a condition causing painful swelling in the joints), and Lyme disease (bacterial infection) are less frequent causes of talonavicular joint discomfort caused by arthritis.
What Are the Symptoms of Talocalcaneonavicular Joint Abnormalities?
The anterior ankle and midfoot are the only locations where patients with talonavicular joint pain due to arthritis and collagen vascular disease-related joint pain report pain. The pain is exacerbated by activity, particularly when the talonavicular joint is inverted or everted, with some relief coming from rest and heat. It is described as agonizing and never-ending. Sleep disturbance is common when the patient rolls over onto the hurt talonavicular joint. During the physical examination, crepitus (popping or clicking sound in the joint) may be detected. Some patients report a grating, catching, or popping feeling with joint range of motion. With the discomfort brought on by the numerous pathological diseases of the talonavicular joint frequently comes functional impairment. Patients frequently experience growing difficulties carrying out their everyday routines, and walking, climbing stairs, and walking on uneven terrain are particularly challenging. The patient's functional impairment may develop, and muscle wasting may take place if the pathologic process causing their pain symptoms is not appropriately managed.
How Are Talocalcaneonavicular Joint Abnormalities Diagnosed?
All patients who report talonavicular pain should have a plain radiograph taken because the patient may experience additional local pathology as talonavicular pain in addition to intrinsic talonavicular disease. Further testing, such as tests for the total blood count, sedimentation rate, and antinuclear antibodies, may be necessary depending on the clinical presentation of the patient. If avascular necrosis (the lack of blood causing bone tissue to die) or a meniscal tear (a knee tissue injury) is suspected or if the diagnosis is not obvious, an MRI (magnetic resonance imaging), CT (computed tomography), or ultrasound of the talonavicular joint is advised.
How Are Talocalcaneonavicular Joint Abnormalities Treated?
The optimal course of treatment for acute infectious arthritis of the talonavicular joint includes early diagnosis, synovial fluid culture, sensitivity testing, and the quick beginning of antibiotic therapy. Although talonavicular discomfort caused by collagen vascular disorders (an autoimmune disease where the body’s immune system attacks its own tissues) responds remarkably effectively to ultrasound-guided intra-articular injection of the talonavicular joint, the collagen vascular illnesses typically manifest as poly arthropathies (arthritis of five or more joints) rather than a monoarthropathy localized to the talonavicular joint.
Conclusion
The talocalcaneonavicular joint is a subtalar joint complex of the foot used in various foot movements. In order to maintain good foot mechanics and function, the talocalcaneonavicular joint is crucial. It enables the foot's inversion and eversion motions, which are necessary for weight-bearing activities like walking and running. Pain, instability, and mobility restrictions can be brought on by a malfunction or injury to this joint. Timely diagnosis and appropriate treatment for talocalcaneonavicular joint abnormalities may have a positive outcome.
