Introduction. The exact action of the Peroneus Longus muscle on the foot is not fully understood. It is involved in a number of pathological processes like tendonitis, tenosynovitis, chronic rupture and neurological conditions. It is described as having a consistent insertion to the base of the first metatarsal, but there have also been reports of significant variations and additional slips. Our aim was to further clarify the anatomy of the main insertion of the Peroneus Longus tendon and to describe the site and frequency of other variable insertion slips. Methods and Materials. The course of the distal peroneus longus tendon and its variable insertion was dissected in 12 embalmed, cadaveric specimens. The surface area of the main insertion footprint and angle of insertion was measured using an Immersion Digital Microscribe and 3D mapping software. The site and frequency of the other insertion slips is also presented. Results. There was a consistent, main insertion to the infero-lateral aspect of the first metatarsal in all specimens. The only additional slip was to the medial cuneiform. This did not increase the total footprint. Discussion. The main footprint of the Peroneus Longus tendon is on the first metatarsal. There was an additional slip to the medial cuneiform in 33% of our specimens. Although we are unsure about the significance of this additional slip, we hope it will lead to a better understanding of the mechanism of action of this muscle and its role both in the normal and pathological foot

Introduction:. The dorsal closing wedge calcaneal osteotomy has been described for the treatment of insertional pathology of the tendo-achilles. The aim of this study was to evaluate the efficacy of the technique using outcome measures. Method:. This was a prospective case series. Patients were included if they had tendo-achilles insertional pathology (calcific tendonitis, bursitis or Haglund's deformity). A short extended lateral approach was used and a 1 cm dorsally based closing wedge osteotomy of the calcaneus performed. Fixation was with 2 staples. Patients were scored pre-operatively and at 6 and 12 months post-operatively using the VISA-A and AOFAS ankle-hindfoot scores. Results were analysed with the paired student t-test. Results:. Twenty five feet in 23 patients were enrolled in the study February 2011 – May 2013. 22 patients underwent the osteotomy (9 males and 14 females). Average age was 47.2 years (range 19–62 years). 12 feet have been followed up for 1 year, 6 for 6 months, 5 less than 6 months. Average VISA-A improvement was 27.87 points (−13–71) at 6 months p=0.001 and 38 (−13–81) at 12 months p=0.001. Average AOFAS improvement was 11 points (−8–31) at 6 months p=0.005 and 11 (−18–42) at 12 months p=0.04. 82.3% of patients would have the procedure again. Complications included minor wound problems (3), sural nerve symptoms (1) and plantar fasciitis (3). All complications have resolved. Conclusion:. The results of this study show that the use of the Zadek osteotomy of the calcaneus can provide consistent symptomatic relief from insertional Achilles pathology by altering the biomechanics of the tendon without disrupting the bursa. There is a small risk of minor complications, which should be included in the consent process

We report an audit of 208 patients with a mean age of 39 years (16 to 65) attending the Orthopaedic Assessment Unit at the Wellington Hospital between January 2006 and December 2007 with an injury of the tendo Achillis requiring immobilisation in a cast. Information on assessment of venous thromboembolism (VTE) risk, prophylactic measures and VTE events for all patients was obtained from the medical records. A VTE risk factor was documented in the records of three (1%) patients. One of the 208 patients received aspirin prophylaxis; none received low molecular weight heparin. In all, 13 patients (6.3%, 95% confidence interval 3.4 to 10.5) developed symptomatic VTE during immobilisation in a cast, including six with a distal deep-vein thrombosis (DVT), four with a proximal DVT, and three with a confirmed pulmonary embolus. This incidence of symptomatic VTE is similar to that reported following elective hip replacement.

We propose that consideration is given to VTE prophylaxis during prolonged immobilisation of the lower limbs in a cast, to ensure that the same level of protection is provided as for patients undergoing elective hip replacement.