Eponymous foot injuries • LITFL • Medical Eponym Library

Eponymythology: The myths at the rear of the history

Eponymythology linked with symptoms, indicators, investigation and management of foot accidents. We evaluation similar eponyms, the particular person at the rear of their origin, their relevance now, and present day terminology

Jones Fracture (1902)

Fracture of the proximal diaphysis of the 5th metatarsal, distal to the tuberosity, with no joint involvement caused by foot inversion / twisting and repetitive pressure. Initially described by Robert Jones in 1902 right after Jones sustained the injury although dancing. He posted his circumstance report and that of 5 very similar accidents precisely noting that the fracture is caused by ‘oblique violence

Whilst dancing, I trod on the outer aspect of my foot, my heel at the instant staying off the ground. One thing gave way midway down my foot, and I at the moment suspected a rupture of the peroneus longus tendonI hobbled down-stairs to my colleague…to X-ray my foot. This was finished, and the fifth metatarsal was found fractured about a few-fourths of an inch from its base.

Jones R, Ann Surg. 1902: 697

Jones fracture and existing classification
Jones Fracture 5th metatarsal fracture
Jones fracture
Köhler ailment I (1908)
Köhler disease 150

Köhler ailment is a rare, self-limiting, avascular necrosis (osteonecrosis) of the navicular bone in small children. Initially described by German radiologist Alban Köhler in 1908.

Be aware: Grownup onset osteonecrosis of the tarsal navicular is regarded as Müller-Weiss syndrome (MWS) (also Brailsford ailment).

Freiberg infraction (1914)
Freiberg infraction 150

Osteochondrosis of the metatarsal heads (usually the 2nd metatarsal head) characterised pathologically by subchondral bone collapse, osteonecrosis, and cartilaginous fissures. Freiberg infraction is a lot more widespread in gals and most typically manifests all through adolescence (aged 10-18 decades). Bilateral presentation in 10% of conditions. Lead to unfamiliar and in all probability multi-factorial. Large-heeled sneakers have been implicated as a causative component.

In 1913, Freiberg introduced a paper to the Southern Surgical and Gynecological Affiliation. He described the conditions of 6 young gals presenting with a unpleasant limp and irritation localized to the second metatarsal, the 1st affected person presenting in 1903. Freiberg utilized applied the phrase ‘infraction’ as the diagnosis (archaic phrase for fracture with no displacement implying trauma as the trigger).

I felt justified in the diagnosis of infraction of the distal conclude of the second metatarsal, a ailment which I have hence much unsuccessful to find described in the literature.

Freiberg 1914

Köhler termed out Freiberg for an ‘incomplete‘ description of ‘metatarsal infraction‘ lacking mention of the widening of the joint line thickening of the shaft of the metatarsal and obliteration of the neck. System often referred to as Köhler ailment II

Freiberg primary description

Calcaneal angles

Böhler angle (1931)
Bohler-Angle-1931-calcaneal-fracture-tuber-angle-2-150

The angle in between line from greatest point of anterior method to greatest point of posterior aspect as well as line tangential to remarkable edge of tuberosity calculated on lateral foot x-ray. Normally 20-40°. If < 20° represents a calcaneal fracture (or more specifically a collapse of the posterior facet)

Normally there exists, between the upper contour of the tuberosity of the os calcis and the line uniting the highest point of the anterior process with the highest point of the posterior articular surface, an angle of thirty to thirty-five degrees. This angle I have named face is driven downward the the “tuber-joint angle“. In fractures of the os calcis this angle becomes smaller, straight, or even reversed

Böhler 1931

Boehler angle
Gissane angle (1946)
Critical-angle-of-Gissane-150

Gissane Angle [aka *critical angle; critical angle of Gissane], like the Böhler angle, can be used to help determine the presence of a calcaneus fracture on a radiograph.

The angle is measured on lateral foot radiograph formed by the intersection of the lines drawn along the downward (posterior facet) and the upward (anterior process) slopes of the calcaneal superior surface. Normal range (120-145°).

Critical Angle of Gissane
Critical angle of Gissane 2

Joints, lines and amputations

Chopart joint (1792)
Chopart fracture dislocation

The mid-tarsal joint is also known as the Chopart joint. Chopart disarticulated this joint when performing forefoot amputations (Chopart amputation). A Chopart fracture-dislocation involves a midtarsal joint (talonavicular and calcaneocuboid) dislocation with associated fractures.

Chopart’s student, Lafiteau provided the first description of Chopart’s method of partial amputation of the foot and Chopart’s joint in Volume IV of Fourcroy ‘La médecine éclairée par les sciences physiques‘ in 1792. The fracture-dislocation was attributed at a later date.

Chopart amputation Garrè, 1922
Lisfranc joint (1815)
Lisfranc joint injury

Lisfranc is eponymously associated with his tarsometatarsal forefoot amputation (Lisfranc amputation). However, Lisfranc was not the first to describe the procedure, with William Hey (1736-1819) first performing the procedure in 1799 and publishing in 1803.

In 1815, Lisfranc described and refined the disarticulation of the forefoot at the tarsometatarsal joint complex which joins the forefoot and midfoot (Lisfranc joint). Lisfranc defined the coup de maître of his disarticulation being the incision of the interosseous ligament (subsequently referred to as the Lisfranc ligament).

The Lisfranc ligament complex includes the dorsal, interosseous, and plantar ligaments which connect C1 (medial cuneiform) to M2 (2nd metatarsal base). Lisfranc injury refers to disruption of the tarsometatarsal joint. Injuries range from sprain (minor diastasis) through to tarsometatarsal fracture-dislocation.

Lisfranc’s description of amputation through the tarsal-metatarsal joints requires several pages to describe it, but it took only 1 minute for him to perform it — not too short a time for the unanesthetized patient

Cassebaum WH, 1963

Lisfranc amputation Garrè, 1922
Syme amputation (1831)
Extrartikulation nach Syme
Pirogov amputation (1854)

Amputation of the ankle joint in which the posterior process of the calcaneus is retained in the skin flap and opposes the distal cut of the tibia.

More…

Morton metarsalgia (1876)

In 1876 Morton described a series of 15 patients of his own and one of a colleague who all shared the same complaints, which he termed metatarsalgia and which he attributed to an injury to the fourth metatarsophalangeal joint.

  • Morton neuroma – benign, perineural fibrotic lesion of a common digital nerve
  • Morton neuralgia, metatarsalgia (1876)

Note: In 1835, Filippo Civinini of Pistoja (1805-1844) described in the anatomic letter entitled “Su un nervoso gangliare rigonfiamento alla pianta del piede” (“On the neural ganglion swelling of the foot sole“) – the fusiform (gangliare) swelling (rigonfiamento) in the common plantar digital nerve to the third interspace. However there was no clinical description (metarsalgia) involved in this report.

In 2005 Larson wrote:

Review of the historical writings demonstrates that Morton did not describe a painful condition related to a common plantar digital nerve of any web space but rather a painful condition related to the fourth metatarsophalangeal joint. He treated this painful condition by resection of the joint and the nerves, probably on both sides of that joint.

Larson 2005

eponymictionary CTA

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