Foot and Ankle Surgery最新文献

Background: The foot and ankle ability measure (FAAM) scale is a patient-reported outcome measure used to assess lower extremity functional status in a variety of musculoskeletal disorders. It was first created in English (E-FAAM) to gauge its applicability across several languages, and other translations are accessible in different languages.

Objectives: This study aimed to translate the English version of the FAAM into Hindi (H-FAAM), evaluate its content validity, conduct cross-cultural adaptation, and assess its test-retest reliability.

Method: Following Beaton guidelines, the translation process involved forward and backward translations by two bilingual translators and a pain specialist, with approval from the original developers. Content validation was conducted using the Delphi method, involving 10 experts with over five years of experience. Cross-cultural adaptation was assessed with 30 outpatient participants who provided feedback on the clarity and relevance of the H-FAAM items. Test-retest reliability was evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC) in 51 patients, with responses collected at two time points.

Results: Of the 21 items in the H-FAAM, 19 achieved universal agreement (100% consensus), while two items received 80% agreement, indicating strong content validity overall. Cross-cultural adaptation was well-received, with 28 out of 30 patients providing positive feedback on the clarity and understanding of the scale. Test-retest reliability was excellent, with Cronbach's alpha and ICC values of 0.94 CONCLUSION: The Hindi version of the FAAM (H-FAAM) demonstrated excellent content validity and test-retest reliability, making it a reliable tool for assessing in native Hindi-speaking populations.

Background: First metatarsophalangeal joint arthrodesis (FMTPA) reliably treats severe hallux deformities. While fixation techniques differ biomechanically, there is no evidence that this influences clinical outcomes. This study compares clinical and radiologic results across three fixation methods.

Methods: One hundred and ten FMTPA were performed, followed for a mean of 41 months (range, 12-156). Plate-and-screws were used in 74 feet, staples in 28 and crossed-screws in 8. Diagnoses included advanced hallux rigidus (72%), hallux valgus with severe deformity (19%) and rheumatoid foot with advanced osteoarthritis (9%). Clinical outcomes included transfer metatarsalgia, pain and functionality (assessed with the European Foot and Ankle Society (EFAS) score). Radiological analysis studied union rate and hallux alignment, assessed using the hallux valgus (HVA), intermetatarsal (IMA) and dorsiflexion angles (DFA) of the first metatarsophalangeal joint.

Results: Twenty-five patients (23%) experienced pain in the operated hallux and 22 (20%) developed transfer metatarsalgia. Mean EFAS score was 29 ± 6, with no differences between techniques (p = 0.95). Eleven patients showed nonunion (10%), without differences (p = 0.46), but 3 patients needed revision surgery due to symptoms. Mean HVA was 10.4º ± 10º, with no differences between groups (p = 0.18) and mean IMA was 6º ± 3º, also with no significant differences (p = 0.38). At the end of follow-up, the mean DFA was 18° ± 11°, with a significant difference between groups (p = 0.03), indicating greater correction in hallux dorsiflexion in patients treated with plates and screws. Twelve patients (11%) required hardware removal, most of them in the plate group.

Conclusions: FMTPA is an effective procedure without major clinical differences between fixation techniques. Plate-and-screws fixation allows for a more predictable alignment of the hallux and, even with a higher number of reoperations, presents comparable functional results.

Level of clinical evidence: III; Retrospective Cohort Comparison.

Background: Differentiating Weber B/SER4a from SER4b fractures relies on weightbearing radiographs and gravity stress tests, assumed to reflect deep posterior tibiotalar ligament (dPTTL) integrity. This study assessed their diagnostic accuracy for dPTTL injury, with arthroscopy as the reference standard.

Methods: We prospectively assessed 20 Weber B/SER4a-b fractures with a medial clear space ≥ 5.0 mm. Arthroscopy under local anesthesia evaluated dPTTL integrity, defined as tensioning and medial joint space closure during dorsiflexion.

Results: Radiographically, 15 fractures were classified as SER4a, and five as SER4b. Arthroscopy revealed intact dPTTL in 14 of 15 SER4a cases, while all SER4b cases had ruptures. Weightbearing radiographs showed 83.3% sensitivity and 100.0% specificity for detecting dPTTL injury; the gravity stress test had 100.0% sensitivity but 0.0% specificity.

Conclusions: Stable weightbearing radiographs reliably indicate dPTTL integrity, while instability suggests dPTTL rupture.

Level of evidence: Level II, Cross-sectional study.

Background: The Foot and Ankle Ability Measure (FAAM) assess physical function in musculoskeletal pathologies of the foot and ankle.

Method: The aim of this study was to translate, culturally adapt and validate the FAAM into Spanish for Chile and LATAM and assess its validity and reliability in patients with non-traumatic surgical orthopaedic pathologies. After translation and adaptation this retrospective cohort study included 940 participants answering FAAM and SF-36 scale.

Results: A high response rate (98%) with no floor or ceiling effect is reported. Excellent internal consistency for the scale (Cronbach's α = 0.972) and subscales (ADLs = 0,974 and Sport = 0,954) were obtained. The principal component factor analysis gave two factors explaining 66% of the variance and reporting the same item structure of the original version. The FAAM-CL sub-scales had direct and significant correlations with the SF-36 components and subcomponents.

Conclusions: The FAAM-CL was culturally adapted and demonstrated a high rate of reliability, validity, and ability to evaluate foot and ankle pathologies among Spanish-speaking patients.

Level of evidence: III.

Background: The biomechanical effects of different tarsometatarsal (TMT) arthrodesis configurations on adjacent joints remain unclear. This finite element study evaluated load transfer and pressure redistribution following selective TMT fusion.

Methods: Six TMT arthrodesis configurations, from isolated first TMT fusion to constructs including the third TMT joint, were analyzed. Joint reaction forces, plantar pressure, and tibiotalar contact pressure were assessed relative to an intact model across stance phases.

Results: Arthrodesis altered midfoot joint reaction forces, while total tibiotalar forces remained largely unchanged. The medial - intermediate intercuneiform and calcaneocuboid joints showed the greatest increases, particularly with inclusion of the third TMT joint. Plantar pressure increased mainly in the first and second metatarsal regions, and tibiotalar contact pressure redistributed along an anterolateral - posteromedial axis.

Conclusion: TMT arthrodesis alters foot biomechanics in a configuration-dependent manner. Extension to the third TMT joint produced the greatest biomechanical alterations.

Level of evidence: V, computational biomechanical study.

Background: The Hospital Frailty Risk Score (HFRS) is associated with adverse events after joint replacement, but outcomes following total ankle arthroplasty (TAA) remain unclear.

Methods: The National Readmissions Database (2017-2019) identified patients undergoing primary TAA, classified as frail or non-frail using HFRS. Thirty-day readmission rates, length of hospital stay (LOS), and hospitalization costs were compared between cohorts. Univariate analysis was used to compare 30-day complication rates, reoperation rates, and disposition designation.

Results: From a total of 6147 patients who underwent TAA, frail patients had longer LOS (2.4 vs. 1.6 days, p < 0.01), higher costs ($27,181 versus $24,777; p < 0.01), and more discharge to higher-level care (44.0 % versus 26.0 %; p < 0.01). Frailty was associated with longer LOS (IRR 1.36; p < 0.001) and increased costs (IRR 1.07; p < 0.001), but not associated with 30-day readmissions, complications, or reoperations.

Conclusion: Frailty was associated with longer LOS, higher costs, and increased discharge to higher-level care in patients undergoing TAA.

Level of evidence: IV.