Foot and Ankle Surgery最新文献

Background: Freiberg's disease is a rare osteochondrosis of the metatarsal head that can cause progressive pain, deformity, and loss of function. The two most widely used joint-preserving surgical options for advanced disease are dorsiflexion closing wedge metatarsal osteotomy (DCWMO) and autologous osteochondral transplantation (AOT). To date, no meta-analysis has directly compared these procedures. This systematic review and meta-analysis aimed to evaluate functional, radiographic, and complication outcomes of AOT versus DCWMO in Freiberg's disease.

Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted in August 2025 according to PRISMA guidelines. Inclusion criteria were clinical studies comparing or reporting outcomes of AOT or DCWMO in Freiberg's disease. Risk of bias was assessed using JBI Critical Appraisal Tools. Pairwise meta-analyses were performed for comparative studies evaluating American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analogue scale (VAS) pain, range of motion (ROM), and complications. Single-arm pooled analyses were conducted for AOT and DCWMO separately to provide context for within-group improvements and complication rates. Random-effects models were applied throughout.

Results: Sixteen studies involving 259 toes were included: 62 treated with AOT and 197 with DCWMO. Three comparative studies (n = 70) demonstrated significantly greater functional gain with AOT (AOFAS mean difference [MD] 7.15, 95 % CI 4.29-10.02; I²=0 %) and superior dorsiflexion both postoperatively (MD 7.85°, 95 % CI 4.40-11.29; I²=0 %) and in terms of gain from baseline (MD 7.46°, 95 % CI 3.77-11.14; I²=0 %). Absolute postoperative AOFAS and VAS pain scores were similar between groups, as were improvements in plantarflexion. DCWMO consistently shortened the metatarsal head (pooled mean 1.76 mm), whereas AOT preserved or slightly increased length (-0.20 mm). Complications were significantly lower with AOT (risk difference -0.20, 95 % CI -0.35 to -0.04; risk ratio 0.23, 95 % CI 0.05-0.96). Single-arm pooled analyses confirmed large improvements in AOFAS (∼25 points) and VAS (∼5 points) for both groups, with pooled complication rates of 1 % for AOT and 6 % for DCWMO.

Conclusion: Both AOT and DCWMO provide meaningful pain relief and functional improvement in advanced Freiberg's disease. However, AOT demonstrated superior functional gains, greater preservation of motion and metatarsal length, and fewer complications, suggesting it may represent the preferred joint-preserving option, particularly for Smillie stage III-IV disease. Future prospective comparative trials with standardized outcome reporting and exploration of lower-morbidity donor graft sources are warranted to refine surgical decision-making.

Level of evidence: Level II, systematic review and meta-analysis.

Background: This study sought to characterize a cohort of talar neck and body fractures, focusing on fracture characteristics, associated injuries, treatment and outcome.

Methods: We reviewed adult patients registered in the Swedish Fracture Register 2011-2021 with talar neck and body fractures. A minimum 2-year follow-up was conducted for treatment outcomes.

Results: We included 313 patients (318 fractures, median age 34 years, 67 % men) of which 106 involved the neck, 134 the body and 78 combined body and neck. 36 % had associated injuries. Operative treatment was implemented for 55 neck (52 %), 81 body (60 %), and 70 combined fractures (90 %). Reoperation rates were, 35 % for neck, 32 % for body and 44 % for combined fractures.

Conclusion: Talar fractures primarily occur in men and are associated with other fractures. A majority of the fractures are treated operatively and one in three patients undergoes reoperation, with higher reoperation rates in combined body and neck fractures.

Background: Ankle fractures are a common type of fracture. Knowledge of functional outcomes are important for patient counseling and expectation management. The aim of this study is to evaluate the functional outcome after surgically treated ankle fractures and which patient, fracture and treatment characteristics are related to the midterm functional outcome after surgical fixation of ankle fractures.

Methods: Between August 2016 and May 2020, patients who were surgically treated for an ankle fracture in one of four participating hospitals were included. Patient, fracture and treatment characteristics were retrieved from medical records. After medical follow-up, patients were questioned about their functional outcome using the Lower Extremity Functional Scale (LEFS) questionnaire. Predictive factors for functional outcome were calculated by doing a linear regression analysis using SPSS.

Results: A total of 552 patients were included in this study. The median follow-up time was 2.3 years (IQR 544-1116 days) after injury, with a median LEFS of 66.40 (53.60-75.20) points. Fracture characteristics (Weber classification or Gustilo classification) were not seen as a significant predictor for the LEFS. Higher age, higher BMI, higher ASA classification, trimalleolar fixation and complications were found to be significant independent predictors of lower LEFS.

Conclusion: Two years after a surgically treated ankle fracture fewer than 25 % of the patients achieve the median functional score observed in the healthy Dutch population. In this study age, BMI, ASA classification, extensive surgical fixation and postoperative complications are the most important significant independent predictors of a lower functional outcome.

Level of evidence: 3:

Purpose: To explore the clinical efficacy of posterior ankle arthroscopy with absorbable screws in treating posterior malleolus fractures (PMFs).

Methods: The data of 33 patients who underwent posterior ankle arthroscopy with absorbable screws for the treatment of PMFs between January 2022 and December 2023 were retrospectively analyzed. The surgical time, postoperative secondary injuries and soft tissue complications were recorded. The articular surface reduction quality and syndesmotic congruence were observed under X-ray and 3D CT. At the last follow-up, the ankle joint flexion mobility and occurrence of toe flexion contracture were recorded. Pains were assessed using Visual Analogue Scale (VAS). Functional efficacy was evaluated using American Orthopeadic Foot and Ankle Society (AOFAS) score, and Olerud-Molander Ankle Score (OMAS).

Results: No secondary injuries or complications occurred postoperatively. The reduction of articular surface and the syndesmotic congruence were good. The fractures had no reduction loss and were all healed on time. At the last follow-up, the ankle joint flexion mobility was excellent, and there was no complication of toe flexion contracture. The VAS scores were 0.67 ± 0.92, the AOFAS scores were 92.73 ± 6.77, and the OMAS scores were 94.84 ± 7.01.

Conclusions: Posterior ankle arthroscopic reduction and fixation for treatment of PMFs with absorbable screws enables direct visualization of articular surface reduction and fixation, avoiding secondary removal of internal fixation and reinjury of soft tissues. Good ankle joint functions can be obtained through soft tissue protection and precise reduction, indicating this scheme is an optional surgical method.

Background: It is unclear whether Broström with InternalBrace™ augmentation enables patients with structural cavovarus deformity to achieve satisfactory patient-reported outcomes. Patient Reported Outcomes Measurement Information System (PROMIS) measures of physical function (PF) and pain interference (PI) are validated metrics of orthopaedic foot and ankle clinical outcomes. The Cumberland Ankle Instability Tool (CAIT) is a validated metric of ankle stability. This study aimed to determine whether augmentation results in better PROMIS and CAIT for patients with deformities compared to non-augmented.

Methods: 37 patients with cavovarus deformity who underwent lateral ankle ligament reconstruction at a single institution between 2013 and 2024 were retrospectively reviewed. Two investigators independently evaluated all records. Revisions, allografts, nonanatomic reconstructions, flexor digitorum longus transfers, progressive collapsing foot deformities, concomitant hindfoot arthrodesis, associated ankle arthroplasties, and concomitant fractures were excluded. Cavovarus deformity was defined radiographically by an increased talo-first metatarsal angle, or Meary's angle, (>4° convex upward), elevated calcaneal pitch (>30°), increased first metatarsal-calcaneal angle, or Hibb's angle, (>45°), and a decreased talocalcaneal angle (<20°). Patients completed surveys containing PROMIS and CAIT. T-tests and Kruskal-Wallis tests assessed associations.

Results: Overall, the mean PROMIS PF and PI in patients with structural deformity were 48.0 ± 8.1 and 51.9 ± 9.8, respectively. Compared to non-augmented Broström, augmentation resulted in significantly higher PF and lower PI for patients with deformities (PF 49.7 ± 7.8 vs. 41.9 ± 6.0, p < 0.01; PI 49.9 ± 7.8 vs. 58.8 ± 6.0, p = 0.04). Postoperative CAIT was not significantly different between augmented and non-augmented (19.1 ± 7.9 vs. 12.8 ± 8.5, respectively p = 0.09).

Conclusions: Augmented Broström may enable patients with structural ankle deformity to achieve improved functional outcomes compared to non-augmented Broström, as augmentation resulted in both statistically and clinically significant improvements in PROMIS PF and PROMIS PI compared to non-augmented.

Level of evidence: III.

Background: The hypermobility of the first ray has been investigated as a possible contributing factor to hallux valgus, but its precise relationship with the condition has not yet been fully clarified. Weight-bearing computed tomography allows us to assess the foot in a three-dimensional and loaded manner, helping us better understand hypermobility. This study aims to evaluate the hypermobility in the sagittal plane of the first metatarsal in individuals with hallux valgus and hypermobility using weight-bearing computed tomography.

Methods: In this prospective study patients with hallux valgus deformity were recruited.The main inclusion criteria were women above 18 years old with hallux valgus, and the main exclusion criteria were other foot and ankle diseases, reumatologic disease, non-idiopatic hallux valgus and disability/contraindication to perform a CT scan. In total 36 patient were confirmed eligible and were imaged by WBCT in a loaded and non-loaded condition. Angular measurements were obtained by using semi-automated software, were we segmented the bones and analyzed the mobility of the first ray bones in three planes of motion.

Results: Although the group with hallux valgus had a higher average of movement on both planes, there was no statistical difference in the mobility of the first metatarsal in the three planes. We observed similar findings in the other bones of the first ray (medial cuneiform, navicular and talus).

Conclusion: We concluded that the mobility of the first metatarsal is not the direct cause of the hypermobility of the first ray. For further studies we suggest analyzing the combine movement of the bones of the first ray to comprehend the hypermobility, and we recommend a bigger cohort to analyze these small movements.

Background: The respective roles of subtalar joint intrinsic ligament (cervical ligament [CL], interosseous talocalcaneal ligament [ITCL]) versus the extrinsic calcaneofibular ligament (CFL) are unclear. This study aimed to use 3D opto-electronic analysis to compare their respective contributions to subtalar joint stability.

Methods: In this cadaveric comparative study, twenty feet were split into intrinsic or extrinsic groups and underwent sequential sectioning: (1) intact, (2) anterior talo-fibular ligament (ATFL) cut, (3) CFL or CL+ITCL cut, (4) all ligaments cut. At each stage, manual anterior drawer and varus-tilt tests in neutral and dorsiflexion were performed. Angular rotations and ligament elongations were recorded.

Results: In both intrinsic and extrinsic groups, sectioning of the CL+ITCL significantly increased varus rotation in dorsiflexion between the calcaneus-talus (+38.4 % and +71.1 %, respectively; p < 0.05) and calcaneus-tibia (+49.2 % and +82.5 %, respectively; p < 0.05). CFL sectioning increased varus rotation in neutral flexion between the calcaneus-tibia (+36.6 % and +30.9 %, respectively; p < 0.05) and talus-tibia (+77.2 % and +95.3 %, respectively; p < 0.05), while also producing a significant increase in ATFL elongation (+4.5 % and +7.2 %, respectively; p < 0.05).

Conclusion: Intrinsic ligaments primarily stabilize the subtalar joint and the tibio-talo-calcaneal complex against varus stress in dorsiflexion, whereas the CFL provides varus stability to both the ankle and the tibio-talo-calcaneal complex in neutral flexion. Sectioning of the CFL increases ATFL proximal-to-distal distance under varus and inversion stress, underscoring the importance of addressing the CFL in cases of combined ATFL and CFL injuries.

Background: Achilles tendinopathy is a common overuse-related musculoskeletal disorder. The relationships among patient-reported outcome measures (PROMs), functional performance, and structural tendon changes remain poorly understood. This study aimed to clarify the relationships among these measures in patients with Achilles tendinopathy.

Methods: 46 patients with mid-portion Achilles tendinopathy were included in the study. Evaluations included PROMs, functional performances, and tendon properties. Pearson correlation analysis and multiple linear regression were used to explore the relationships between measures.

Results: Only Victorian Institute of Sport Assessment-Achilles was found to have a significant association with Achilles tendon thickness (p = 0.038, β = 0.368), and tendon stiffness was found to have a significant association with maximal voluntary isometric contractions of ankle plantarflexion (p < 0.001, β = 0.598).

Conclusion: The relationships among PROMs, tendon properties, and functional performances are weak. Combining these outcomes is suggested for a comprehensive evaluation of patients with Achilles tendinopathy.

Levels of evidence: Level Ⅳ.

Background: Chronic Achilles tendon (AT) ruptures pose a significant reconstructive challenge. While various surgical techniques have been described, comparative data between open allograft augmentation and endoscopic autograft transfer remain scarce.

Methods: This study evaluated 41 patients with chronic AT rupture treated surgically: 21 underwent open repair with tendon allograft (Group A) and 20 received endoscopic transfer of the flexor hallucis longus (FHL) tendon (Group B). Complications were recorded, and clinical outcomes were compared between groups.

Results: At a minimum 24-month follow-up, both groups showed excellent functional and clinical outcomes. Complication rates were low and comparable: two in Group A (wound dehiscence, deep vein thrombosis) and three in Group B (tibial nerve irritation, plantar pain, insufficient tensioning of the tendon transfer).

Conclusions: Both techniques achieved high patient-reported outcomes and low complication rates. Open repair with allograft provides durable reconstruction in complex cases, while endoscopic FHL transfer offers a less invasive alternative.

Level of evidence: Level III, retrospective comparative study.

Background: This study aimed to develop the Turkish version of TENDINS-A (TENDINS-A-TR) and evaluate its measurement properties.

Materials and methods: A total of 130 participants (n = 60 Achilles tendinopathy, 34.7 ± 11.7 years; n = 70 healthy, 27.8 ± 8.9 years) completed TENDINS-A-TR, Victorian Institute of Sport Assessment-Achilles (VISA-A), Foot and Ankle Outcome Score (FAOS), and Numeric Pain Rating Scale (NPRS). Construct validity, discriminative validity (cut-off score, sensitivity, specificity), test-retest reliability, standard error of measurement (SEM), internal consistency, minimal detectable change (MDC), minimal important change (MIC) and ceiling/floor effects were assessed.

Results: TENDINS-A-TR showed strong correlations with VISA-A (r = -0.71, p < 0.001), FAOS subscales (r_range=-0.55 to -0.77, all p < 0.001), and NPRS (r_range=0.61-0.80, all p < 0.001). The area under the ROC curve was 0.961 (95 %CI:0.934-0.988, p < 0.001) showing excellent accuracy with 0.817 sensitivity and 0.871 specificity at 18.5 cut-off score. Test-retest reliability was excellent (ICC=0.94, 95 %CI 0.90-0.97) with an excellent internal consistency (Cronbach's alpha=0.97). SEM and MDC were 5.92 and 16.4, respectively. MIC was 10.1, representing 26.4 % points of change in participants with Achilles tendinopathy. Lastly, there was no ceiling/floor effects.

Conclusion: Turkish version of TENDINS-A demonstrated strong validity, reliability and accuracy to evaluate pain, symptoms, and physical function in people with Achilles tendinopathy.