Foot and Ankle Surgery最新文献

Background: There is no consensus on optimal patient-reported outcome measures (PROMs) for pilon fractures. Current ankle trauma scoring systems focus mainly on pain, which accounts for 80 % of score variability. This review aims to assess widely used PROMs for pilon fractures and report their reliability and validity.

Methods: A systematic search of PubMed, SCOPUS, and Web of Science was conducted. Studies were included if they involved at least 10 patients with AO-OTA 43 C fractures, assessed at least one PROM, and had a minimum one-year follow-up. Studies were screened using Rayyan, utilizing author consensus.

Results: 87 studies (3828 patients) were included. Of the 26 total PROMs tools utilized, the AOFAS Hindfoot-Ankle Score was the most used PROM (57 %), with pain assessed in 75 % of cases. Mental health was considered in only 23 %, and no PROMs were specifically validated for pilon fractures. Three studies (3.4 %) explicitly validated or assessed the reliability of the PROMs utilized.

Conclusion: The review highlights the heterogeneity in PROM selection for pilon fractures and insufficient reliability and validity measurements, emphasizing the need for standardized, pilon fracture-specific PROMs to better evaluate outcomes. The results of this study can guide future consensus statements on developing a standardized set of PROMs for pilon fractures to improve evaluation of patient outcomes.

Level of evidence: III.

Background: Minimally invasive surgery (MIS) chevron osteotomy has emerged as an alternative to the traditional open chevron (OC) osteotomy for hallux valgus correction, aiming to achieve similar deformity correction with reduced soft-tissue trauma and faster recovery. However, the relative clinical and radiographic outcomes of these techniques remain debated.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and Cochrane databases were searched through June 2025 for randomized controlled trials (RCTs) and cohort studies comparing MIS and OC osteotomies in patients with hallux valgus. Only studies explicitly describing a percutaneous, burr-based V-shaped Chevron osteotomy were included. Primary outcomes included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Visual Analog Scale (VAS) pain scores, radiographic parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) and complication rates. Random-effects meta-analyses were performed, with subgroup analyses at early (≤6 months), mid-term (6-12 months), and long-term (>12 months) follow-ups.

Results: Six studies (3 RCTs, 1 prospective, 2 retrospective) comprising 342 patients (352 feet) were included. MIS chevron osteotomy demonstrated no significant differences compared with OC in postoperative AOFAS, VAS scores, HVA correction, or DMAA correction at any follow-up. Early postoperative VAS scores favored MIS, while postoperative and corrected IMA values at selected time points favoured open Chevron. However, all differences were small in magnitude and unlikely to be clinically meaningful. Complication rates were comparable between the techniques (OR 2.10, 95 % CI 0.82-5.40, p = 0.12, I²=23 %).

Conclusion: This systematic review and meta-analysis demonstrate that MIS Chevron osteotomy provides clinical and radiological outcomes comparable to those of open Chevron osteotomy. Differences in pain scores, angular correction, and complication rates were small and not clinically meaningful. These findings suggest that MIS Chevron is a safe and effective alternative to open Chevron osteotomy.

Background: This study aimed to identify factors affecting ankle dorsiflexion range of motion (DROM) under non-weightbearing (knee extended and flexed) and weightbearing conditions.

Methods: Thirty-four healthy participants were assessed using 3D foot scanner, Foot Posture Index (FPI-6), hallux extension ROM, anterior ankle displacement, and muscle stiffness (gastrocnemius and soleus) via ultrasonic shear wave elastography and myotonometer.

Results: Multiple regression showed that DROM was associated with arch height index and lateral gastrocnemius compression stiffness via myotonometer under non-weightbearing with the knee extended; with FPI-6, hallux extension ROM, and lateral gastrocnemius compression stiffness under non-weightbearing with the knee flexed; and with FPI-6 and soleus compression stiffness under weightbearing conditions (adjusted R² = 0.34-0.46, P < 0.001).

Conclusions: This study indicates that ankle DROM is associated with foot structure, hallux ROM, and compression stiffness of gastrocnemius and soleus muscles. Specific contributing factors were identified for DROM under non-weightbearing and weightbearing conditions.

Introduction: Acute compartment syndrome (ACS) of the foot is practically unknown following elective surgeries. Therefore, the purpose of this study is to: 1. investigate the incidence, relative risk (RR) and odds ratio (OD) in relation to the type of foot surgery, 2. to study the benefits of prophylactic decompression of the forefoot on the occurrence of ACS, postoperative pain, hospital stay, additional surgeries and morbidity MATERIALS AND METHODS: This retrospective study was done in children operated between 2008 and 2022. The feet were divided into group -1 (2008-2018) with no prophylactic decompression of the forefoot and group -2 (2019-2022), with prophylactic decompression of the forefoot at the time of foot surgery. The surgeries performed were divided into 6 types. A single-tailed T-test for unpaired samples was used.

Results: 29 feet in 26 children developed ACS in group -1 (1164 feet). 26 feet in 19 children (5.3 %) with 'risk of ACS' received a prophylactic decompression in group -2 (482 feet). The overall incidence of ACS in group -1 was 2.49 %, with Talectomy showing the highest relative risk (9.2 %). The mean time to diagnosis was 2.7 days. The pain intensity, duration of hospital stay, additional surgeries and morbidity (42,6 %) were significantly higher in group -1.

Conclusion: Despite the lack of literature on this subject, ACS is a possible complication following a complex elective foot surgery. Rigid foot deformities needing complex corrections are susceptible and therefore, a prophylactic decompression of forefoot is beneficial and reduces morbidity with no complications.

Purpose: The tibialis anterior tendon (TAT) is a critical structure for foot dorsiflexion and medial arch stabilization. Despite its functional importance, the morphological variability of the TAT remains underrecognized in clinical and surgical settings. This review aims to present a comprehensive overview of TAT anatomical variants, their diagnostic imaging features, and implications for foot and ankle surgery.

Methods: We systematically analyze the current anatomical classifications of the TAT, with particular focus on the Olewnik et al. (2019) system, which integrates cadaveric dissection and high-resolution ultrasound findings. Comparative analysis with historical systems (Musiał, Brenner, Willegger) is included. Clinical risk stratification, imaging strategies (ultrasound, MRI), and type-specific surgical approaches are also discussed.

Results: Six distinct TAT types (I-VI) were identified, with Type VI detectable only via ultrasound. Variants involving single-band insertions (Types V and VI) pose the highest intraoperative risk due to limited insertional dispersion and altered fiber rotation. Incorporation of morphological typing into preoperative imaging protocols significantly improves surgical planning and minimizes iatrogenic injury. A clinical algorithm and rehabilitation guidelines tailored to each TAT variant are proposed.

Conclusion: The morphological variability of the TAT has direct surgical, diagnostic, and rehabilitative implications. Integrating a type-based TAT classification into routine foot-and-ankle work flow sparticularly for procedures involving the medial cuneiform or first metatarsal may support preoperative planning; whether its use reduces complication or reoperation rates requires prospective validation. Multicenter prospective and biomechanical studies are needed to evaluate clinical impact and refine variant-based surgical planning.

Background: Achilles tenotomy is an integral component of the Ponseti method for treating congenital talipes equinovarus (CTEV). Although traditionally performed using a scalpel in a sterile setting, percutaneous needle tenotomy has emerged as a minimally invasive alternative. However, comparative evaluations of these techniques using clinical and ultrasonographic parameters remain limited.

Methods: This retrospective, dual-center study included 145 feet from 95 pediatric patients treated with the Ponseti method between 2022 and 2024. Seventy-two feet underwent percutaneous needle tenotomy, while 73 feet received traditional percutaneous scalpel tenotomy. Demographic characteristics, initial Pirani and Dimeglio scores, maximum dorsiflexion angles, and ultrasonographic findings (tendon thickness, width, length, echotexture, and elastography values) were compared between groups. All ultrasonographic evaluations were performed using standardized protocols and blinded assessment.

Results: There were no significant differences between groups in terms of age, sex, or initial clinical scores (p > 0.05). Tendon stiffness (kPa), shear wave velocity (m/s), and morphologic parameters (thickness, length, and fibril organization) were similar across both groups. Functional outcomes, as assessed by maximum ankle dorsiflexion angle, also did not differ significantly (p > 0.05).

Conclusions: Percutaneous needle Achilles tenotomy is a safe and effective alternative to percutaneous scalpel tenotomy, yielding comparable clinical, functional, and ultrasonographic outcomes. Both techniques appear equally reliable in terms of tendon healing and biomechanical integrity.

Background: Osteochondral lesions of the talus (OCD) are common intra-articular ankle pathologies with unclear anatomical risk factors. Morphometric variations may predispose to OCD by altering joint biomechanics.

Methods: We retrospectively evaluated 70 patients with talar OCD and 70 age- and sex-matched controls. Nine morphometric parameters-tibial axis-medial malleolus angle (TMM), talus position (TalPos), anterior opening angle of the talus (AOT), plafond malleolar angle, lateral distal tibial angle (LDTA), anterior distal tibial angle (ADTA), trochlear tali arc length (TaL), trochlear tali height (TaH), and trochlear tali surface (TaS)-were measured on ankle MRIs in coronal, sagittal, and axial planes. Inter- and intra-observer reliability was assessed using intraclass correlation coefficients (ICC). Group comparisons were performed using parametric and non-parametric tests, and logistic regression identified independent predictors.

Results: Three parameters significantly differed between groups: tibial axis-medial malleolus angle (OCD: 18.6° vs. control: 16.2°), talus position (1.94 mm vs. 1.51 mm), and anterior opening angle of the talus (9.3° vs. 7.4°) (all p < 0.001). Other parameters showed no differences. Reliability was excellent (ICC > 0.80).

Conclusions: Altered ankle alignment and trochlear morphology are significant risk factors for talar OCD.

Level of evidence: Level III, retrospective comparative study.

Background: To investigate autologous cartilage-bone graft survivorship and outcomes among young patients with symptomatic osteochondritis dissecans lesion of the talus a long-term follow-up study is warranted.

Methods: Nineteen patients who underwent a mosaicplasty operation of the talus were included. Follow-up assessment included a clinical follow-up visit with patient outcomes, and radiograph and magnetic resonance imaging evaluations.

Results: All mosaicplasty transfers were incorporated, 89 % of patients felt satisfied or neutral about the surgery, 53 % of patients retained the same osteoarthritis grade, and range of movement in the ankles was nearly the same. Patients were well-off in terms of pain and activities in daily living.

Conclusions: Mosaicplasty reconstruction seems to result in pain relief and improved subjective satisfaction and function. The results support the use of this treatment for symptomatic patients with large osteochondral defects of the talus after failed nonoperative management or other operative treatment.

Levels of evidence: IV.

Background: This study aimed to report our experience with the combined use of hemiwedge supramalleolar osteotomy (SMO) procedure and open ankle arthrodesis (AA) for correcting end-stage ankle arthritis with large varus deformity in the same operative session.

Methods: This retrospective study prospectively followed 14 consecutive patients (15 ankles), consisting of 5 men and 9 women, with a mean age of 68.3 years, and underwent SMO/AA for treating end-stage ankle arthritis and varus deformity of the hindfoot of ≥ 15° from April 2019 to June 2023. The participants were followed up for a mean duration of 3.4 years.

Results: All patients experienced pain relief and walking ability improvement after SMO/AA. The mean osteotomy wedge height was 7.0 mm. The mean time to full-weight bearing and bone union time was 8.4 weeks and 11.7 weeks, respectively. The mean visual analog scale and the Japanese Society for Surgery of the Foot scale score significantly improved from 7.3 and 51.9 preoperatively to 1.4 and 82.2 postoperatively, respectively (p < 0.001). Further, the Self-Administered Foot Evaluation Questionnaire was significantly improved on all subscales (p < 0.001). The mean hindfoot alignment angle significantly decreased from 22.5° preoperatively to 1.8° postoperatively (p < 0.001). Complications included secondary subtalar joint arthritis in two, asymptomatic stress fracture of the calcaneus in one, and delayed union of the osteotomy site in one patient.

Conclusions: Combined SMO/AA is a potential option for preserving the subtalar joint in treating end-stage ankle arthritis with large varus deformity. This technique successfully corrects ankle/hindfoot varus deformity and preserves leg length and subtalar joint motion. Further, a single lateral incision minimizes the risk of impaired blood supply. One-stage surgical treatment reduces recovery time, hospitalization duration, and surgical cost. Rigid locking fixation with careful postoperative weightbearing is required to attain uneventful bone healing.

Level of evidence: IV.

Background: Needle arthroscopy (nanoscopy) is gaining recognition as a minimally invasive alternative to standard arthroscopy, offering improved visualization of intra-articular structures. This cadaveric study evaluates its feasibility, effectiveness, and learning curve in the ankle joint.

Methods: Twenty fresh-frozen cadaveric ankle specimens were examined using a 1.9 mm NanoScope™ (Arthrex, Naples FL, USA). Four orthopedic surgeons (two experienced - Group 1, two inexperienced - Group 2) performed the procedures. Visualization of five key anatomical structures was assessed using a 5-point Likert scale.

Results: Needle arthroscopy enabled complete visualization of all predefined structures. The tibiofibular syndesmosis had the highest visualization scores (Group 1: 4.8 ± 0.16; Group 2: 4.5 ± 0.26), while the visualization of the ankle joint was the most challenging (Group 1: 4.53 ± 0.36; Group 2: 3.53 ± 0.51; p < 0.05). Deltoid ligament visualization was significantly better in experienced surgeons (4.65 ± 0.23 vs. 3.75 ± 0.29; p = 0.048).

Conclusion: Needle arthroscopy enhances visualization of deep ankle structures while remaining minimally invasive. Despite a learning curve, visualization scores were comparable across experience levels. Further research is needed to assess clinical outcomes and optimize training.