Traditionally, metatarsal Ewing sarcoma (ES) is managed with disarticulation above the tarsometatarsal joint and ray amputation. In this study, we evaluate the outcomes of a less invasive approach in patients with metatarsal ES and good response to neoadjuvant chemotherapy.
Methods
Eleven patients with metatarsal ES (mean age: 11.5 ± 3) and complete radiologic response to neoadjuvant chemotherapy who underwent resection and reconstruction with fibular strut allograft were included.
Results
At a mean follow-up of 8.5 ± 4 years, the mean Musculoskeletal Tumor Society (MSTS) score of the patients was 29 ± 1.7. Patients with metatarsophalangeal joint fusion had limitations in reactional activities. One patient had a local recurrence. Postoperative complications included wound dehiscence (n = 1), superficial infection (n = 1), and allograft fracture (n = 1). Only one patient required revision surgery.
Conclusion
Fibular allograft reconstruction after resection of metatarsal ES can be regarded as a valuable alternative to amputation in patients who respond well to neoadjuvant chemotherapy.
{"title":"Outcomes of metatarsal Ewing sarcoma following the resection and intercalary reconstruction with fibular strut allograft: A retrospective case series","authors":"Khodamorad Jamshidi , Abolfazl Bagherifard , Seyyed Saeed Khabiri , Alireza Mirzaei","doi":"10.1016/j.fas.2025.02.001","DOIUrl":"10.1016/j.fas.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, metatarsal Ewing sarcoma<span><span> (ES) is managed with disarticulation above the </span>tarsometatarsal joint<span> and ray amputation. In this study, we evaluate the outcomes of a less invasive approach in patients with metatarsal ES and good response to neoadjuvant chemotherapy.</span></span></div></div><div><h3>Methods</h3><div>Eleven patients with metatarsal ES (mean age: 11.5 ± 3) and complete radiologic response to neoadjuvant chemotherapy who underwent resection and reconstruction with fibular strut allograft were included.</div></div><div><h3>Results</h3><div><span><span><span>At a mean follow-up of 8.5 ± 4 years, the mean Musculoskeletal Tumor Society (MSTS) score of the patients was 29 ± 1.7. Patients with metatarsophalangeal </span>joint fusion had limitations in reactional activities. One patient had a local recurrence. </span>Postoperative complications included </span>wound dehiscence (n = 1), superficial infection (n = 1), and allograft fracture (n = 1). Only one patient required revision surgery.</div></div><div><h3>Conclusion</h3><div>Fibular allograft reconstruction after resection of metatarsal ES can be regarded as a valuable alternative to amputation in patients who respond well to neoadjuvant chemotherapy.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 6","pages":"Pages 492-497"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.fas.2025.02.009
Tomas Urrutia, Jorge Faundez, Catalina Vidal, Joaquín Palma, Jorge Filippi
Background
Pilon fractures, constituting 3–10 % of all tibia fractures, present significant challenges due to their complex nature and frequent involvement of soft tissue damage. Effective management necessitates careful preoperative planning and strategic surgical approach selection. This study aims to provide a comprehensive cadaveric analysis comparing eight distinct surgical approaches to tibial pilon fractures, focusing on the consistently exposed segment and the extent of the exposed bone area for each approach.
Methods
Sixteen foot and ankle specimens, obtained through our university's body donation program, were utilized for this study. Each specimen underwent two different approaches, resulting in four repetitions for each assessed method. The approaches analyzed included anteromedial, anterolateral, lateral, posterolateral, posteromedial, posterior modified posteromedial, anterior modified posteromedial, and medial approaches. Standardized incisions and retraction techniques were employed to measure the exposed bone area using ImageJ software, while the consistently exposed segment was determined through axial cuts and photographic analysis.
Results
The anteromedial approach yielded the largest exposed area (18.36 cm²), whereas the anterolateral approach provided the greatest exposed segment (72°). The posteromedial approach proved most effective for exposing the Volkmann fragment, and the anterolateral approach was optimal for accessing the Chaput fragment and comminution areas. Combining the posteromedial and posterior modified posteromedial approaches could be suggested for extensive posterior malleolus fractures to maximize bone surface exposure while minimizing soft tissue damage.
Conclusion
This study offers objective data on the exposed area and segment for various surgical approaches, providing a valuable resource for orthopedic surgeons in preoperative planning and decision-making. By enhancing the understanding of the capabilities and limitations of each approach, this research aims to improve surgical outcomes for patients with complex tibial pilon fractures.
{"title":"Visualizing access in pilon fractures: A comparative study of eight approaches","authors":"Tomas Urrutia, Jorge Faundez, Catalina Vidal, Joaquín Palma, Jorge Filippi","doi":"10.1016/j.fas.2025.02.009","DOIUrl":"10.1016/j.fas.2025.02.009","url":null,"abstract":"<div><h3>Background</h3><div>Pilon fractures, constituting 3–10 % of all tibia fractures, present significant challenges due to their complex nature and frequent involvement of soft tissue damage. Effective management necessitates careful preoperative planning and strategic surgical approach selection. This study aims to provide a comprehensive cadaveric analysis comparing eight distinct surgical approaches to tibial pilon fractures, focusing on the consistently exposed segment and the extent of the exposed bone area for each approach.</div></div><div><h3>Methods</h3><div>Sixteen foot and ankle specimens, obtained through our university's body donation program, were utilized for this study. Each specimen underwent two different approaches, resulting in four repetitions for each assessed method. The approaches analyzed included anteromedial, anterolateral, lateral, posterolateral, posteromedial, posterior modified posteromedial, anterior modified posteromedial, and medial approaches. Standardized incisions and retraction techniques were employed to measure the exposed bone area using ImageJ software, while the consistently exposed segment was determined through axial cuts and photographic analysis.</div></div><div><h3>Results</h3><div>The anteromedial approach yielded the largest exposed area (18.36 cm²), whereas the anterolateral approach provided the greatest exposed segment (72°). The posteromedial approach proved most effective for exposing the Volkmann fragment, and the anterolateral approach was optimal for accessing the Chaput fragment and comminution areas. Combining the posteromedial and posterior modified posteromedial approaches could be suggested for extensive posterior malleolus fractures to maximize bone surface exposure while minimizing soft tissue damage.</div></div><div><h3>Conclusion</h3><div>This study offers objective data on the exposed area and segment for various surgical approaches, providing a valuable resource for orthopedic surgeons in preoperative planning and decision-making. By enhancing the understanding of the capabilities and limitations of each approach, this research aims to improve surgical outcomes for patients with complex tibial pilon fractures.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 6","pages":"Pages 539-546"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.fas.2024.09.006
Katherine Ning Li
{"title":"Letter to the editor to comment on: Prevalence and risk factors of ankle osteoarthritis in a population-based study","authors":"Katherine Ning Li","doi":"10.1016/j.fas.2024.09.006","DOIUrl":"10.1016/j.fas.2024.09.006","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 6","pages":"Page 557"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to investigate if the numbers of cells and platelets in the bone marrow aspirate concentrate (BMAC) added to a hyaluronic acid membrane influence the clinical outcome up to long-term follow-up in the treatment of osteochondral lesions of the talus (OLTs).
Methods
A total of 102 patients with symptomatic OLTs underwent this one-step treatment. Eighty-five patients (53 men, 32 women, age 32.3 ± 10.6 years, lesion size 2.7 ± 1.6 cm2) were prospectively evaluated at baseline and at 2–5–10 years using the AOFAS ankle-hindfoot score, the NRS for pain, and the Tegner score. Satisfaction and failures were documented as well. Laboratory analysis of BMAC was performed for the count of mononucleated cells (MNCs) and platelets.
Results
The AOFAS improved from baseline (59.1 ± 13.7) to the final follow-up (82.3 ± 14.9, p < 0.0005). NRS improved from 7.1 ± 1.1 at baseline to 3.9 ± 2.8 at the final follow-up (p < 0.0005). Tegner improved from a pre-op 2.0 median to 3.0 at the final follow-up (p < 0.0005), not reaching the pre-injury level. MNCs and platelets in BMAC were 148.2 ± 54.2 × 109/L and 454.3 ± 277.5 × 109/L, respectively. MNCs correlated with NRS at 2 years (p = 0.018; rho=-0.260). However, MNCs number, as well as platelet number, did not influence the improvement from baseline of the clinical scores at all follow-up evaluations.
Conclusion
This study demonstrated, in a large series of patients evaluated up to a long-term follow-up, that the number of MNCs and platelets present in BMAC does not influence the overall clinical outcomes in patients affected by OLTs treated with a one-step hyaluronic acid scaffold implantation augmented with BMAC.
{"title":"The influence of cell and platelet number on clinical outcomes provided by a one-step scaffold transplantation with bone marrow concentrate for the treatment of osteochondral lesions of the talus","authors":"Luca Berveglieri , Francesca Vannini , Laura Ramponi , Angelo Boffa , Carola Cavallo , Annarita Cenacchi , Giuseppe Filardo , Roberto Buda , Cesare Faldini","doi":"10.1016/j.fas.2025.01.014","DOIUrl":"10.1016/j.fas.2025.01.014","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to investigate if the numbers of cells and platelets in the bone marrow aspirate concentrate (BMAC) added to a hyaluronic acid membrane influence the clinical outcome up to long-term follow-up in the treatment of osteochondral lesions of the talus (OLTs).</div></div><div><h3>Methods</h3><div>A total of 102 patients with symptomatic OLTs underwent this one-step treatment. Eighty-five patients (53 men, 32 women, age 32.3 ± 10.6 years, lesion size 2.7 ± 1.6 cm<sup>2</sup><span>) were prospectively evaluated at baseline and at 2–5–10 years using the AOFAS<span><span> ankle-hindfoot score, the NRS for pain, and the </span>Tegner score. Satisfaction and failures were documented as well. Laboratory analysis of BMAC was performed for the count of mononucleated cells (MNCs) and platelets.</span></span></div></div><div><h3>Results</h3><div>The AOFAS improved from baseline (59.1 ± 13.7) to the final follow-up (82.3 ± 14.9, p < 0.0005). NRS improved from 7.1 ± 1.1 at baseline to 3.9 ± 2.8 at the final follow-up (p < 0.0005). Tegner improved from a pre-op 2.0 median to 3.0 at the final follow-up (p < 0.0005), not reaching the pre-injury level. MNCs and platelets in BMAC were 148.2 ± 54.2 × 10<sup>9</sup>/L and 454.3 ± 277.5 × 10<sup>9</sup>/L, respectively. MNCs correlated with NRS at 2 years (p = 0.018; rho=-0.260). However, MNCs number, as well as platelet number, did not influence the improvement from baseline of the clinical scores at all follow-up evaluations.</div></div><div><h3>Conclusion</h3><div>This study demonstrated, in a large series of patients evaluated up to a long-term follow-up, that the number of MNCs and platelets present in BMAC does not influence the overall clinical outcomes in patients affected by OLTs treated with a one-step hyaluronic acid scaffold implantation augmented with BMAC.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 6","pages":"Pages 486-491"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Our purpose was to evaluate the reliability and validity of the Persian version of the visual analog scale foot and ankle (VAS-FA) among patients with foot and ankle problems and healthy subjects.
Methods
The VAS-FA was translated and adapted into Persian (Farsi). Then, 82 participants, including 41 healthy subjects and 41 patients with foot and ankle problems, fulfilled the questionnaire in two sessions. The validity was assessed by correlating VAS-FA with the Persian version of the foot and ankle outcome score (FAOS) and the foot and ankle ability measure (FAAM). Intraclass correlation coefficient (ICC) and Cronbach's α were used to assess test-retest reliability and internal consistency.
Results
There was a statistically significant difference between healthy participants and patients regarding the total VAS-FA score and its subscales (P < 0.001). The test-retest reliability was excellent, and the internal consistency was good to excellent. The correlation between the total VAS-FA score and FAAM and FAOS scores was good for the healthy subjects and good to excellent for patients.
Conclusion
The Persian version of VAS-FA is valid and reliable.
{"title":"Visual analog scale foot and ankle (VAS-FA): Reliability and validity of the Persian version","authors":"Hooshmand Zarei , Miad Nosratpour , Seyed Mohammadmisagh Moteshakereh , Mahyar Mahdavi , Amir Sabaghzadeh","doi":"10.1016/j.fas.2025.02.004","DOIUrl":"10.1016/j.fas.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Our purpose was to evaluate the reliability and validity of the Persian version of the visual analog scale foot and ankle (VAS-FA) among patients with foot and ankle problems and healthy subjects.</div></div><div><h3>Methods</h3><div><span>The VAS-FA was translated and adapted into Persian (Farsi). Then, 82 participants, including 41 healthy subjects and 41 patients with foot and ankle problems, fulfilled the questionnaire in two sessions. The validity was assessed by correlating VAS-FA with the Persian version of the foot and ankle outcome score (FAOS) and the foot and ankle ability measure (FAAM). Intraclass correlation coefficient (ICC) and </span>Cronbach's α<span> were used to assess test-retest reliability and internal consistency.</span></div></div><div><h3>Results</h3><div>There was a statistically significant difference between healthy participants and patients regarding the total VAS-FA score and its subscales (P < 0.001). The test-retest reliability was excellent, and the internal consistency was good to excellent. The correlation between the total VAS-FA score and FAAM and FAOS scores was good for the healthy subjects and good to excellent for patients.</div></div><div><h3>Conclusion</h3><div>The Persian version of VAS-FA is valid and reliable.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 6","pages":"Pages 517-520"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.fas.2024.08.005
Nicola Maffulli, Filippo Spiezia,
{"title":"Letter to the editor to comment on “A comparative biomechanical study of the krackow suture technique with three common percutaneous suture techniques in the treatment of Achilles tendon ruptures”","authors":"Nicola Maffulli, Filippo Spiezia,","doi":"10.1016/j.fas.2024.08.005","DOIUrl":"10.1016/j.fas.2024.08.005","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 6","pages":"Pages 555-556"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.fas.2025.02.002
Jacob S. Gandløse , Kristoffer W. Barfod , Rikke Hoeffner , Maria Swennergren Hansen , Marianne Christensen , Henrik Riel
Background
Acute Achilles tendon rupture (ATR) is a common injury associated with a high rate of deep vein thrombosis (DVT) during rehabilitation. This study assessed whether DVT affects long-term self-reported function.
Methods
Data from the Danish Achilles Tendon Database were used to compare Achilles tendon Total Rupture Scores (ATRS) at 6, 12, and 24 months between patients with and without symptomatic DVT, adjusting for covariates.
Results
No significant ATRS difference between DVT and non-DVT groups was observed over time (adjusted mean difference = −0.7, 95 % CI: −4.8–3.3, p = 0.72). However, patients with DVT reported lower ATRS at 24 months (adjusted mean difference = −4.9, 95 % CI: −9.0 to −0.9, p = 0.02).
Conclusions
Symptomatic DVT is not significantly associated with self-reported function over time in patients with ATR. However, patients with DVT may experience a recovery plateau, leading to lower long-term function, though the clinical significance is unclear.
{"title":"Impact of symptomatic deep vein thrombosis on self-reported function and treatment outcome following an acute Achilles tendon rupture: A register study","authors":"Jacob S. Gandløse , Kristoffer W. Barfod , Rikke Hoeffner , Maria Swennergren Hansen , Marianne Christensen , Henrik Riel","doi":"10.1016/j.fas.2025.02.002","DOIUrl":"10.1016/j.fas.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>Acute Achilles tendon rupture (ATR) is a common injury associated with a high rate of deep vein thrombosis (DVT) during rehabilitation. This study assessed whether DVT affects long-term self-reported function.</div></div><div><h3>Methods</h3><div>Data from the Danish Achilles Tendon Database were used to compare Achilles tendon Total Rupture Scores (ATRS) at 6, 12, and 24 months between patients with and without symptomatic DVT, adjusting for covariates.</div></div><div><h3>Results</h3><div>No significant ATRS difference between DVT and non-DVT groups was observed over time (adjusted mean difference = −0.7, 95 % CI: −4.8–3.3, p = 0.72). However, patients with DVT reported lower ATRS at 24 months (adjusted mean difference = −4.9, 95 % CI: −9.0 to −0.9, p = 0.02).</div></div><div><h3>Conclusions</h3><div>Symptomatic DVT is not significantly associated with self-reported function over time in patients with ATR. However, patients with DVT may experience a recovery plateau, leading to lower long-term function, though the clinical significance is unclear.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 6","pages":"Pages 498-504"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-09DOI: 10.1016/j.fas.2025.07.002
Song Ho Chang , Yuichi Nagase , Rikyo Kuhara , Taro Kasai , Jun Hirose , Shinji Mishima , Tetsuro Yasui
Background
While transfibular total ankle arthroplasty (TAA) demonstrates favorable short-term outcomes, factors influencing postoperative ankle dorsiflexion remain underexplored. This is the first study aimed to identify factors influencing dorsiflexion range of motion after transfibular TAA.
Methods
Forty-nine patients undergoing transfibular TAA were classified into dorsiflexion-improved (DF-improved) group (≥5°,n = 26) and dorsiflexion-non-improved (DF-non-improved) group (<5°, n = 23). Radiographic parameters, residual medial tibial osteophytes, and Achilles tendon lengthening were evaluated.
Results
The DF-improved group had smaller anterior talar implant depth (3.1 ± 2.0 mm vs. 5.5 ± 1.7 mm), greater γ angle (17.4 ± 4.3°vs. 14.4 ± 5.1°), smaller proportion of postoperative residual medial tibial osteophyte (2 vs. 10), and more Achilles tendon lengthening than the DF-non-improved group (9 vs. 2).
Conclusions
Close consideration of the depth and angle of talar implant placement, meticulous osteophyte resection of medial tibia, and Achilles tendon lengthening may improve the postoperative dorsiflexion following transfibular TAA.
Levels of evidence
Level III case-control study (retrospective comparative study).
{"title":"Factors associated with improvement in ankle dorsiflexion after transfibular total ankle arthroplasty","authors":"Song Ho Chang , Yuichi Nagase , Rikyo Kuhara , Taro Kasai , Jun Hirose , Shinji Mishima , Tetsuro Yasui","doi":"10.1016/j.fas.2025.07.002","DOIUrl":"10.1016/j.fas.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>While transfibular total ankle arthroplasty (TAA) demonstrates favorable short-term outcomes, factors influencing postoperative ankle dorsiflexion remain underexplored. This is the first study aimed to identify factors influencing dorsiflexion range of motion after transfibular TAA.</div></div><div><h3>Methods</h3><div>Forty-nine patients undergoing transfibular TAA were classified into dorsiflexion-improved (DF-improved) group (≥5°,n = 26) and dorsiflexion-non-improved (DF-non-improved) group (<5°, n = 23). Radiographic parameters, residual medial tibial osteophytes, and Achilles tendon lengthening were evaluated.</div></div><div><h3>Results</h3><div>The DF-improved group had smaller anterior talar implant depth (3.1 ± 2.0 mm vs. 5.5 ± 1.7 mm), greater γ angle (17.4 ± 4.3°vs. 14.4 ± 5.1°), smaller proportion of postoperative residual medial tibial osteophyte (2 vs. 10), and more Achilles tendon lengthening than the DF-non-improved group (9 vs. 2).</div></div><div><h3>Conclusions</h3><div>Close consideration of the depth and angle of talar implant placement, meticulous osteophyte resection of medial tibia, and Achilles tendon lengthening may improve the postoperative dorsiflexion following transfibular TAA.</div></div><div><h3>Levels of evidence</h3><div>Level III case-control study (retrospective comparative study).</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 1","pages":"Pages 94-99"},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-03DOI: 10.1016/j.fas.2025.06.008
A. Herrera-Rodríguez , M. Uroz-de la Iglesia , J. Ojeda-Jiménez , D. Rendón-Díaz , E. Morales-Pérez , J.M. García-López , R. Infante-Alonso , L. Touray-Conteh , M. Herrera-Pérez
Introduction
Percutaneous forefoot surgery is a minimally invasive surgical technique with the advantages of lower morbidity and earlier recovery by allowing immediate weight bearing. These benefits represent an ideal indication for older patients with high comorbidity. This study presents the functional outcomes of this surgical technique in a series of patients with these characteristics at a tertiary-level university hospital.
Methodology
A retrospective observational study of a case series of patients who underwent this minimally invasive technique between 2022 and 2023. Epidemiological variables were collected, and the outcomes were analysed based on three parameters: resolution of ulcers, disappearance of keratoses, and the ability to wear shoes. The complete resolution of all three parameters evaluated was considered satisfactory, two resolved was acceptable, and the persistence of two or more was unsatisfactory. Given the characteristics of the series collected, only clinical follow-up was performed, with no radiological follow-up in any case.
Results
The first 30 cases operated on were collected. They had a mean age of 82.8 years and an average follow-up of 6.57 months, sufficient to evaluate medium-term postoperative results. The results were satisfactory in 83 % of cases. Half of the patients had two or more comorbidities—type 2 diabetes mellitus being the most prevalent—and the higher the number of comorbidities, the greater the risk of an unsatisfactory outcome. Surgical complications were few and mostly mild, affecting only 33 % of patients (10 cases). Those with ulcers before surgery presented the worst outcomes.
Conclusions
Percutaneous forefoot surgery for severe digital deformities in older patients with high comorbidity is an ideal minimally invasive technique with good functional outcomes and an acceptable percentage of complications.
{"title":"Efficacy of percutaneous surgery for digital deformities in older patients with comorbidities","authors":"A. Herrera-Rodríguez , M. Uroz-de la Iglesia , J. Ojeda-Jiménez , D. Rendón-Díaz , E. Morales-Pérez , J.M. García-López , R. Infante-Alonso , L. Touray-Conteh , M. Herrera-Pérez","doi":"10.1016/j.fas.2025.06.008","DOIUrl":"10.1016/j.fas.2025.06.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Percutaneous forefoot surgery is a minimally invasive surgical technique with the advantages of lower morbidity and earlier recovery by allowing immediate weight bearing. These benefits represent an ideal indication for older patients with high comorbidity. This study presents the functional outcomes of this surgical technique in a series of patients with these characteristics at a tertiary-level university hospital.</div></div><div><h3>Methodology</h3><div>A retrospective observational study of a case series of patients who underwent this minimally invasive technique between 2022 and 2023. Epidemiological variables were collected, and the outcomes were analysed based on three parameters: resolution of ulcers, disappearance of keratoses, and the ability to wear shoes. The complete resolution of all three parameters evaluated was considered satisfactory, two resolved was acceptable, and the persistence of two or more was unsatisfactory. Given the characteristics of the series collected, only clinical follow-up was performed, with no radiological follow-up in any case.</div></div><div><h3>Results</h3><div>The first 30 cases operated on were collected. They had a mean age of 82.8 years and an average follow-up of 6.57 months, sufficient to evaluate medium-term postoperative results. The results were satisfactory in 83 % of cases. Half of the patients had two or more comorbidities—type 2 diabetes mellitus being the most prevalent—and the higher the number of comorbidities, the greater the risk of an unsatisfactory outcome. Surgical complications were few and mostly mild, affecting only 33 % of patients (10 cases). Those with ulcers before surgery presented the worst outcomes.</div></div><div><h3>Conclusions</h3><div>Percutaneous forefoot surgery for severe digital deformities in older patients with high comorbidity is an ideal minimally invasive technique with good functional outcomes and an acceptable percentage of complications.</div></div><div><h3>Level of evidence</h3><div>IV. Type of study: Case series.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 1","pages":"Pages 85-93"},"PeriodicalIF":2.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-03DOI: 10.1016/j.fas.2025.06.002
Grace Bennfors, Ronit Kulkarni, Joshua Morningstar, Richard J. Friedman, Christopher E. Gross, Daniel J. Scott
Introduction
Recent literature, particularly in the fields of total joint arthroplasty, has raised concern for increased perioperative complications following joint arthroplasty in patients with osteoporosis. The purpose of this study is to evaluate the influence of preoperative osteoporosis on 6-month postoperative outcomes following total ankle arthroplasty (TAA).
Methods
The Nationwide Readmissions Database (NRD) was queried from 2015 to 2020 to identify 29,705 patients undergoing primary elective TAA. Patients were divided into two cohorts based on the presence of preoperative osteoporosis, with 943 (3.2 %) having this diagnosis. Preoperative demographics, comorbidities, postoperative outcomes, cost of admission, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to control for predictors of adverse postoperative outcomes other than preoperative osteoporosis.
Results
The overall cohort was majority male (54.2 %) with mean age of 64.15 (range 17–90) years, and Charlson-Deyo Comorbidity Index (CCI) score of 0.65 (range 0–12). When stratifying by preoperative osteoporosis, it was found that osteoporosis patients were statistically significantly older (Osteoporosis=68.72 years; Non-osteoporosis=65.03 years; p < .001), more likely to have Medicare insurance (p < .001), and had a higher CCI score (Osteoporosis=0.98; Non-Osteoporosis=0.64; p < .001). Multivariate regression analysis of 180-day postoperative outcomes found that preoperative osteoporosis was significantly predictive of increased risk of any complication (OR=1.428; p < .001), transfusion (OR=3.370; p < .001), pulmonary embolism (OR=5.625; p = .016), Pneumonia (OR=3.872; p < .001), non-routine discharge (OR=1.445; p < .001), and extended stay greater than 4 days (OR=1.310; p < .001). Further, preoperative presence of osteoporosis is predictive of nearly a $3000 increase in total cost of procedure (β= 2980.22; p < .001).
Conclusion
The presence of osteoporosis was significantly predictive of higher rates of postoperative complications, LOS, and a substantially higher cost of procedure following TAA. Physicians and patients alike should consider this comorbidity when stratifying risk for outcomes following total ankle arthroplasty.
{"title":"The effect of preoperative osteoporosis on postoperative outcomes following total ankle arthroplasty","authors":"Grace Bennfors, Ronit Kulkarni, Joshua Morningstar, Richard J. Friedman, Christopher E. Gross, Daniel J. Scott","doi":"10.1016/j.fas.2025.06.002","DOIUrl":"10.1016/j.fas.2025.06.002","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Recent literature, particularly in the fields of total joint arthroplasty, has raised concern for increased </span>perioperative complications<span> following joint arthroplasty in patients with osteoporosis<span>. The purpose of this study is to evaluate the influence of preoperative osteoporosis on 6-month postoperative outcomes following total ankle arthroplasty (TAA).</span></span></div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database (NRD) was queried from 2015 to 2020 to identify 29,705 patients undergoing primary elective TAA. Patients were divided into two cohorts based on the presence of preoperative osteoporosis, with 943 (3.2 %) having this diagnosis. Preoperative demographics, comorbidities, postoperative outcomes, cost of admission, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to control for predictors of adverse postoperative outcomes other than preoperative osteoporosis.</div></div><div><h3>Results</h3><div>The overall cohort was majority male (54.2 %) with mean age of 64.15 (range 17–90) years, and Charlson-Deyo Comorbidity Index (CCI) score of 0.65 (range 0–12). When stratifying by preoperative osteoporosis, it was found that osteoporosis patients were statistically significantly older (Osteoporosis=68.72 years; Non-osteoporosis=65.03 years; <em>p</em> < .001), more likely to have Medicare insurance (<em>p</em><span> < .001), and had a higher CCI score (Osteoporosis=0.98; Non-Osteoporosis=0.64; </span><em>p</em> < .001). Multivariate regression analysis of 180-day postoperative outcomes found that preoperative osteoporosis was significantly predictive of increased risk of any complication (OR=1.428; <em>p</em> < .001)<em>,</em> transfusion (OR=3.370; <em>p</em><span> < .001), pulmonary embolism (OR=5.625; </span><em>p</em> = .016), Pneumonia (OR=3.872; <em>p</em> < .001), non-routine discharge <em>(</em>OR=1.445; <em>p</em> < .001), and extended stay greater than 4 days (OR=1.310<em>; p</em> < .001). Further, preoperative presence of osteoporosis is predictive of nearly a $3000 increase in total cost of procedure (β= 2980.22; <em>p</em> < .001).</div></div><div><h3>Conclusion</h3><div>The presence of osteoporosis was significantly predictive of higher rates of postoperative complications, LOS, and a substantially higher cost of procedure following TAA. Physicians and patients alike should consider this comorbidity when stratifying risk for outcomes following total ankle arthroplasty.</div></div><div><h3>Level of evidence</h3><div>Level III, Retrospective Cohort Study</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 1","pages":"Pages 40-44"},"PeriodicalIF":2.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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