Journal of Foot & Ankle Surgery最新文献

The purpose was to compare the rehabilitation practices and procedures following arthroscopic ankle lateral ligament repair (ALLR) (reconstruction/Broström repair) among high-volume and low-volume surgeons in France. The hypothesis was that there would be no differences in practices and procedures between high-volume and low-volume surgeons. In 2023, an online questionnaire was emailed to members of the francophone arthroscopy society (SFA). Fifty-two surgeons responded, of which 10 (19.2%) were excluded as they did not perform arthroscopic ALLR. The questionnaire focused on four main topics: (i) surgeon experience and technique, (ii) immobilisation, (iii) weight-bearing, and (iv) cryotherapy. Surgeons were divided into high- (≥35 cases/year) and low-volume (<35 cases/year) surgeons, according to the number of ankle arthroscopies performed. A greater proportion of high-volume surgeons prescribe less restrictive immobilisation compared to low-volume surgeons (46% vs 22%). A smaller proportion of high-volume surgeons restrict immediate weight-bearing compared to low-volume surgeons (8% vs 33%). A greater proportion of high-volume surgeons would prescribe crutches only if patients request them, compared to low-volume surgeons (79% vs 50%). A greater proportion of high-volume surgeons prescribe cryotherapy compared to low-volume surgeons, more frequently (87% vs 78%) and immediately following surgery (46% vs 22%). This survey revealed that high-volume surgeons prescribe less restrictive immobilisation and allow earlier weight-bearing following arthroscopic ALLR, compared to low-volume surgeons. The clinical relevance is that low-volume surgeons should gain greater confidence in prescribing less restrictive immobilisation and immediate weight-bearing, based on experience of high-volume peers, which could help improve outcomes of arthroscopic ALLR and reduce healthcare and economic burdens.

This prospective, multicenter study assessed the radiographic, clinical, and patient-reported outcomes for hallux valgus (HV) correction performed with an instrumented 1st tarsometatarsal (TMT) system through a mini-open incision (≤4cm) with a biplanar plating construct and early return to weightbearing. One hundred and five patients were treated, with 75 and 11 patients completing their 12- and 24-month visits, respectively. The median (min, max) length of the primary dorsal incision was 3.5 cm (3.0, 4.0). Patients underwent an early weightbearing protocol with mean (95 % CI) of 7.9 (6.7, 9.1) days to weightbearing in a CAM boot. Significant improvements from baseline in mean radiographic measurements for Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Tibial Sesamoid Position (TSP), and osseous foot width (OFW) were maintained through 12 months. Using recurrence definitions of greater than 15° and 20° postoperative HVA, recurrence rates were 5.5 % (95 % CI: 1.5 %, 13.4 %) and 0.0 % at 12 months and 0.0 % for both thresholds at 24 months, respectively. Significant improvements in patient-reported outcomes [Visual Analog Scale (VAS), Manchester-Oxford Foot Questionnaire (MOxFQ) and Patient-Reported Outcomes Measurement Information System (PROMIS)] were maintained through 12 and 24 months. A clinically meaningful assessment of the scar appearance was observed in the POSAS scores. One (1.0 %) patient in the overall treated cohort of 105 required reoperation for removal of hardware due to pain. The results of this prospective, multicenter study on a mini-open 1st TMT system demonstrated improvements in radiographic correction, low recurrence, early return to activity with low complication rates, and improvements in patient-reported outcomes.

Total ankle arthroplasty (TAA) is a common intervention for the treatment of end-stage ankle arthritis. Unfortunately, use of a longitudinal anterior incision to gain access to the ankle is commonly associated with postoperative wound dehiscence. In this retrospective cohort study the incidence of postoperative anterior wound dehiscence following TAA in 100 consecutive patients was 21%, and 7 (33.33%) of the dehiscence cases were serious enough to require additional operative treatment. The anterior soft tissue depth (ASTD) at the level of the tibiotalar joint was measured from the anterior margin of the skin to the anterior margin of the ankle as viewed on the standard lateral radiograph. The overall median ASTD for the entire cohort was 21.79 (range 5.7 to 37.3) mm, whereas that in the non-dehiscence group was 22.06 (5.7, 37.3) mm and that in the dehiscence group was 18.6 (12.78, 35.9) mm, and this difference was statistically significant (p = 0.0240). Receiver operating characteristic (ROC) curve analyses showed that a preoperative ASTD ≤ 16 mm maximized diagnostic sensitivity and specificity and predicted dehiscence.

Both orthopedic surgeons and podiatric surgeons perform the Hallux Valgus (HV) Bunionectomy, yet limited information exists on which procedures are being performed more often and which specialty is performing them.. This study aims to analyze specialty-specific trends in treatment for HV within the Medicare population. In a retrospective analysis, data for bunionectomies from 2013 to 2022 were obtained from the Centers for Medicare & Medicaid Services. Bunionectomies were identified using Current procedural terminology [CPT] codes (28292, 28296, 28297, 28298, 28299 from 2013-2022 and 28295 from 2017-2022). The results were further categorized based on operator type (orthopedist, podiatrist) and place of service (inpatient, outpatient, other). Work Relative Value Units (wRVU) were calculated for osteotomy and Lapidus procedures. 217,750 bunionectomies were identified. From 2013 to 2022, the number of bunionectomies declined from 81.48 to 42.18 per 100,000 patients, a decrease of 48.23%. Orthopedic surgeons had a 9.8% increase in relative procedure share of bunionectomies performed and a 12.95% decrease in bunionectomies performed per 100,000 patients compared to a 9.8% decrease and 54.12% decrease, respectively, for podiatrists. There was a 67.32% increase in Lapidus procedures (CPT Code: 28297) performed per 100,000 patients from 2013 to 2022. Outpatient services increased by 0.1%, inpatient increased by 0.1%, and other places decreased by 0.2%.There was a substantial decline in bunionectomies performed in the Medicare population between 2013 to 2022 with an increase in the number of Lapidus procedures. Trends show an increase in utilization of orthopedic surgeons for bunionectomies and minimal change in place of service.

A prospective nonrandomized study was conducted on consecutive patients undergoing foot surgery at a single academic medical center from April 1, 2022 through June 30, 2022. All patients underwent elective bone surgery, e.g. hallux abductovalgus surgery, lesser metatarsal osteotomy, midfoot procedures, hindfoot procedures. All patients obtained immediate x-rays in the post-anesthesia care unit per postoperative protocol at the medical center. A total of 56 patients were enrolled. The study was approved by the Institutional Review Board (IRB) of the medical center. The primary aim of the study was to determine if immediate postoperative x-rays altered the course of patient care in terms of unplanned return to the operating room, change in immobilization or a change in weightbearing recommendations. Eighteen (32 %) patients underwent hallux abductovalgus surgery, 10 (18 %) patients underwent lesser metatarsal surgery, 3 (5 %) underwent midfoot procedures, 10 (18 %) underwent hindfoot procedures and 15 (27 %) underwent other bone procedures. No patient required an early or unplanned return to the operating room based on the results of the immediate postop x-rays and 0 patients experienced a change in postoperative immobilization or weightbearing instructions. This relatively small prospective study suggests there is little value in obtaining immediate postoperative x-rays in the postanesthesia care unit as none resulted in immediate changes in postoperative management of patients. While immediate postoperative radiographs can be advantageous in specific clinical scenarios, the routine adoption of this practice should be carefully evaluated, considering added costs resulting in limited clinical benefits.

Although fluoroscopy-assisted calcaneal pin placement for ankle-spanning external fixation or skeletal traction was advocated in the literature, evidence for necessity of fluoroscopy for this application is lacking. This study aimed to compare the calcaneal pin locations and complications of patients who underwent pin placement with and without fluoroscopy guidance. In this retrospective cohort study, adult patients that underwent external fixation for ankle fractures between October 2022 and May 2024 were included. The primary outcome was the rate of the pins that were inside the safe zone. Secondary outcomes were the distance of pins to the tip of medial malleolus and the posteriormost point of calcaneus and complications such as neurovascular deficit and calcaneal fracture. Eighty-two patients (mean age 47±16.4 - min. 18 - max. 89, 54.9 % male) were involved in the study. Forty-five patients (group 1) had their pins placed without fluoroscopy assistance and thirty-seven patients (group 2) with fluoroscopy assistance. Five patients (11.1 %) in group 1 and seven patients (18.9 %) in group 2 had their pins placed outside the safe zone (P = 0.320). Distance of the hole from medial malleolus was mean 38.8 ± 7.9 mm for group 1 and 51.3 ± 8.32 mm for group 2 (P < 0.001), and distance from posteriormost point of calcaneus was mean 25.2 ± 6.3 mm for group 1 and 21.4 ± 7.9 mm for group 2 (P = 0.019). No neurovascular complications or calcaneal fracture were seen during follow-up. In conclusion, fluoroscopy guidance does not provide any additional benefit for placing calcaneal pins.

Plantar heel pain is a common musculoskeletal problem in adults that causes limitation and disability in daily life activities. This study aimed to compare the effects of extracorporeal shock wave therapy(ESWT) and kinesio taping(KT) treatments on pain, functionality and quality of life in the treatment of plantar heel pain secondary to plantar fasciitis and a calcaneal spur. Patients who received ESWT or KT treatment for plantar heel pain between September 2023 and February 2024 were retrospectively screened. Before treatment and at the third month after treatment, pain levels were evaluated with Visual Analog Scale (VAS), sensitivity with Heel Tenderness Index (HTI), functional status with Foot Function Index (FFI) and quality of life with the 12-item short form health survey(SF-12).A total of 60 patients were included in the study,32 patients in the ESWT group and 28 patients in the KT group. There was no significant difference between the groups in terms of age, gender, VAS value, HTI level, FFI value and SF-12 physical component score (PCS) before treatment. There was a significant improvement in VAS, HTI, FFI, and SF-12 PCS evaluations after treatment in both groups compared to the baseline. Furthermore, while both treatment methods resulted in a regression in VAS levels and improvement in FFI scores, the KT group demonstrated significantly better outcomes than the ESWT group. There was no significant difference in improvement in SF-12 PCS scores between the two groups. Our study indicates KT may be more effective than ESWT for treating plantar heel pain in terms of pain and functionality, but both treatment modalities have similar effects on quality of life.

This retrospective case series investigated the treatment outcomes for hallux rigidus. A total of 153 patients (130 females, 49 males) were included. Of the 153 patients, 26 were bilateral and 179 procedures met the inclusion criteria. The patients had undergone 1 of the following procedures: cheilectomy (Group 1), hemi-implant arthroplasty (Group 2), decompression metatarsal osteotomy (DMO) (Group 3), and DMO with hemi-implant (Group 4). Mean patient age was 57 years (range 18-82), and the mean follow-up period was 26 months (range 12-72). All patients regardless of procedure had improvement in pain score with Group 4 demonstrating the greatest reduction in pain at 99 %. The majority of patients in the study had Stage II hallux limitus/rigidus (HL/HR) (67 patients), followed by 62 patients with Stage III and 49 patients with Stage IV. Preoperatively, the majority of patients lacked dorsiflexion at the first metatarsophalangeal joint. Group 1 gained 16° in dorsiflexion from preoperative to postoperative, Group 2 gained 20°, Group 3 gained 30° and Group 4 gained 24° by the 12 month followup. The results revealed that adhesions were the most common complication for all 4 surgical groups. These four surgical procedures for the treatment of Stage II, III and IV hallux rigidus are viable options and lead to satisfactory long-term outcomes that restore function, relieve pain and improve joint range of motion. Each procedure has demonstrated satisfactory long-term outcomes and high patient satisfaction.

The Brostrom technique is widely accepted as the gold standard surgical intervention for the treatment of chronic lateral ankle instability. Concerns with persistent postoperative instability, incomplete restoration of preinjury biomechanical strength, and variable return-to-sport rates have, however, led to growing interest in novel augmentation procedures. Suture tape augmentation, which reinforces the anterior talofibular ligament and acts as a secondary stabilizer, is one such method. This study assesses 5-year patient-reported outcomes of primary repair with suture tape augmentation for anterior talofibular ligament injuries. Seventy-seven patients undergoing anterior talofibular ligament repair with suture tape augmentation were prospectively followed for at least 5-years. The visual analogue scale for pain (VAS), veteran rands 12 (VR-12) score, functional foot index (FFI), and the foot and ankle ability measure sports subscale (FAAM-S) were assessed at baseline, 2-year follow-up and 5-year follow-up. Of the seventy-seven patients initially included, sixty-eight (88.3%) completed follow-up. The median VAS, VR-12, FFI, and FAAM-S scores all demonstrated significant improvement at both 2-year and 5-year follow-up, compared to preoperative baseline. Only the FFI demonstrated improvement between the 2-year and 5-year follow-up timepoints. In conclusion, primary repair with suture tape augmentation for anterior talofibular ligament injury demonstrates satisfactory patient-reported outcomes at a minimum of 5-year follow-up. These results suggest that this technique should be considered as an alternative to conventional Brostrom repair for treatment of lateral ankle instability. LEVEL OF EVIDENCE: Level IV.

Direct or indirect internal fixation for posterior ankle fractures remains a controversial topic. While direct plate or screw internal fixation is believed to provide better reduction, it may also cause more severe soft tissue damage, while indirect screw internal fixation is thought to result in less damage but may carry the risk of poor reduction. We conducted this meta-analysis to investigate the clinical efficacy and safety of direct versus indirect reduction internal fixation for posterior ankle fractures. The Preferred Reporting Items for Systematic Evaluation and Meta-Analysis (PRISMA) guidelines were used to search the China Knowledge Network database (CNKI), PubMed, Web of Science, Embase, and other databases from the year of establishment- February 2025, and relevant journals were manually searched to collect the relevant literature, and articles that met the requirements were screened and analyzed. Meta-analysis was conducted using RevMan 5.4 software, and a systematic evaluation was carried out when the data from the included studies could not be synthesized. A total of 17 articles involving 1538 study subjects were included, and the results showed that there were no statistical differences in postoperative AOFAS scores, complications, and Dorsiflexion restriction between ankle fractures after direct plate or screw reduction and fixation and those after indirect screw reduction and fixation; however, the Radiological evaluation>2 mm and Osteoarthritis (P < 0.05) were statistically different. Direct reduction and fixation of posterior ankle fractures has better imaging performance and reduces the incidence of postoperative arthritic events.