Journal of Foot & Ankle Surgery最新文献

Many fixation options exist for correction of a hallux valgus (HV) deformity with a first tarsometatarsal (TMT) joint arthrodesis with pros and cons to each. Few have looked at utilizing a SMA (shape memory alloy) staple made from nitinol for fixation. This study evaluates the effectiveness of a modified Lapidus technique using a nitinol (shape memory alloy) staple combined with a two-screw construct for first tarsometatarsal (TMT) joint arthrodesis in correcting hallux valgus (HV) deformity. The non-union rate, time to weightbearing in both a boot and a shoe, hardware removal of the staples, and the need for revision surgeries were all evaluated. A retrospective review of 42 patients meeting the inclusion criteria was conducted, with an average follow-up time of 12.3 months (SD 4.5). Bony union was achieved in 47 of 48 (97.92%) cases for a non-union rate of 2.08%. The average time to weightbearing in a boot was 27.35 days (SD 3.47), while in a shoe, it was 55.58 days (SD 10.03). There was a total of 3 procedures requiring staple removal (3/48) (6.25%), and no revision surgeries were needed due to loss of correction or non-union. These outcomes suggest that the nitinol staple and two-screw construct is a reliable option for first tarsometatarsal joint arthrodesis in hallux valgus deformity, showing similar results compared to other fixation methods. Level of Clinical Evidence: 4.

Plantar fasciitis is a common musculoskeletal issue that can cause severe pain and limit functionality. This study aimed to compare the effectiveness of Extracorporeal shock-wave therapy and Low-dye taping in relieving pain and improving functionality in plantar fasciitis. The study included cases with a confirmed diagnosis of plantar fasciitis, which were randomly divided into two groups: Extracorporeal shock-wave therapy and Low-dye taping. The subjects in the Extracorporeal shock-wave therapy group were treated with Extracorporeal shock-wave therapy, while the subjects in the Low-dye taping group were treated with Low-dye taping and sham Extracorporeal shock-wave therapy. Both treatments were administered in three sessions, once a week. Pain and functionality levels were evaluated using the Visual analog scala and Foot&Ankle Outcome Score. Evaluations were conducted pre- and post-treatment, and at the six-week follow-up. Seventy-two subjects completed the study, and at the end of the treatment and follow-up periods, both groups showed a significant decrease in pain levels (p≤0.001) and an increase in functionality levels (p≤0.001) compared to the beginning. However, there was no significant difference between the groups regarding pain and functionality levels at the end of the treatment and follow-up period (p>0.05). Therefore, both Extracorporeal shock-wave therapy and Low-dye taping treatments were found to have similar effects in treating plantar fasciitis. These findings can guide clinicians in choosing the most effective conservative treatment for plantar fasciitis patients.

Accurate diagnoses of peroneal pathologies remains a challenge due to limitations of conventional 2D (dimensional) imaging, which can impact long-term patient outcomes. This study evaluates MRI accuracy and inter-reader reliability of peroneal compartment pathology for 2D and 3D MRI. A consecutive series of patients who underwent peroneal compartment surgery with preoperative 1.5- or 3.0-Tesla ankle MRIs from 2009 to 2024 included 32 scans (22 with 2D, 10 with 2D+3D) from 31 patients (ages 17-74 years, all genders). Three musculoskeletal readers blinded to surgical findings independently analyzed MRI scans for common peroneal tenosynovitis, peroneus brevis and peroneus longus tenosynovitis, tendinopathy, and tears. Inter-reader reliability and diagnostic performance measures were calculated. Using majority vote, overall accuracy, sensitivity, and specificity for peroneal tendons using 2D MRI were 80%, 81%, and 79%, respectively. Using 3D MRI sequences, whether in isolation or combination with 2D MRI, accuracy, sensitivity, and specificity increased to 85%, 88%, and 83%, respectively. The inter-reader reliability for peroneus brevis lesions was 0.45-0.75 for 2D, 0.25-0.35 for 3D, and 0.31-0.54 for combined 2D+3D, while for peroneus longus lesions, it was 0.45-0.90 for 2D, 0.20-0.71 for 3D, and 0.64-0.81 for combined 2D+3D scans. The inter-reader reliability for tenosynovitis ranged from 0.62-0.64 for 2D, 0.25-0.37 for 3D, and 0.57-0.66 for combined 2D+3D scans. The addition of 3D MRI to 2D high-resolution ankle MRI protocol or 3D MRI alone increases accuracy of peroneal compartment lesion detection with minor decrease in inter-reader reliability for peroneal brevis tendon assessment. Larger studies may help validate our findings.

Giant cell tumour of tendon sheath (TSGCT) is an uncommon soft tissue tumor, especially in its diffuse subtype (D-TSGCT), which is rare and associated with a high recurrence rate after treatment. This condition significantly affects joint function and quality of life. This retrospective study evaluated the clinical characteristics, surgical outcomes, and long-term follow-up of 24 patients who underwent wide-margin resection for ankle D-TSGCT from 2011 to 2018. The average patient age was 36.5 years, with common symptoms including palpable masses and ankle swelling. All patients received wide-margin resection, with a mean follow-up period of 75.7 months. Tumor recurrence occurred in five patients (21%), with complications included postoperative infections, surgical site pain, ankle instability, and stiffness. There was a significant improvement in the Musculoskeletal Tumor Society (MSTS) scores post-surgery. Additionally, the Foot and Ankle Ability Measure (FAAM) showed improvements in daily living and physical activities, though Ankle Joint Functional Assessment Tool (AJFAT) scores did not demonstrate significant change. These findings indicate that wide-margin resection is an effective treatment for D-TSGCT, preserving ankle function and demonstrating a low recurrence rate, although it may lead to ankle instability requiring careful postoperative monitoring and rehabilitation.

Distal tibiofibular joint injury is quite common in rotational ankle fractures, with high malreduction rates reported. Although several intraoperative techniques evaluate the optimal tibiofibular reduction, they are critically debated due to high error rates and subjective interpretation of the results. We attempted to describe specific anatomical landmarks and anatomical relationships of the ankle joint through capsulotomy and inspection of the anterior incisura fibularis corner and evaluate their reliability regarding optimal tibiofibular reduction. Sixty patients with malleolar fractures and concomitant distal tibiofibular joint disruption were randomized into two groups. Patients of Group A were treated with a standard approach. In Group B, the reduction was performed following specific anatomical landmarks of the anterolateral ankle joint through capsulotomy. Reduction quality was evaluated with postoperative bilateral ankle CT. Distal tibiofibular joint reduction after direct visualization resulted in significantly better rotation and fibula length values than patients treated with the standard approach. In addition, clinical scores were better in the 3rd and 6th postoperative months. Direct visualization of the anterolateral ankle joint can provide trustworthy anatomical landmarks to achieve high-quality reduction of the distal tibiofibular joint in ankle fractures. Additional repair of the ligamentocapsular structures of the corner enhances joint stability and provides better clinical outcomes in 12 months.

Citation count and impact factor of the publishing journal are two historically utilized metrics to determine an article's impact in its research field. However, these metrics are limited given the rise in research dissemination through social media. Across other orthopedic specialties, the Altmetric Attention Score (AAS) has been used to determine which articles are most impactful. This study utilizes the AAS to highlight the 100 most impactful articles in foot and ankle surgery and determine if bibliometric factors and article characteristics are predictive of AAS. The AAS website was queried on a single day in September 2024 and 4,262 articles were retrieved. The top 100 relevant foot and ankle articles published after 2010 were ranked by AAS and analyzed for bibliometric factors, study design, and study subject. The median (IQR) AAS was 18 (14, 42.5). A majority of the top 100 impactful articles were published in the Journal of Foot and Ankle Surgery and Foot and Ankle Surgery. Most articles were original clinical research articles (54%). Facebook and news mentions were positively correlated with AAS (p = 0.019, p < 0.0001, respectively) while other social media mentions had no significant relationship (p > 0.05). Study design and study subject were not significant predictors of AAS (p > 0.05). In conclusion, our study finds that, while citation count indicates an article's longitudinal impact, it does not correlate with AAS in foot and ankle surgery, which provides an immediate, dynamic metric to directly compare articles' impacts. Level of Evidence: Level IV.

The optimal treatment for displaced or comminution fifth metatarsal base fractures remain debated. Ninety displaced or comminution fifth metatarsal base fractures patients were randomly selected into three groups: the ulnar hook plate fixation group (n=30), the immobilization treatment group (n=18), and the early functional group (n=30). The assessed factors included the duration until union, time to resume daily activities, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Disability Index (FADI) scores, visual analog scale (VAS) ratings and occurrence of complications. The VAS scores showed no significant differences observed among the three treatments. The mean AOFAS score and mean FADI after treatment in the plate group and exhibited significant better than that of the immobilization group and the early functional group at 1 moth, 3 months and 6 months (P˂0.05) . After a duration of 12 months, all three treatments exhibited comparable outcomes and facilitated restoration of daily activities. In the plate group, one patient developed a wound infection, one patient experienced sural nerve injury or irritation, and three patients exhibited implant prominence. One patient encountered nonunion in the immobilization group.The union time and the time of return to daily activities and the early functional group exhibited significant shorter durations than that of the immobilization group and the plate group(P˂0.05). Overall, the early functional treatment is recommended for managing displaced or comminution fifth metatarsal base fractures. Evidences level: III.

The purpose of this study was to identify if complicated open reduction internal fixation (ORIF) of calcaneal fractures (i.e. requiring bone graft) performed in the outpatient setting poses an excess risk for 30-day complications compared to inpatient procedures. We included patients who underwent ORIF of the calcaneus involving the use of bone graft utilizing CPT code 28420 from the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) between 2014 and 2019. Postoperative complications, demographic data, patient characteristics, and operative factors were compared between groups. T-tests were performed to assess univariate associations between outpatient status and surgical/patient demographics for continuous variables while chi-squared tests were performed to evaluate categorical variables. A total of 113 patients were included, experiencing a 2.6% short term complication rate (3/113). All 3 complications occurred in the outpatient setting. 51.3% of surgeries were performed on an inpatient basis. In the univariate analysis, there were no statistically significant differences between inpatient and outpatient 30-day postoperative complication rates. Although more complications were recognized in the outpatient population, this did not reach statistical significance and suggests that complicated calcaneal ORIF procedures involving bone graft may be performed in the outpatient setting without posing an excess risk.

This study provides an in-depth exploration of patient expectations with hallux valgus surgery using a qualitative approach. Twenty patients awaiting surgery for symptomatic hallux valgus in our practice completed a 20-minute semi-structured interview to elicit rich, nuanced information regarding their expectations in bunion surgery. Interviews were transcribed and independently coded by three reviewers. Codes were combined and analyzed by three reviewers to produce over-arching themes that represented patient motivations and goals with hallux valgus surgery. Pain and activity were key decision-making factors influencing both the decision to pursue surgery and in defining surgical success. Many participants feared worsening pain and progression of deformity if left untreated. Cosmetic appearance was an important concern, as well, but secondary to pain, activity and functional ability. Participants valued clear, comprehensive instructions from their care team regarding their immediate postoperative care. Lastly, we observed wide variability in expectations regarding the postoperative recovery timeline, suggesting, perhaps, a greater need for providing rehabilitation timelines that better align expectations with clinical reality. These findings provide evidence that hallux valgus deformity, in the eyes of our patients, is a disabling musculoskeletal condition which can substantially restrict daily activities. Additionally, the work offers insight into patient goals and motivations for pursuing hallux valgus surgery and highlights potential areas for improved dialog during preoperative consultations. LEVEL OF CLINICAL EVIDENCE: N/A.