Journal of Foot & Ankle Surgery最新文献

Background: Comparative trials evaluating surgical outcomes are critical in guiding treatment for hallux valgus. However, the statistical stability of these outcomes is not well documented. Purpose The purpose of this study was to evaluate the statistical fragility of comparative studies analyzing minimally invasive surgery (MIS) versus open techniques for hallux valgus correction.

Study: Design A systematic review identified comparative studies assessing MIS versus open hallux valgus correction.

Methods: Outcome data were extracted with Fragility Index (FI) and Continuous Fragility Index (CFI) calculated for significant outcomes, and reverse FI (rFI) and reverse CFI (rCFI) for nonsignificant outcomes. Fragility Quotient (FQ) was calculated for each and compared to the number of patients lost to follow-up (LTFU).

Results: Of 628 studies screened, 18 met inclusion criteria, totaling 1,369 patients. Among 88 dichotomous outcomes, the median FI was 2, FQ was 0.021, rFI was 4, and rFQ was 0.072. For 236 continuous outcomes, the median CFI was 8, CFQ was 0.116, rCFI was 19, and rCFQ was 0.280.

Conclusion: This is the first study to evaluate fragility in comparative trials on MIS versus open hallux valgus correction and among the first to assess reverse fragility in continuous outcomes. Significant results were more fragile than nonsignificant data and dichotomous outcomes were more fragile than continuous ones with nearly a quarter having an FI lower than the number of patients LTFU. Both outcome types demonstrated considerable statistical fragility supporting the cautious interpretation of MIS vs open hallux valgus findings and the reporting of statistical fragility data alongside P-values to better contextualize the robustness of clinical research.

Background: Sesamoid displacement is a characteristic feature of hallux valgus; however, its three-dimensional positional changes relative to the surrounding bony structures remain unclear.

Purpose: To compare the three-dimensional position of the lateral sesamoid in hallux valgus with sesamoid dislocation and in normal feet using computed tomography.

Study design: Retrospective comparative study.

Methods: Feet with hallux valgus and sesamoid dislocation (Group A) were compared with normal feet (Group B). Three-dimensional computed tomography reconstructions were used to evaluate the spatial relationship between the lateral sesamoid and adjacent bones. Distances between the center of the lateral sesamoid and the second metatarsal were measured along the mediolateral (X-axis), dorsoplantar (Y-axis), and straight-line axes. Additional measurements included distances from the lateral edge of the lateral sesamoid to the distal shaft of the third metatarsal and to the lateral center of the first metatarsal head.

Results: The straight-line distance between the lateral sesamoid and the second metatarsal did not differ significantly between groups. However, the lateral sesamoid was positioned significantly more laterally and dorsally in Group A. The distance to the distal third metatarsal shaft was significantly greater, whereas the distance to the lateral center of the first metatarsal head was significantly shorter in Group A.

Conclusion: Hallux valgus with sesamoid dislocation is characterized by three-dimensional dorsolateral displacement of the lateral sesamoid without a change in straight-line distance. This displacement may mechanically impede first metatarsal reduction and should be considered during surgical correction.

Level of clinical evidence: 3.

Background: Workforce data analyses of contemporary US podiatric physicians might be relatively lacking in comparison to other specialties. This information is important given concerns for the aging US population and predicted long-term physician shortages.

Purpose: The objective of this investigation was to provide a comprehensive contemporary demographic and geographic descriptive analysis of the podiatric specialty in the US.

Study design: Epidemiologic descriptive analysis.

Methods: The National Downloadable File produced by the Centers for Medicare & Medicaid Services (CMS) was accessed in July 2025. Demographic and geographic data related to those physicians with a credential of "DPM" was extracted and analyzed.

Results: The number of podiatric physicians with an active NPI was 15658. Of these, 70.9% were male. 22.8% graduated from podiatric medical school prior to 1991, while 31.6% graduated after 2011. Podiatric physicians with an active NPI billed within 6678 different zip codes and at 26386 different billing addresses. Although it was most frequent for DPMs with an active NPI to bill from one address (37.8%), the mean±standard deviation (range) of billing addresses per NPI was 1.7±1.5 (1-50).

Discussion: The results of this investigation provide unique information on the demographic and geographic characteristics of podiatric physicians with an active NPI. It is our hope that this primarily descriptive raw data is utilized by state and national organizations for improved work force analyses for the podiatric specialty.

Level of evidence: IV.

Background: Percutaneous hallux valgus correction is gaining popularity in the United States. However, its benefits compared to the traditional open technique remain debated. Adoption of the technique has been slow, largely due to the lack of long-term studies incorporating patient-reported outcomes in the U.S.

Population:

Purpose: To evaluate the one-year clinical and radiographic outcomes of percutaneous chevron-Akin osteotomy for hallux valgus correction using patient-reported functional outcome measures.

Study design: Retrospective cohort study METHODS: We identified 295 patients who underwent percutaneous chevron-Akin osteotomy for hallux valgus correction between September 2019 and April 2023. A total of 355 procedures were performed, including 61 bilateral surgeries. After applying inclusion criteria and accounting for survey non-respondents, 137 patients (125 females, 12 males) with 170 procedures were included in the final analysis. Patients were contacted and surveyed at a minimum of 12 months postoperatively. The primary functional outcome was assessed using the Foot Function Index (FFI). Radiographic evaluations were conducted using preoperative and final postoperative imaging.

Results: Statistically significant improvements (p < 0.05) were observed in all patient-reported outcome measures, including the FFI, as well as in radiographic angle measurements from preoperative to postoperative evaluations.

Conclusion: Percutaneous hallux valgus correction demonstrates favorable outcomes at one year, with significant improvement in both patient-reported function and radiographic parameters. While these findings support the efficacy of the percutaneous approach, further comparative studies with the open technique are warranted.

Level of evidence: 3:

Background: The first tarsometatarsal joint (TMTJ) arthrodesis is a common, reproducible procedure performed for severe hallux valgus correction and first TMTJ arthritis. As technology innovations evolve, minimally invasive surgery (MIS) is becoming popular and starting to be utilized for first TMTJ arthrodesis.

Purpose: The purpose of this study was to evaluate the efficacy of first TMTJ preparation using a 3.0 mm MIS burr through a single versus double portal approach. Additionally, we evaluated surrounding soft tissue structures at risk for iatrogenic injury.

Study design: This was an anatomic study comprised of 17 cadaveric specimens.

Methods: Preparation of the first TMTJ was performed through a single portal for all right specimens and a double portal for all left specimens using a 3.0 mm burr for two-minutes. The specimens were then dissected and surrounding soft tissue structures were evaluated. After joint disarticulation, the cartilage resection surface area ratios were evaluated.

Results: The total medial cuneiform and first metatarsal base ratio was 64.80% and 70.71% respectively. There was no significant difference in cartilage debridement of the medial cuneiform (P = 0.33) or first metatarsal base (P = 0.35) in the single versus the double portal group. No damage to the extensor hallucis longus (EHL) nor medial dorsal cutaneous nerve (MDCN) was noted.

Conclusion: In conclusion, the authors believe that with adequate time and experience, successful joint preparation of the first TMTJ can be achieved using both a single or double portal approach with minimal iatrogenic risk to surrounding soft tissue and neurovascular structures.

Background: Plate fixation with an interfragmentary lag screw is often used for Weber B fibular fractures. However, consensus is lacking regarding whether lateral locking plate fixation without a lag screw is also a viable option for Weber B fractures PURPOSE: Compare union rates of Weber B fibular fractures fixated using a lateral locking plate and lag screw versus a lateral locking plate-only.

Study design: Retrospective cohort study METHODS: A retrospective review was conducted on patients who underwent ankle open reduction internal fixation (ORIF) at a single institution between 01/01/2022 and 01/01/2024. Patients had a minimum of a 12 month follow-up. Primary outcome measured included fracture union within 12 weeks which was defined as radiographic evidence of bridging callus across the fracture site with resolution of fracture line, painless weightbearing, and minimal or no tenderness on palpation over the fracture site. Secondary outcomes included time to union and complication rates.

Results: Seventy-one patients were included, 41 of which were treated with a plate and lag screw, and 30 with a plate-only. There was no significant difference in union rates (plate + lag screw: 97.56% vs plate-only 93.33%, p=0.38) or time to union (plate + lag screw: 8.45 weeks vs plate-only 9.10 weeks, p=0.23). The plate-only group showed a slightly lower complication rate, although not statistically significant (p=0.76).

Conclusion: With no significant differences observed in union rates, time to union, or complication rates, plate-only fixation seems to be a reliable alternative when insertion of an interfragmentary lag screw may not be feasible.

Background: Charcot neuroarthropathy affects 0.4-13% of diabetic patients and can be limb threatening, often requiring surgical stabilization. Traditionally, intramedullary fixation ("beaming") has been utilized, but more recently intramedullary compression nails ("IM nails") have been introduced.

Purpose: This study compared radiographic union, hardware failure, and major reoperations between IM nails and traditional beaming for Charcot midfoot reconstruction.

Study design: Patient outcomes following Charcot midfoot reconstruction were retrospectively analyzed at a single center from 2016 to 2021.

Methods: We identified patients with midfoot Charcot treated with extended intramedullary fixation and ≥9 months follow-up. Patients with ulceration, ankle Charcot, or external fixation were excluded. Demographics, construct type, and radiographic outcomes were evaluated. Union was assessed by two fellowship-trained surgeons. Multivariable logistic regression controlled for construct type and subtalar arthrodesis.

Results: Forty-two feet (mean age 56.6 ± 9.2 years) were included: 18 beaming and 24 IM nail constructs. Mean follow-up was 2.2 ± 1.2 years (clinical) and 12.8 ± 7.1 months (radiographic). Demographics were similar between groups. Secondary surgery was required in 19 feet (45.2%) with no significant difference between groups (p = 0.07). IM nail constructs had significantly higher union rates (91.7% vs 50.0%, p = 0.004) and lower hardware failure rates (12.5% vs 66.7%, p < 0.001). Regression analysis showed this association was independent of concomitant subtalar arthrodesis status.

Conclusions: Intramedullary compression nails demonstrated superior union and hardware failure rates than traditional beaming constructs in midfoot Charcot reconstruction, benefits that persisted independent of concomitant subtalar arthrodesis. Further investigation is needed to determine whether this is primarily attributable to implant design or additive effects of hindfoot stabilization.

Background: First metatarsophalangeal arthrodesis is the standard for advanced hallux rigidus; the Cartiva synthetic cartilage implantation (polyvinyl alcohol hydrogel hemiarthroplasty) preserves motion, but its role is uncertain.

Methods: We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus to 6 June 2025 for adult comparisons of synthetic cartilage hemiarthroplasty using a polyvinyl alcohol hydrogel implant (Cartiva®; Stryker, Kalamazoo, MI, USA) versus arthrodesis (≥12-month follow-up). Outcomes were pain, function, range of motion, satisfaction, complications, and reoperations. Random-effects meta-analysis pooled standardized mean differences and risk ratios.

Results: Six studies (one randomized, five cohorts; ∼600 patients: 348 synthetic cartilage implantation, 252 arthrodesis) met criteria. At 12-24 months, both procedures improved pain and function; functional differences were not consistent (low-certainty evidence). Cartiva preserved ∼6° dorsiflexion, whereas arthrodesis showed greater pain relief (SMD 0.44, 95% CI 0.25-0.64; I²=0%). For reoperations, counting all subsequent surgeries showed no difference (RR 0.90, 95% CI 0.45-1.78; I²=35%); restricting to true revisions suggested a nonsignificant increase with Cartiva (RR 1.79, 95% CI 0.69-4.65; I²=0%). Complications were otherwise similar.

Conclusions: Cartiva may preserve motion with similar short-term function, whereas pain relief likely favors arthrodesis. Evidence for reoperations and complications is very uncertain; sensitivity analysis suggested a possible increase in true revisions after Cartiva. Given the small, heterogeneous, short-term evidence base, findings should be interpreted cautiously and confirmed in longer-term studies.

Background: This study investigates the relationship between isokinetic ankle strength and dynamic postural control during single-leg drop landing (SLDL) in females with chronic ankle instability (CAI). Ankle muscle strength is vital for stability, yet the relationship between isokinetic strength and SLDL postural control remains underexplored in this population.

Purpose: To investigate associations between isokinetic ankle strength (dorsiflexion, plantar flexion, inversion, eversion) and dynamic postural stability during forward, medial, and lateral SLDL in females with CAI.

Study design: correlational strategy study.

Methods: Forty-two physically active females with CAI (mean age 29.4 ± 6.5 years, CAIT score 17.7 ± 5.0) underwent isokinetic dynamometry at 60°/s and 120°/s to measure peak torque normalized to body mass. Dynamic postural control was assessed via center of pressure (COP) deviations during SLDL from a 16-cm platform. Spearman's correlations analyzed relationships (p < 0.05).

Results: Forward SLDL COP deviations negatively correlated with invertor (rs = -0.538 to -0.522), evertor (rs = -0.575 to -0.484), plantar flexor (rs = -0.619 to -0.658), and dorsiflexor (rs = -0.423) peak torques (all p ≤ 0.005). Medial SLDL COP deviations negatively correlated with evertor-to-invertor ratios (rs = -0.335 to -0.384, p ≤ 0.030). No significant correlations emerged for lateral SLDL.

Conclusion: Isokinetic ankle strength is associated with reduced COP deviations in forward SLDL, while evertor-to-invertor ratios support medial SLDL stability. These findings highlight direction-specific demands, informing targeted rehabilitation for CAI.

Level of clinical evidence: Level 4.