Journal of Foot & Ankle Surgery最新文献

Background: Surgical stabilization is crucial for managing syndesmosis injuries following ankle trauma. While syndesmosis screws provide anatomical stability, they are associated with issues such as potential loosening or the need for removal. Screw breakage, although frequently reported, may not represent a true complication in asymptomatic patients. The suture-button technique aims to preserve physiological mobility and enhance functional outcomes.

Purpose: To compare the clinical and radiological outcomes of screw fixation and suture-button fixation in syndesmosis injuries with isolated lateral malleolus fractures.

Study design: Retrospective comparative study.

Methods: This study included 73 patients treated between 2018 and 2022. Patients were divided into two groups: suture-button fixation (n = 41) and syndesmosis screw fixation (n = 32). Clinical outcomes were assessed using AOFAS and OMAS scores, while MCS, TFCS, and TFO were used for radiological evaluation. The MCID was applied to determine the clinical relevance of score differences.

Results: Both groups showed significant improvements in AOFAS and OMAS scores (p < 0.05). At final follow-up, the suture-button group demonstrated significantly higher AOFAS (95.9 ± 6.1 vs. 89.4 ± 12.6, p = 0.005) and OMAS (94.2 ± 8.1 vs. 88.9 ± 11.7, p = 0.025) scores, exceeding MCID thresholds. Although complication rates were lower in the suture-button group (p = 0.022), this difference became insignificant after excluding screw breakage (p = 0.951). Range of motion was also significantly better in the suture-button group (p = 0.033).

Conclusion: The suture-button technique provided superior clinical outcomes and joint mobility, while both methods offered comparable radiographic stability.

Objective: Malnutrition is a very critical health problem, especially among developing countries. It is considered one of the major risk factors for diseases and mortality in children. Clubfoot or congenital talipes equinovarus (CTEV) is the most common form of congenital orthopedic abnormality, and the Ponseti method has become the gold standard of treatment for clubfoot over the last two decades. This research study aimed at identifying the malnutrition prevalence in clubfoot patients and its relation with the Ponseti technique's outcome for the patients coming to the Orthopedic Clinic of a tertiary care hospital in Karachi, Pakistan. We further attempted to investigate the relationship of the clinical tests between CBC, serum albumin level, serum electrolytes, and nutritional status.

Methods: This was a cross-sectional study carried out from January to December 2022 with a total of 105 clubfoot patients. The WHO classification of weight-for-age index was used to assess the nutritional status of patients, and clinical tests were also conducted to evaluate the correlation between malnutrition and the outcome of the Ponseti technique. Statistical analysis was performed with a P value ≤ 0.05 deemed significant.

Results: Among 105 patients, 84 (80%) had good nutritional status and 21 (20%) had malnutrition. The average number of casts per patient and the percentage of patients requiring 6 or more casts were higher in the malnourished group at 45.5% compared to 21.42%. The number of Achilles tenotomy procedures performed was higher in the malnourished group at 76.4% compared to 51.8%. Clinical tests proved a straight correlation of nutritional status and results after the Ponseti technique.

Conclusion: Malnutrition remains a critical determinant of Ponseti technique outcomes in clubfoot patients. Addressing nutritional deficits through early interventions and incorporating clinical tests into routine evaluations can significantly improve treatment efficacy. These findings highlight a strong correlation between malnutrition and increased treatment complexity, but causality cannot be concluded from this study. Further longitudinal or interventional research is warranted to explore these relationships more definitively.

Background: Total ankle arthroplasty and arthrodesis utilization has significantly increased in recent years with limited current studies examining physician reimbursement rates.

Purpose: This study provides an analysis of physician fee reimbursement from 2007 to 2025 and utilization trends from 2007 to 2022 for foot and ankle arthrodesis and arthroplasty procedures.

Study design: Retrospective analysis METHODS: Physician reimbursement data were extracted from the CMS Physician Fee Schedule Look-Up Tool using CPT codes between 2007 and 2025. National payment amounts were inflation-adjusted using the Consumer Price Index (January 2025 values) and reported in 2025 USD. For each CPT code, nominal and inflation-adjusted reimbursement trends were analyzed. Medicare Part B Summary Data File was used to collect utilization trends per CPT code from 2007 to 2022.

Results: From 2007 to 2025, nominal reimbursement rates changed for most CPT codes: 27702 (-1.21 %), 27815 (- 0.38 %), 27870 (- 0.44 %), 28725 (- 1.52 %), and 29899 (-1.71 %). The procedures that showed nominal increases were 27871 (+3.41 %) and 28740 (+1.46 %). When adjusted for inflation, all procedures experienced declines: 27702 (-37.05 %), 27815 (-36.52 %), 27870 (-36.56 %), 27871 (-34.11 %), 28725 (-37.25 %), 28740 (-35.35 %), and 29899 (-37.37 %). The total percentage change from 2007 to 2022 showed increased utilization for CPT codes 27702 (+502.54 %), 27870 (+8.06 %), 28725 (+69.78 %), and 28740 (+156.98 %) and reductions for CPT codes 27871 (-32.88 %), 28715 (-9.52 %), and 29899 (-17.35 %).

Conclusion: Between 2007 and 2025, inflation-adjusted reimbursement reductions ranged from 34.11 % to 37.25 %, while utilization rates varied for foot and ankle arthroplasty and arthrodesis procedures.

Background: Open ankle fractures can pose a threat to life in the geriatric population, aged 65 years and older. These patients are susceptible to postoperative complications, often related to poor bone mineral density and soft tissue quality. While the mortality rate associated with open ankle fractures in the elderly has been explored, there is a lack of studies addressing mortality outcomes beyond one year. Furthermore, there is an absence of comparison to the general population. Without that comparison, it is difficult to determine whether open ankle fractures are independently associated with an increased mortality risk.

Purpose: This study aimed to determine the mortality rate of open ankle fractures in geriatric patients and to compare that to the mortality rate of a general geriatric population. Additionally, we aimed to identify potential risk factors associated with increased mortality.

Study design: A retrospective review of 115 patients who sustained open ankle fractures at our institution between 2012 and 2024 was performed.

Results: Of these, 41 patients had a documented date of death, and our analysis revealed a 12.0 % mortality rate at 1-year and a 29.2 % mortality rate at 5-years post-surgery. The standardized mortality ratio was calculated to contextualize the observed mortality relative to the expected mortality in the general population after age and sex matching, which showed a higher 1-year mortality rate in our geriatric patients with open ankle fractures compared to the general population.

Conclusion: These findings offer valuable insights for clinicians and highlight the risk faced by this population.

Open arthrodesis remains the gold standard for management of end stage subtalar joint arthritis. Rate of isolated subtalar fusion complicated by nonunion has been documented between 4-22.8 %. However, little is known about success of subtalar joint fusion when performed underneath a previously constructed ankle arthrodesis. The aim of this systematic review was to assess the cases of nonunion in patients who underwent a subtalar joint fusion with documented history of previous ipsilateral ankle fusion. A broad literature search was performed through PubMed, Google Scholar, and Cochrane Database using the following search terms: "Time to fusion, ankle fusion complication, outcomes ankle fusion." Meta-regression was performed to assess the effects of study sample size and publication year on the non-union rate. Three studies met inclusion and exclusion criteria. The non-union rates of subtalar joint arthrodesis following ankle fusion in the included studies ranged from 20 % to 55.6 %. The pooled rate was 38 % (95 % CI: 18.2 % to 59.8 %). Our series included a larger number of cases, allowing statistical analysis that clearly demonstrated a markedly lower subtalar fusion rate in patients with previous ipsilateral ankle fusion when compared to what has been documented in the literature.

Background: Acute Achilles tendon rupture is a common injury. The optimal management of acute Achilles tendon rupture remains controversial.

Purpose: Compare the efficacy and complications of minimally invasive repair with improved oval forceps suture-guiding method and open repair with modified Kessler method.

Study design: A clinical measurement.

Methods: We enrolled 60 patients from Jan 2017 to Jun 2019. Patients were randomly divided into Group Mini (30 cases) and Group Open (30 cases). The operation duration and length of incision were compared. The functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society score, Achilles tendon total rupture score, range of motion of the ankle and plantarflexion strength ratio. The time from surgery to return to work and sports were recorded and the complications were also assessed.

Results: The operation duration and length of incision in Group Mini were significantly less than that in Group Open, which reduced wound complications and improved cosmesis. However, there were no significant differences between the two groups in term of the functional outcomes. The time from surgery to return to work and sports in Group Mini were significantly shorter than that in Group Open. As for complications, the postoperative complication rate in Group Mini were significantly lower than that in Group Open.

Conclusions: There may be benefits to the minimally invasive approach in the treatment of acute Achilles tendon rupture compared to open.

Objective: This study aims to evaluate the relationship between plantar fascia (PFa) thickness and the morphology and paratenon measurements of the Achilles tendon (AT) in individuals diagnosed with plantar fasciitis (PF) based on magnetic resonance imaging (MRI) findings, and to investigate their role in PF development.

Methods: A total of 108 patients diagnosed with plantar fasciitis who underwent an ankle MRI between 2014 and 2024 were included in the study, along with a control group of 100 healthy individuals of similar age. In both groups, PFa thickness, AT anteroposterior (AP) and mediolateral (ML) diameters, and AT paratenon dimensions (diameters and area) were measured. The presence of retrocalcaneal bursitis and Achilles tendinopathy was also assessed. Measurements were repeated by two observers, and interobserver agreement was evaluated.

Results: PFa thickness and AT, AP and ML diameters were significantly higher in the PF group compared to controls (p < 0.05). Women had significantly greater PFa thickness than men. Retrocalcaneal bursitis and Achilles tendinopathy were also significantly more common in the PF group (p < 0.001). A weak positive correlation was observed between PFa thickness and AT diameters in the control group. Interobserver measurement agreement was high (ICC > 0.8).

Conclusion: Individuals diagnosed with PF showed increased morphometric characteristics of the AT, indicating a possible mechanical linkage between the plantar fascia and Achilles tendon. The findings support the role of the AT and associated structures in the pathophysiology of PF, emphasizing the importance of a comprehensive assessment of these structures in diagnosis and treatment.

Background: The choice between limb salvage with the controversial midfoot amputation or below-knee amputation (BKA) is largely subjective.

Purpose: We seek to compare patient-reported outcome measures (PROMs) and complication rates of the Chopart and Lisfranc midfoot amputations to BKA.

Study design: A single-center retrospective cohort study was performed from October 2017 to September 2023 of adult patients undergoing Lisfranc, Chopart, or BKA. Lisfranc and Chopart amputations were grouped as midfoot amputations and compared to BKA.

Methods: Patient demographics, comorbidities, adverse outcomes, and PROMs were compared. The Lower Extremity Functional Scale (LEFS), PROM Information System Pain Intensity (PROMIS-3a), Self-Reporting Questionnaire-20 (SRQ-20), and Connor-Davidson Resilience Scale (CD-RISC) were collected from ambulatory patients at least 6 months after surgery.

Results: A TOTAL OF 73 PATIENTS WERE INCLUDED: 18 underwent midfoot amputation (6 Lisfranc and 12 Chopart), and 55 BKA. The average age was 62.5 ± 12.0 years with an average Charlson Comorbidity Index of 5.0 [IQR: 4.0] and a median follow-up duration of 40.6 [27.8] months. Midfoot amputees had insignificantly higher rates of postoperative complication (16.7% vs 3.6%, p = 0.092) and significantly higher rates of recurrence requiring revision surgery (44.4% vs 18.2%, p = 0.025). PROMs were similar between groups. Multivariate regression analysis revealed that function was independently associated with peripheral vascular disease (B = -10.1, p = 0.047) and psychological distress (B = -2.4, p = 0.002), but not amputation type (p = 0.978).

Conclusion: With a team-based approach that prioritizes function and patient preference, patient-reported function is impacted by comorbidity and mental health, not by amputation level.

Background: In total ankle replacement (TAR), the tibial component is positioned at 90° to the tibial axis, although distal tibia angles (DTAs) of healthy ankle joints vary. This study investigated DTA changes during TAR and their impact on prosthesis survival.

Methods: In this retrospective case series of 152 consecutive third-generation TARs (142 patients), pre- and postoperative lateral and anterior distal tibia angles (LDTA, ADTA) and changes (ΔLDTA, ΔADTA) were measured. Prosthesis survival (all causes) was compared using Hazard ratios (HRs) between patients with and without alterations of native DTAs. Secondly, associations between postoperative alignment and revision, as well as consistency of LDTA measurements between Mortise and Whole Limb views, were evaluated.

Results: Mean follow-up was 6.7 ± 4.5 (0.01-18.4) years. Twenty (13.2%) TARs were revised after an average of 5.4 ± 4.7 years (5-year survival of 86.8%). No correlation was found between DTA alteration and revision for either LDTA (HRs 1.03-2.29, p=0.18-0.98) or ADTA (HRs 1.06-2.28, p=0.23-0.91). No significant differences were observed among change-in-alignment groups. However, in the sagittal plane, a trend was observed favoring maintenance of non-neutral alignment (>3°) over altering ADTAs >3° to neutral. LDTAs measured on the different views appeared comparable (p=0.16).

Conclusion: Non-neutral postoperative alignment appeared to have less direct influence on revision rates than previously described. Although no significant association was found between changes in native tibial anatomy and TAR revision rates, this study highlights that surgeons may want to consider native anatomy more closely, rather than adhering to a rigid, neutral manufacturer's approach.

Background: Hallux valgus (HV) is a complex triplanar deformity.

Purpose: To utilize preoperative weightbearing computed tomography (WBCT) of patients with HV deformity to characterize the true triplanar nature of the deformity, as well as to assess first metatarsophalangeal joint pathology.

Study design: Retrospective case series.

Methods: A retrospective study of adult patients with HV deformity treated between 1/2020 and 7/2024.

Results: Sixty-four patients were included. Inter-rater reliability for all radiographic measurements demonstrated good to excellent agreement. WBCT findings demonstrated that 38 patients (59 %) exhibited both first metatarsal pronate and tibial sesamoid subluxation, while 7 patients (11 %) showed neither deformity. 51 patients (80 %) presented true sesamoid subluxation. The rate of pseudo-sesamoid subluxation was 9 % (6/64 patients). WBXR findings showed that 42 patients (66 %) had moderate HV deformity with 37 patients (58 %) demonstrating an abnormal HVA, 20 patients (31 %) with mild HV, and 2 patients (3 %) with severe HV. 37 patients (58 %) observed with first metatarsal joint degeneration and 30 patients (47 %) exhibited erosion of the intersesamoid crista. The tibial sesamoid subluxation grade demonstrated a statistically significant and meaningful moderate correlation with HVA, degeneration of the first metatarsal joint and erosion of the intersesamoidal crista, but a slightly less meaningful moderate correlation with HV deformity.

Conclusion: WBCT provides a reproducible, three-dimensional assessment of HV deformity, offering more accurate evaluation of first metatarsal pronation, sesamoid subluxation, and degenerative of both the first metatarsophalangeal joint and the intersesamoidal crista compared to conventional radiographs.