Journal of Foot & Ankle Surgery最新文献_第3页

Description of anatomical differences in 3D bone morphology between female individuals with progressive collapsing foot deformity and asymptomatic controls 描述女性进行性塌陷足畸形和无症状对照之间的三维骨形态解剖差异。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.003

Takuma Miyamoto MD, PhD , Rich J. Lisonbee MS , Kassidy Knutson PhD , Hiroaki Kurokawa MD, PhD , Akira Taniguchi MD, PhD , Yasuhito Tanaka MD, PhD , Amy L. Lenz PhD

Background

Progressive collapsing foot deformity (PCFD) represents a multifaceted three-dimensional condition. However, there has been limited discussion regarding how the morphology of each bone affects PCFD.

Purpose

To determine morphological differences within each bone of the foot and ankle in females affected by PCFD compared to asymptomatic controls.

Study Design

Comparative cross-sectional study.

Methods

We hypothesized the medial column bones would exhibit the most substantial shape differences between groups. We developed multiple statistical shape models (SSMs) to analyze the 3D shape of the distal tibia, distal fibula, talus, calcaneus, navicular, cuboid, cuneiforms, and metatarsals. We quantified and compared results between 23 female PCFD patients and 23 asymptomatic females.

Results

SSM analyses revealed significant modes of variation across several bones. Notably, the fibula showed reduced fibular tip height in PCFD patients. The talus exhibited decreased lateral and posterior processes and an inferior, adducted talar head shift. The calcaneus had a narrowed posterior facet and anteriorly shifted anterior-medial facet. In PCFD patients, the navicular tuberosity was displaced toward the body with medial-inferior articular defects. The cuboid showed increased prominence of the tuberosity and beak.

Conclusion

These SSM results provide novel characterization of the 3D shape of bones from tibia to metatarsals in PCFD and asymptomatic females. Patients with PCFD exhibited distinct 3D shape differences in the distal fibula, talus, calcaneus, navicular, and cuboid, suggesting that PCFD is primarily characterized by deformities of the hindfoot bones.

背景：进行性塌陷足畸形（PCFD）是一种多面三维疾病。然而，关于各骨形态如何影响PCFD的讨论有限。目的：确定与无症状对照组相比，女性PCFD患者足部和踝关节各骨的形态学差异。研究设计：比较横断面研究。方法：我们假设两组之间的内侧柱骨表现出最显著的形状差异。我们开发了多个统计形状模型（SSMs）来分析胫骨远端、腓骨远端、距骨、跟骨、舟骨、长方体、楔形骨和跖骨的三维形状。我们量化并比较了23名女性PCFD患者和23名无症状女性的结果。结果：SSM分析揭示了几块骨头的显著变异模式。值得注意的是，PCFD患者的腓骨显示腓骨尖端高度降低。距骨表现为外侧和后侧突减少，距骨下内收头移位。跟骨后侧关节面狭窄，前内侧关节面前移位。在PCFD患者中，舟状结节向身体移位并伴有中-下关节缺损。长方体显示结节和喙的突出。结论：这些SSM结果提供了PCFD和无症状女性从胫骨到跖骨的三维形状的新特征。PCFD患者在腓骨远端、距骨、跟骨、舟骨和长方体表现出明显的三维形状差异，表明PCFD主要以后足骨畸形为特征。

{"title":"Description of anatomical differences in 3D bone morphology between female individuals with progressive collapsing foot deformity and asymptomatic controls","authors":"Takuma Miyamoto MD, PhD , Rich J. Lisonbee MS , Kassidy Knutson PhD , Hiroaki Kurokawa MD, PhD , Akira Taniguchi MD, PhD , Yasuhito Tanaka MD, PhD , Amy L. Lenz PhD","doi":"10.1053/j.jfas.2025.08.003","DOIUrl":"10.1053/j.jfas.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Progressive collapsing foot deformity (PCFD) represents a multifaceted three-dimensional condition. However, there has been limited discussion regarding how the morphology of each bone affects PCFD.</div></div><div><h3>Purpose</h3><div>To determine morphological differences within each bone of the foot and ankle in females affected by PCFD compared to asymptomatic controls.</div></div><div><h3>Study Design</h3><div>Comparative cross-sectional study.</div></div><div><h3>Methods</h3><div>We hypothesized the medial column bones would exhibit the most substantial shape differences between groups. We developed multiple statistical shape models (SSMs) to analyze the 3D shape of the distal tibia, distal fibula, talus, calcaneus, navicular, cuboid, cuneiforms, and metatarsals. We quantified and compared results between 23 female PCFD patients and 23 asymptomatic females.</div></div><div><h3>Results</h3><div>SSM analyses revealed significant modes of variation across several bones. Notably, the fibula showed reduced fibular tip height in PCFD patients. The talus exhibited decreased lateral and posterior processes and an inferior, adducted talar head shift. The calcaneus had a narrowed posterior facet and anteriorly shifted anterior-medial facet. In PCFD patients, the navicular tuberosity was displaced toward the body with medial-inferior articular defects. The cuboid showed increased prominence of the tuberosity and beak.</div></div><div><h3>Conclusion</h3><div>These SSM results provide novel characterization of the 3D shape of bones from tibia to metatarsals in PCFD and asymptomatic females. Patients with PCFD exhibited distinct 3D shape differences in the distal fibula, talus, calcaneus, navicular, and cuboid, suggesting that PCFD is primarily characterized by deformities of the hindfoot bones.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 16.e1-16.e11"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intramedullary tension band technique versus distal ulnar hook plate in treating the fifth metatarsal base fractures 髓内张力带技术与尺远端钩钢板治疗第五跖骨底骨折。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.001

Jingquan Guo , Qianwen Jia , Fei Xiao , Keke Cheng , Tianrun Lei , Bo Wu

Background

Displaced or comminuted fifth metatarsal base fractures remain challenging, with no consensus on optimal surgical treatment.

Purpose

To compare clinical outcomes between intramedullary tension-band and distal ulna hook plate fixation for treating Zone 1 (tuberosity avulsion) fractures of the fifth.

Study Design

Retrospective cohort study.

Methods

This study included 43 patients with Zone 1 fractures treated surgically between August 2019 and August 2023. Patients were divided into two groups: 22 treated with intramedullary tension-band and 21 treated with hook plate fixation. Clinical and radiographic outcomes were assessed, including operative time, incision length, reduction quality, fracture healing time, AOFAS scores at 3, 6, and 12 months, and postoperative complications.

Results

The tension-band group showed significantly shorter operative time (28.4 ± 3.2 vs. 48.9 ± 8.6 min, P < 0.01) and smaller incisions (3.5 ± 0.3 vs. 6.1 ± 0.6 cm, P < 0.01), with no cases of implant irritation or nerve symptoms. The hook plate group achieved better immediate reduction (0.2 ± 0.2 vs. 0.7 ± 0.3 mm, P = 0.01), faster union (6 vs. 8 weeks, P < 0.01), and higher AOFAS scores at 3 months (P < 0.01). However, functional outcomes were similar at 6 and 12 months. Both groups achieved complete fracture union.

Conclusion

Both techniques are effective for Zone 1 fifth metatarsal base fractures. Tension-band fixation offers a less invasive alternative with reduced morbidity and need for implant removal, while the hook plate provides faster early recovery.

背景：移位或粉碎性第五跖骨基底骨折仍然具有挑战性，对于最佳手术治疗尚无共识。目的：比较髓内张力带与远端尺骨钩钢板内固定治疗第五节1区（结节撕脱性）骨折的临床效果。研究设计：回顾性队列研究。方法：本研究纳入2019年8月至2023年8月手术治疗的43例1区骨折患者。患者分为两组：22例采用髓内张力带固定，21例采用钩钢板固定。评估临床和影像学结果，包括手术时间、切口长度、复位质量、骨折愈合时间、3、6和12个月的AOFAS评分以及术后并发症。结果：张力带组手术时间明显缩短（28.4±3.2 vs 48.9±8.6 min, P < 0.01），切口更小（3.5±0.3 vs 6.1±0.6 cm, P < 0.01），无种植体刺激及神经症状。钩钢板组即刻复位效果较好（0.2±0.2 vs. 0.7±0.3 mm, P = 0.01），愈合速度较快（6 vs. 8周，P < 0.01）， 3个月时AOFAS评分较高（P < 0.01）。然而，在6个月和12个月时，功能结果相似。两组均实现骨折完全愈合。结论：两种方法治疗第五跖底1区骨折均有效。张力带固定提供了一种侵入性较小的替代方法，降低了发病率和移除植入物的需要，而钩钢板提供了更快的早期恢复。

{"title":"Intramedullary tension band technique versus distal ulnar hook plate in treating the fifth metatarsal base fractures","authors":"Jingquan Guo , Qianwen Jia , Fei Xiao , Keke Cheng , Tianrun Lei , Bo Wu","doi":"10.1053/j.jfas.2025.07.001","DOIUrl":"10.1053/j.jfas.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>Displaced or comminuted fifth metatarsal base fractures remain challenging, with no consensus on optimal surgical treatment.</div></div><div><h3>Purpose</h3><div>To compare clinical outcomes between intramedullary tension-band and distal ulna hook plate fixation for treating Zone 1 (tuberosity avulsion) fractures of the fifth.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>This study included 43 patients with Zone 1 fractures treated surgically between August 2019 and August 2023. Patients were divided into two groups: 22 treated with intramedullary tension-band and 21 treated with hook plate fixation. Clinical and radiographic outcomes were assessed, including operative time, incision length, reduction quality, fracture healing time, AOFAS scores at 3, 6, and 12 months, and postoperative complications.</div></div><div><h3>Results</h3><div>The tension-band group showed significantly shorter operative time (28.4 ± 3.2 vs. 48.9 ± 8.6 min, <em>P</em> < 0.01) and smaller incisions (3.5 ± 0.3 vs. 6.1 ± 0.6 cm, <em>P</em> < 0.01), with no cases of implant irritation or nerve symptoms. The hook plate group achieved better immediate reduction (0.2 ± 0.2 vs. 0.7 ± 0.3 mm, <em>P</em> = 0.01), faster union (6 vs. 8 weeks, <em>P</em> < 0.01), and higher AOFAS scores at 3 months (<em>P</em> < 0.01). However, functional outcomes were similar at 6 and 12 months. Both groups achieved complete fracture union.</div></div><div><h3>Conclusion</h3><div>Both techniques are effective for Zone 1 fifth metatarsal base fractures. Tension-band fixation offers a less invasive alternative with reduced morbidity and need for implant removal, while the hook plate provides faster early recovery.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 4.e1-4.e6"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is the posterior malleolus reliably reduced by fibula fixation alone? A prospective CT-based study 仅靠腓骨固定就能可靠地复位后踝吗？一项前瞻性ct研究。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.06.016

Meletis Rozis PhD , Lyndon Mason PhD , Dimitrios-Stergios Evangelopoulos PhD , Eleftherios Stavridis MD , Spyros Pneumaticos PhD

Background

Posterior malleolus fractures have the potential to be automatically reduced after fibula fixation, thus not requiring fixation. Nevertheless, there are no data in the literature supporting this theory. We have performed a prospective CT study to evaluate the quality of indirect posterior malleolus fragment reduction via ligamentotaxis in ankle fractures.

Purpose

To examine the role of ligamentotaxis in posterior malleolus reduction.

Study design

Prospective, Computed Tomography study.

Methods

We included seventy-one patients with ankle fractures who did not undergo direct fixation of the posterior malleolus. Postoperative CT scans compared the injured and normal ankles, assessing reduction quality based on fragment translation.

Results

The fractures were classified as Mason type 1, 2A, 2B, and 3. The results showed that indirect reduction was anatomical in 91.3 % of Mason type 1 fractures, 54.5 % of Mason type 2A fractures, 31.25 % of Mason type 2B fractures, and 76.2 % of Mason type 3 fractures. Mason type 2 fractures exhibited the most variability in reduction quality. The incisura anatomy was additionally affected, with a significant decrease in the normal notch retroversion.

Conclusion

Indirect reduction of the posterior malleolus via ligamentotaxis yields unpredictable results related to the fragment morphology, making preoperative CT evaluation highly suggested for ankle fracture treatment. Our study indicates that the posterior malleolus cannot be always reduced through fibula fixation in patients with Mason 2 and Mason 3 fracture types, with those fractures requiring direct fixation. Further research is needed to evaluate the clinical importance of malreduced posterior malleolar fragments on ankle joint function.

背景：后踝骨折有可能在腓骨固定后自动复位，因此不需要固定。然而，在文献中没有数据支持这一理论。我们进行了一项前瞻性CT研究，以评估踝关节骨折通过韧带趋向性间接后踝碎片复位的质量。目的：探讨韧带趋向性在后内踝复位中的作用。研究设计：前瞻性，计算机断层扫描研究方法：我们纳入了71例踝关节骨折患者，他们没有接受后踝直接固定。术后CT扫描比较受伤踝关节和正常踝关节，基于碎片平移评估复位质量。结果：Mason骨折分为1型、2A型、2B型和3型。结果表明，Mason 1型骨折91.3%、Mason 2A型骨折54.5%、Mason 2B型骨折31.25%、Mason 3型骨折76.2%为解剖性间接复位。Mason 2型骨折复位质量变化最大。切牙解剖结构也受到影响，正常切迹后翻明显减少。结论：通过韧带趋近术间接复位后踝的结果与骨折碎片的形态有关，因此术前CT评估是踝关节骨折治疗的重要依据。我们的研究表明，对于需要直接固定的Mason 2和Mason 3型骨折患者，后踝不能总是通过腓骨固定复位。后踝骨碎片复位不良对踝关节功能的影响有待进一步研究。证据等级：2级，前瞻性队列研究。

{"title":"Is the posterior malleolus reliably reduced by fibula fixation alone? A prospective CT-based study","authors":"Meletis Rozis PhD , Lyndon Mason PhD , Dimitrios-Stergios Evangelopoulos PhD , Eleftherios Stavridis MD , Spyros Pneumaticos PhD","doi":"10.1053/j.jfas.2025.06.016","DOIUrl":"10.1053/j.jfas.2025.06.016","url":null,"abstract":"<div><h3>Background</h3><div>Posterior malleolus fractures have the potential to be automatically reduced after fibula fixation, thus not requiring fixation. Nevertheless, there are no data in the literature supporting this theory. We have performed a prospective CT study to evaluate the quality of indirect posterior malleolus fragment reduction via ligamentotaxis in ankle fractures.</div></div><div><h3>Purpose</h3><div>To examine the role of ligamentotaxis in posterior malleolus reduction.</div></div><div><h3>Study design</h3><div>Prospective, Computed Tomography study.</div></div><div><h3>Methods</h3><div>We included seventy-one patients with ankle fractures who did not undergo direct fixation of the posterior malleolus. Postoperative CT scans compared the injured and normal ankles, assessing reduction quality based on fragment translation.</div></div><div><h3>Results</h3><div>The fractures were classified as Mason type 1, 2A, 2B, and 3. The results showed that indirect reduction was anatomical in 91.3 % of Mason type 1 fractures, 54.5 % of Mason type 2A fractures, 31.25 % of Mason type 2B fractures, and 76.2 % of Mason type 3 fractures. Mason type 2 fractures exhibited the most variability in reduction quality. The incisura anatomy was additionally affected, with a significant decrease in the normal notch retroversion.</div></div><div><h3>Conclusion</h3><div>Indirect reduction of the posterior malleolus via ligamentotaxis yields unpredictable results related to the fragment morphology, making preoperative CT evaluation highly suggested for ankle fracture treatment. Our study indicates that the posterior malleolus cannot be always reduced through fibula fixation in patients with Mason 2 and Mason 3 fracture types, with those fractures requiring direct fixation. Further research is needed to evaluate the clinical importance of malreduced posterior malleolar fragments on ankle joint function.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 2.e1-2.e5"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Histopathological analysis from proximal bone samples during minor amputations for diabetes-related foot infections: A single-center, retrospective study 糖尿病相关足部感染小截肢患者近端骨样本的组织病理学分析：单中心回顾性研究

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.014

Henco Nel , Lucy Stopher , Joseph Hanna , Laurens Manning , Shirley Jansen , Thomas Gliddon

Background

Minor amputations, defined as resection of bone below the ankle, are important procedures for managing diabetes-related foot infections (DFI). The optimal method to determine the presence of residual bone infection is unclear and unplanned reoperation rates are common. Although international guidelines endorse the use of histopathology, this approach has not been universally adopted.

Purpose

We evaluated the utility of histopathological analysis from samples collected from ‘proximal’ or ‘marginal’ bone during minor amputations.

Study Design

A retrospective, single-center study was conducted at Sir Charles Gairdner Hospital, in Perth, Western Australia.

Methods

The primary outcome of interest was treatment success at six months, defined as being alive and no unplanned reoperation at the original operation site.

Results

Of 67 cases, 22 (33 %) had positive histopathology. Patients with positive margins were less likely to have treatment success compared to those with negative margins (50 % versus 82 %; P = 0.006). Antibiotic duration was significantly shorter in patients with negative histopathological margins compared to patients with positive histopathological margins (median 14 vs 42 days; P = 0.0003). The concordance between histopathology and microbiology was 51 %.

Conclusion

Positive histopathology was associated with lower rates of treatment success, despite receiving longer antibiotic durations. Positive culture from the same samples were not predictive of outcome. Larger, prospective studies are needed to define optimal sampling methods and antibiotic therapy following minor amputation.

背景：小截肢，定义为切除踝关节以下的骨骼，是治疗糖尿病相关足部感染（DFI）的重要手术。确定残余骨感染存在的最佳方法尚不清楚，意外再手术率很常见。虽然国际指南认可使用组织病理学，但这种方法尚未被普遍采用。目的：我们评估了在轻微截肢时从“近端”或“边缘”骨采集样本的组织病理学分析的效用。研究设计：在西澳大利亚珀斯查尔斯·盖尔德纳爵士医院进行了一项回顾性、单中心研究。方法：关注的主要结果是6个月时治疗成功，定义为存活且未在原手术部位发生意外再手术。结果：67例患者中，22例（33%）组织病理学阳性。与边缘阴性的患者相比，边缘阳性的患者治疗成功的可能性更小（50%对82%；P=0.006）。与组织病理边缘阳性患者相比，组织病理边缘阴性患者的抗生素使用时间显著缩短（中位数14天vs 42天；P=0.0003）。组织病理学与微生物学的一致性为51%。结论：尽管接受较长的抗生素治疗时间，但组织病理学阳性与较低的治疗成功率相关。来自相同样本的阳性培养不能预测结果。需要更大规模的前瞻性研究来确定最佳的采样方法和轻微截肢后的抗生素治疗。

{"title":"Histopathological analysis from proximal bone samples during minor amputations for diabetes-related foot infections: A single-center, retrospective study","authors":"Henco Nel , Lucy Stopher , Joseph Hanna , Laurens Manning , Shirley Jansen , Thomas Gliddon","doi":"10.1053/j.jfas.2025.08.014","DOIUrl":"10.1053/j.jfas.2025.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Minor amputations, defined as resection of bone below the ankle, are important procedures for managing diabetes-related foot infections (DFI). The optimal method to determine the presence of residual bone infection is unclear and unplanned reoperation rates are common. Although international guidelines endorse the use of histopathology, this approach has not been universally adopted.</div></div><div><h3>Purpose</h3><div>We evaluated the utility of histopathological analysis from samples collected from ‘proximal’ or ‘marginal’ bone during minor amputations.</div></div><div><h3>Study Design</h3><div>A retrospective, single-center study was conducted at Sir Charles Gairdner Hospital, in Perth, Western Australia.</div></div><div><h3>Methods</h3><div>The primary outcome of interest was treatment success at six months, defined as being alive and no unplanned reoperation at the original operation site.</div></div><div><h3>Results</h3><div>Of 67 cases, 22 (33 %) had positive histopathology. Patients with positive margins were less likely to have treatment success compared to those with negative margins (50 % <em>versus</em> 82 %; <em>P</em> = 0.006). Antibiotic duration was significantly shorter in patients with negative histopathological margins compared to patients with positive histopathological margins (median 14 vs 42 days; <em>P</em> = 0.0003). The concordance between histopathology and microbiology was 51 %.</div></div><div><h3>Conclusion</h3><div>Positive histopathology was associated with lower rates of treatment success, despite receiving longer antibiotic durations. Positive culture from the same samples were not predictive of outcome. Larger, prospective studies are needed to define optimal sampling methods and antibiotic therapy following minor amputation.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 26.e1-26.e5"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anatomical variations of the deep plantar arterial arch: surgical implications for partial foot amputations and soft tissue reconstruction 足底深动脉弓的解剖变异：部分足部截肢和软组织重建的外科意义。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.012

Jessica L. Morehouse , Jordan M. Konstanty , Anna C. Cacini , Jamie M. Stern , Sara S. Sloan

Background

The forefoot receives its primary blood supply through the deep plantar arterial arch, typically formed by an anastomosis between the deep branch of the lateral plantar artery and the deep plantar artery. Accurate identification and localization of the deep plantar arch are critical during flap procedures and transmetatarsal amputations to minimize the risk of vascular compromise.

Purpose

To assess the anatomical variability, dominance patterns, and location of the deep plantar arch to inform surgical planning and reduce intraoperative vascular complications.

Study Design

This was a descriptive anatomical study conducted through cadaveric dissection.

Methods

Eighty-nine feet from 45 formalin-embalmed cadavers were dissected, with associated arteries traced from their origins and external diameters measured to determine arterial dominance. Distances from key anatomic landmarks were recorded to identify the arch’s position within the foot.

Results

The deep plantar arch was present in all specimens. Lateral plantar artery dominance and deep plantar artery dominance were each observed in 42.70%, while co-dominance occurred in 12.36%, and medial plantar artery dominance in 2.25%. On average, the arch was located 58.48% of the distance from the calcaneal tuberosity to the distal phalanx. Medial deviation of the arch was found to be influenced by biological sex and the type of vascular dominance.

Conclusion

The deep plantar arch demonstrates variability in both its dominance patterns and anatomic position. These findings underscore the importance of preoperative vascular assessment to optimize surgical outcomes and reduce the risk of ischemic complications during forefoot procedures.

背景：前足通过足底深动脉弓接受其主要血液供应，足底深动脉弓通常由足底外侧动脉深支与足底深动脉之间的吻合形成。在皮瓣手术和经跖骨截肢中，准确识别和定位足底深弓是将血管损伤风险降至最低的关键。目的：评估足底深弓的解剖变异、优势模式和位置，为手术计划提供信息，减少术中血管并发症。研究设计：这是一项通过尸体解剖进行的描述性解剖学研究。方法：对45具经福尔马林防腐处理的尸体进行了89英尺的解剖，追踪了相关动脉的来源，并测量了其外径，以确定动脉的优势。记录与关键解剖标志的距离，以确定足弓在足内的位置。结果：所有标本均存在深足底弓。足底外侧动脉占42.70%，足底深动脉占12.36%，足底内侧动脉占2.25%。平均而言，足弓位于跟骨结节至远端指骨距离的58.48%。研究发现足弓内侧偏度受生物性别和血管优势类型的影响。结论：足底深足弓在优势形态和解剖位置上都具有可变性。这些发现强调了术前血管评估对优化手术结果和降低前足手术中缺血性并发症风险的重要性。临床证据等级：5。

{"title":"Anatomical variations of the deep plantar arterial arch: surgical implications for partial foot amputations and soft tissue reconstruction","authors":"Jessica L. Morehouse , Jordan M. Konstanty , Anna C. Cacini , Jamie M. Stern , Sara S. Sloan","doi":"10.1053/j.jfas.2025.07.012","DOIUrl":"10.1053/j.jfas.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>The forefoot receives its primary blood supply through the deep plantar arterial arch, typically formed by an anastomosis between the deep branch of the lateral plantar artery and the deep plantar artery. Accurate identification and localization of the deep plantar arch are critical during flap procedures and transmetatarsal amputations to minimize the risk of vascular compromise.</div></div><div><h3>Purpose</h3><div>To assess the anatomical variability, dominance patterns, and location of the deep plantar arch to inform surgical planning and reduce intraoperative vascular complications.</div></div><div><h3>Study Design</h3><div>This was a descriptive anatomical study conducted through cadaveric dissection.</div></div><div><h3>Methods</h3><div>Eighty-nine feet from 45 formalin-embalmed cadavers were dissected, with associated arteries traced from their origins and external diameters measured to determine arterial dominance. Distances from key anatomic landmarks were recorded to identify the arch’s position within the foot.</div></div><div><h3>Results</h3><div>The deep plantar arch was present in all specimens. Lateral plantar artery dominance and deep plantar artery dominance were each observed in 42.70%, while co-dominance occurred in 12.36%, and medial plantar artery dominance in 2.25%. On average, the arch was located 58.48% of the distance from the calcaneal tuberosity to the distal phalanx. Medial deviation of the arch was found to be influenced by biological sex and the type of vascular dominance.</div></div><div><h3>Conclusion</h3><div>The deep plantar arch demonstrates variability in both its dominance patterns and anatomic position. These findings underscore the importance of preoperative vascular assessment to optimize surgical outcomes and reduce the risk of ischemic complications during forefoot procedures.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 14.e1-14.e6"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Percutaneous cannulated screw fixation vs open reduction and plate fixation for displaced intra-articular Sanders II and III calcaneal fracture: A two-center retrospective propensity-matched analysis 经皮空心螺钉固定与切开复位钢板固定治疗移位的关节内Sanders II和III跟骨骨折：一项双中心回顾性倾向匹配分析

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.008

Qingbing Jiang MD , Yifeng Shang MD , Xiong Liao MD , Wei Su MD

Background

The optimal surgical strategy for treating displaced intra-articular calcaneal fractures remains controversial.

Purpose

The purpose of this retrospective cohort study was to compare the clinical and radiologic outcomes of percutaneous cannulated screw fixation versus open reduction and plate fixation via the sinus tarsi approach in patients with displaced intra-articular Sanders II or III calcaneal fractures.

Study Design

A retrospective analysis was performed on the records of patients with displaced Sanders II or III calcaneal fractures.

Methods

We analyzed data from 124 patients using propensity score matching applied at a 1:1 ratio. The primary outcome was assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale for evaluating ankle function. Secondary outcomes included radiological outcomes, operative time, postoperative Visual Analogue Scale, wound complication rates, and hardware removal rates.

Results

There was no statistical difference in the American Orthopaedic Foot and Ankle Society ankle-hindfoot Scale (p=.104) and radiological outcomes (Böhler’s angle, p=0.21; Gissane’s angle, p=0.29) between the two groups. The percutaneous cannulated screw fixation group demonstrated better ankle-hindfoot complex motion, shorter operative time (65±35 mins vs 95±40 mins), lower postoperative Visual Analogue Scale (5±1 vs 8±1.5), fewer wound complications (3.2 % vs 9.6 %), and no hardware removal needed (0 % vs 14.5 %).

Conclusion

This study suggests that both techniques achieved comparable functional and radiographic outcomes for displaced intra-articular Sanders II or III calcaneal fractures; however, percutaneous cannulated screw fixation demonstrated favorable advantages in several aspects.

背景：治疗移位的跟骨关节内骨折的最佳手术策略仍然存在争议。目的：本回顾性队列研究的目的是比较经皮空心螺钉内固定与经跗骨窦入路切开复位钢板内固定治疗移位的Sanders II或III型跟骨骨折的临床和影像学结果。研究设计：对移位的Sanders II型或III型跟骨骨折患者的记录进行回顾性分析。方法：我们对124例患者的数据进行分析，采用1:1比例的倾向评分匹配。主要结果采用美国骨科足踝协会踝关节-后足量表评估踝关节功能。次要结果包括放射学结果、手术时间、术后视觉模拟评分、伤口并发症发生率和硬体移除率。结果：两组患者的美国骨科足踝学会踝关节-后足量表（p= 0.104）和影像学指标（Böhler’s角，p=0.21; Gissane’s角，p=0.29）比较，差异均无统计学意义。经皮空心螺钉固定组表现出更好的踝关节-后足复合运动，更短的手术时间（65±35分钟比95±40分钟），更低的术后视觉模拟评分（5±1比8±1.5），更少的伤口并发症（3.2%比9.6%），不需要取出硬体（0%比14.5%）。结论：本研究表明，对于移位的关节内Sanders II或III型跟骨骨折，这两种技术的功能和影像学结果相当；然而，经皮空心螺钉内固定在几个方面显示出有利的优势。

{"title":"Percutaneous cannulated screw fixation vs open reduction and plate fixation for displaced intra-articular Sanders II and III calcaneal fracture: A two-center retrospective propensity-matched analysis","authors":"Qingbing Jiang MD , Yifeng Shang MD , Xiong Liao MD , Wei Su MD","doi":"10.1053/j.jfas.2025.08.008","DOIUrl":"10.1053/j.jfas.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>The optimal surgical strategy for treating displaced intra-articular calcaneal fractures remains controversial.</div></div><div><h3>Purpose</h3><div>The purpose of this retrospective cohort study was to compare the clinical and radiologic outcomes of percutaneous cannulated screw fixation versus open reduction and plate fixation via the sinus tarsi approach in patients with displaced intra-articular Sanders II or III calcaneal fractures.</div></div><div><h3>Study Design</h3><div>A retrospective analysis was performed on the records of patients with displaced Sanders II or III calcaneal fractures.</div></div><div><h3>Methods</h3><div>We analyzed data from 124 patients using propensity score matching applied at a 1:1 ratio. The primary outcome was assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale for evaluating ankle function. Secondary outcomes included radiological outcomes, operative time, postoperative Visual Analogue Scale, wound complication rates, and hardware removal rates.</div></div><div><h3>Results</h3><div>There was no statistical difference in the American Orthopaedic Foot and Ankle Society ankle-hindfoot Scale (p=.104) and radiological outcomes (Böhler’s angle, p=0.21; Gissane’s angle, p=0.29) between the two groups. The percutaneous cannulated screw fixation group demonstrated better ankle-hindfoot complex motion, shorter operative time (65±35 mins vs 95±40 mins), lower postoperative Visual Analogue Scale (5±1 vs 8±1.5), fewer wound complications (3.2 % vs 9.6 %), and no hardware removal needed (0 % vs 14.5 %).</div></div><div><h3>Conclusion</h3><div>This study suggests that both techniques achieved comparable functional and radiographic outcomes for displaced intra-articular Sanders II or III calcaneal fractures; however, percutaneous cannulated screw fixation demonstrated favorable advantages in several aspects.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 20.e1-20.e7"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Heterotopic ossifications in anterior and lateral approach total ankle replacement: A retrospective evaluation 前路和外侧入路全踝关节置换术中的异位骨化：回顾性评价。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.001

Giammarco Gardini , Silvio Caravelli , Carlo Capodagli , Giulio Vara , Stefano Ratti , Marco Di Ponte , Massimiliano Mosca

Heterotopic periarticular ossifications (HO) are a frequent short to mid-term complication following Total Ankle Replacement (TAR). Historically two primary surgical approaches exist—Lateral Approach (LA) and Anterior Approach (AA)—each bound with different prosthetic designs. However, there is no consensus on the incidence, real clinical impact, or need for reintervention of HO between these approaches, nor on the necessity of prophylactic treatments. This retrospective, monocentric, comparative study (evidence level III) involved radiological classification of patients using the modified Brooker Classification System (mBCS) by two independent orthopedic surgeons. A total of 105 patients undergoing LA or AA TAR at the same center were included. Radiographic HO was observed in 84 patients (80 %). Of these, 19 (23 %) required surgical intervention due to symptomatic HO. In the AA group (62 patients, Vantage Exactech prosthesis), 45 (73 %) developed HO, with 10 having sufficient symptoms which were treated with arthrolysis. In the LA group (43 patients, Trabecular Metal Zimmer prosthesis), 39 (91 %) developed HO, with 9 requiring arthrolysis. HO was more prevalent in the LA group than in the AA group (91 % vs. 73 %). A direct correlation was found between clinical scores (FAAM and Pain Score) and HO severity. Prosthesis with LA more frequently develop HO than AA. In addition, young patients, delayed ankle mobilization and weightbearing can be accounted as risk factors in the development of HOs; conversely smoking, BMI, duration of surgery and post-traumatic arthritis were not found to have a significant impact.

异位关节周围骨化（HO）是全踝关节置换术（TAR）后常见的中短期并发症。历史上存在两种主要的手术入路-外侧入路（LA）和前路(AA)-每种入路都有不同的假体设计。然而，对于这些方法之间的发病率、实际临床影响或再干预的必要性，以及预防性治疗的必要性，目前尚无共识。这项回顾性、单中心、比较研究（证据水平III）涉及两位独立骨科医生使用改良的Brooker分类系统（mBCS）对患者进行放射学分类。共纳入105例在同一中心接受LA或AA TAR的患者。84例（80%）患者出现影像学上的HO。其中19例（23%）因症状性HO需要手术干预。在AA组（62例患者，Vantage Exactech假体）中，45例（73%）发生HO，其中10例有足够的症状，并进行了关节松解治疗。在LA组（43例患者，使用金属小梁假体）中，39例（91%）发生HO，其中9例需要关节松解。HO在LA组比AA组更普遍（91%对73%）。临床评分（FAAM和Pain Score）与HO严重程度之间存在直接相关性。LA假体比AA假体更容易发生HO。此外，年轻患者、踝关节活动迟缓和负重可被认为是HOs发生的危险因素；相反，吸烟、身体质量指数、手术时间和创伤后关节炎并没有明显的影响。

{"title":"Heterotopic ossifications in anterior and lateral approach total ankle replacement: A retrospective evaluation","authors":"Giammarco Gardini , Silvio Caravelli , Carlo Capodagli , Giulio Vara , Stefano Ratti , Marco Di Ponte , Massimiliano Mosca","doi":"10.1053/j.jfas.2025.08.001","DOIUrl":"10.1053/j.jfas.2025.08.001","url":null,"abstract":"<div><div>Heterotopic periarticular ossifications (HO) are a frequent short to mid-term complication following Total Ankle Replacement (TAR). Historically two primary surgical approaches exist—Lateral Approach (LA) and Anterior Approach (AA)—each bound with different prosthetic designs. However, there is no consensus on the incidence, real clinical impact, or need for reintervention of HO between these approaches, nor on the necessity of prophylactic treatments. This retrospective, monocentric, comparative study (evidence level III) involved radiological classification of patients using the modified Brooker Classification System (mBCS) by two independent orthopedic surgeons. A total of 105 patients undergoing LA or AA TAR at the same center were included. Radiographic HO was observed in 84 patients (80 %). Of these, 19 (23 %) required surgical intervention due to symptomatic HO. In the AA group (62 patients, Vantage Exactech prosthesis), 45 (73 %) developed HO, with 10 having sufficient symptoms which were treated with arthrolysis. In the LA group (43 patients, Trabecular Metal Zimmer prosthesis), 39 (91 %) developed HO, with 9 requiring arthrolysis. HO was more prevalent in the LA group than in the AA group (91 % vs. 73 %). A direct correlation was found between clinical scores (FAAM and Pain Score) and HO severity. Prosthesis with LA more frequently develop HO than AA. In addition, young patients, delayed ankle mobilization and weightbearing can be accounted as risk factors in the development of HOs; conversely smoking, BMI, duration of surgery and post-traumatic arthritis were not found to have a significant impact.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 15.e1-15.e6"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Are interfragmentary lag screws necessary in surgical treatment of Weber B ankle fractures? 在韦伯B型踝关节骨折的手术治疗中是否需要椎间拉力螺钉？

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.007

Alyssa Schreiber BS , Jane Brennan MS , Andrea Johnson MSN, CRNP , Adrienne Spirt MD, PhD , Elizabeth Friedmann MD , David Keblish MD , Justin Turcotte PhD, MBA

Background

Traditionally, open reduction and internal fixation (ORIF) for Weber B fibular fractures involves placement of a lag screw across the fracture plane along with plate fixation.

Purpose

To compare outcomes of Weber B fractures treated with plate-only (PO) vs. plate and lag screw (PLS) fixation.

Study Design

Retrospective cohort study.

Methods

Retrospective review of 318 patients undergoing ORIF for Weber B fractures (2022-2024) was performed. Univariate and multivariate statistics were used to compare patient characteristics and outcomes of those treated with PLS (n=167) vs. those treated with PO (n=151) fixation.

Results

Patients in the PO-group were older, had a greater comorbidity burden (measured as Charlson Comorbidity Index [CCI]), and were more likely to have osteoporosis/osteopenia and diabetes than those in the PLS-group. Further, the PO-group was more likely to present with a trimalleolar fracture. Similar rates of complications (PO: 20.5 vs. PLS: 22.2%, p=0.829), reoperations (PO: 7.9 vs. PLS: 9.0%, p=0.897) and reporting “normal or nearly normal” levels of function at 6-months postoperatively (PO: 54.8 vs. PLS: 60.2%, p=0.630) were observed. After adjusting for age, CCI, osteoporosis/osteopenia, fracture type, and surgical setting in the multivariate regression models there were no significant differences in complication rates, reoperation rates, or patient-reported outcomes at 6-months postoperatively between groups.

Conclusion

Surgical correction of Weber B fractures with a fibular plate yielded similar outcomes with and without placement of a lag screw. While further studies are needed to confirm these findings, plate-only fixation of Weber B ankle fractures appears to be a safe technique.

背景：传统上，Weber B型腓骨骨折的切开复位内固定（ORIF）包括沿骨折平面放置拉力螺钉和钢板固定。目的：比较单纯钢板（PO）与钢板+拉力螺钉（PLS）固定治疗Weber B型骨折的疗效。研究设计：回顾性队列研究。方法：对318例Weber B型骨折行ORIF治疗的患者（2022-2024）进行回顾性分析。采用单因素和多因素统计比较PLS （n=167）和PO （n=151）固定治疗的患者特征和结果。结果：与pls组相比，po组患者年龄较大，共病负担（以Charlson共病指数[CCI]衡量）更大，骨质疏松症/骨质减少症和糖尿病的发生率更高。此外，po组更有可能出现三踝骨折。观察到相似的并发症发生率（PO: 20.5 vs. PLS: 22.2%, p=0.829），再手术率（PO: 7.9 vs. PLS: 9.0%, p=0.897）和术后6个月报告“正常或接近正常”的功能水平（PO: 54.8 vs. PLS: 60.2%, p=0.630）。在多变量回归模型中调整年龄、CCI、骨质疏松症/骨质减少症、骨折类型和手术环境后，两组术后6个月的并发症发生率、再手术率或患者报告的结果无显著差异。结论：使用腓骨钢板矫正Weber B型骨折的效果与不使用拉力螺钉的效果相似。虽然需要进一步的研究来证实这些发现，但Weber B型踝关节骨折的单钢板固定似乎是一种安全的技术。

{"title":"Are interfragmentary lag screws necessary in surgical treatment of Weber B ankle fractures?","authors":"Alyssa Schreiber BS , Jane Brennan MS , Andrea Johnson MSN, CRNP , Adrienne Spirt MD, PhD , Elizabeth Friedmann MD , David Keblish MD , Justin Turcotte PhD, MBA","doi":"10.1053/j.jfas.2025.08.007","DOIUrl":"10.1053/j.jfas.2025.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, open reduction and internal fixation (ORIF) for Weber B fibular fractures involves placement of a lag screw across the fracture plane along with plate fixation.</div></div><div><h3>Purpose</h3><div>To compare outcomes of Weber B fractures treated with plate-only (PO) vs. plate and lag screw (PLS) fixation.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>Retrospective review of 318 patients undergoing ORIF for Weber B fractures (2022-2024) was performed. Univariate and multivariate statistics were used to compare patient characteristics and outcomes of those treated with PLS (n=167) vs. those treated with PO (n=151) fixation.</div></div><div><h3>Results</h3><div>Patients in the PO-group were older, had a greater comorbidity burden (measured as Charlson Comorbidity Index [CCI]), and were more likely to have osteoporosis/osteopenia and diabetes than those in the PLS-group. Further, the PO-group was more likely to present with a trimalleolar fracture. Similar rates of complications (PO: 20.5 vs. PLS: 22.2%, p=0.829), reoperations (PO: 7.9 vs. PLS: 9.0%, p=0.897) and reporting “normal or nearly normal” levels of function at 6-months postoperatively (PO: 54.8 vs. PLS: 60.2%, p=0.630) were observed. After adjusting for age, CCI, osteoporosis/osteopenia, fracture type, and surgical setting in the multivariate regression models there were no significant differences in complication rates, reoperation rates, or patient-reported outcomes at 6-months postoperatively between groups.</div></div><div><h3>Conclusion</h3><div>Surgical correction of Weber B fractures with a fibular plate yielded similar outcomes with and without placement of a lag screw. While further studies are needed to confirm these findings, plate-only fixation of Weber B ankle fractures appears to be a safe technique.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 19.e1-19.e5"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Radiographic and clinical outcomes following single stage brachymetatarsia correction of greater than or equal to 15 mm 大于或等于15mm的单期短跖骨矫正术后的影像学和临床结果。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.011

Shane Sato DPM , Matthew Greenblatt DPM , Noman A. Siddiqui DPM, MHA, FACFAS

Background

Brachymetatarsia is a shortening of one or more metatarsal bones. This condition can result in pedal complaints of metatarsalgia, calluses, toe deformities, and shoe irritation. When non-surgical treatments fail, surgical options include acute one-stage lengthening with a bone graft or gradual callus distraction with an external fixator. Acute correction is preferred for lengthening under 14 mm, while gradual methods are favored for corrections over 15 mm due to concerns of neurovascular injury and achieving incomplete correction. Gradual correction, however, can be associated with prolonged treatment, malalignment risk, pin tract infections, and patient compliance issues.

Purpose

The purpose of this study was to assess the clinical and radiographic outcomes of acute one-stage lengthening of 15 mm or more.

Methods

A retrospective review of patients who underwent acute brachymetatarsia correction of greater than or equal to 15 mm at a single institution was performed.

Results

Twenty-one patients (26 corrections) underwent an average lengthening of 17.6 mm, with a mean osseous consolidation time of 9.7 weeks. No cases of delayed union, malunion, nonunion, or neurovascular injury occurred. The most common complication was radiographic, asymptomatic fourth metatarsophalangeal joint arthritis (34.6 %). Preoperative metatarsal parabola length averaged 12.7 mm and significantly decreased to 0.27 mm postoperatively (P < 0.001).

Conclusion

These findings support acute corrections exceeding 15 mm, challenging concerns of neurovascular injury with this approach.

背景：短跖骨是指一个或多个跖骨的缩短。这种情况可导致脚跖痛、老茧、脚趾畸形和鞋刺激。当非手术治疗失败时，可选择手术治疗，包括急性一期骨移植延长或逐渐骨痂牵引外固定器。对于14毫米以下的长度，首选急性矫正，而对于超过15毫米的长度，由于担心神经血管损伤和实现不完全矫正，首选渐进矫正方法。然而，渐进式矫正可能会导致治疗时间延长、排列不当风险、针道感染和患者依从性问题。目的：本研究的目的是评估急性一期延长15mm或以上的临床和影像学结果。方法：回顾性分析在单一机构接受大于或等于15mm的急性短跖畸形矫正的患者。结果：21例患者（26例矫正）平均延长17.6 mm，平均骨巩固时间为9.7周。无延迟愈合、畸形愈合、不愈合或神经血管损伤病例发生。最常见的并发症是影像学上无症状的第四跖趾关节关节炎（34.6%）。术前跖骨抛物线长度平均为12.7 mm，术后明显缩短至0.27 mm （P < 0.001）。结论：这些发现支持超过15毫米的急性矫正，挑战了神经血管损伤的担忧。临床证据等级：IV。

{"title":"Radiographic and clinical outcomes following single stage brachymetatarsia correction of greater than or equal to 15 mm","authors":"Shane Sato DPM , Matthew Greenblatt DPM , Noman A. Siddiqui DPM, MHA, FACFAS","doi":"10.1053/j.jfas.2025.08.011","DOIUrl":"10.1053/j.jfas.2025.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Brachymetatarsia is a shortening of one or more metatarsal bones. This condition can result in pedal complaints of metatarsalgia, calluses, toe deformities, and shoe irritation. When non-surgical treatments fail, surgical options include acute one-stage lengthening with a bone graft or gradual callus distraction with an external fixator. Acute correction is preferred for lengthening under 14 mm, while gradual methods are favored for corrections over 15 mm due to concerns of neurovascular injury and achieving incomplete correction. Gradual correction, however, can be associated with prolonged treatment, malalignment risk, pin tract infections, and patient compliance issues.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to assess the clinical and radiographic outcomes of acute one-stage lengthening of 15 mm or more.</div></div><div><h3>Methods</h3><div>A retrospective review of patients who underwent acute brachymetatarsia correction of greater than or equal to 15 mm at a single institution was performed.</div></div><div><h3>Results</h3><div>Twenty-one patients (26 corrections) underwent an average lengthening of 17.6 mm, with a mean osseous consolidation time of 9.7 weeks. No cases of delayed union, malunion, nonunion, or neurovascular injury occurred. The most common complication was radiographic, asymptomatic fourth metatarsophalangeal joint arthritis (34.6 %). Preoperative metatarsal parabola length averaged 12.7 mm and significantly decreased to 0.27 mm postoperatively (<em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>These findings support acute corrections exceeding 15 mm, challenging concerns of neurovascular injury with this approach.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 22.e1-22.e6"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early weight-bearing following modified Lapidus arthrodesis: A retrospective review of 104 cases & postoperative protocol 改良Lapidus关节融合术后早期负重：104例回顾性分析及术后方案。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.09.001

Akram Uddin BSc (Hons), MSc, FRCPodS , John. W. Bramall BSc (Hons), FRCPodS , Keng Leong NG , Kajetan Klos , Edgar Roth , Derek Santos BSc (Hons), MSc, PhD

Background

Lapidus arthrodesis is indicated for the treatment of first ray dysfunction or hypermobility, hallux valgus (HV) and functional hallux limitus (FHL). Postoperative weightbearing protocols vary amongst surgeons.

Purpose

To report radiographic osseous healing and patient-reported outcome measures (PROMS) following a single early weightbearing protocol.

Study Design

Retrospective review of 104 adults (≥18 years) (104 feet) who underwent open modified Lapidus arthrodesis (without bone graft) by single compression screw and medial locking plate by two surgeons at one centre (between January 2019 to May 2023).

Methods

Pre- and postoperative radiographs and electronic records were reviewed for evidence of osseous healing and return to full weightbearing. Secondary measures included deformity reduction and PROMS.

Results

At 6-weeks follow-up 98 patients (94 %) were confirmed of osseous healing and returned to full weightbearing. Six patients (6 %) had delayed osseous healing at 6-weeks but showed signs of osseous healing by 3-months follow-up. Postoperative HV and intermetatarsal angle (IMA) showed significant reduction (mean difference: -12 (SD = 8) and -5 (SD = 4) degrees respectively; p < 0.001 for both). Ten patients (10 %) had postoperative complications: hardware irritation 5 (5 %), sesamoiditis 2 (2 %), hypertrophic scar 2 (2 %) and joint stiffness 1 (1 %). Eight patients (8 %) required further surgery (5 required fixation removal due to hardware irritation. Three underwent either; 1st MTPJ open-mobilization, excision of scar or distal metatarsal osteotomy with tibial sesamoid planing). Manchester-Oxford Foot Questionnaire (MOXFQ) showed significant improvement across all domains (mean difference (SD): -51 (SD = 22); walking/standing -49 (SD = 24); pain -52 (SD = 22); and social interaction -51 (SD = 28); (p < 0.001 for all) with clinically significant effect size (Cohen’s d: 2.37; 2.01; 2.37; and 1.84 respectively). Patient satisfaction questionnaire (PSQ-10) score was high mean of 91 (SD = 8). 5 patients (5 %) were lost by 6-months follow-up.

Conclusion

Early weightbearing achieved consistent osseous healing and high PROMS. Larger controlled studies are required to validate these results.

背景：Lapidus关节融合术适用于治疗一线功能障碍或活动过度，拇外翻（HV）和功能性拇受限（FHL）。术后负重方案因外科医生而异。目的：报告单一早期负重治疗方案后的放射学骨愈合和患者报告的结果测量（PROMS）。研究设计：回顾性分析在2019年1月至2023年5月期间，由两名外科医生在一个中心（2019年1月至2023年5月）通过单个压缩螺钉和内侧锁定钢板接受开放式改良Lapidus关节融合术（无骨移植）的104名成年人（≥18岁）（104英尺）。方法：回顾术前和术后x线片和电子记录，以寻找骨愈合和完全负重的证据。次要措施包括畸形复位和PROMS。结果：随访6周，98例（94%）患者骨愈合，恢复完全负重。6例患者（6%）在6周时骨愈合延迟，但在3个月的随访中显示骨愈合迹象。术后HV和跖间角（IMA）均显著降低(平均差值分别为-12 （SD=8）度和-5 （SD=4）度；后MTPJ开放活动，切除疤痕或远端跖骨截骨与胫骨籽骨计划)。曼彻斯特-牛津足部问卷（MOXFQ）在所有领域均有显著改善(平均差（SD）： -51 (SD=22)；行走/站立-49 (SD=24)；疼痛-52 (SD=22)；社会互动-51 (SD=28)；结论：早期负重可获得一致的骨愈合和高PROMS。需要更大规模的对照研究来验证这些结果。证据水平：回顾性研究。第三级:

{"title":"Early weight-bearing following modified Lapidus arthrodesis: A retrospective review of 104 cases & postoperative protocol","authors":"Akram Uddin BSc (Hons), MSc, FRCPodS , John. W. Bramall BSc (Hons), FRCPodS , Keng Leong NG , Kajetan Klos , Edgar Roth , Derek Santos BSc (Hons), MSc, PhD","doi":"10.1053/j.jfas.2025.09.001","DOIUrl":"10.1053/j.jfas.2025.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Lapidus arthrodesis is indicated for the treatment of first ray dysfunction or hypermobility, hallux valgus (HV) and functional hallux limitus (FHL). Postoperative weightbearing protocols vary amongst surgeons.</div></div><div><h3>Purpose</h3><div>To report radiographic osseous healing and patient-reported outcome measures (PROMS) following a single early weightbearing protocol.</div></div><div><h3>Study Design</h3><div>Retrospective review of 104 adults (≥18 years) (104 feet) who underwent open modified Lapidus arthrodesis (without bone graft) by single compression screw and medial locking plate by two surgeons at one centre (between January 2019 to May 2023).</div></div><div><h3>Methods</h3><div>Pre- and postoperative radiographs and electronic records were reviewed for evidence of osseous healing and return to full weightbearing. Secondary measures included deformity reduction and PROMS.</div></div><div><h3>Results</h3><div>At 6-weeks follow-up 98 patients (94 %) were confirmed of osseous healing and returned to full weightbearing. Six patients (6 %) had delayed osseous healing at 6-weeks but showed signs of osseous healing by 3-months follow-up. Postoperative HV and intermetatarsal angle (IMA) showed significant reduction (mean difference: -12 (SD = 8) and -5 (SD = 4) degrees respectively; <em>p</em> < 0.001 for both). Ten patients (10 %) had postoperative complications: hardware irritation 5 (5 %), sesamoiditis 2 (2 %), hypertrophic scar 2 (2 %) and joint stiffness 1 (1 %). Eight patients (8 %) required further surgery (5 required fixation removal due to hardware irritation. Three underwent either; 1st MTPJ open-mobilization, excision of scar or distal metatarsal osteotomy with tibial sesamoid planing). Manchester-Oxford Foot Questionnaire (MOXFQ) showed significant improvement across all domains (mean difference (SD): -51 (SD = 22); walking/standing -49 (SD = 24); pain -52 (SD = 22); and social interaction -51 (SD = 28); (<em>p</em> < 0.001 for all) with clinically significant effect size (Cohen’s d: 2.37; 2.01; 2.37; and 1.84 respectively). Patient satisfaction questionnaire (PSQ-10) score was high mean of 91 (SD = 8). 5 patients (5 %) were lost by 6-months follow-up.</div></div><div><h3>Conclusion</h3><div>Early weightbearing achieved consistent osseous healing and high PROMS. Larger controlled studies are required to validate these results.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 24.e1-24.e8"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0