Journal of Foot & Ankle Surgery最新文献_第4页

Cadaveric evaluation of MIS akin variation on length and angular correction MIS Akin长度和角度校正变化的尸体评价。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.010

Steven R. Cooperman DPM, MBA, AACFAS , Jaeyoon Kim DPM, AACFAS , Orlando Martinez DPM , Lauren M. Christie DPM, AACFAS , Roberto A. Brandão DPM, FACFAS

Background

Hallux abductovalgus, or bunion deformity, is a common forefoot condition with numerous described techniques for surgical correction. Minimally invasive surgery (MIS) is gaining popularity in the foot and ankle community; however, limited data exists regarding the degree of correction achievable with MIS Akin osteotomies.

Purpose

To compare the angular and length changes produced by oblique and transverse Akin osteotomies using two burr sizes (2.0 and 2.9 mm) in a cadaveric model.

Ethics

The authors state that every effort was made to follow all local and international ethical guidelines and laws that pertain to the use of human cadaveric donors in anatomical research. As a cadaveric study, no IRB review was required.

Study Design

Level IV cadaveric study

Methods

Twenty thawed above-knee cadaveric limbs (ten bilateral pairs) were used. Matched pairs underwent either oblique or transverse osteotomies, with the left limbs treated using a 2.0 mm burr and the right limbs with a 2.9 mm burr. Angular correction of the longitudinal axis of the proximal phalanx and medial cortical bone shortening were measured.

Results

The 2.9 mm burr produced significantly greater angular correction and bone shortening than the 2.0 mm burr across all groups (p = 0.002). For oblique osteotomies, the 2.9 mm burr achieved a mean correction of 9.40° versus 4.43° with the 2.9 mm burr (p = 0.037). For transverse osteotomies, angular correction was 14.87° with the 2.9 mm burr compared to 6.64° with the 2.0 mm burr (p = 0.037)

Conclusion

Burr size and osteotomy orientation significantly affect the degree of correction in MIS Akin osteotomies. These findings support careful preoperative planning and deliberate burr selection to optimize surgical outcomes.

背景：拇外翻或拇外翻畸形是一种常见的前足疾病，有许多手术矫正技术。微创手术（MIS）在足部和踝关节界越来越受欢迎；然而，关于MIS Akin截骨术可达到的矫正程度的数据有限。目的：比较在尸体模型中使用两种尺寸（2.0和2.9 mm）的Akin斜向和横向截骨术所产生的角度和长度变化。伦理：作者声明，已尽一切努力遵守与在解剖研究中使用人类尸体捐赠者有关的所有当地和国际伦理准则和法律。作为一项尸体研究，不需要IRB审查。研究设计：IV级尸体研究方法：使用20个膝盖以上解冻的尸体四肢（10对双侧）。对配对的患者进行斜向或横向截骨，左肢采用2.0 mm的毛刺，右肢采用2.9 mm的毛刺。测量近端指骨纵轴的角度矫正和内侧皮质骨缩短。结果：2.9 mm毛刺比2.0 mm毛刺在所有组中产生更大的角度矫正和骨缩短（p = 0.002）。对于斜向截骨术，2.9 mm毛刺的平均矫正度为9.40°，而2.9 mm毛刺的平均矫正度为4.43°（p = 0.037）。对于横截骨，2.9 mm毛刺的角度矫正为14.87°，而2.9 mm毛刺的角度矫正为6.64°（p = 0.037）。结论：毛刺大小和截骨方向显著影响MIS Akin截骨术的矫正程度。这些发现支持术前计划和慎重选择毛刺来优化手术结果。证据等级：四级尸体研究。

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引用次数: 0

Hallux rigidus with an increased or equal first metatarsal length after a cheilectomy and first metatarsal shortening osteotomy (FMSO) using a small shortening scarf: A retrospective 7-year clinical and gait analysis follow-up 掌骨切除术和第一跖骨缩短截骨术（FMSO）后第一跖骨长度增加或相等的拇僵直：一项回顾性的7年临床和步态分析随访。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.002

Karl-Heinz Kristen , Hans Jörg Trnka , Aneele Fischer , Peter Bock

Background

In hallux rigidus, the relative length of the first metatarsal has been implicated in its pathogenesis, suggesting a potential benefit from combined surgical approaches.

Purpose

To evaluate the long-term outcomes of a combined surgical approach using cheilectomy and shortening SCARF osteotomy for moderate hallux rigidus (Coughlin grades 2-3) in active patients with a first metatarsal index equal to or longer than the second metatarsal.

Study Design

Retrospective cohort study.

Methods

Twenty-three feet in 20 patients (mean age 49.4 ± 8.4 years) underwent combined cheilectomy and 4-mm shortening SCARF osteotomy. Outcomes were assessed at a mean follow-up of 6.7 ± 2.5 years using the American Orthopedic Foot and Ankle Society and European Foot and Ankle Surgery scores, range of motion, and gait analysis.

Results

American Orthopedic Foot and Ankle Society scores improved from 32.2±11.7 preoperatively to 86.6±6.2 at the follow-up, and European Foot and Ankle Surgery scores increased from 13.8±2.8 perioperatively to 35.4±3.9 at the follow-up. The total range of motion increased from 32.8° to 44.7° ±16,3°. Gait analysis revealed a physiological plantar pressure distribution at follow-up. Complications included the recurrence of joint stiffness and pain in three patients and transient transfer metatarsalgia in one patient.

Conclusion

Shortening SCARF osteotomy plus mild cheilectomy may be an effective joint-preserving procedure in patients with first metatarsal overlength, with results comparable to those of cheilectomy and other first metatarsal shortening osteotomies.

背景：在拇僵直中，第一跖骨的相对长度与其发病机制有关，提示联合手术入路有潜在的益处。目的：评价第一跖骨指数等于或大于第二跖骨的中度拇趾僵直（Coughlin分级2-3）患者，采用颧骨切除术和短截骨术联合手术的长期疗效。研究设计：回顾性队列研究。方法：20例23尺患者（平均年龄49.4±8.4岁）行颧骨切除联合缩短4mm围巾截骨术。采用美国骨科足踝学会和欧洲足踝外科评分、活动范围和步态分析，平均随访6.7±2.5年评估结果。结果：American orthopaedic Foot and Ankle Society评分从术前的32.2±11.7分提高到随访时的86.6±6.2分，European Foot and Ankle Surgery评分从围手术期的13.8±2.8分提高到随访时的35.4±3.9分。总活动范围从32.8°增加到44.7°±16.3°。步态分析在随访中显示了生理足底压力分布。并发症包括3例患者关节僵硬和疼痛复发，1例患者短暂转移性跖骨痛。结论：缩短围骨带截骨加轻度掌骨切除术可能是第一跖骨过长患者有效的保关节手术，其效果与骨切除和其他第一跖骨缩短截骨术相当。

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引用次数: 0

Efficiency of the combination of Wide Awake Local Anesthesia No Tourniquet (WALANT) and sciatic nerve block for Achilles tendon repair: A preliminary study of feasibility 全清醒局麻无止血带联合坐骨神经阻滞治疗跟腱修复的可行性初步研究。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.009

Sébastien Bloc MD , Cyril Quemeneur MD , Cécile Naudin PhD , David Barouk MD , Guillaume Dufour MD , Mario Bucciero MD , Anaelle Fedida MD , Matthieu Karoubi MD , Xavier Deloin MD , Romain Rousseau MD , Marc Elkaim MD , Anthony Wajsfisz MD , Fréderic Le Saché MD

Background

Various anesthetic techniques are available for surgical repair of Achilles tendon rupture. The main limitation of peripheral nerve blocks is the risk of failure that can be attributed to the failure of the "tourniquet" block or of the “surgical” block.

Purpose

This retrospective study assessed the feasibility and the reproducibility of the association of WALANT technique to sciatic nerve block for Achilles tendon repair surgery.

Study Design

Data from 34 adult patients scheduled for Achilles tendon repair were collected retrospectively from January 2022 to April 2023.

Methods

Sciatic nerve block (15 ml of Ropivacaine 0.375 %) and WALANT (30 ml of lidocaine 1 % with epinephrine) were performed under ultrasound guidance 30 minutes before surgery. A pneumatic thigh tourniquet was applied but not inflated. The primary endpoint was the efficiency of the combination of sciatic nerve block and WALANT, defined by anesthetic and hemostasis qualities.

Results

Efficacy of the combination of sciatic nerve block and WALANT was 91.2 %: one patient required sedation due to pain during skin incision (percutaneous technique), and two others due to discomfort. The hemostatic quality of WALANT was appropriate in 100 % of cases, no pneumatic tourniquet was required.

Conclusion

The combination of sciatic nerve block and WALANT infiltration provides an efficient and reproducible technique for the Achilles tendon repair. It avoids the need for a pneumatic tourniquet and limits the risk of peripheral nerve block failure.

背景：多种麻醉技术可用于外科修复跟腱断裂。末梢神经阻滞的主要限制是失败的风险，这可归因于“止血带”阻滞或“手术”阻滞的失败。目的：本回顾性研究评估WALANT技术联合坐骨神经阻滞用于跟腱修复手术的可行性和可重复性。研究设计：从2022年1月至2023年4月回顾性收集34例预定进行跟腱修复的成年患者的数据。方法：术前30 min在超声引导下行坐骨神经阻滞（罗哌卡因0.375% 15 ml）和WALANT（利多卡因1%加肾上腺素30 ml）。使用气动大腿止血带，但未充气。主要终点是坐骨神经阻滞联合WALANT的有效性，由麻醉和止血质量来定义。结果：坐骨神经阻滞联合WALANT的有效率为91.2%，1例患者因皮肤切开（经皮穿刺）时疼痛需要镇静，2例患者因不适需要镇静。WALANT的止血质量100%合适，不需要使用气动止血带。结论：坐骨神经阻滞联合WALANT浸润是一种高效、可重复性好的跟腱修复技术。它避免了气动止血带的需要，并限制了周围神经阻滞失败的风险。

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引用次数: 0

Risk factors for surgical site infections in patients with pilon fractures: A systematic review and meta-analysis 皮隆骨折患者手术部位感染的危险因素：系统回顾和荟萃分析。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.006

Pei Zhen Li , Jia Wei He , Xian Sheng Xia

Background

Pilon is a severe ankle fracture, and surgical site infections is an important postoperative complication that often leads to catastrophic consequences. Understanding its risk factors is crucial for optimizing patient outcomes and improving clinical management strategies.

Methods

We searched PubMed, Embase, Web of Science, and the Cochrane Library for prospective and retrospective studies related to surgical site infections in patients with Pilon fractures, covering the period from January 2000 to March 2025. Following the screening and quality assessment of eligible studies, data were extracted and a meta-analysis was conducted utilizing Stata 16.0 and RevMan 5.3 software.

Result

Ten studies involving 4,120 patients were included in the analysis. The meta-analysis revealed that the pooled incidence of surgical site infections was 17 % (95 % CI: 12 %–23 %). Significant risk factors identified for surgical site infections in patients with Pilon fractures included age, diabetes, hypertension, albumin, open fracture, AO/OTA fracture type(≥C), preoperative hospital stay, and surgical duration.

Conclusion

This study identified several significant risk factors linked to surgical site infections in patients with Pilon fractures. Surgeons should closely monitor high-risk populations, optimize perioperative management, and implement effective preventive measures to prevent unnecessary complications.

背景：皮隆是一种严重的踝关节骨折，手术部位感染是一个重要的术后并发症，往往导致灾难性的后果。了解其风险因素对于优化患者预后和改善临床管理策略至关重要。方法：我们检索PubMed、Embase、Web of Science和Cochrane图书馆，检索2000年1月至2025年3月期间与皮隆骨折患者手术部位感染相关的前瞻性和回顾性研究。在对符合条件的研究进行筛选和质量评估后，提取数据并利用Stata 16.0和RevMan 5.3软件进行meta分析。结果：10项研究共纳入4120例患者。荟萃分析显示手术部位感染的总发生率为17% （95% CI: 12% - 23%）。年龄、糖尿病、高血压、白蛋白、开放性骨折、AO/OTA骨折类型（≥C）、术前住院时间和手术时间是导致Pilon骨折患者手术部位感染的重要危险因素。结论：本研究确定了与皮隆骨折患者手术部位感染相关的几个重要危险因素。外科医生应密切监测高危人群，优化围手术期管理，实施有效的预防措施，防止不必要的并发症。

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引用次数: 0

Superiority of ultra-shortterm clinical outcome after minimally invasive distal metatarsal chevron osteotomy in comparison to the open technique: a prospective study 一项前瞻性研究：微创远端跖骨截骨术与开放技术相比超短期临床疗效的优势。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.013

Viktoria Hofmann MD , Gerhard Kaufmann MD , Michael Liebensteiner MD, PhD , Franz Endstrasser MD , Moritz Wagner MD , Hanno Ulmer PhD , Luke Cicchinelli DPM, FACFAS

Swelling and pain is a frequent finding after hallux valgus correction. Aim of our study was to detect clinical differences in the initial postoperative period after minimally invasive chevron osteotomy (MIS) and the open chevron technique (OC). From the included patients clinical outcome was assessed preoperatively, and then at two, four, six and 12 weeks postopertively in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot Score, the Japanese Society for Surgery of the Foot (JSSF) metatarsophalangeal-interphalangeal Scale, the Maryland Foot Score (MFS), the SF12 Life Quality Scale, the Visual Analogue Scores (VAS) of pain, swelling of the foot, range of motion (ROM) and patient satisfaction. Radiographic parameters were taken preoperatively, as well as two, six and twelve weeks after surgery. The Charlson Comorbidity Index (CCI) was recorded preoperatively only, pain medication consumption was documented for the intial two weeks after surgery. Sixty-three feet were analyzed (33 MIS; 30 OC). Patient demographic characteristics and amount of the deformity in both groups did not differ significantly. Both techniques demonstrated good radiographic correction of the hallux deformity without superiority of one technique. We detected lower pain levels and reduced pain medication consumption as well as reduced swelling in the MIS group at the time points two, four and six weeks postoperatively. AOFAS score and the satisfaction score showed significantly better results in the MIS group as well. Minimally invasive chevron osteotomy shows better clinical ultra-shortterm outcome and lower pain levels in comparision to the open technique with comparable radiographic results.

肿胀和疼痛是拇外翻矫正后常见的症状。我们的研究目的是检测微创颅角截骨术（MIS）和开放颅角截骨术（OC）术后初期的临床差异。对入选患者进行术前、术后2周、4周、6周和12周的临床结果评估，分别采用美国骨科足踝学会（AOFAS）前足评分、日本足外科学会（JSSF）跖趾-指间量表、马里兰足部评分（MFS）、SF12生活质量量表、疼痛、足部肿胀、活动范围（ROM）和患者满意度的视觉模拟评分（VAS）。术前、术后2周、6周和12周分别测量影像学参数。术前仅记录Charlson合并症指数（CCI），术后最初两周记录止痛药的使用情况。分析了63英尺（33 MIS; 30 OC）。两组患者的人口学特征和畸形数量无显著差异。两种技术均表现出良好的拇畸形x线矫正效果，没有任何一种技术的优势。我们在术后2周、4周和6周的时间点检测到MIS组疼痛水平降低，止痛药用量减少，肿胀减轻。MIS组患者的AOFAS评分和满意度评分均显著高于MIS组。与具有相似影像学结果的开放式技术相比，微创chevron截骨术具有更好的临床超短期疗效和更低的疼痛水平。

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引用次数: 0

Short-term clinical outcomes of cross-linked hyaluronic acid filler injection in the treatment of plantar fat-pad atrophy syndrome 交联透明质酸填充剂注射治疗足底脂肪-垫萎缩综合征的近期临床疗效观察。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.004

Seung Hyo Ko MD, Bomsoo Kim MD, PhD

Background

Plantar fat-pad atrophy syndrome is characterized by thinning of the heel and forefoot fat pads, causing pain and functional limitation. Conventional treatments, such as heel cups and taping, offer only temporary relief and are often hindered by poor patient compliance.

Purpose

To evaluate the short-term clinical outcomes and complications of cross-linked hyaluronic acid (HA) filler injections into the plantar region of the foot.

Study Design

Prospective case series.

Methods

Twenty-eight patients (30 feet) with plantar fat-pad atrophy received injections of cross-linked HA filler (YVOIRE® Contour Plus C, LG Chem, Ltd., Seoul, Korea). The primary outcome was change in Visual Analogue Scale (VAS) at 24 weeks. Secondary outcomes included EQ-5D-3 L, Foot and Ankle Outcome Score (FAOS), Foot Function Index (FFI), fat pad thickness, and patient satisfaction. Adverse events were recorded.

Results

VAS improved from 6.86 ± 1.67 to 3.50 ± 2.67 at 24 weeks (p < .001). EQ Index, FAOS, and FFI scores also improved significantly (all p < .05). Repeated measures ANOVA showed significant time effects across all clinical outcomes (p < .05). Fat pad thickness increased by 1.45 ± 1.59 mm at the heel and 2.67 ± 0.63 mm at the forefoot. Six patients experienced adverse events (pain, inflammation, and migration), all resolved conservatively.

Conclusion

Cross-linked HA filler injections provide short-term pain relief and functional improvement in plantar fat-pad atrophy. Future work should focus on optimizing filler materials, injection techniques, and rehabilitation protocols.

背景：足底脂肪垫萎缩综合征的特征是脚跟和前足脂肪垫变薄，引起疼痛和功能限制。传统的治疗方法，如鞋跟杯和胶布，只能提供暂时的缓解，而且往往因患者依从性差而受到阻碍。目的：评价交联透明质酸（HA）填充剂在足跖区注射的近期临床效果及并发症。研究设计：前瞻性病例系列。方法：28例（30英尺）足底脂肪垫萎缩患者接受交联HA填充剂注射（YVOIRE®Contour Plus C, LG Chem, Ltd, Seoul, Korea）。主要观察指标为24周时视觉模拟评分（VAS）的变化。次要结局包括EQ-5D-3L、足踝结局评分（FAOS）、足功能指数（FFI）、脂肪垫厚度和患者满意度。记录不良事件。结果：24周时VAS由6.86±1.67改善至3.50±2.67 （p < 0.001）。EQ指数、FAOS和FFI评分也显著提高（均p < 0.05）。重复测量方差分析显示，所有临床结果均存在显著的时间效应（p < 0.05）。鞋跟脂肪垫厚度增加1.45±1.59 mm，前足脂肪垫厚度增加2.67±0.63 mm。6例患者出现不良事件（疼痛、炎症和迁移），均经保守治疗。结论：交联羟基磷灰石填充剂注射可短期缓解足底脂肪垫萎缩的疼痛并改善足底功能。未来的工作应侧重于优化填充材料、注射技术和康复方案。临床证据等级：4级，病例系列。

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引用次数: 0

Minimally invasive osteotomies of the second and third metatarsals for the management of metatarsalgia in hallux valgus with plantar plate rupture 第二、三跖骨微创截骨术治疗拇外翻伴足底板破裂跖痛。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.06.015

Barbara Piclet-Legré , Lucile Vais , Stéphanie Cohen , Lolita Micicoi

Background

Distal Minimally invasive metatarsal osteotomies (DMMOs) shorten the metatarsals While allowing automatic adjustment of the metatarsal heads in all three planes through immediate weight-bearing. In hallux valgus (HV) surgery, transfer metatarsalgia can be managed with percutaneous DMMOs.

Purpose

This study is a retrospective study that evaluates the clinical and radiological outcomes of DMMOs limited to the second and third metatarsals for metatarsalgia with plantar plate injury associated with HV.

Study design

A single-center study of 102 patients who underwent surgery between 2011 and 2020.

Methods

Demographic, radiological, clinical (AOFAS score), and complication data were analyzed. Minimally invasive DMMOs of the second and third metatarsals were performed under fluoroscopic guidance, followed by a chevron osteotomy of M1 to realign forefoot length.

Results

We observed significant metatarsal shortening and AOFAS a signifiant improvement (p < 0.05) with a postoperative value of 92.25 ± 3.7 (range: 71.2–98.2). No recurrences, three cases of transfer metatarsalgia, and six delayed unions were reported DMMOs of the second and third metatarsals appear to be a reliable option for treating metatarsalgia with plantar plate injury in HV.

Conclusion

DMMOs of the second and third metatarsals appear to be a reliable option for treating metatarsalgia with plantar plate injury in association with surgical correction of HV. We observed no recurrence of metatarsalgia, and the risk of transfer metatarsalgia was less than 2.9 %

背景：远端微创跖骨截骨术（DMMOs）缩短了跖骨，同时允许通过立即负重在所有三个平面上自动调整跖骨头。在拇外翻（HV）手术中，转移性跖痛可用经皮dmmo治疗。目的：本研究是一项回顾性研究，评估限制于第二和第三跖骨的DMMOs治疗HV相关跖骨痛伴足底板损伤的临床和影像学结果。研究设计：对2011年至2020年间接受手术的102例患者进行单中心研究。方法：对患者的人口学、影像学、临床（AOFAS评分）及并发症资料进行分析。在透视引导下对第二和第三跖骨进行微创DMMOs，然后进行M1的字形截骨术以调整前足长度。结果：我们观察到跖骨明显缩短，AOFAS明显改善（p < 0.05），术后值为92.25±3.7（范围：71.2 ~ 98.2）。无复发，3例转移性跖骨痛和6例延迟愈合被报道，第二和第三跖骨的dmmo似乎是治疗HV跖骨痛伴足底板损伤的可靠选择。结论：第二和第三跖骨的dmmo似乎是治疗足底板损伤伴HV手术矫正的跖痛的可靠选择。我们没有观察到跖骨痛复发，转移性跖骨痛的风险小于2.9。

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引用次数: 0

Chronic deltoid ligament insufficiency results in greater anterior translation and positive arthroscopic drive-through sign 慢性三角韧带功能不全导致大前平移和关节镜下通过标志阳性。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.005

Ryan B. Rigby D.P.M. FACFAS , Sarah J. Ingwer B.S. , Nathan Ptak D.P.M. AACFAS , Justin Fleming D.P.M, FACFAS , Oliver Hauck M.S. , Anthony N. Khoury Ph.D.

Background

Diagnosis and treatment of medial deltoid ligament instability is inconsistent.

Purpose

This biomechanical study evaluated arthroscopic drive-through sign as a viable and reproducible diagnostic method to determine chronic deltoid instability and determined the restorative potential of combined medial and lateral ligament repair on ankle stability.

Study Design

Controlled laboratory study.

Methods

The proximal tibia (n = 5) was mounted in 20° plantar flexion. Anterior translation was simulated by loading specimens with 2 kg/3 kg/4 kg. Arthroscopic drive-through sign and anterior translation distance were evaluated at the following ligament release and repair phases: intact, lateral instability, dual-sided instability, dual-sided repair, and lateral repair alone. Arthroscopic drive-through was attempted with 2.0-5.0 mm diameter probes before each phase. A positive arthroscopic drive-through sign was defined as passage into the medial gutter.

Results

Positive arthroscopic drive-through sign for intact specimens were observed with 2.0 mm (4/5) and 2.5 mm (1/5) probes. In the dual-sided instability model, probe sizes ranged from 3.5 mm to 4.5 mm. Dual-sided repair restored the medial gutter distance to intact. The lateral repair alone did not restore to intact. Anterior translation in dual-sided instability was significantly greater than intact (14.3 ± 1.9 mm[12.6-16.0] vs. 7.4 ± 1.5 mm[6.1-8.7], P < 0.001). Dual-sided repair and lateral repair alone restored intact anterior translation (4.8±0.8 mm[4.1-5.5], P = 0.637; 7.0 ± 1.1 mm[6.0-8.0], P = 0.958).

Conclusion

The arthroscopic drive-through sign seems to be a reliable method to detect medial deltoid instability. Combined medial and lateral ligament repair effectively restores anterior translation to intact levels. Medial deltoid repair contributed to 23.2 % of the total anterior translation reduction from the dual-sided instability phase to dual-sided repair phase.

背景：三角韧带内侧不稳的诊断和治疗不一致。目的：本生物力学研究评估关节镜下驾车穿过标志作为一种可行且可重复的诊断方法来确定慢性三角肌不稳定，并确定内侧和外侧韧带联合修复对踝关节稳定性的恢复潜力。研究设计：对照实验室研究方法：胫骨近端（n=5）以20°足底屈曲固定。通过2kg/3kg/4kg的载荷模拟标本的前平移。在以下韧带释放和修复阶段（完整、外侧不稳定、双侧不稳定、双侧修复和单独外侧修复）评估关节镜下的穿过标志和前路平移距离。在每个阶段之前，尝试使用2.0-5.0mm直径的关节镜穿透探针。关节镜下通过标志为进入内侧沟的通道。结果：使用2.0mm（4/5）和2.5mm（1/5）探针观察到完整标本的关节镜驾车通过阳性标志。在双面不稳定模型中，探针尺寸在3.5mm到4.5mm之间。双侧修复后内侧沟距恢复完整。单靠外侧修复不能恢复到完整。双侧不稳定患者的前平移明显大于完整患者（14.3±1.9mm[12.6-16.0] vs. 7.4±1.5mm[6.1-8.7]）。结论：关节镜下穿过标志似乎是检测内侧三角肌不稳定的可靠方法。联合内侧和外侧韧带修复有效地恢复前平移到完整的水平。从双侧不稳定期到双侧修复期，内侧三角肌修复贡献了23.2%的总前平移复位。

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引用次数: 0

Diplomacy in foot and ankle surgery, a systematic review of divisive literature within the field 足部和踝关节手术中的外交，对该领域分歧文献的系统回顾。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.002

Christopher Hyer DPM, MS, FACFAS , Cameron Meyer DPM, AACFAS , Jae Yoon Kim DPM, AACFAS , Orlando Martinez DPM , Roberto Brandão DPM, FACFAS

Foot and ankle pathology is most often managed by orthopedic surgeons and podiatric surgeons. Over time, podiatric surgery has been privy to literature criticizing its influence on patient outcomes, hospital systems, and the orthopedic community. To better understand where this literature is coming from, the authors performed a literature search through PubMed, Google Scholar, and Cochrane Database using the following search terms: “surgeon type, podiatric surgeon, orthopedic surgeon, foot and ankle, podiatry, and doctors of podiatric medicine.” Included studies were assessed for study characteristics and outcomes. Article categories included: journal, year of publication, level of evidence, degree of primary author, presence of a podiatric surgeon (DPM) on author panel, discussion of training discrepancies, and outcome variable utilized.

We identified seventeen thousand two hundred twenty-nine articles through our search method. Seventeen studies met inclusion and exclusion criteria. Reviewers were blinded to authorship and asked to state whether or not training discrepancies were mentioned in the papers between DPM and orthopedic surgery. Eight (47 %) studies were found to discuss training discrepancies. Seven (87.5 %) of these articles discussing training discrepancy were found to be primarily authored by orthopedic surgeons.

The authors concluded that, published articles which question professional work of a differing medical degree tends to support the degree of the primary author. More attention is needed to create a collaborative interprofessional relationship among these two societies. A stronger podiatric surgery research effort is necessary to support its influence on the community, hospitals, and surgical literature. Level of Evidence: Level 4

足部和踝关节病理通常由骨科医生和足部外科医生处理。随着时间的推移，足部外科一直被文献批评其对患者预后、医院系统和骨科社区的影响。为了更好地理解这些文献的来源，作者通过PubMed，谷歌Scholar和Cochrane数据库进行了文献检索，使用以下搜索词：“外科医生类型，足部外科医生，矫形外科医生，足部和脚踝，足部医学和足部医学医生。”评估纳入的研究的研究特征和结果。文章类别包括：期刊、发表年份、证据水平、主要作者的程度、作者小组中足部外科医生（DPM）的存在、培训差异的讨论和使用的结果变量。通过我们的搜索方法，我们确定了一万七千二百二十九篇文章。17项研究符合纳入和排除标准。审稿人不知道作者身份，并被要求说明DPM和骨科之间的培训差异是否在论文中被提及。发现有8项（47%）研究讨论了训练差异。这些讨论培训差异的文章中有7篇（87.5%）主要由骨科医生撰写。作者的结论是，发表的质疑不同医学学位的专业工作的文章往往支持第一作者的学位。需要更加注意在这两个社会之间建立合作的跨专业关系。加强足部外科研究是必要的，以支持其对社区、医院和外科文献的影响。证据等级：三级。

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引用次数: 0

Four-year outcomes following triplanar tarsometatarsal arthrodesis with early weightbearing for Hallux Valgus: A multicenter prospective study 三平面跗跖关节融合术早期负重治疗拇外翻的四年疗效：一项多中心前瞻性研究。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.007

Daniel J. Hatch DPM, FACFAS , Avneesh Chhabra MD, MBA, FACR , Mindi Dayton DPM, MHA, FACFAS , Paul D. Dayton DPM, MS, FACFAS , Daniel C. Farber MD , Deidre A. Kile MS , Jennifer Koay MD , George T. Liu DPM, MPH, FACFAS , Jody P. McAleer DPM, FACFAS , Robert D. Santrock MD

Background

Traditional hallux valgus surgery has been focused on two-dimensional repair with high reported recurrence rates.

Purpose

We report the 4-year interim analysis of a prospective, 5-year, multicenter study of radiographic, clinical, and patient-reported outcomes following triplanar first tarsometatarsal arthrodesis with early weightbearing.

Study Design

This is a prospective, multicenter, clinical trial involving 7 US-based centers and 13 surgeons. One-hundred and seventy-three patients were treated, of whom 139 (80.3%) achieved their 48-month visit. Clinical and radiographic parameters were evaluated at all follow-up visits along with patient-reported outcomes [Visual Analog Scale (VAS), Manchester-Oxford Foot Questionnaire (MOxFQ) and Patient-Reported Outcomes Measurement Information System (PROMIS).

Methods

Institutional review board approval was obtained for each study site. A consecutive cohort of patients were enrolled from November 2018 to April 2021 who received first TMT arthrodesis to correct their symptomatic hallux valgus. Inclusion and exclusion criteria were established.

Results

Significant improvements in triplanar radiographic correction (hallux valgus angle, intermetatarsal angle, tibial sesamoid position, sagittal-plane IMA, and osseous foot width) were maintained at all timepoints. Using recurrence definitions of > 15° and 20° postoperative hallux valgus angle, recurrence rates were 8.4% (95% CI:4.27%, 14.53%) and 0.8% (95% CI:0.02%, 4.18%) at 48 months, respectively. Mean (95% CI) time to weightbearing in a boot walker was 7.7 (6.6, 8.8) days.

Conclusion

The 4-year interim results of this prospective, multicenter study demonstrate favorable improvement of the triplanar hallux valgus deformity, maintenance of correction, low complication rate, and favorable patient-reported outcomes with early return to protected weightbearing.

背景：传统的拇外翻手术以二维修复为主，复发率高。目的：我们报告了一项为期4年的前瞻性、5年、多中心研究的中期分析，研究了早期负重的第一跗跖关节融合术后的影像学、临床和患者报告的结果。研究设计：这是一项前瞻性、多中心临床试验，涉及7个美国中心和13名外科医生。173例患者接受了治疗，其中139例（80.3%）完成了48个月的随访。在所有随访中评估临床和放射学参数以及患者报告的结果[视觉模拟量表（VAS），曼彻斯特-牛津足问卷（MOxFQ）和患者报告的结果测量信息系统（PROMIS）]。方法：每个研究地点都获得了机构审查委员会的批准。2018年11月至2021年4月，连续招募了一组接受首次TMT关节融合术以纠正症状性外翻的患者。建立了纳入和排除标准。结果：三平面放射矫正（拇外翻角、跖间角、胫骨籽骨位置、矢状面IMA和骨足宽度）在所有时间点均保持显著改善。采用术后拇外翻角> 15°和20°的复发定义，48个月的复发率分别为8.4% （95% CI:4.27%, 14.53%）和0.8% （95% CI:0.02%, 4.18%）。行走靴到负重的平均（95% CI）时间为7.7（6.6,8.8）天。结论：这项前瞻性、多中心研究的4年中期结果显示，拇外翻三面畸形得到了良好的改善，矫正得以维持，并发症发生率低，患者报告的早期恢复保护负重的良好结果。

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引用次数: 0