Journal of Foot & Ankle Surgery最新文献_第5页

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

A retrospective comparison of bone culture techniques 骨培养技术的回顾性比较。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.010

Jennifer A. Kipp DPM , Lindsay K. LeSavage DPM, AACFAS , Greg Russell MS , Kevin P. High MD, MS , Nicholas S. Powers DPM, FACFAS , Cody D. Blazek DPM, FACFAS

Background

The gold standard test for diagnosing osteomyelitis is bone biopsy, and IDSA 2023 guidelines recommend obtaining a “bone culture” for microbiological analysis in the setting of osteomyelitis. However, there is no consensus on the optimal method by which to obtain this bone sample.

Purpose

The purpose of this study was to retrospectively compare two intraoperative methods to obtain bone cultures: bone tissue cultures and bone swab cultures.

Study Design

A retrospective review was performed on one-hundred three patients who underwent 126 surgical procedures for concern of osteomyelitis in the lower extremity.

Methods

Intraoperatively, a bone swab culture and a bone tissue culture were obtained following debridement or amputation from the same operative site and submitted for microbiological analysis.

Results

Bone swab cultures yielded positive results in 40.5 % (51/126) of procedures, while bone tissue cultures were positive in 32 % (40/126)(p = 0.027). Complete agreement between both methods occurred in 80 % (101/126) cases. In cases of disagreement, bone swab cultures resulted positive more than bone tissue cultures (p = 0.028).

Conclusion

These findings suggest that the bone swab is more sensitive overall, and surgeons may even consider the use of both bone tissue and swabs for culture.

背景：诊断骨髓炎的金标准测试是骨活检，IDSA 2023指南建议在骨髓炎的情况下进行“骨培养”进行微生物分析。然而，对于获得该骨样本的最佳方法尚无共识。目的：本研究的目的是回顾性比较两种术中获得骨培养的方法：骨组织培养和骨拭子培养。研究设计：本研究对103例因骨髓炎而接受126次手术的患者进行回顾性研究。方法：在同一手术部位清创或截肢后进行骨拭子培养和骨组织培养，并进行微生物学分析。结果：40.5%（51/126）的骨拭子培养为阳性，32%（40/126）的骨组织培养为阳性（p=0.027）。80%（101/126）病例两种方法完全吻合。在不一致的情况下，骨拭子培养比骨组织培养阳性（p=0.028）。结论：这些发现表明骨拭子总体上更敏感，外科医生甚至可以考虑同时使用骨组织和拭子进行培养。临床证据等级：3。

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引用次数: 0

Comparison of elastic fixation and rigid fixation in the treatment of distal tibiofibular syndesmosis injury 弹性内固定与刚性内固定治疗胫腓骨远端联合损伤的比较。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.09.003

Ke Chen, Qiang Zhu, Wenping Huo, Jian Zhang, Shitao Wang

Objective

Compare clinical outcomes of elastic (Rigidloop) vs. rigid (screw) fixation for distal tibiofibular syndesmosis injury.

Methods

Eighty-eight patients were divided into an elastic fixation group (n = 43) and a rigid fixation group (n = 45) groups, with the elastic fixation group undergoing Rigidloop fixation and the rigid fixation group undergoing screw fixation. Clinical data (operation time, blood loss, weight-bearing/fracture healing time), radiographic parameters (talocalcaneal fusion site [TFCS], tibiofibular overlap [TFO], medial clear space [MCS]), American Orthopaedic Foot and Ankle Society (AOFAS) scores, plantar flexion range, and complications were analyzed.

Results

Preoperative and 12-month TFCS, TFO, and MCS were comparable (P > 0.05). The elastic fixation group had shorter operation time (60.23 ± 11.67 vs. 66.32 ± 12.28 min), reduced blood loss (151.05 ± 21.04 vs. 159.47 ± 22.11 mL), earlier weight-bearing (6.12 ± 1.06 vs. 7.75 ± 1.36 weeks), and faster wound/fracture healing compared with the rigid fixation group(P <0.05). At 3 months, the elastic fixation group showed superior plantar flexion (42.68 ± 4.00 vs. 40.18 ± 4.08°) and AOFAS scores (81.30 ± 5.23 vs. 77.98 ± 5.70 points, P < 0.05), but both groups tended to be consistent by 12 months (P > 0.05). Complications of the elastic fixation group (loosening, infection, re-separation) were lower (9.3 % vs. 24.4 %, P <0.05); satisfaction rates were similar (P > 0.05).

Conclusion

Rigidloop fixation is as effective as screw fixation in stabilizing syndesmosis injuries, and the Rigidloop system has the advantages of faster recovery, fewer complications, and early functional benefits, making it superior to screw fixation.

目的：比较弹性（Rigidloop）与刚性（螺钉）固定治疗胫腓联合远端损伤的临床效果。方法：88例患者分为弹性固定组（n=43）和刚性固定组（n=45），弹性固定组采用Rigidloop固定，刚性固定组采用螺钉固定。分析临床资料（手术时间、出血量、负重/骨折愈合时间）、影像学参数（距跟骨融合部位[TFCS]、胫腓骨重叠部位[TFO]、内侧间隙[MCS]）、美国矫形足踝学会（AOFAS）评分、足底屈曲范围及并发症。结果：术前和12个月TFCS、TFO、MCS具有可比性（P < 0.05）。弹性内固定组手术时间短（60.23±11.67 vs 66.32±12.28 min），出血量少（151.05±21.04 vs 159.47±22.11 mL），负重早（6.12±1.06 vs 7.75±1.36周），创面/骨折愈合快（P < 0.05）。弹性固定组并发症（松动、感染、再分离）发生率较低（9.3%比24.4%,P < 0.05）。结论：在稳定韧带联合损伤方面，Rigidloop固定与螺钉固定一样有效，且Rigidloop系统具有恢复快、并发症少、早期功能获益等优点，优于螺钉固定。

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引用次数: 0

Evaluation of the clinical and radiological outcomes of syndesmotic screws not parallel to the ankle joint 不平行于踝关节的关节联合螺钉的临床和影像学结果评价。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.005

Abdurrahman Aydın MD , Muhammed Bilal Kürk MD

Purpose

This study aimed to evaluate the clinical and radiological outcomes of parallel and non-parallel placements of a single syndesmotic screw relative to the ankle joint line in the coronal plane used to enhance tibiofibular stability after syndesmosis injuries in ankle trauma surgery.

Methods

Eighty-nine patients with isolated Weber B and C fractures treated from January 2021 to December 2024 were evaluated. They were divided into two groups based on the angulation of the syndesmotic screw: Group 1 (49 patients) had screws angled between −3° and +3° (parallel), while Group 2 (40 patients) had nonparallel screws. Comparisons were made on surgical duration, fluoroscopic shots needed for fixation, intraoperative fluoroscopic shots, postoperative medial clear space, ankle range of motion (ROM) at 3 and 6 months, American Orthopaedic Foot and Ankle Society (AOFAS) scores at those intervals, rates of implant fracture or failure, and radiolucencies around implants.

Results

The angulation of the syndesmotic screw was significantly different between the groups, measuring 1.87 ± 0.77 in Group 1 and 4.66 ± 1.68 in Group 2 (p < 0.001). Surgical duration averaged 51.32 ± 7.71 minutes in Group 1 compared to 40.62 ± 6.75 minutes in Group 2 (p = 0.027). At 3 months, ankle ROM was 32.95 ± 4.11 in Group 1 and 30.55 ± 3.44 in Group 2 (p = 0.026), but no significant difference was found at 6 months (p = 0.078). AOFAS scores showed significant differences at 3 months (p < 0.001) but not at 6 months (p = 0.862)

Conclusion

The study found that syndesmotic screws placed parallel or nonparallel to the joint in the coronal plane had similar clinical outcomes.

目的：本研究旨在评估在踝关节创伤手术中联合损伤后，在冠状面平行或非平行放置单关节联合螺钉以增强胫腓骨稳定性的临床和影像学结果。方法：对2021年1月至2024年12月收治的89例孤立性Weber B型和C型骨折患者进行回顾性分析。根据关节联合螺钉的角度将患者分为两组：1组（49例）螺钉角度在-3°至+3°（平行）之间，而2组（40例）螺钉角度不平行。比较手术时间、固定所需的x线透视、术中x线透视、术后内侧间隙、3个月和6个月时踝关节活动范围（ROM）、美国骨科足踝学会（AOFAS）评分、植入物骨折或失败率以及植入物周围的放射性。结果：两组间胫腓联合螺钉角度差异有统计学意义，1组为1.87±0.77,2组为4.66±1.68 （p < 0.05）

{"title":"Evaluation of the clinical and radiological outcomes of syndesmotic screws not parallel to the ankle joint","authors":"Abdurrahman Aydın MD , Muhammed Bilal Kürk MD","doi":"10.1053/j.jfas.2025.08.005","DOIUrl":"10.1053/j.jfas.2025.08.005","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the clinical and radiological outcomes of parallel and non-parallel placements of a single syndesmotic screw relative to the ankle joint line in the coronal plane used to enhance tibiofibular stability after syndesmosis injuries in ankle trauma surgery.</div></div><div><h3>Methods</h3><div>Eighty-nine patients with isolated Weber B and C fractures treated from January 2021 to December 2024 were evaluated. They were divided into two groups based on the angulation of the syndesmotic screw: Group 1 (49 patients) had screws angled between −3° and +3° (parallel), while Group 2 (40 patients) had nonparallel screws. Comparisons were made on surgical duration, fluoroscopic shots needed for fixation, intraoperative fluoroscopic shots, postoperative medial clear space, ankle range of motion (ROM) at 3 and 6 months, American Orthopaedic Foot and Ankle Society (AOFAS) scores at those intervals, rates of implant fracture or failure, and radiolucencies around implants.</div></div><div><h3>Results</h3><div>The angulation of the syndesmotic screw was significantly different between the groups, measuring 1.87 ± 0.77 in Group 1 and 4.66 ± 1.68 in Group 2 (p < 0.001). Surgical duration averaged 51.32 ± 7.71 minutes in Group 1 compared to 40.62 ± 6.75 minutes in Group 2 (p = 0.027). At 3 months, ankle ROM was 32.95 ± 4.11 in Group 1 and 30.55 ± 3.44 in Group 2 (p = 0.026), but no significant difference was found at 6 months (p = 0.078). AOFAS scores showed significant differences at 3 months (p < 0.001) but not at 6 months (p = 0.862)</div></div><div><h3>Conclusion</h3><div>The study found that syndesmotic screws placed parallel or nonparallel to the joint in the coronal plane had similar clinical outcomes.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 1","pages":"Pages 18.e1-18.e6"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876550","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

Functional and neuromuscular effects of rehabilitation in acute ankle sprain and chronic ankle instability 急性踝关节扭伤和慢性踝关节不稳的康复对功能和神经肌肉的影响。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.08.004

Andrea De Fazio MD , Giorgio Fravolini MD , Elena Gabrielli MD , Matteo Turchetta MD , Marianna Citro MS , Fabrizio Forconi MD , Giulio Maccauro Prof , Raffaele Vitiello Prof

Background

Lateral ankle sprains (LAS) are common injuries that may progress to chronic ankle instability (CAI), characterized by recurrent sprains, proprioceptive deficits, and neuromuscular impairments.

Purpose

This study evaluated the impact of rehabilitation on functional outcomes and electromyographic (EMG) parameters in patients with acute LAS and CAI.

Study Design

Prospective observational cohort study.

Methods

Between August 2022 and September 2023, 119 patients (73 with acute LAS, 46 with CAI) were assessed at baseline (T0) and after a three-months rehabilitation program (T1). Assessments included range of motion (ROM), muscle strength, surface EMG, balance tests (Y-Balance, Foot Lift, Side Hop, 6-m Hop), and the FAAM questionnaire. Rehabilitation consisted of individualized protocols integrating gym-based exercises and hydrotherapy, targeting ROM restoration, proprioceptive training, and muscle strengthening.

Results

LAS patients demonstrated significant baseline impairments in plantarflexion ROM (49.32 ± 13.37 vs. 61.76 ± 17.67; p = 0.01) and Foot Lift Test performance (168 ± 191.28 vs. 18.52 ± 58.38; p = 0.01). Post-rehabilitation, both groups showed improvements in ROM, strength, and functional scores. CAI patients achieved greater proprioceptive gains (Y-Balance, Side Hop), while LAS patients exhibited superior recovery in plantarflexion strength. However, EMG analysis revealed persistent neuromuscular deficits in both groups.

Conclusion

Despite clinical improvements, persistent EMG deficits, especially in CAI, indicate incomplete neuromuscular recovery. These findings highlight the limitations of standard rehabilitation protocols and underscore the need for personalized neuromuscular interventions and objective return-to-sport criteria. Future research should aim to refine diagnostic tools, standardize protocols, and incorporate technology-assisted rehabilitation to improve long-term outcomes.

背景：外侧踝关节扭伤（LAS）是一种常见的损伤，可发展为慢性踝关节不稳定（CAI），其特征是反复扭伤、本体感觉缺陷和神经肌肉损伤。目的：本研究评估康复对急性LAS和CAI患者功能结局和肌电图（EMG）参数的影响。研究设计：前瞻性观察队列研究方法：在2022年8月至2023年9月期间，对119例患者（73例急性LAS， 46例CAI）在基线（T0）和三个月康复计划（T1）后进行评估。评估包括活动范围（ROM）、肌肉力量、表面肌电图、平衡测试（Y-Balance、足举、侧跳、6米跳）和FAAM问卷。康复包括个体化方案，包括基于健身房的锻炼和水疗，目标是ROM恢复，本体感觉训练和肌肉强化。结果：LAS患者表现出明显的跖屈ROM基线损伤(49.32 ± 13.37 vs. 61.76 ± 17.67；p = 0.01)和足举试验性能(168 ± 191.28 vs. 18.52 ± 58.38； = 0.01页)。康复后，两组的ROM、力量和功能评分均有改善。CAI患者获得了更大的本体感觉（Y-Balance, Side Hop），而LAS患者在跖屈曲强度方面表现出更好的恢复。然而，肌电图分析显示两组患者均存在持续的神经肌肉缺陷。结论：尽管临床有所改善，但持续的肌电图缺损，特别是CAI，表明神经肌肉恢复不完全。这些发现强调了标准康复方案的局限性，并强调了个性化神经肌肉干预和客观回归运动标准的必要性。未来的研究应致力于完善诊断工具，规范治疗方案，并结合技术辅助康复来改善长期疗效。

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引用次数: 0

The efficacy of microfracture combined with extracorporeal shock wave therapy and hyaluronic acid injections for treating osteochondral lesion of the talus and its impact on early rehabilitation: A retrospective case study 微骨折联合体外冲击波治疗和透明质酸注射治疗距骨软骨病变的疗效及对早期康复的影响：回顾性病例研究。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.05.020

Jia Zheng MMed , Changgui Zhang MMed , Liu Yang MD , Xin Chen MA , Xiaojun Duan MD

Arthroscopic microfracture is a conventional technique for treating osteochondral lesions of the talus (OLT) that are less than 1.5 cm² in area. Since the defects are filled with fibrocartilage after repair, some patients experience local pain postoperatively, subsequently affecting early rehabilitation. This study evaluates efficacy of combining microfracture with extracorporeal shock wave therapy (ESWT) and intra-articular hyaluronic acid (HA) injections for treating OLT and its impact on early rehabilitation. Patients were divided into Group A with patients experiencing walking pain at full weight-bearing 4-6 weeks after surgery, Group B with those experiencing pain 6-8 weeks after surgery. ESWT targeted the cartilage injury area and other pressure pain points, delivered weekly for five sessions. After each session, a 2.0-2.5 mL intra-articular injection of HA was administered to the ankle joint. Assessments were made before ESWT began, six weeks after the final treatment, and at the final follow-up. The primary outcome was the Visual Analogue Scale (VAS) pain score, and the secondary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Forty-two patients were included, with a pre-treatment VAS score of 7.16 ± 1.54 decreasing to 2.11 ± 1.09 at the final follow-up, and the AOFAS score increasing from 67.78 ± 13.87 to 93.54 ± 4.10, showing significant differences (p < 0.05). Group A and B showed no significant differences in VAS and AOFAS scores across each time points (p > 0.05). ESWT synergizes with HA injections to significantly reduce post-microfracture weight-bearing pain and promote early joint function recovery.

关节镜下微骨折是治疗距骨软骨病变（OLT）面积小于1.5 cm²的常规技术。由于修复后缺损被纤维软骨填充，部分患者术后出现局部疼痛，影响早期康复。本研究评估微骨折联合体外冲击波治疗（ESWT）和关节内透明质酸（HA）注射治疗OLT的疗效及其对早期康复的影响。将术后4-6周出现完全负重行走疼痛的患者分为A组，术后6-8周出现疼痛的患者分为B组。ESWT针对软骨损伤区域和其他压力痛点，每周进行五次。每次疗程结束后，踝关节关节内注射2.0-2.5 mL HA。评估分别在ESWT开始前、最终治疗后6周和最终随访时进行。主要观察指标为视觉模拟评分（VAS）疼痛评分，次要观察指标为美国骨科足踝协会（AOFAS）踝关节-后足评分。纳入42例患者，治疗前VAS评分为7.16±1.54，最终随访时VAS评分为2.11±1.09，AOFAS评分由67.78±13.87上升至93.54±4.10，差异均有统计学意义（p < 0.05）。A、B组VAS、AOFAS评分各时间点差异无统计学意义（p < 0.05）。ESWT与HA注射协同作用，显著减轻微骨折后负重疼痛，促进早期关节功能恢复。临床证据等级：4级。

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引用次数: 0

Risk of revision and other complications in total ankle arthroplasty do not differ by surgeon specialty: Analysis of the PearlDiver healthcare claims database from 2010 to 2023 全踝关节置换术翻修和其他并发症的风险不因外科医生专业而异：2010年至2023年PearlDiver医疗索赔数据库分析

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.003

Adam E. Fleischer DPM, MPH, FACFAS , Rachel H. Albright DPM, MPH, FACFAS , Khushiben Patel BS , Hector Santiago DPM , Jonathan Hook DPM, MHA, FACFAS , Dyane Tower DPM, MPH, MS, FACFAS , Lowell Weil Jr. DPM, MBA, FACFAS

Background

Total ankle arthroplasty (TAA) utilization has significantly increased in the US in recent years, and current studies examining surgeon specialty and TAA outcomes are limited.

Purpose

To explore the effect of surgeon specialty on long-term TAA survivorship and short-term postoperative complications

Study Design

Retrospective cohort study and time-to-event analysis

Methods

Using a large, national claims database (PearlDiver, Inc.) with more than 170 million patient files we examined the association of surgeon specialty (podiatric surgeon vs. other) on adverse patient outcomes from January 2010 to April 2023. Relevant covariates were adjusted for using multivariable Cox and logistic regression models.

Results

There were 16,485 people who underwent TAA for a cumulative rate of 9.7 per 100,000. Surgeon specialty was known for 13,514 TAA surgeries. There were 714 revisions corresponding to a revision rate of 0.053 (714/13,514) over the 13-year study period. Patients who underwent TAA by podiatric surgeons were no more likely to experience revision surgery than those undergoing TAA by other surgeon specialties (adjusted hazards ratio [HR] 0.84, 95 % CI 0.46 to 1.53, p = 0.57). Furthermore, the risk of readmission (adjusted odds ratio [OR] 1.0, 95 % CI 0.77 to 1.30), infection (adjusted OR 0.91, 95 % CI 0.77 to 1.07), and venous thromboembolism (adjusted OR 0.83, 95 % CI 0.61 to 1.09) within the first 90 days postoperatively did not differ among surgeon specialty.

Conclusion

This information may be of interest to third party payers, health administrators, and healthcare consumers.

背景：近年来，全踝关节置换术（TAA）的使用率在美国显著增加，目前关于外科医生专业和TAA结果的研究有限。目的：探讨外科专科对TAA远期生存率及术后短期并发症的影响。研究设计：回顾性队列研究和事件时间分析方法：使用一个拥有超过1.7亿患者档案的大型国家索赔数据库（PearlDiver, Inc.），我们检查了2010年1月至2023年4月外科医生专业（足部外科医生与其他外科医生）对不良患者结局的关联。采用多变量Cox和logistic回归模型对相关协变量进行校正。结果：16485人接受了TAA，累积率为9.7 / 10万。外科专业以13,514例TAA手术而闻名。在13年的研究期间，有714次修订，对应的修订率为0.053（714/13,514）。由足部外科医生进行TAA的患者与由其他专科外科医生进行TAA的患者相比，不太可能进行翻修手术（校正风险比[HR] 0.84, 95% CI 0.46 ~ 1.53, p = 0.57）。此外，术后90天内再入院（校正优势比[OR] 1.0, 95% CI 0.77 ~ 1.30）、感染（校正优势比[OR] 0.91, 95% CI 0.77 ~ 1.07）和静脉血栓栓塞（校正优势比[OR] 0.83, 95% CI 0.61 ~ 1.09）的风险在外科医生专业类型之间没有差异。结论：这些信息可能会引起第三方支付者、医疗管理人员和医疗保健消费者的兴趣。临床证据水平：3；

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引用次数: 0

Results of ingrown toenails treated with modified Winograd technique using lateral edge inversion modification 改良Winograd技术治疗向内生趾甲的效果，采用侧缘反转改良：“侧缘反转技术治疗向内生趾甲”。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.07.011

Mehmet EKİCİ

Background

Ingrown toenail is a common condition, especially among young individuals, characterized by pain, swelling, redness, and infection. Surgical intervention is often required in stage II and III cases, with the Modified Winograd (MW) technique being the most widely used. Nevertheless, recurrence and infection remain notable concerns.

Purpose

To assess whether lateral edge inversion modification added to the MW technique reduces recurrence rates.

Study Design

Retrospective comparative observational study.

Methods

A total of 341 patients treated between January and November 2023 were analyzed. Group 1 (n = 96) underwent MW with lateral edge inversion, while Group 2 (n = 245) underwent MW alone. Demographics, surgical time, infection rates, recurrence, and recovery were compared.

Results

The mean age was 25.2 years, with 223 males and 118 females. Surgical time was comparable between groups. Early infection occurred in 4.16 % of Group 1 and 6.53 % of Group 2 (p > 0.05). Recurrence was observed in 10 patients in Group 2 but none in Group 1 (p < 0.05), indicating a significant reduction with lateral edge inversion.

Conclusion

Lateral edge inversion modification is a simple and effective addition to the MW technique, significantly reducing recurrence rates in the treatment of ingrown toenails.

背景：趾甲内生是一种常见的疾病，尤其是在年轻人中，其特征是疼痛、肿胀、发红和感染。II期和III期病例通常需要手术干预，其中最广泛使用的是改良的Winograd （MW）技术。然而，复发和感染仍然值得关注。目的：评估在MW技术中加入侧缘反转改良是否能降低复发率。研究设计：回顾性比较观察性研究。方法：对2023年1 - 11月收治的341例患者进行分析。组1 （n=96）行MW +侧缘反演，组2 （n=245）行单纯MW。比较人口统计学、手术时间、感染率、复发率和恢复率。结果：平均年龄25.2岁，男性223例，女性118例。手术时间组间比较。1组早期感染发生率为4.16%，2组为6.53% （p < 0.05）。2组10例复发，1组无复发(p)结论：侧缘内翻改良术是MW技术的一种简单有效的补充，可显著降低内生趾甲的复发率。证据水平：III。

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引用次数: 0

A magnetic resonance imaging safe distance beyond the flexor hallucis longus tendon and the application of the safe arthroscopic approach to prevent neurovascular injury in posterior ankle arthroscopy 磁共振成像幻觉长屈肌腱安全距离及安全关节镜入路预防后踝关节镜神经血管损伤的应用。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-01-01 DOI: 10.1053/j.jfas.2025.09.006

Penpun Lertwattanachai MD , Thos Harnroongroj MD MSc , Bavornrit Chuckpaiwong MD , Theerawoot Tharmviboonsri MD , Nuntich Singsumpun MD , Ishthayapong Kanjanakeereewong MD

Background

The flexor hallucis longus (FHL) tendon is used as a medial landmark for posterior ankle arthroscopy. However, some posterior ankle pathologies require working medial to the FHL. The safe distance beyond the FHL to the neurovascular bundle has never been established.

Purpose

To report the safe distances beyond the FHL and neurovascular bundle and the incidence of neurovascular injury after using “safe arthroscopic approach”.

Methods

The 63 MRIs with posterior ankle pathologies were included. Measurements were the FHL-tibial nerve (TN) and FHL-posterior tibial artery (PTA) distances at the level of fibular tip, 1.2 cm above and 1.2 cm below. Twenty FHL tenosynovitis patients underwent arthroscopic debridement utilizing a safe arthroscopic approach developed by the authors based on the MRI findings. The incidence of neurovascular injury and clinical outcomes were assessed.

Results

The closest mean (standard deviation, SD) distances of FHL-TN and FHL-PTA were 2.14 (0.81) mm and 5.23 (2.11) mm. The incidence of neurovascular injury after using “safe arthroscopic approach” was 1/20. The NRS for pain during activity daily living (ADL) and FAAM for ADL were statistically improved at 6-month follow-up from 6.36 (1.50) to 1.14 (1.29) and 72.4 (5.78) to 89.4 (7.96), p<0.001.

Conclusion

This study demonstrated close margins between the FHL and the TN and PTA of 2.14 mm and 5.23 mm. The “safe arthroscopic approach” for arthroscopic FHL debridement had a TN injury incidence of 1/20 which was equivalent to previous reported incidences of the arthroscopic surgery which did not go beyond FHL.

背景：拇长屈肌（FHL）肌腱被用作后踝关节镜的内侧标志。然而，一些踝关节后病变需要在FHL内侧工作。从FHL到神经血管束的安全距离从未确定过。目的：报道“安全关节镜入路”手术后FHL及神经血管束外的安全距离及神经血管损伤的发生率。方法：对63例有后踝病变的mri进行分析。测量fhl -胫骨神经（TN）和fhl -胫骨后动脉（PTA）在腓骨尖端水平的距离，上面1.2 cm和下面1.2 cm。20例FHL腱鞘炎患者接受关节镜清创，采用作者基于MRI发现开发的安全关节镜方法。评估神经血管损伤的发生率和临床结果。结果：FHL-TN和FHL-PTA最接近的平均（标准差，SD）距离分别为2.14 (0.81)mm和5.23 (2.11)mm，经“安全关节镜入路”后神经血管损伤发生率为1/20。在6个月的随访中，活动日常生活疼痛（ADL）的NRS和FAAM从6.36（1.50）提高到1.14(1.29)，从72.4（5.78）提高到89.4(7.96)，具有统计学意义。结论：本研究显示FHL与TN和PTA的差值分别为2.14 mm和5.23 mm。关节镜下FHL清创的“安全关节镜入路”的TN损伤发生率为1/20，与先前报道的未超出FHL的关节镜手术的发生率相当。

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引用次数: 0