Journal of Foot & Ankle Surgery最新文献

Background: Intraoperative patient positioning for trimalleolar ankle fracture fixation may affect surgical exposure, reduction quality, operative time, and complication rates.

Purpose: To compare the clinical, radiographic, and functional outcomes of trimalleolar ankle fracture fixation performed in the lateral-to-supine, prone-to-supine, and prone positions.

Methods: Eighty-six patients who underwent open reduction and internal fixation for trimalleolar ankle fractures between 2018 and 2023 were retrospectively reviewed, with a minimum follow-up of 12 months. Patients were categorized according to intraoperative positioning: lateral-to-supine (n = 23), prone-to-supine (n = 28), and prone (n = 35). All procedures were performed by a single experienced orthopedic trauma surgeon using the same fixation system and standardized postoperative protocol. Demographic and perioperative variables, including age, sex, body mass index, smoking status, time to surgery, tourniquet and operative times, and number of fluoroscopic images, were recorded. Radiographic assessments included fibular shortening, medial and posterior step-off, medial clear space, and talar tilt. Complications such as infection, wound problems, implant irritation retained intraosseous hardware, sensory nerve injury, intra-articular screw penetration, nonunion, and reoperation were evaluated. Functional outcomes were assessed using the visual analog scale (VAS) for pain, ankle range of motion, and the American Orthopaedic Foot & Ankle Society (AOFAS) score.

Results: Baseline characteristics, including age, BMI, smoking status, and injury laterality, were comparable among groups (all p > 0.05). The prone group required more fluoroscopy (p < 0.001), while the prone-to-supine group had the longest operative time (p < 0.001) and highest infection rate (p = 0.03). The prone group showed greater medial malleolar step-off ≥2 mm and screw joint penetration, resulting in higher revision rates (p = 0.03, 0.04). Postoperative pain scores were lowest in the lateral-to-supine group (p = 0.03).

Conclusion: The lateral-to-supine position provides safe, efficient, and reproducible access for trimalleolar ankle fracture fixation, with fewer complications, lower pain, and better radiographic alignment than prone and prone-to-supine positioning.

Background: Progressive collapsing foot deformity (PCFD) grade I AB can cause progressive structural changes and functional limitations. Surgical intervention is indicated when deformity progression or symptoms significantly impair daily activities.

Purpose: To compare the effectiveness of lateral column lengthening (LCL) and subtalar arthroereisis (STA) in the surgical treatment of early-stage PCFD.

Study design: Retrospective comparative study.

Methods: Fifty-six patients with grade I AB PCFD were reviewed retrospectively; 16 underwent STA and 40 underwent LCL combined with medializing calcaneal osteotomy and medial soft tissue procedures. All radiographic measurements were performed by a single surgeon not involved in the surgeries. Primary outcomes were changes in angular parameters and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Mean follow-up was 28.6 months (range, 18-72 months).

Results: Preoperative functional scores averaged 47.15 points, improving to 98.3 points postoperatively. Both techniques achieved statistically significant improvements in most angular parameters and functional scores. The Costa-Bartani angle did not significantly change in the STA group. No statistically significant differences were observed between groups in postoperative angular correction or functional scores. Patients aged 42-65 years showed greater improvements in the lateral talocalcaneal angle compared to other age groups, suggesting a possible age-related influence on certain radiographic outcomes.

Conclusion: Both LCL and STA are effective surgical options for the management of early-stage PCFD, producing significant radiographic and functional improvements. Age may influence specific radiographic parameters, warranting further investigation.

Background: Displaced intra-articular calcaneal fractures (DIACFs) are challenging injuries. The sinus tarsi approach (STA) offers comparable reduction quality to the extensile lateral approach with lower complication rates. The optimal fixation method following STA remains debated.

Purpose: This study aimed to compare radiological and functional outcomes of a modified screw fixation(MSF) versus screw plus mini-plate fixation (PF) in DIACFs.

Study design: Retrospective Comparative Study, Level 3 Evidence.

Methods: This retrospective study included 40 patients(42 fractures) treated via STA between September 2018 and May 2024.Patients aged ≥16 years with Sanders type II-III fractures, ≥12 months of follow-up, treated via sinus tarsi approach and complete radiographs/CT scans were included; open injuries, subtalar dislocation, prior foot/ankle surgery were excluded.Group A(MSF, n=22) underwent screw-only fixation and Group B(PF, n=20) received a lateral mini-plate plus percutaneous screws. Radiological assessment included Böhler and Gissane angles, calcaneal height, length, width, and posterior facet step-off. Functional outcomes were evaluated using the Visual Analog Scale (VAS), AOFAS Hindfoot Score, EFAS Score, and Olerud-Molander Score(OM).

Results: Both groups showed significant postoperative improvement in radiological parameters(p<0.01), with no intergroup differences. Group A demonstrated superior clinical results with lower VAS(2.00±1.66 vs. 3.45±1.76, p=0.011), higher EFAS(17.82±5.06 vs. 14.40±5.75, p=0.038), and higher OM scores(79.09±16.81 vs. 59.50±20.06, p=0.001). AOFAS scores favored Group A without statistical significance(p=0.066). Implant removal was less frequent in Group A(13.6% vs. 30.0%) without statistical significance(p=0.269).

Conclusion: The MSF technique, performed via STA yields superior functional outcomes, lower pain scores, and reduced complication rates compared to PF in the surgical treatment of DIACF.

Objective: To compare the clinical efficacy and complication profiles of internal fixation for intra-articular calcaneal fractures via two surgical approaches: the minimally invasive tarsal sinus approach and the extended lateral approach.

Methods: A retrospective analysis was conducted on 87 single-center patients with calcaneal fractures treated from January 2018 to December 2022. Patients were divided into two groups by surgical approach: 44 cases in the minimally invasive group and 43 in the extended lateral group. Preoperative waiting time, preoperative and 3-month postoperative calcaneal parameters (Böhler angle, Gissane angle, width, height), 12-month postoperative AOFAS ankle-hindfoot score, and early complications (incision infection, flap edge necrosis, etc.) were compared.

Results: The minimally invasive group had significantly shorter preoperative waiting time than the extended lateral group (P < 0.05). Both groups showed improved calcaneal parameters at 3 months postoperatively (P < 0.05), but no significant differences existed between groups in these parameters, AOFAS score, or complication rate (P > 0.05).

Conclusion: Both approaches effectively restore calcaneal anatomy, improve function, and have comparable complications. However, the minimally invasive approach shortens preoperative waiting time, reducing the economic burden on patients and society.

Background: First metatarsophalangeal (MTP) joint arthrodesis is commonly performed to treat hallux rigidus. Traditional stainless steel or titanium constructs (e.g., locking plates with screws) provide sufficient stiffness but are prone to permanent deformation after excessive pre-fusion loading, leading to plantar gapping and malalignment. Superelastic NiTiNOL staples capable of sustained dynamic compression (SDC) have been developed to address these shortcomings.

Purpose: To compare the biomechanical performance of first MTP arthrodesis constructs using static fixation, SDC staples, or hybrid static/SDC fixation.

Study design: Controlled laboratory study using synthetic MTP joint replicas.

Methods: Solid foam first MTP models (N=6/group) underwent arthrodesis with one of five constructs. Specimens were cyclically loaded for 1,000 cycles at physiologic loads, followed by destructive displacement testing. Bending stiffness, plantar gapping at simulated walking loads, and permanent plantar gapping were quantified. One-way ANOVA comparisons were performed with the locking plate and screw construct as the control.

Results: Bending stiffness and plantar gapping at simulated walking loads were not significantly different across groups (p>.07). However, all SDC constructs demonstrated significantly reduced permanent plantar gapping compared with locking plate and screw (≤0.29 mm vs. 0.85 mm, p<.001). The four-leg Y staple alone or in combination with a static screw provided the highest bending stiffness and greatest reduction in permanent plantar gapping.

Conclusion: Superelastic NiTiNOL SDC staples yield equivalent construct stiffness and markedly reduce permanent plantar gapping compared with static fixation. Hybrid constructs may further enhance biomechanical stability, supporting future clinical evaluation of SDC devices in first MTP arthrodesis.

Objective: The purpose of this study was to evaluate the clinical efficacy of the "Reversed L" osteotomy combined with lateral soft tissue release for moderate to severe hallux valgus.

Methods: A retrospective analysis was performed on the clinical and radiographic data in patients diagnosed with moderate to severe hallux valgus who underwent surgical treatment between January 2023 and January 2025. Patients were categorized into two groups based upon technique: the ReveL group (ReveL group: n=244 feet) and the Scarf group (Scarf group: n=234 feet). Clinical and radiological parameters were compared between two groups pre and post operatively. The clinical and radiological outcomes of the two groups were rigorously studied assessing both diagnostic accuracy and treatment efficacy.

Result: All patients successfully underwent surgery and completed the follow-up. Compared with the Scarf group, the ReveL group exhibited a significantly shorter operation time (70±13 vs. 90±21 minutes, P=0.038). Statistically significant differences were noted in all preoperative and postoperative clinical and imaging parameters within each group (all P<0.001). Postoperatively, statistically significant differences were observed between the two groups in hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and visual analog scale (VAS)(P<0.05). Specifically, the postoperative HVA and DMAA values in the ReveL group were significantly lower than those in the Scarf group (P <0.05), in addition, the postoperative VAS score in the ReveL group was significantly lower than in the Scarf group (P<0.01).

Conclusion: Compared to Scarf osteotomy, ReveL osteotomy demonstrates superior correction of metatarsal rotational deformity and provides more significant improvement in moderate to severe hallux valgus. Therefore, it serves as an effective and reliable surgical option for correcting deformities in this patient population.

Clinical trial number: not applicable.

Background: Foot deformities, particularly pes planovalgus, are common in individuals with cerebral palsy, often requiring surgical interventions such as lateral column lengthening (LCL) to improve foot alignment and function. While LCL is a well-established procedure for treating valgus deformities, the long-term effects on bone morphology, particularly in the talus and calcaneus, have not been thoroughly explored.

Purpose: To evaluate the morphological differences in the talus and calcaneus in individuals with cerebral palsy who have undergone LCL surgery compared to nonsurgical patients and controls.

Study design: Comparative cross-sectional study.

Methods: Thirty individuals were divided into three groups: control, surgical, and nonsurgical. Computed tomography scans were used to generate 3D models of the talus and calcaneus. Statistical shape modeling was employed to analyze and quantify shape variations, utilizing principal component analysis and Hotelling's T-squared test to identify significant morphological differences between groups.

Results: LCL surgery resulted in significant morphological differences in the talus, including a more anterior tibiotalar joint and wider talonavicular articulating surface compared to nonsurgical patients and controls. Significant shape variations in the calcaneus were observed in the surgical group, with a smaller calcaneal tuberosity and altered subtalar facet. Hotelling's T-squared tests confirmed these significant differences between group mean shapes.

Conclusion: LCL surgery results in significant morphological alterations to the talus and calcaneus, suggesting the procedure affects not only the target bone but also neighboring structures. These changes may have long-term implications for foot biomechanics. Future research should investigate functional outcomes and explore longitudinal adaptations in bone shape following surgery.

Background: The anterior talofibular ligament (ATFL) is the most injured component of the lateral ankle ligament complex. While most patients recover with conservative care, those with prolonged instability often require intervention. While many techniques have been described, direct repair of the ATFL is a widely utilized technique with intact native tissue, however in advanced disease the ligament is indirectly repaired using an anchor. Despite the frequent use of suture anchors, there remains a lack of consensus regarding the ideal placement, and potential iatrogenic injury within the distal fibula.

Purpose: Determine the optimized placement of distal fibular soft tissue anchor in lateral ankle stabilization.

Study design: We conducted a cadaveric study using nineteen below-knee fresh-frozen lower extremities. Following careful anatomic dissection, 3.3 mm Medline DEXTACK^TM PUSH suture anchors were inserted into three defined zones along the distal fibula.

Methods: Following anchor placement, the fibula was hemisected to measure distances between the anchors and surrounding at-risk structures as well as anatomic relationship to ligamentous structures and lateral malleolus.

Results: Statistically significant differences between zones were found in relation to the proximity of the anchors to the superficial peroneal nerve, lateral ankle gutter, AITFL, and ATFL origin (p < 0.05). No neurovascular injury was observed in any of the specimens. There were no cases of anchor violation of the posterior fibular cortex.

Conclusion: Zone-strategic placement may help minimize the risk of iatrogenic injury. Our findings reveal the need for meticulous surgical planning and consideration of appropriate anchor placement to optimize patient outcomes. Further clinical studies are recommended to confirm these results and guide future surgical practices.

Background: While social media use in medicine grows, patients increasingly encounter medical content at various stages of treatment; however, little is known about the nature or tone of posts related to bunion procedures.

Purpose: This study aims to characterize the content, authorship, and sentiment of such posts to better understand patient exposure.

Study design: An exhaustive cross-sectional content analysis queried Instagram®, Facebook®, and Reddit® for "bunion surgery," identifying the 100 most recent posts per platform.

Methods: Posts were coded for surgery type, author, topic, media, timing, tone, and sentiment, with multiple-response coding applied when posts contained more than one element. Data were summarized descriptively and compared across platforms.

Results: Significant differences were observed across platforms for surgery type, author, topic, timing, and sentiment (p < 0.001), with no differences in media type (p = 0.27). Instagram® was enriched for minimally invasive surgery, physician authorship, advertisements, and positive sentiment, whereas Reddit® was dominated by patient authorship, pre-operative discussions, inquiries, and negative/mixed sentiment; Facebook® showed intermediate, more balanced patterns. Sentiment score analysis confirmed these findings, with Instagram® and Facebook® trending positive and Reddit® most negative and mixed (p < 0.001).

Conclusions: Surgeons should be aware that patients frequently encounter positive, promotional content on Instagram® and Facebook®, but more critical or apprehensive discussions on Reddit®. In particular, minimally invasive bunion surgery appears disproportionately represented on visual platforms like Instagram®, reflecting both marketing and patient interest. Recognizing these narratives can help guide preoperative counseling, address misconceptions, and proactively shape patient expectations.

Background: An increasing number of patients in the working population are undergoing total ankle replacement (TAR) for end-stage osteoarthritis. While improvements in pain and functional outcomes are the primary goals of this procedure, the timeline for return to work significantly factors into the measure of success for these patients. The aim of this study was to establish the time required before patients return to work after TAR.

Patients and methods: A retrospective review of TARs performed between January 2019 and January 2024 was performed. Patients undergoing primary TAR, less than 65 years old, employed or actively participating in a full-time position, and minimum 6 months of follow-up were included. Exclusion criteria were prior ankle arthrodesis, active Workers' Compensation patients, and those undergoing treatment for psychological disease. The primary outcome measure was time to return to work following TAR. Secondary measures included demographic data, patient reported outcomes, and rates of reoperation and revision.

Results: Fifty-three patients met inclusion and exclusion criteria. The mean time to return to sedentary work was 2.73 weeks (SD = 1.03), and the return to laborious work was 13.15 weeks (SD = 3.51). Five patients retired or reduced their role after TAR (9.4 %). Mean follow-up was 22.9 months (SD = 11.0, median = 25). Significant improvement was noted in patient outcome scores post-operatively. A total of 10 complications occurred with no revision TAR required at this short-term follow-up.

Conclusion: The majority of patients employed before TAR return to work post-operatively. Manual labor workers required an average of over 4 times longer to resume work.