Journal of Foot & Ankle Surgery最新文献

Background: Hallux valgus is associated with pain, functional limitation and reduced life quality. Percutaneous surgical techniques with multimodal analgesia have emerged as alternatives to conventional approaches. Some studies suggest that percutaneous techniques result in less pain than open surgery.

Purpose: To compare rescue analgesic use and postoperative pain between the Scarf and META techniques in patients undergoing hallux valgus surgery.

Methods: A prospective cohort comprising two matched groups of patients who underwent hallux valgus surgery with either the Scarf or META technique was conducted. The same anesthetic and analgesic protocol was used in both groups. Pain was assessed using the Visual Analog Scale (VAS). Surveys were administered daily from postoperative day 1 to 7 and weekly from the second to the sixth week. Rescue analgesia (opioids) was also recorded.

Results: 53 patients were enrolled: 28 in the META and 25 in the Scarf osteotomy group; demographic data were similar between groups. On postoperative day 1, VAS pain was 0.5 (0-2) in the META group and 2 (0-5) in the Scarf group. On day 2, it was 1 (0-2) and 7.1,^3-10 respectively. By week 6, pain were similar in both groups. Opioid use was higher in the open group. Differences in pain and analgesic use were statistically significant (p < 0.05).

Conclusion: The percutaneous group required lower doses of analgesia and reported less pain than the open technique, particularly during the first two postoperative weeks.

Background: Ruptures of the Achilles tendon are common, functionally debilitating injuries that can be managed nonoperatively or surgically. Preoperative depression has been associated with worse outcomes in orthopedic procedures, but its impact on surgical decision-making and recovery after Achilles repair is unclear.

Purpose: This study evaluates the impact of preoperative depression on operative treatment rates and postoperative outcomes following Achilles tendon repair.

Methods: TriNetX database identified adults with Achilles tendon rupture (2005-2024). Patients were stratified by preoperative depression, with a secondary analysis comparing antidepressant users and non-users among depressed patients. Propensity score matching (1:1) was performed using demographic and clinical variables. Outcomes included 90-day postoperative complications and one-year outcomes. Relative risks (RRs) and P-values were calculated.

Results: Among patients with Achilles tendon rupture, those with preoperative depression were less likely to undergo operative repair than those without depression (6.30% vs 7.40%; 1067 vs 1144; P = 0.0008). Patients with depression experienced higher 90-day rates of infection (4.54% vs 2.31%, P = 0.0015), acute postoperative pain (6.80% vs 3.60%, P < 0.001), and physical therapy evaluation (32.0% vs 27.8%, P = 0.0183). At one year, persistent ankle pain was more frequent in the depression cohort (29.19% vs 23.53%, P = 0.0009). Among patients with depression, antidepressant use was associated with a higher likelihood of undergoing surgery (7.10% vs 5.90%; 359 vs 296; P = 0.0110) and higher rates of acute postoperative pain (8.70% vs 4.90%, P = 0.027).

Conclusion: Preoperative depression was associated with altered surgical decision-making and worse postoperative outcomes following Achilles tendon repair. Although patients with depression were less likely to undergo surgery, those treated operatively experienced greater postoperative pain and poorer recovery. Antidepressant use increased the likelihood of surgery but did not mitigate postoperative risk. These findings highlight the importance of preoperative mental health assessment and targeted perioperative strategies.

Background: Chronic lateral ankle instability (CLAI) is frequently associated with intra-articular pathology.

Purpose of the study: The study compared functional outcomes of lateral ligament reconstruction in patients with isolated CLAI versus CLAI with concomitant talar OCD.

Study design: We conducted a retrospective review of patients who underwent lateral ligament reconstruction between January 2018 and December 2023.

Methods: Preoperative MRI was used to confirm CLAI and identify talar OCD. Patients were classified into two groups: Group A - isolated CLAI, and Group B - CLAI with talar OCD (<1 cm²). Functional outcomes were measured using the Manchester-Oxford Foot Questionnaire (MOxFQ), EQ-5D, and EQ-VAS.

Results: Seventy patients met the inclusion criteria: 39 in Group A (55.7%) and 31 in Group B (44.3%). Mean follow-up was 54.2 months (range 36.8-66.4). Group A: MOxFQ improved from 61.8 ± 20.4 to 22.5 ± 12.2; EQ-5D from 18.3 ± 7.7 to 4.4 ± 2.7; EQ-VAS from 54.6 ± 11.9 to 68.3 ± 19.8.

Group b: MOxFQ improved from 44.4 ± 10.0 to 18.0 ± 7.8; EQ-5D from 15.1 ± 2.5 to 8.5 ± 1.3; EQ-VAS from 46.7 ± 17.8 to 72.8 ± 29.3. There was no statistically significant difference in functional outcomes between the two groups (p = 0.145).

Conclusion: Lateral ligament reconstruction with suture tape augmentation in patients with chronic lateral ankle instability, with or without concomitant talar osteochondral defects, demonstrated no significant differences in functional outcomes between groups, suggesting that smaller osteochondral lesions less than 1cm² in size may not require surgical repair.

Background: Fourth-generation operative techniques for hallux valgus correction utilize a transverse extracapsular osteotomy to maximize correction while minimizing stiffness and risk of intra-articular debris. Previous studies have not provided anatomically based methods of ensuring an extracapsular osteotomy.

Purpose: This study aimed to provide a practical, anatomically based reference for surgeons to utilize to perform an extracapsular metatarsal osteotomy while validating previous reports of capsular insertion anatomy.

Study design: Cadaveric study METHODS: Twenty-one cadaveric specimens (13 female, 8 male) from 13 cadavers were dissected and used for this study. Mean age of specimens was 78.1 years. Capsular origin at the hallux metatarsophalangeal joint was measured from the central point of the metatarsal head in the dorsal, medial, lateral, plantar-medial, and plantar-lateral aspects. Ratios of capsular length to total metatarsal length in the dorsal and plantar dimensions were calculated to generate a length-independent reference unaffected by parallax or fluoroscopic magnification.

Results: The mean distances from the central hallux metatarsal head to the metatarsophalangeal joint proximal capsular origin were 14.1 mm dorsal, 7.7 mm lateral, 6.3 mm medial, 16.8 mm plantar-medial, and 17.5 mm plantar-lateral. The mean total length of the metatarsal was 64.2 mm dorsally and 67.1 mm plantarly. The dorsal capsular ratio was 0.22, plantar-medial capsular ratio was 0.25, and plantar-lateral capsular ratio was 0.26.

Conclusion: The metatarsophalangeal joint-metatarsal ratio provides an anatomically based reference to identify the proximal capsular insertion independent of individual metatarsal size, fluoroscopic magnification, or parallax. This study validates previous descriptions of capsular insertion variation.

Background: Recalcitrant plantar fasciitis persisting after conservative care and extracorporeal shock wave therapy (ESWT) remains a therapeutic challenge.

Purpose: Our aim was to evaluate the clinical efficacy and procedural tolerability of tibial nerve block (TNB) compared to local corticosteroid injection (CSI).

Study design: This is a prospective, single-blind randomized controlled trial.

Methods: In this study 69 adults with ESWT-refractory plantar fasciitis were randomized (1:1:1) to conservative care (control), ultrasound-guided CSI (intrafascially) or ultrasound-guided TNB (perineurally). Pain (VAS), plantar fascia thickness (PFT), Heel Tenderness Index (HTI) were assessed at baseline, 1 week, 1 month, and 3 months; and SF-12 and IPAQ-SF at baseline and 3 months. Injection-related pain (VAS-injection) was recorded during procedures.

Results: No significant VAS change occurred in controls. Both CSI and TNB produced significant VAS and HTI improvements at all follow-ups versus baseline (p < 0.001), attenuating by 3 months. Between-group differences in pain reduction were not significant. PFT decreased only after CSI at 1 week (p = 0.002) and 1 month (p = 0.015), with loss of effect at 3 months. Injection pain was significantly lower with TNB than CSI (p < 0.001). SF-12 improved at 3 months; IPAQ-SF did not.

Conclusion: Ultrasound-guided TNB provides clinically meaningful short-term analgesia comparable to CSI while avoiding intrafascial injection and reducing procedural pain; importantly, it may also serve as a valuable treatment option for patients in whom corticosteroid use is contraindicated.

Background: Fourth-generation minimally invasive bunion surgery (MIBS) has gained popularity given its minimal soft tissue disruption, small incisions, and potential for expedited recovery. Although early outcomes have been encouraging, limited data exists regarding complication rates during the initial learning curve phase of this most recent technique evolution.

Purpose: To evaluate postoperative complications associated with early adoption of fourth-generation MIBS.

Study design: Retrospective review.

Methods: 72 fourth-generation MIBS procedures (67 patients) performed by three surgeons during their initial experience with the operative technique were reviewed. Patient demographics, radiographic measurements, and postoperative complications were collected and analyzed.

Results: 53 (88.9 %) procedures were completed without notable postoperative complications. Hardware failure occurred in 6 (8.3 %) procedures. Reoperation, surgical site dehiscence, and postoperative infection each occurred in 5 (6.9 %) procedures. Deformity recurrence, postoperative first metatarsal fracture, and first metatarsophalangeal joint stiffness each occurred in 2 (2.8 %) procedures. Symptomatic nonunion, sesamoiditis, and intraoperative metatarsal fracture each occurred in 1 (1.4 %) procedure. No instances of paresthesia, avascular necrosis, or hallux varus were observed.

Conclusion: These findings offer important insights into the outcomes of fourth-generation MIBS during initial procedure implementation. Postoperative complication rates during early adoption of fourth-generation MIBS appear acceptable and comparable to those reported for other bunion correction techniques. Understanding the complication profile during this phase can help guide technique refinement, enhance patient selection, and promote successful outcomes in hallux valgus correction.

Background: Potential advantages of bio-integrative implants, such as lower removal rates, and superior bone interaction, have been advocated. While many biomechanical and histological reports sustain its structural and biological properties, few clinical studies have supported its use. This trial aimed to determine the bio-integrative screws' capacity to achieve non-inferior clinical outcomes as metallic screws in calcaneal osteotomies. Our main hypothesis was that both implants would not differ in healing or complications.

Methods: This was a single-center, parallel-group, randomized non-inferiority clinical trial (NCT05018130) with patients undergoing a calcaneal osteotomy from September 2021 to March 2023. Patients were randomized in a 1:1 ratio to the metallic or bio-integrative groups, and allocation was performed after anaesthesia. Surgeries were performed with the same technique and two canulated 4 mm screws, either titanium or ossiofiber. The primary outcome was determined by bone healing at 6 weeks. Secondary outcomes included minor and major complications, patient-reported-outcomes (PROs) and healing at the 12th, 24th, 48th and 96th weeks of follow-up.

Results: After 29 patients were evaluated, 24 feet were included in the study. Groups were similar demographically (ps>0.111), with 12 allocated to the bio-integrative and 12 to the metallic groups. Follow-up was 2 years, with no losses to endpoints. Considering bone healing at 6 weeks, the bio (83.3%) and the metallic (66.7%) groups had similar rates (p = 0.640), which was maintained at 12 weeks (100% vs. 91.7%; p = 1) and 96 weeks (100% vs. 100%; p = 1). Minor complications (16.7% vs. 16.7%; p = 1) and PROs (ps>0.059) were equivalent. No major complications or secondary surgeries were observed.

Conclusion: Bio-integrative screws have shown non-inferior results to metallic screws in calcaneal osteotomies regarding bone healing and complications. This non-inferiority clinical trial adds to the literature on the use of bio-integrative implants. Larger and longer trials are needed to determine whether any implant is superior and to assess its global effect on surgical care.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are becoming increasingly popular for managing type 2 diabetes and obesity. Beyond their metabolic effects, they have shown anti-inflammatory properties, which may impact post-surgical recovery. However, their role in orthopedic procedures is not yet well defined. This study investigates whether GLP-1 RA use affects post-operative complications, including wound infection, venous thromboembolism, hospital readmission, and reintervention for Achilles tendon repair patients.

Methods: A retrospective cohort study was conducted on 337 patients who underwent Achilles tendon repair. Among them, 11.6% were GLP-1 RA users. Post-operative complications, including wound infection, Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE), readmission, and reintervention, were analyzed. Logistic regression models and correlation analysis were used to estimate odds ratios (OR) for complications while controlling for potential confounders. Variance inflation factor (VIF) analysis was conducted to evaluate collinearity between independent variables.

Results: GLP-1 RA users had a lower risk of wound infection compared to non-users (OR: 0.19, 95% CI: 0.04-0.88, p = 0.03). Additionally, GLP-1 RA users had lower rates of Venous Thromboembolism (VTE) (2.6% vs. 6.4%, p = 0.5), readmission (2.6% vs. 7.7%, p = 0.12), and reintervention (0.0% vs. 6.7%, p = 1.00); however, these differences were not statistically significant. Diabetes showed the strongest positive correlation with wound infection (r = 0.29, p < 0.01).

Conclusion: This study suggests that GLP-1 RA use is associated with a lower risk of wound infection following Achilles tendon repair. These findings suggest a potential protective role of GLP-1 RAs in surgical outcomes.

Background: Although many diabetic foot ulcers can be managed with limb-salvage strategies, a subset of patients ultimately progress to major lower-extremity amputation, including below-knee amputation (BKA), particularly when limb salvage is no longer feasible. While BKA is performed as a source-control procedure aimed at limiting proximal spread of infection, postoperative mortality following BKA remains high.

Purpose: The purpose of this study was to evaluate patients with diabetes undergoing primary below-knee amputation (BKA) and to identify preoperative demographic, clinical, and laboratory factors associated with short- and intermediate-term all-cause mortality following the procedure.

Study design: Retrospective cohort study evaluating mortality outcomes after primary below-knee amputation in patients with diabetes.

Methods: A retrospective cohort study was conducted including patients who underwent primary below-knee amputation for diabetes-related complications. Mortality was evaluated at predefined postoperative time points (30, 90, 180, 365 days and overall mortality). Multivariate logistic regression was performed to identify independent predictors of mortality.

Results: A total of 1,487 patients were analyzed (68.8% male; mean age 67.9 ± 12.4 years). Overall, 1,096 patients died during follow-up. Non-survivors were older at all time points and had higher Charlson Comorbidity Index scores and lower serum albumin levels compared to survivors. Multivariate analysis for overall mortality identified five independent predictors of increased mortality: CKD (OR 2.20, 95% CI 1.289-3.760, p = 0.004), albumin <2.95 g/dL (OR 2.85, 95% CI 1.843-4.409, p < 0.001), WBC >13.805 × 10⁹/L (OR 1.63, 95% CI 1.059-2.500, p = 0.026), Charlson Comorbidity Index >5.5 (OR 2.61, 95% CI 1.672-4.067, p < 0.001), and postoperative oral rather than IV antibiotic therapy (OR 1.95, 95% CI 1.102-3.456, p = 0.022).

Conclusions: This study demonstrates that preoperative comorbidities and laboratory markers-including CKD, hypoalbuminemia, elevated WBC count, and higher comorbidity burden-are strongly associated with increased mortality after BKA in diabetic patients. These findings underscore the importance of comprehensive preoperative assessment and targeted perioperative strategies to improve outcomes in this high-risk population.

Background: First metatarsophalangeal joint arthrodesis is a well-established procedure for symptomatic relief of a painful, arthritic hallux abductovalgus deformity with substantial correction of the first intermetatarsal angle. Several recent studies have reported comparable union rates between open and minimally invasive techniques for first metatarsophalangeal joint arthrodesis, with hallux rigidus being the main indication.

Purpose: There is sparse literature on the impact of a minimally invasive approach to first metatarsophalangeal joint arthrodesis on intermetatarsal angle in the setting of hallux abductovalgus.

Study design: A retrospective review was performed at our institution between January 2023 and August 2025.

Results: A total of 20 patients undergoing either a percutaneous first metatarsophalangeal joint arthrodesis (n = 10) or an open approach (n = 10) were included for analysis. All patients had hallux abductovalgus deformity with a preoperative intermetatarsal angle greater than 11°. In the open group, the average preoperative intermetatarsal angle was 13.41° compared to 13.47° degrees for the percutaneous group. Our results demonstrated average postoperative intermetatarsal angles of 9.62° and 8.60° for open and percutaneous approaches, respectively, with no statistically significant difference between the two.

Conclusion: While previous literature reports high clinical fusion with good functional outcomes and low morbidity for percutaneous first metatarsophalangeal joint arthrodesis, this study specifically focuses on the intermetatarsal angle correction obtained for hallux abductovalgus through this approach. Our findings demonstrate that percutaneous first metatarsophalangeal joint arthrodesis can provide a similar correction of the intermetatarsal angle in moderate to severe hallux abductovalgus deformity comparable to traditional, open procedures.