Journal of Foot & Ankle Surgery最新文献

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.

Background: Metatarsophalangeal (MTP) joint instability may cause forefoot sensory disturbances, often misattributed to Morton's neuroma. This study investigated the association between MTP joint instability and sensory disturbances.

Methods: Thirty-three patients were enrolled, including 58 feet in total. All patients underwent surgery for moderate to severe hallux valgus, and in unilateral cases, the contralateral foot was also included when eligible. MTP instability was classified as stable, subluxed, or dislocated using the drawer test under fluoroscopy. Sensory disturbances in the 2nd-4th web spaces were evaluated with the Semmes-Weinstein monofilament test.

Results: Instability was most frequent in the 2nd (69.0%) and 3rd (65.5%) toes. Sensory disturbance rates in the 2nd and 3rd web spaces were significantly higher in feet with instability in both the 2nd and 3rd MTP joints compared to stable feet (P = .02, P = .03), while no significant difference was found for the 4th web space (P = .42).

Conclusions: MTP joint instability may cause sensory disturbances by affecting adjacent plantar digital nerves and should be considered in clinical evaluations.

Background: Total ankle arthroplasty (TAA) and ankle arthrodesis (AAD) are the established surgical options for end-stage ankle arthritis.

Purpose: This study aimed to compare the two procedures and to investigate factors associated with postoperative outcomes, including ankle range of motion (ROM) measured on lateral radiographs. ROM was assessed as the motion of the foot relative to the lower leg and was defined as the apparent ankle ROM (AROM).

Methods: We retrospectively analyzed data from 38 patients who underwent TAA (n=18) or AAD (n=20) between 2015 and 2023. Patients with a minimum of 1-year follow-up were included in this study. Preoperative and postoperative evaluations included the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and AROM. Comparisons between groups were made using non-parametric tests.

Results: Both groups showed significant postoperative improvements in the JSSF scores (p<0.001). The TAA group showed no significant change in AROM (p=0.093), whereas the AAD group showed a significant decrease in AROM (p=0.011). Postoperative AROM differed significantly between the groups. In the TAA group, postoperative JSSF scores correlated with age, and postoperative AROM correlated with preoperative AROM. In the AAD group, postoperative JSSF scores correlated with preoperative JSSF score and postoperative AROM.

Conclusion: Both TAA and AAD yielded favorable outcomes. The JSSF score following TAA was associated with age, whereas outcomes after AAD were more closely linked to the preoperative clinical status and postoperative AROM, highlighting the importance of adjacent joint mobility after surgery. The timing of surgery and rehabilitation strategies are essential for optimizing results.

Background: Surgical site infections are estimated to occur in 1.4 % - 5.5 % of all patients who undergo ankle fracture open reduction with internal fixation.

Purpose: While other studies only report on infection rates after ankle ORIF, this study evaluated the association between infection rates and operative factors.

Study design: We performed a retrospective cohort study of adults at Kaiser Permanente Northern California who underwent ankle fracture ORIF between January 1, 2010 and September 30, 2022.

Methods: Patients were followed up to 6 weeks after initial surgery for return to the operating room, and charts were reviewed for deep SSI. We utilized 6 weeks return to the operating room to identify patients with acute and subacute deep SSI.

Results: Among the 9,749 eligible patients who underwent ankle fracture ORIF, 33 (0.3 %) returned to the operating room within 6 weeks, 3 of whom returned within 2 weeks. The rate of return to operating room was higher in patients with incision time greater than 120 min (OR 5.16, 95 % CI 2.59-10.26; p < 0.001), with tourniquet time of 90-150 minutes (OR 4.30, 95 % CI 1.909.71; p < 0.0001), with immunocompromised status (OR 14.19, 95 % CI 3.3061.12; p < 0.0001), and with hemoglobin A1c greater than 8.0 %(OR 4.12, 95 % CI 1.40-12.12; p = 0.01).

Conclusion: We concluded that decreasing operative time and tourniquet time are important modifiable variables in the prevention of deep SSI in ankle fracture patients. Body mass index, Ioban use, and antibiotic powder use were not associated with the development of deep SSI.

Level of clinical evidence: Level 3: This retrospective cohort study holds a designation based on the analysis of patients who underwent ankle fracture ORIF.

Introduction: There is limited evidence investigating the use of memory staples for first metatarsophalangeal joint (MTPJ) arthrodesis. This study reports the midterm clinical and functional outcomes of patients who underwent the procedure.

Methods: A retrospective review of 78 first MTPJ arthrodeses carried out between 2016 and 2018 in the study centre was performed. Patients were followed up via telephone call to complete the Manchester-Oxford Foot Questionnaire (MOXFQ) and service review questionnaire.

Results: The mean follow-up period was 6.6 ± 0.9 years. The asymptomatic nonunion rate was 2.6 %. The post-operative MOXFQ-index was 12.9 ± 19.5, MOXFQ-pain 12.3 ± 22.6, MOXFQ-walking 16.3 ± 23.8 and MOXFQ-social 9.7 ± 17.3. Eighty-seven percent of patients responded to their toe being better postoperatively. Eighty-four percent of patients were satisfied with the operation. Ninety-five percent of patients felt the operation met their expectations.

Conclusion: This study has shown that first MTPJ arthrodesis with memory staples is associated with low complication rates and good patient-reported outcomes at midterm follow-up.

Background: Sinus tarsi syndrome is a clinical condition characterized by diffuse lateral foot pain, with underlying causes that remain incompletely understood. Radiographic parameters reflecting sagittal foot morphology and load distribution may be related to this condition.

Purpose: To investigate the relationship between sinus tarsi syndrome and radiographic parameters that may influence load distribution and reflect sagittal foot morphology.

Study design: Retrospective comparative study.

Methods: Between 2018 and 2022, 61 patients with chronic nontraumatic lateral foot pain and magnetic resonance imaging findings consistent with sinus tarsi syndrome were evaluated. A control group of 61 patients with similar demographics, no specific foot pathology on examination, and no MRI findings suggestive of sinus tarsi syndrome was selected. On weightbearing lateral radiographs, calcaneal inclination angle, lateral talocalcaneal angle, Böhler's angle, Gissane angle, sinus tarsi length, and sinus tarsi depth were measured. The sinus tarsi steepness index was calculated by dividing depth by length.

Results: Patients with sinus tarsi syndrome showed smaller Gissane and lateral talocalcaneal angles and shorter sinus tarsi length, but greater depth and steepness index compared with controls. In multivariable analysis, sinus tarsi depth, length, and steepness index were independently associated with sinus tarsi syndrome.These findings indicate a steeper sinus tarsi configuration that may underlie the condition's pathomechanics.

Conclusion: A steeper sinus tarsi morphology is associated with sinus tarsi syndrome, likely due to altered ligament tension and increased intra-sinus pressure. Recognizing this morphology may help identify high-risk patients and guide surgical planning when conservative treatment fails.

Background: When performing arthrodesis of the first metatarsophalangeal joint (MTPJ), reported fixation options have been vast with high success rates and a low complication profile. Immediate postoperative weightbearing status typically varies by surgeon irrespective of fixation construct.

Purpose: There has been a paucity of literature regarding the effect postoperative weight bearing status has on the nonunion rate following first MTPJ arthrodesis.

Study design/methods: We performed a systematic review and identified a total of 40 studies and 3,222 feet that underwent first MTPJ arthrodesis with a cohort of patients that were made heel weightbearing as tolerated (HWB), non weightbearing (NWB), and full weightbearing (FWB).

Results: Nonunion rate was found to be lowest in the FWB cohort at 4.34% compared to 8.20% for that of the HWB group, and 9.27% for NWB (p < 0.001). Time to union was found to be fastest in the NWB group at 8.8 weeks, compared to 10.42 weeks for immediate full weight bearing and 12.18 weeks for immediate heel weight bearing (p < 0.001).

Conclusion: While time to union varied, immediate full weightbearing was associated with the lowest nonunion rate, with no adverse effect on fusion success compared to delayed protocols.

Level of clinical evidence: 4-Retrospective.