Journal of Foot & Ankle Surgery最新文献

Objective: This study aims to evaluate the relationship between plantar fascia (PFa) thickness and the morphology and paratenon measurements of the Achilles tendon (AT) in individuals diagnosed with plantar fasciitis (PF) based on magnetic resonance imaging (MRI) findings, and to investigate their role in PF development.

Methods: A total of 108 patients diagnosed with plantar fasciitis who underwent an ankle MRI between 2014 and 2024 were included in the study, along with a control group of 100 healthy individuals of similar age. In both groups, PFa thickness, AT anteroposterior (AP) and mediolateral (ML) diameters, and AT paratenon dimensions (diameters and area) were measured. The presence of retrocalcaneal bursitis and Achilles tendinopathy was also assessed. Measurements were repeated by two observers, and interobserver agreement was evaluated.

Results: PFa thickness and AT, AP and ML diameters were significantly higher in the PF group compared to controls (p < 0.05). Women had significantly greater PFa thickness than men. Retrocalcaneal bursitis and Achilles tendinopathy were also significantly more common in the PF group (p < 0.001). A weak positive correlation was observed between PFa thickness and AT diameters in the control group. Interobserver measurement agreement was high (ICC > 0.8).

Conclusion: Individuals diagnosed with PF showed increased morphometric characteristics of the AT, indicating a possible mechanical linkage between the plantar fascia and Achilles tendon. The findings support the role of the AT and associated structures in the pathophysiology of PF, emphasizing the importance of a comprehensive assessment of these structures in diagnosis and treatment.

Background: The choice between limb salvage with the controversial midfoot amputation or below-knee amputation (BKA) is largely subjective.

Purpose: We seek to compare patient-reported outcome measures (PROMs) and complication rates of the Chopart and Lisfranc midfoot amputations to BKA.

Study design: A single-center retrospective cohort study was performed from October 2017 to September 2023 of adult patients undergoing Lisfranc, Chopart, or BKA. Lisfranc and Chopart amputations were grouped as midfoot amputations and compared to BKA.

Methods: Patient demographics, comorbidities, adverse outcomes, and PROMs were compared. The Lower Extremity Functional Scale (LEFS), PROM Information System Pain Intensity (PROMIS-3a), Self-Reporting Questionnaire-20 (SRQ-20), and Connor-Davidson Resilience Scale (CD-RISC) were collected from ambulatory patients at least 6 months after surgery.

Results: A TOTAL OF 73 PATIENTS WERE INCLUDED: 18 underwent midfoot amputation (6 Lisfranc and 12 Chopart), and 55 BKA. The average age was 62.5 ± 12.0 years with an average Charlson Comorbidity Index of 5.0 [IQR: 4.0] and a median follow-up duration of 40.6 [27.8] months. Midfoot amputees had insignificantly higher rates of postoperative complication (16.7% vs 3.6%, p = 0.092) and significantly higher rates of recurrence requiring revision surgery (44.4% vs 18.2%, p = 0.025). PROMs were similar between groups. Multivariate regression analysis revealed that function was independently associated with peripheral vascular disease (B = -10.1, p = 0.047) and psychological distress (B = -2.4, p = 0.002), but not amputation type (p = 0.978).

Conclusion: With a team-based approach that prioritizes function and patient preference, patient-reported function is impacted by comorbidity and mental health, not by amputation level.

Background: In total ankle replacement (TAR), the tibial component is positioned at 90° to the tibial axis, although distal tibia angles (DTAs) of healthy ankle joints vary. This study investigated DTA changes during TAR and their impact on prosthesis survival.

Methods: In this retrospective case series of 152 consecutive third-generation TARs (142 patients), pre- and postoperative lateral and anterior distal tibia angles (LDTA, ADTA) and changes (ΔLDTA, ΔADTA) were measured. Prosthesis survival (all causes) was compared using Hazard ratios (HRs) between patients with and without alterations of native DTAs. Secondly, associations between postoperative alignment and revision, as well as consistency of LDTA measurements between Mortise and Whole Limb views, were evaluated.

Results: Mean follow-up was 6.7 ± 4.5 (0.01-18.4) years. Twenty (13.2%) TARs were revised after an average of 5.4 ± 4.7 years (5-year survival of 86.8%). No correlation was found between DTA alteration and revision for either LDTA (HRs 1.03-2.29, p=0.18-0.98) or ADTA (HRs 1.06-2.28, p=0.23-0.91). No significant differences were observed among change-in-alignment groups. However, in the sagittal plane, a trend was observed favoring maintenance of non-neutral alignment (>3°) over altering ADTAs >3° to neutral. LDTAs measured on the different views appeared comparable (p=0.16).

Conclusion: Non-neutral postoperative alignment appeared to have less direct influence on revision rates than previously described. Although no significant association was found between changes in native tibial anatomy and TAR revision rates, this study highlights that surgeons may want to consider native anatomy more closely, rather than adhering to a rigid, neutral manufacturer's approach.

Background: Hallux valgus (HV) is a complex triplanar deformity.

Purpose: To utilize preoperative weightbearing computed tomography (WBCT) of patients with HV deformity to characterize the true triplanar nature of the deformity, as well as to assess first metatarsophalangeal joint pathology.

Study design: Retrospective case series.

Methods: A retrospective study of adult patients with HV deformity treated between 1/2020 and 7/2024.

Results: Sixty-four patients were included. Inter-rater reliability for all radiographic measurements demonstrated good to excellent agreement. WBCT findings demonstrated that 38 patients (59 %) exhibited both first metatarsal pronate and tibial sesamoid subluxation, while 7 patients (11 %) showed neither deformity. 51 patients (80 %) presented true sesamoid subluxation. The rate of pseudo-sesamoid subluxation was 9 % (6/64 patients). WBXR findings showed that 42 patients (66 %) had moderate HV deformity with 37 patients (58 %) demonstrating an abnormal HVA, 20 patients (31 %) with mild HV, and 2 patients (3 %) with severe HV. 37 patients (58 %) observed with first metatarsal joint degeneration and 30 patients (47 %) exhibited erosion of the intersesamoid crista. The tibial sesamoid subluxation grade demonstrated a statistically significant and meaningful moderate correlation with HVA, degeneration of the first metatarsal joint and erosion of the intersesamoidal crista, but a slightly less meaningful moderate correlation with HV deformity.

Conclusion: WBCT provides a reproducible, three-dimensional assessment of HV deformity, offering more accurate evaluation of first metatarsal pronation, sesamoid subluxation, and degenerative of both the first metatarsophalangeal joint and the intersesamoidal crista compared to conventional radiographs.

Background: In advanced stages of progressive collapsing foot deformity, attenuation of the deltoid ligament can contribute to valgus tilt of the talus within the ankle mortise. Hindfoot arthrodesis is the standard treatment for late-stage progressive collapsing foot deformity; however, unrecognized deltoid ligament insufficiency may predispose patients to postoperative tibiotalar valgus.

Purpose: To evaluate the accuracy of preoperative MRI in detecting deltoid ligament insufficiency in patients undergoing hindfoot arthrodesis for late-stage PCFD.

Study design/methods: 37 feet from 35 patients undergoing arthrodesis for advanced PCFD were reviewed. Preoperative MRI findings were compared to intraoperative valgus stress radiographs. Sensitivity, specificity, and odds ratio for MRI detecting deltoid incompetence were calculated.

Results: Deltoid ligament disruption occurred in 18.9% (7/37) of cases as confirmed by both MRI and intraoperative stress testing. 35.1% (13/37) had a negative MRI but a positive stress exam. An additional 10.8% (4/37) had MRI-positive findings unconfirmed by stress test. Overall, 54.1% (20/37) demonstrated deltoid ligament insufficiency in intraoperative stress examination. MRI identified deltoid tears in 29.7% (11/37) of cases, yielding a sensitivity of 63.6% and specificity of 50.0%. The odds ratio of a positive MRI predicting actual deltoid ligament insufficiency was 1.75.

Conclusion: MRI as a standalone modality demonstrated limited accuracy in detecting functionally significant deltoid laxity. Functional deltoid incompetence should be considered in surgical planning, and adjunctive intraoperative assessments should be performed to confirm deltoid instability. Prospective studies are needed to determine the best method of reducing the incidence of postoperative tibiotalar valgus.

Level of clinical evidence: Level III evidence.

Background: Total talus replacement (TTR) using a customized implant is an effective joint-salvaging option for severe talar destruction. Although favorable results have been reported with ceramic, cobalt-chrome, and titanium alloy prostheses, outcomes of pure titanium implants have not been described.

Purpose: To evaluate clinical outcomes of TTR using a pure titanium prosthesis.

Study design: Retrospective cohort study.

Methods: Thirty-nine patients underwent TTR for primary or post-traumatic avascular necrosis (AVN) of the talus with a mean follow-up of 23.2 ± 10.2 months (range, 12-55). Each prosthesis was fabricated from commercially pure titanium (Cp-Ti). Patient-reported outcomes, satisfaction, range of motion (ROM), and complications were assessed.

Results: Pain VAS improved from 8.2 ± 1.0 preoperatively to 2.1 ± 2.4 at final follow-up (p < 0.001). FAOS, FFI, EQ-5D, and EQ-VAS showed significant improvement. ROM increased from 52.2 ± 31.3° to 95.9 ± 23.3° (p < 0.001). Asymptomatic tibial osteophytes developed in 5 cases (12.8 %), and subchondral cysts in 3 (7.7 %), including two with mild implant settling. Thirty-six patients (92.3 %) were very satisfied and three (7.7 %) satisfied; all would undergo the same procedure again. The post-traumatic group had stiffer ankles and more concomitant procedures but achieved comparable improvement.

Conclusion: Short-term outcomes of TTR using pure titanium prostheses were favorable, showing significant pain relief, functional recovery, and high satisfaction. Pure titanium TTR is a feasible and effective treatment for primary or post-traumatic talar AVN.

Background: Tantalum-coated metal spacers (TCMS) have been increasingly utilized to fill and provide structure to large bony defects in the hindfoot. There is a paucity of literature assessing the outcomes of tantalum-coated metal spacers in foot and ankle surgery.

Purpose: This study serves to assess clinical outcomes and fusion rates of patients who underwent tibiotalocalcaneal arthrodesis with tantalum augmentation.

Study design: This is a retrospective cohort study (N = 65) of patients who underwent tibiotalocalcaneal arthrodesis with and without TCMS at a tertiary care center between 2015 and 2021.

Methods: Computed tomography scans at the six-month postoperative point were reviewed to determine fusion status. Patient-reported outcomes measures were collected after at least 1 year postoperatively. A multivariate logistic regression model was used to measure the likelihood of achieving fusion with tantalum augmentation.

Results: There was a statistically significant lower rate of hardware failure in the TCMS group (4.76 % vs. 34.09 %, p = 0.021). TCMS-augmentation was a nonsignificant predictor of increased odds of fusion at the six-month postoperative point (OR = 4.84, p = 0.124).

Conclusion: This study is the largest to date to present 6-month postoperative CT scans demonstrating successful tibiotalocalcaneal arthrodesis fusion with tantalum augmentation, contributing to our understanding of its utility. Further studies are needed to evaluate the efficacy of TCMS-augmented fusions as a viable substitute to custom printed cages.