Foot & ankle specialist最新文献

Mallet hallux injuries are relatively rare, and management can range from conservative treatment to surgical fixation. Only a few cases of surgically treated are reported, and there is no consensus on the superiority of one technique to others in surgical treatment. We reviewed various options for surgical fixation of Mallet hallux injury and presented a case of mallet hallux injury treated with Kirschner wires with an extension blocking technique.Level of Evidence: V.

BackgroundSubtalar arthrodesis (STA) is a known complication of calcaneus open reduction and internal fixation (ORIF), yet risk factors and timing remain unclear. Limited data exist on patient demographics and predictors associated with STA following ORIF. Our purpose was to evaluate risk factors, timing, and patient characteristics to guide risk stratification and postoperative management in patients undergoing calcaneus ORIF.MethodsThe TriNetX US Collaborative Network database was queried to identify patients aged 18 and older who underwent operative treatment for calcaneus fractures between 2004 and 2023. Patients were divided into 2 cohorts based on whether they subsequently underwent STA. Baseline demographics and comorbidities were compared, and risk factors for STA were analyzed. The timing of STA was stratified into short-term (0-2 years), mid-term (2-5 years), and long-term (>5 years) post-ORIF to assess risk factors over time.Results11,640 patients underwent calcaneus ORIF, with 431 (3.7%) later requiring STA. Of the 431, 301 (70%) occurred within 2 years, 94/431 (22%) between 2 and 5 years, and 36/431 (8%) beyond 5 years. Significant risk factors for STA included obesity, nicotine dependence, hypertension, psychiatric disorders, and divorced status. Black or African American race was associated with a significantly lower likelihood of undergoing STA.ConclusionObesity, hypertension, nicotine dependence, psychiatric disorders, and marital status are key risk factors for STA following calcaneus ORIF. Obesity, hypertension, and nicotine dependence are key modifiable risk factors associated with STA risk highlighting the need for patient-specific counseling and risk modification. In high-risk patients, primary arthrodesis may be a more appropriate surgical option to reduce the need for revision surgery. In addition, sociodemographic differences identified emphasize the importance of individualized and equitable surgical decision-making.Level of Evidence:Level III: Retrospective cohort study.

BackgroundThis study aimed to evaluate outcomes after a minimum 5-year follow-up of feet with tarsal tunnel syndrome (TTS) after electroneuromyographic (ENMG) diagnosis and treatment. Possible predictive factors of outcome were sought.MethodsAll patients underwent, at the least, initial clinical evaluation, ENMG diagnosis, ultrasound and medical treatment for TTS. If treatment was unsuccessful after 6 months, tibial nerve release was proposed. Outcomes were classified as satisfactory (excellent and good) or unsatisfactory (fair and poor) based on Pfeiffer's classification.ResultsSeventy-six feet received conservative treatment, with 65% of satisfactory outcomes, rising to 78% in case of additional tibial nerve release (16 feet, 21%, excellent results in 10 of 76 feet). Improvement was insufficient in 14% of feet, but the patients did not consider that surgery was necessary. Five years after medical treatment, outcome was satisfactory in 5 of 8 feet with nerve contact on ultrasound within the tarsal tunnel, and in 9 of 10 feet with isolated talus-nerve contact. Finally, 18% of feet had nerve contact on ultrasonography and a satisfactory outcome after conservative treatment when evaluated after a minimum of 5 years. Results tended to be better in the absence of static disorders (P = .058), hindfoot varus in particular (P = .032), and in women (P = .047).ConclusionsConservative treatment of TTS yielded satisfactory outcomes at 5-year follow-up. Except in rare cases, it should be the first-line treatment even when nerve contact is seen on imaging. Surgical release appeared to be beneficial after failure of medical treatment at 6 months. Outcomes appeared poorer in feet with static disorders and better in women.Levels of Evidence:Therapeutic, Level IV, Retrospective.

Freiberg's disease is a condition characterized by progressive flattening and eventual collapse of a metatarsal head. Core decompression, metatarsophalangeal joint (MTPJ) debridement, metatarsal osteotomies, autologous osteochondral transplantation (AOT), interpositional arthroplasties, and synthetic implant hemiarthroplasties comprise the surgical management options for patients with Freiberg's disease. Although autografts harvested from the iliac crest have been utilized for the treatment of various osteochondral pathologies of the lower extremity, their use for Freiberg's disease has not been reported to date. We present the case of a novel technique of metatarsal osteoperiostic grafting from the iliac crest (MetOPIC) to the second metatarsal head with injection of concentrated bone marrow aspirate (cBMA) in a 28-year-old former collegiate cheerleader with a longstanding history of chronic pain due to Freiberg's disease. The patient was able to return to her normal activities and participate in sporting activity 8 weeks following the operation. To the authors' knowledge, this is the first report of the use of the MetOPIC procedure to surgically correct Freiberg's disease.Levels of Evidence: V, Case report.

Background: Charcot neuroarthropathy (CN) is a rare joint destructive process that occurs in the setting of peripheral neuropathy. CN can cause deformity and joint instability and has been shown to decrease quality of life. Given the rarity but severity of this condition, a better understanding of the epidemiology and treatment trends are needed. Therefore, the purpose of this study was to explore recent trends in the observed cumulative burden of CN as well as the incidence of different surgical treatments.

Methods: This study utilized a large commercial insurance claims database to estimate the diagnostic cumulative burden of CN from 2009 to 2019. Patients were identified through International Classification of Disease codes. Current procedural terminology (CPT) codes were cross-matched with diagnostic codes to identify patients who underwent surgical procedures related to their CN. Incidence rates of procedures were calculated to assess for trends in management, stratified by age, sex, and geographic region.

Results: From 2009 to 2019, the cumulative case rate of CN increased from 2.96 to 5.00 patients per 10 000 people (estimated 12 836 observed cases starting in 2009 to 167 145 observed cumulative cases by 2019) in the United States. In this time period, the total incidence of surgical procedures performed for these patients increased from 4.35 to 9.70 procedures per 100 000 person-years. The most common procedures included debridement and excision/resection procedures (75.21%) and arthrodesis or osteotomy procedures (9.85%).

Conclusion: Current epidemiological trends for CN are not well known. This study demonstrated an increasing case burden of CN within the United States, alongside increasing incidences of surgical procedures for this disease. These trends provide important insights for patient-specific and public health advocacy. Future studies should continue to explore the contributory financial, cultural, and educatory factors of this disease.Levels of Evidence: III Retrospective cohort study.

Background: Chronic syndesmotic instability alters normal ankle biomechanics and impairs load distribution, potentially leading to degenerative arthritis. The aim of this study was to describe a technical tip for the treatment of chronic tibiofibular instability using a triple-fixation construct, combining a suture button and FiberTape.

Methods: We described the triple-fixation technique and reviewed the cases of 3 patients, aged 22, 25, and 53 years, all diagnosed with chronic syndesmotic instability associated with incongruence of the distal tibiofibular joint.

Results: The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were 54, 73, and 77, respectively. Postoperatively, all patients achieved a score of 100. The mean follow-up periods were 11, 14, and 17 months, respectively. One patient reported mild discomfort at the suture-button knot site, but no other complications were reported.

Conclusion: The triple-fixation technique proved effective in stabilizing chronic syndesmotic injuries in all cases presented. This construct may be considered a viable option for addressing residual instability in patients with chronic distal tibiofibular joint lesions. However, these findings should be interpreted within the context of the study's limitations, including its technical-tip design, small cohort size, relatively short follow-up for a chronic pathology, and lack of randomization.Level of Evidence: V, technical tip and case report.

Background: The optimal surgical approach for mild-to-moderate insertional Achilles tendinopathy (IAT) with Haglund deformity remains controversial. This study compares the clinical and radiological outcomes of Zadek Calcaneal Closing Wedge Osteotomy (ZCCWO) and Calcaneal Exostectomy with Tendon Repair (CE-TR).

Material and methods: This retrospective study included 30 patients (15 ZCCWO, 15 CE-TR) with mild-to-moderate IAT associated with calcaneal exostosis. Clinical outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score and Numeric Pain Rating Scale (NPRS). Radiological evaluations included the Fowler-Phillip (FP), Calcaneal Pitch (CP), and Chaveaux-Liet (CL) angles. The mean follow-up was 39 ± 8.8 months (ZCCWO) and 31.4 ± 5 months (CE-TR).

Results: Both groups demonstrated significant improvements in AOFAS and NPRS scores (P < .00001) with no statistically significant differences between them (AOFAS: P = .6, NPRS: P = .65). The postoperative decline in FP angle was comparable (ZCCWO: 10.1°±3.9°, CE-TR: 9.7°±4.4°; P > .05). Non-union occurred in 1 ZCCWO case (6.6%), while superficial wound infections were more common in the CE-TR group (13.3% vs 6.6%).

Conclusion: The ZCCWO and CE-TR provide equivalent functional and radiological outcomes for mild-to-moderate IAT associated with Haglund deformity. Both procedures are effective and safe, with complication profiles that warrant consideration in surgical planning.

Level of evidence: level IIIClinical trial registration:Not applicable.

Background: This systematic review and meta-analysis aimed to evaluate the outcomes of intra-articular hyaluronic acid (HA) injections for the treatment of ankle osteoarthritis (OA).

Methods: A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was conducted in February 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extracted included patient demographics, injection protocols, subjective clinical outcomes, ankle range of motion, complications, and failures.

Results: Six randomized controlled trials (RCTs) were included, comprising 145 patients (149 ankles) who received intra-articular HA injections and 129 patients (138 ankles) in the control cohorts. The weighted mean follow-up was 5.2 ± 3 months for the HA group. There were no significant differences between HA and control groups in terms of visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, and ankle osteoarthritis scale (AOS) scores. Complication rates were similar between groups, with transient injection site pain being the most common complication.

Conclusion: This systematic review and meta-analysis indicate that intra-articular HA injections provide limited clinical benefit for ankle OA, with no significant improvements in pain or functional outcomes compared to control treatments. Further high-quality randomized trials are needed to determine the precise role of HA in the management of ankle OA.Levels of Evidence: I, meta-analysis of randomized controlled trials.

Schwannomas are benign encapsulated nerve sheath tumors that are rarely found in the lower extremity. We report a unique case of a 65-year-old woman presenting with chronic lateral ankle instability and a palpable mass posterior to the lateral malleolus. Magnetic resonance imaging revealed an 11 by 6 by 10 mm lesion contiguous with the sural nerve. The mass was excised via meticulous enucleation with nerve preservation. Histopathology confirmed a cellular schwannoma. The patient underwent concurrent ankle arthroscopy and lateral ligament repair, thereby achieving complete resolution of symptoms and return to function at 6 months. This is the first reported case of a sural nerve schwannoma associated with chronic lateral ankle instability.

BackgroundResearch is an essential component of medical advancement and knowledge dissemination in foot and ankle (FA) orthopaedic surgery. With an ever-growing body of literature, it can be challenging to fully understand and monitor the discipline's vast publishing landscape. The purpose of this study is to provide a practical resource that outlines journal characteristics and publication trends to help identify suitable journals for an investigator's FA manuscript.MethodsWe examined all published articles from 58 English language journals, including general orthopaedic, sport, and FA-specific journals between 2018-2022 in an observational, cross-sectional study design. The author team generated keyword lists and categorized articles into 9 broad topics. We calculated a 5-year impact factor by using Web of Science total citation counts in 2023 for articles published between 2018-2022 divided by the total publications from 2018 to 2022. Variables such as publishing nationality, author count, and research type were also collected using MEDLINE article metadata and summarized for each journal.ResultsThe 58 journals published 81 675 articles (13 157 specifically FA, 16.1%) between 2018 and 2022. FA articles contributed to ≥10% of publications in only 30 journals. On average, ankle/hindfoot topics were the most popular FA topic across the 30 journals, accounting for 76.5% of all FA articles. Arthroscopy/minimally invasive surgery articles were the most impactful at 1.43 ± 0.04 citations per year. On average, larger author teams are mildly associated with increased citations (R² = 0.337 linear relationship).ConclusionAnkle/hindfoot and arthroscopic/minimally invasive surgery were the most popular and impactful topics in recent FA literature, respectively, making them high yield areas of research for investigators. However, we outline notable differences in the preferences among FA topics and research type across journals, ultimately providing a valuable tool for optimizing FA research by identifying the most suitable journals for a manuscript.Levels of Evidence:4.