Foot & ankle specialist最新文献

IntroductionThis study analyzes the incidence rate and median workdays missed due to foot and ankle injuries across age groups, sexes, and industries.MethodsWorkplace injury data from 2003 to 2019 were obtained using the Nonfatal Cases Involving Day Away from Work: Selected Characteristics database provided by the Bureau of Labor Statistics (BLS). The data were grouped by injury location (ie, foot, ankle), injury type (ie, fracture, sprain), and industry, and reported with injury incidence rates and median workdays missed.ResultsThe incidence rate of foot and ankle injuries significantly decreased from 2003 to 2019 (P < .001). With increasing age, the incidence rate of foot and ankle injuries decreased (P < .001) and median workdays missed increased (P < .001). Men had significantly higher rates of foot and ankle injuries (P < .001). Agriculture, forestry, fishing, and hunting (foot=10.23%, ankle=10.41%); construction (foot=8.14%, ankle=8.68%); and transportation and warehousing (foot=11.06%, ankle=13.80%) industries had the highest injury incidence rates. Transportation and warehousing (foot=16.8 days, ankle=16.3 days), mining (foot=44.9 days, ankle=17.1 days), and utilities (foot=26.7 days, ankle=24.4 days) industries had the highest median workdays missed.ConclusionIncreased incidence and severity of workplace foot and ankle injuries are associated with male sex and heavy labor industries. Age was positively associated with severity and negatively associated with incidence of workplace ankle injuries.Levels of Evidence:Level III, Retrospective cohort study.

Tibialis anterior tendon (TAT) ruptures are rare, equating to less than 1% of all musculotendinous injuries. These injuries can be acute or atraumatic, with the latter often associated with chronic degenerative tendinopathy. Surgical repair is indicated when conservative measures fail in meeting functional demands. Direct end-to-end repair is the preferred method for TAT ruptures but may not be feasible with a large tendon defect. Various surgical techniques have been described to address this pathology, including allograft tendon interposition or extensor hallucis longus (EHL) transfer. The authors present a unique technique utilizing a minimal incision TAT turn-down with dermal matrix allograft augmentation, and, in addition, a case implementing this technique in a patient with a large insertional defect. The patient's postoperative course and outcomes were favorable, with improvements in pain, satisfaction, functional scores, and strength. The surgical technique offers versatility and can be adapted to different tendon defect sizes. It also allows for minimal-incision exposure, beneficial for patients with comorbidities or compromised skin integrity. In conclusion, the authors present a case report and surgical technique for the management of large-deficit, chronic TAT ruptures using split TAT turn-down. This technique provides a potential solution for cases where direct end-to-end repair is not feasible.Level of Evidence: Level V.

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.

Introduction: Chopart injuries are often misdiagnosed due to subtle presentations affecting a combination of the talar head, navicular, calcaneus, or cuboid bone. These injuries typically occur on both medial and lateral sides, but rarely both structures at a single side are injured. The aim of this study was to investigate functional outcome and complications in Chopart injuries with a transnavicular-transtalar fracture pattern.

Methods: This retrospective cohort study examined patients with Chopart injury with concomitant navicular and talar head fractures. Patient characteristics, trauma mechanism, fracture classification, surgical management, follow-up, and complications were reported. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and Foot Function Index (FFI). Quality of life was measured with the EuroQol-5D (EQ-5D). Patient satisfaction and general health were scored on a 0-10 visual analogue scale (VAS).

Results: Twenty-two patients with Chopart injuries with concomitant navicular and talar head injuries were included. Four common injury pattern combinations were identified based on anatomical affected structures. Most cases underwent ORIF. Two underwent primary arthrodesis of the talonavicular joint. Mean follow-up was 57.6 months. Secondary talonavicular arthrodesis due to painful osteoarthritis (n = 3) was performed after a mean of 12.3 months. Implants were removed in 47% due to complaints after a mean of 10.5 months. There were no postoperative wound infections or cases of avascular necrosis. All fractures showed union. Functional outcome was good (median AOFAS 80.6; median FFI 20.5). Mean EQ-5D index was 0.46. Patient-reported outcomes were good (mean VAS treatment satisfaction 8.4; mean VAS perceived health 8.1).

Conclusion: There is a significant amount of diversity among Chopart injuries. If treated correctly, outcomes are good, although a substantial number of patients require secondary surgery. Considering the rarity and complexity of these injuries with concomitant foot fractures, prompt referral to specialized foot surgeons and centralization of complex foot surgery are recommended.Levels of Evidence: 4.

Background: Lag screw-only fixation has been proposed as a less invasive alternative to traditional plating for simple oblique fractures of the distal fibula. This technique may reduce hardware-related complications while maintaining adequate stability and promoting fracture healing. This review aims to assess whether a lag screw-only construct can provide sufficient stability and reduce complications commonly associated with traditional lag screw-plus plate fixation in patients with simple oblique distal fibular fractures.

Methods: A narrative review of the literature was conducted through PubMed, Embase, and the Cochrane Library. Studies were included if they reported clinical or biomechanical outcomes of lag screw-only fixation in simple oblique fibular fractures. Biomechanical studies and editorials relevant to the technique were also reviewed for context.

Results: Eight clinical and 6 biomechanical studies were identified. Patients included primarily presented with Lauge-Hansen SER-type fractures without comminution. Across studies, lag screw-only fixation demonstrated 100% union rates, with clinical and functional outcomes comparable to traditional plating. Validated scores such as Olerud and Molander (OM), Foot and Ankle Ability Measure (FAAM), and Single Assessment Numeric Evaluation (SANE) indicated excellent postoperative function. Complication rates were generally low. Biomechanical models suggested similar stability to plating. Early mobilization and weightbearing were rarely implemented, with only a letter to the editor suggesting their safety.

Conclusion: For selected cases, lag screw-only fixation may be a viable option in the treatment of distal fibular fractures. However, current evidence remains limited and heterogeneous. Further studies are needed to validate its safety and suitability for early rehabilitation protocols. This study is designed as a narrative review.Levels of Evidence: V.

Objective: This study aimed to evaluate the efficacy and feasibility of arthroscopic resection of tarsal coalitions via an ultrasonic bone scalpel.

Methods: A retrospective analysis was conducted on a 29-year-old male patient suffering from persistent pain due to a tarsal coalition. The patient underwent arthroscopic resection of the tarsal coalition via an ultrasonic bone scalpel, followed by a 3-month postoperative follow-up. Intraoperative blood loss and operative time were recorded. Postoperative outcomes were assessed via X-ray, computed tomography (CT), and magnetic resonance (MR) images to evaluate the completeness of the resection and soft tissue recovery. Pain levels and functional recovery were evaluated via the visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, respectively. Complications were also documented.

Results: The surgery was successfully completed without nerve or vascular injury, with minimal blood loss (~5 mL) and a total operative time of 45 minutes. At the 3-month follow-up, the patient's VAS pain score improved significantly from 7 preoperatively to 1 postoperatively. The AOFAS score increased from 65 to 90. The CT scans confirmed the complete resection of the tarsal coalition, with no recurrence observed. The MR images revealed no significant vascular or neural injury. The patient was satisfied with the surgical outcome, and no complications were reported.

Conclusion: Arthroscopic resection of tarsal coalitions via an ultrasonic bone scalpel is feasible and promising. This procedure significantly improves pain symptoms and ensures functional recovery without causing notable damage to surrounding soft tissues.

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.