Foot & ankle specialist最新文献

BackgroundUnion deformities are relatively common in proximal fifth metatarsal (5MT) fractures following both conservative and surgical treatment. Several risk factors have been identified to guide risk prediction and management. This review aimed to summarize factors contributing to delayed or nonunion in 5MT fractures.MethodsA literature search for studies reporting risk factors for 5MT fractures was performed using PubMed/Medline, EMBASE, ScienceDirect, Web of Science, and CINAHL databases. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Data on bone healing rates, complications, fracture zones, treatment approach, and healing outcomes were collected and summarized.ResultsThe initial search identified 668 articles, of which 13 met inclusion criteria, including over 1000 cases. Multiple risk factors were significantly associated with impaired union in 5MT fractures. Fracture zone (particularly zone 2), a plantar gap >1 mm, small screw diameter, and early return to activity before radiographic healing were the most consistent predictors of delayed or nonunion. Surgical treatment led to faster union but higher rates of delayed union and refracture. Bone grafting and larger screw diameters significantly improved union outcomes.ConclusionHealing outcomes in 5MT fractures are influenced by multiple risk factors, with fracture zone, fracture chronicity, and fixation strategy being the most significant contributors to union deformities. Identifying high-risk patients and tailoring treatment may reduce nonunion and improve recovery. Further high-quality studies are warranted to establish standardized definitions, treatment protocols and risk stratification models.Level of Evidence:Level IV: scoping review.

BackgroundThe purpose of this systematic review is to evaluate the mid-term to long-term clinical outcomes, physical exam findings, radiographic findings, implant survivorship, and complications between the Salto and Salto-Talaris total ankle replacement (TAR) implant designs for the treatment of end-stage arthritis.MethodsDuring September 2025, the PubMed, EMBASE, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes and survivorship following TAR with Salto or Salto-Talaris implants. Of note, most included studies were non-comparative case series.ResultsFifteen studies comprising 1196 patients (1221 ankles) who underwent TAR with Salto or Salto-Talaris implants were included. The weighed mean follow-up time for Salto and Salto-Talaris implant patients was 86.4 ± 24.9 and 73.6 ± 23.5 months, respectively. The weighted mean American Orthopaedic Foot and Ankle Society score increased 42.6 ± 16.8 points for the Salto implant cohort and 28.1 ± 15.1 points for the Salto-Talaris implant cohort. For patients who received the Salto implant, 33 (6.8%) ankles required revisions at a weighted mean time of 4.8 ± 1.4 years. Survivorship of the Salto implant at 5- and 10-year follow-up was 92% and 89%, respectively. For patients who underwent the Salto-Talaris implant, 27 (3.7%) ankles required revisions at a weighted mean time of 3.6 ± 2.5 years. Survivorship of the Salto-Talaris implant at 5- and 10-year follow-up was 97% and 92%, respectively.ConclusionsMid-term and long-term follow-ups for patients who received either Salto or Salto-Talaris implants demonstrated improvements in clinical outcomes, radiographic findings, range of motion, and implant survivorship. Overall, both implants provided favorable and largely comparable performance profiles, with low rates of clinical complications and revisions. The absence of formal comparative statistical analyses and head-to-head studies prevents definitive conclusions regarding implant superiority. Further prospective, comparative studies are warranted to establish which implant offers superior longevity for the treatment of end-stage ankle arthritis.Levels of EvidenceIV, systematic review.

BackgroundGlucagon-like peptide-1 receptor agonists (GLP) are widely prescribed for type 2 diabetes mellitus (T2DM) and obesity, with established metabolic and anti-inflammatory benefits. Their musculoskeletal impact, particularly on joint-specific outcomes such as ankle osteoarthritis (OA), remains poorly defined.MethodsUsing the TriNetX database, we conducted a retrospective cohort study of adults treated from 2016 to 2020 with a minimum 5-year follow-up. Two main cohorts were analyzed: obese (body mass index [BMI] ≥30 kg/m²) and T2DM patients. The primary outcome was the development of ankle OA, while secondary outcomes included interventions such as joint injection, total ankle arthroplasty (TAA), and ankle arthrodesis. Propensity score matching balanced age, sex, race, BMI, HbA_1c, comorbidities, and socioeconomic variables. Subgroup analyses stratified the obese cohort by BMI groups (30-34.9, 35-39.9, 40-44.9, ≥45 kg/m²).ResultsAfter matching, 2363 obese and 37 737 diabetic patients were included. In obese patients, GLP use was not associated with a significant increase in the risk of ankle OA (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 0.9-1.5). In diabetic patients, GLP use was associated with a higher risk of ankle OA (OR = 1.3, 95% CI = 1.2-1.4) and joint injection (hazard ratio [HR] = 1.3, 95% CI = 1.1-1.4). No differences were observed in the risk of surgical outcomes, including TAA or arthrodesis. Subgroup analysis revealed no consistent stepwise increase in OA risk across BMI strata in GLP users, whereas non-users demonstrated higher OA risk with increasing BMI.ConclusionThe GLP use was associated with an elevated risk of ankle OA in diabetic but not obese patients, without increased risk of surgical intervention. These findings highlight the importance of considering mechanical and biologic mechanisms unique to the ankle when assessing OA progression.Level of EvidenceLevel III: Retrospective cohort study.

Background: Synthetic graft supplements such as Augment (recombinant human platelet-derived growth factor-BB [rhPDGF-BB] and beta-tricalcium phosphate [β-TCP]) are increasingly used to promote fusion in foot and ankle arthrodesis. However, mid- to long-term outcomes remain underreported. This study assessed union rates and time to union with and without graft supplementation in ankle and subtalar fusions.

Methods: A retrospective review of 112 patients from 3 centers was conducted. Patients who received synthetic grafts formed the case group; those without any graft formed the control group. Postoperative radiographs and CT scans were used to assess union status and time to union. Statistical analysis was performed using SPSS (P < .05 significant).

Results: Patients receiving graft supplementation had significantly faster union (160.5 ± 116.2 days) than controls (248.4 ± 282.3 days, P < .01). Nonunion rates did not differ significantly between groups (P = .71).

Conclusion: Synthetic graft supplementation accelerates time to union in ankle and subtalar arthrodesis, potentially enabling earlier recovery and reduced rehabilitation costs. Further research is warranted.Level of Evidence: 3.

Hindfoot reconstruction is a frequently performed procedure for many complex hindfoot deformities including flatfoot, end-stage arthritis, and Charcot arthropathy. Literature has supported the treatment of these patients with a tibiotalocalcaneal (TTC) arthrodesis. However, this limb salvage procedure is complex in nature and is traditionally performed as an open surgery. Minimally invasive (MIS) tibiotalar and subtalar fusions have allowed for similar efficacy as the open procedure, with the potential for less wound complications. The current study presents a guide for TTC nailing with MIS preparation of the tibiotalar and subtalar joints for severe, progressive hindfoot deformity in the high-risk patient. This technique allows for maintenance of the soft tissue envelope; maintaining the integrity of these structures may help surgeons avoid many wound related complications, infections, or need for revision. This guide provides surgeons with an effective and reproducible approach to intervene in complex cases requiring hindfoot reconstruction.Levels of Evidence: Level V Evidence.

IntroductionLateral ankle sprain (LAS) is the most common orthopaedic injury, yet initial diagnosis often lacks precision, leading to suboptimal management and persistent symptoms. This study aimed to compare findings from routine clinical tests with magnetic resonance imaging (MRI) results following LAS.MethodsPatients presenting with LAS were re-evaluated 7 to 10 days post-injury using standardized clinical tests. Ligaments assessed included the anterior talo-fibular (ATFL), calcaneo-fibular (CFL), antero-inferior tibiofibular (AITFL), interosseous talo-calcaneal (ITCL), and superficial and deep deltoid ligaments (sDL, dDL). Specific tests included Anterior Drawer Test (ADT) for ATFL; Varus Talar Tilt Test (VTTT) for CFL; palpation pain for ATFL, CFL, ITCL, and DL; VTTT in dorsiflexion and sinus tarsi pain for ITCL; medial malleolus and deltoid pain for DL; Squeeze Test, External Rotation Test, and syndesmosis pain for AITFL. The MRI performed within 3 weeks served as the reference standard. Sensitivity (Se) and specificity (Sp) were calculated for each individual and combined test per ligament. Results. Isolated ATFL ± CFL injuries were found in 50% of cases. Combined tests showed the highest sensitivity. "Pain on palpation" was the most reliable test for ATFL, CFL, and ITCL (Se/Sp: 100%/33.3%, 70.8%/56.2%, 70.8%/56.2%). Dynamic tests like ADT, VTTT, and VTTT in dorsiflexion showed limited diagnostic value (Se/Sp: 58.8%/66.7%, 29.2%/68.8%, 29.2%/68.8%). For sDL and dDL, "pain on deltoid" had low sensitivity but high specificity (0%/84.2 and 44.4%/93.5%). Squeeze and External Rotation Tests were poor for general AITFL injuries (0%/84.2%) but highly accurate for unstable syndesmosis (100%/91.9%).ConclusionLateral ankle sprains often involve more than just the lateral ligament complex. Clinical tests alone lack accuracy, particularly for deltoid and AITFL injuries. Combining tests improves sensitivity. Suspicion of syndesmosis, subtalar, or medial injury should prompt further imaging due to the low sensitivity of clinical evaluation.

BackgroundApproximately 20% of diabetic foot ulcers progress to amputation. While elevated glucose levels are known to increase infection risk in elective surgeries, their role in outcomes following non-elective amputation remains unclear. Methods. We conducted a 2-year retrospective chart review of adult patients who underwent non-elective, diabetes-related lower-extremity amputations at a tertiary care health system. Of 185 charts reviewed, 108 patients with at least 6 months of follow-up were included. Preoperative and immediate postoperative glucose values were recorded. Primary and secondary outcomes included healing time, postoperative infection, emergency department visits, and hospital readmissions. Multivariable regression models were used to adjust for patient sex, amputation level, and relevant comorbidities.ResultsThe mean healing time was 13.8 weeks (SD 12.9). Elevated perioperative glucose (>180 mg/dL) was associated with a 42% increase in healing time (P = .037). Postoperative infections occurred in 14.8% of patients and were associated with an almost two-fold increase in healing time (P=.001), as well as increased rates of emergency department visits and readmissions. Peripheral arterial disease and end-stage renal disease were independently associated with delayed healing and higher readmission rates.ConclusionElevated perioperative glucose levels, postoperative infection, peripheral arterial disease, and end-stage renal disease are associated with prolonged wound healing and higher complication rates after non-elective lower-extremity amputations in patients with diabetes. These findings underscore the importance of perioperative glucose optimization, infection prevention, and comprehensive management of comorbidities to improve surgical outcomes in this high-risk population.

BackgroundManaging critically sized osseous defects of the hindfoot and ankle remains challenging, particularly in the setting of failed arthrodesis, trauma, Charcot, or failed total ankle arthroplasty. Custom 3D-printed titanium implants have emerged as a potential alternative to structural allografts, offering mechanical stability and biologic incorporation through patient-specific geometry and engineered porosity.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A search of major databases identified studies reporting outcomes of tibiotalocalcaneal (TTC) arthrodesis using 3D-printed titanium implants for critical-sized defects. Union rates, complications, and limb-salvage outcomes were extracted and synthesized. A random-effects model was used to calculate pooled rates.ResultsFifteen studies comprising 142 patients met the inclusion criteria. Indications included segmental bone loss (n = 32), failed total ankle replacement (n = 31), avascular necrosis (n = 21), and nonunion (n = 20). The pooled union rate was 88.2% (95% CI: 82.0%-94.5%), and the limb-salvage rate was 92.3% (95% CI: 87.3%-97.3%). The complication rate was 16.9%, with infection and nonunion being the most frequent types. Functional outcome scores improved significantly in multiple studies. Only 6.3% of patients required below-knee amputation.ConclusionCustom 3D-printed titanium implants demonstrate high union and limb-salvage rates with acceptable complication profiles in the treatment of large osseous hindfoot and ankle defects. These implants may offer a favorable alternative to traditional grafting in complex salvage scenarios.

Metatarsal head osteonecrosis, also known as Freiberg's disease, is a painful and debilitating condition that is difficult to treat both nonoperatively and operatively. In this report, we present 2 cases of Freiberg's disease in a 49-year-old man and 32-year-old woman who were treated using a combination of focused extracorporeal shockwave therapy (F-SWT) with extracorporeal magnetotransduction therapy (EMTT). Extracorporeal shockwave therapy generates high-energy sound waves hypothesized to stimulate tissue healing through multiple pathways including angiogenesis, immunomodulation, and local cellular proliferation and differentiation. Extracorporeal magnetotransduction therapy, while still a very novel technology is understood to generate high-intensity electromagnetic fields, potentially altering cellular signaling to stimulate healing. Following a series of F-SWT and EMTT, these patients had both significant improvement of symptoms and radiologic improvement. They were able to return to activities following treatment. This report highlights that F-SWT and EMTT may be a nonoperative treatment option for metatarsal head osteonecrosis.

PurposeAcross the United States, there is a well-documented projected shortage of orthopaedic surgeons, including those with foot and ankle subspecialty training. We sought to better understand the current state of patient access to orthopaedic foot and ankle surgeons across region, socioeconomic metrics, and rural areas.MethodsIn this cross-sectional analysis, foot and ankle surgeons identified through the American Academy of Orthopaedic Surgeons (AAOS) website were assigned a county, and distribution trends were contextualized by socioeconomic factors, including insurance coverage rates, unemployment rates, poverty rates, and median household income. Surgeon and location data were sourced from September 2024 to November 2024 via the AAOS "Find a Surgeon" directory, with Doximity and Google searches conducted in the event of partially empty profiles.ResultsDisparities in the presence and availability of orthopaedic foot and ankle surgeons by region were identified, with 4 states having only a single orthopaedic foot and ankle surgeon. While the national average of orthopaedic foot and ankle surgeons per million people was 2.87, with the northeast and midwestern regions above this value, the southern and western regions were below the national average. Counties with at least one orthopaedic foot and ankle surgeon had greater median household incomes ($77 459.24 vs $60 682.49; P < .001) and lower poverty rates (11.67% vs 14.20%; P < .001).ConclusionsInequality in the distribution of orthopaedic foot and ankle surgeons is prevalent at the regional, state, and county levels, as well as by rurality and household income/poverty status. Strategies that implement early exposure and/or focused mentorship for the subspeciality in medical school and/or residency can be combined with targeted programs for those interested in the field who wish to practice in underserved areas.