Foot & ankle specialist最新文献

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.

A serious complication of diabetes mellitus is the plantar diabetic foot ulcer (DFU) and is the primary cause of amputations worldwide. The causes of plantar diabetic foot ulceration are multifactorial, including hyperglycaemia, peripheral arterial occlusive disease, infection, and pressure-related issues, such as deformity due to polyneuropathy and shortening of the triceps surae complex, as possible contributing factors. The plantar DFU can be treated conservatively, but with a high recurrence rate. Lengthening of the triceps surae complex is an effective way in lowering ulcer recurrence. Proximal medial gastrocnemius release (PMGR) is effective in reducing tightness of the gastrocnemius muscle. However, the success rate of this procedure as treatment for the plantar DFU is unknown. The goal of this study is to determine the recurrence risk of the plantar DFU in patients who underwent a PMGR procedure. This retrospective medical record analysis describes the outcomes of 20 PMGR procedures in 14 patients. The duration of the ulcer, preoperative dorsiflexion, wound healing postoperatively, and duration until recurrence were considered. Postoperatively 18 of 20 (90%) of the procedures achieved wound healing of the DFU within 4 weeks and 4 of 20 (20%) of the procedures had postoperative complications. At a mean of 9.2 months 10 of 20 (50%) of the procedures showed a recurrence of the ulcer and recurrence in gastrocnemius shortening of which 9 of 10 (90%) chose for a secondary procedure. This retrospective medial record analysis shows that PMGR is effective in short-term wound closure in patients with a plantar DFU, and, however, does not provide sufficient length gain in the longer term during treatment of plantar DFU, and there is a high risk of recurrence of the ulcer. These findings suggest that PMGR is ineffective in the long-term treatment of the plantar DFU. More powerful procedures should be considered, such as more distal gastrocnemius release or percutaneous Achilles tendon lengthening.Level of Evidence: Level IV, Retrospective Case Series.

Percutaneous Achilles tendon lengthening (PATL) is a widely used procedure for addressing gastrocnemius and gastroc-soleus equinus contractures. This study evaluates the biomechanical and anatomical outcomes of PATL using different incision distances from the Achilles tendon insertion. Twenty matched-pair cadaveric specimens underwent PATL with incisions spaced either 3 or 5 cm apart. Key outcomes included ankle dorsiflexion improvement, tendon integrity, and sural nerve injury. The 3-cm incision group showed dorsiflexion improvements of 12.70° with a straight knee and 14.60° with a flexed knee, while the 5-cm incision group showed improvements of 10.50° and 12.40°, respectively. Both techniques effectively increased ankle range of motion, with 3-cm incisions yielding greater dorsiflexion gains and higher success rates for proximal hemisections. However, the 5-cm incision group demonstrated a higher incidence of incomplete proximal cuts and insufficient tendon sliding, leading to less effective lengthening. Sural nerve injuries were observed in 25% of specimens, and a 10% incidence of Achilles tendon rupture was recorded, particularly with 3-cm incisions. Anatomical variations in the gastrocnemius aponeurosis also influenced outcomes. These findings underscore the need for meticulous surgical planning and consideration of individual anatomical differences to optimize patient outcomes. Further clinical studies are recommended to confirm these results and guide future surgical practices.Level of Evidence:Level IV: Cadaveric Study.

Chronic exertional compartment syndrome (CECS) is a challenging pathology that causes pain and physical limitations. Fasciotomy is the gold standard and different techniques have been described. Techniques that allow a fast return to sports and low recurrence rates are of great interest for the athletic population. This is a prospective case series presenting a mini open surgical technique and its results regarding the level of return to sports and quality of life in 13 patients. A specific CECS questionnaire was applied and analyzed concerning the distance patients were able to run before and after treatment, Tegner score, Medical Outcomes Short-Form Health Survey (SF-36), and epidemiological measures. The minimum follow-up was 12 months. The mean distance the patients were able to run per week following the surgical treatment improved from 14.1 to 38.1 km (P = .042) and the mean Tegner score improved from 3.92 to 7.08 (P = .01). Notably, 12 out of 13 patients were satisfied or very satisfied with the outcome. In this sample, the mini open technique improved patients' sports performance and quality of life and minimized pain. Chronic exertional compartment syndrome can be safely approached using a mini open technique with a good rate of satisfaction and return to sport.Levels of Evidence: IV.

BackgroundThe optimal placement for a syndesmosis reduction clamp remains an open question. This study compared the center-center axis, which localizes clamp placement using only an internally rotated lateral ankle X-ray, with other common approaches, whose accuracy can only be confirmed using computed tomography (CT).MethodsBone models of anatomically aligned (n = 6) and malreduced (n = 48) limbs were generated from CT scans of cadaveric specimens. Four axes for guiding clamp placement (center-center, centroid, B2, and trans-syndesmotic) were then analyzed, using digitally reconstructed radiographs derived from the bone models. Each axis' location was defined using angle-height pairs that describe axis orientation along the full anatomical region where syndesmosis fixation occurs.ResultsIn anatomically aligned limbs, the center-center axis was located on average (±95% CI [confidence interval]), 0.64° (±0.50°) internal rotation, 1.03° (±0.73°) internal rotation, and 2.09° (±7.29°) external rotation from the centroid, B2, and trans-syndesmotic axes, respectively. Fibular displacement altered the magnitude of limb rotation needed to identify the center-center axis.ConclusionThe center-center technique is a valid method that closely approximates previously described methods for syndesmosis clamp placement without using CT, and the magnitude of C-arm rotation needed to transition from a talar dome lateral to a center-center view may be a potential method for assessing syndesmosis reduction.Levels of Evidence:Level III: Retrospective comparative study.

IntroductionCorrection of hallux valgus through minimally invasive surgery (MIS) has grown in popularity in recent years. Despite the increase in use, there has been limited research into the learning curve associated with the procedure, which has been documented extensively for other MIS procedures. Our study looked to determine the learning curve associated with MIS hallux valgus surgery.MethodsA retrospective review was conducted of patients who underwent MIS hallux valgus surgery, performed by 2 foot and ankle fellowship-trained orthopaedic surgeons, between November 2021 and April 2023. Demographic information, procedure data, and postoperative data were collected for each patient. A multivariable analysis was conducted for each surgeon to determine the relationship between case number and operative duration, patient-reported outcomes, and complications. Findings were significant if P < .05.ResultsCase number was found to have a significant negative relationship with operative duration for both of our surgeons (β = -0.578, -0.736, R² = 0.637, 0.426, P < .001, .02). There was no significant relationship between case number and patient-reported outcomes (P = .49, .408) or complications (P = .319, .387) for either surgeon.ConclusionWe established the presence of a learning curve for operative duration, but not for patient-reported outcomes or complications. Overall, our results are conflicting regarding the presence of a learning curve for MIS hallux valgus procedures. Further study with other institutions is needed to further elucidate the presence of a learning curve.Level of Evidence:III.