Foot & ankle specialist最新文献

BackgroundBoth isolated talonavicular arthrodesis and talonavicular and subtalar (such as double) arthrodesis can be effective treatments for adult-acquired flatfoot deformity (AAFD) with good success rates, but double arthrodesis has become more commonly performed in recent years. The purpose of this study is to evaluate whether isolated talonavicular versus talonavicular and subtalar arthrodesis led to significantly different 30-day postoperative complication rates in patients with AAFD.MethodsWe performed a retrospective review to identify a large cohort of adult patients with the diagnosis of AAFD or posterior tibial tendon deformity (PTTD) who underwent isolated talonavicular or talonavicular and subtalar arthrodesis between 2006 and 2020 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). To investigate whether there was a difference in complication rate between the 2 surgical cohorts, we estimated logistic regression models and log-binomial models on each of the outcomes while also adjusting for sex and age.ResultsWe found that there was no significant difference in the rate of major complications (P = .567) or readmissions (P = .567) between patients who underwent isolated talonavicular versus talonavicular and subtalar arthrodesis for AAFD. However, there was a significantly higher rate of minor complications in patients who underwent isolated talonavicular arthrodesis when compared with patients who underwent talonavicular and subtalar arthrodesis (P = .009).ConclusionThis study found that there was no increased risk of 30-day postoperative complications or readmissions with talonavicular and subtalar arthrodesis when compared with isolated talonavicular arthrodesis for AAFD. In addition, there was no increased risk of major complications for talonavicular and subtalar arthrodesis when compared with isolated talonavicular arthrodesis, and isolated talonavicular arthrodesis actually carried a higher risk of minor complications for this surgical cohort. This may provide valuable information for surgeons considering surgical treatment for a particular case of AAFD.Level of Evidence:Level III.

Hallux rigidus is the most common arthritic condition of the foot, typically treated with arthrodesis. Polyvinyl alcohol (PVA) hydrogel hemiarthroplasty implant, commonly known as the brand name Cartiva, has been a mainstream alternative treatment. Failure of PVA hydrogel implant may necessitate revision to arthrodesis. This study assessed radiographic and clinical outcomes of patients who underwent arthrodesis following failed first metatarsophalangeal joint (1st MTPJ) PVA hydrogel hemiarthroplasty. A comprehensive retrospective chart review and direct patient contact were conducted for all 1st MTPJ hemiarthroplasty procedures performed with a PVA hydrogel implant between 2009 and 2021 (n = 173). For patients requiring revision to arthrodesis, time to revision, fixation method and use of bone graft or substitutes were recorded. Functional outcomes were assessed using radiographic imaging and validated scoring systems. Of the 173 PVA hydrogel implants, 16 failures and subsequent conversion to arthrodesis were included in the analysis. Four of the 16 patients (26.6%) developed symptomatic nonunion, requiring secondary revisions, resulting in no significant loss of metatarsal length. Average SF-36 PFS (short form 36 physical functioning score) was 39.5, with an FAAM-ADL (Foot and Ankle Ability Measure-activities of daily living) of 77.2 and an Foot and Ankle Ability Measure-Sports subscales (FAAM-SDL) of 59.4, and visual analogue scale (VAS) pain score was 3.2. The Kaplan-Meier analysis demonstrated a 12-year revision-free PVA hydrogel implant survival probability of 84.16%. In conclusion, PVA hydrogel implants demonstrated good mid-term to long-term survival and converting a failure to fusion did not significantly affect metatarsal length but did show higher nonunion rates and worse functional outcomes compared with primary arthrodesis.Levels of Evidence: Level IV.

BackgroundInstability of the first cuneiform (C1)-second cuneiform (C2) joint (C1C2J) is a risk factor for hallux valgus (HV) recurrence after first tarsometatarsal joint arthrodesis. This instability could be associated with mechanical stress on C1C2J. This study aimed to investigate the stress distribution on C1C2J in patients with HV based on subchondral Hounsfield unit (HU) values and determine the associated factors.MethodsWe retrospectively reviewed 123 feet with HV. The control group included 29 feet without HV. The HU value of the subchondral bone was measured on coronal slices of preoperative computed tomography in 8 regions of C1C2J: anterodorsal (AD), anteroplantar (AP), posterodorsal (PD), and posteroplantar (PP) regions of C1 and C2. The HU values of C1C2J were divided by those of the fourth metatarsal (HU ratio). The HU ratios were compared between the HV and control groups, and the relationship between the HU ratios and radiographic parameters was compared in the HV group.ResultsThe HU ratios were significantly higher in the HV group than in the control group in AD, AP, and PD regions of C1 and C2. In the HV group, the HU ratios were negatively correlated with the calcaneal pitch angle (CPA) in all regions (r = -0.56 to -0.32) and Meary's angle (MA) in all regions of C1 and AD, AP, and PD regions of C2 (r = -0.41 to -0.21). Furthermore, the HU ratios were significantly higher in all regions for CPA under 15 degrees. The HU ratios were significantly higher in AD, AP, and PD regions of C1 and C2 for MA under -4 degrees. There was no correlation between the HU ratio and the HV angle.ConclusionsPatients with HV had higher stress loads on C1C2J than those without HV. This stress was associated with the medial longitudinal arch.

BackgroundPatients frequently turn to online resources to better understand their diagnoses and treatment options. While prior research has shown that orthopaedic patient education materials (PEMs) often exceed the recommended reading level, little is known about the readability of information specifically related to foot and ankle conditions. This study aimed to assess whether online PEMs for Hallux Rigidus are written at or below the recommended sixth-grade reading level. We hypothesized that the readability of these materials would exceed this threshold.MethodsA Google search was conducted using the terms "Hallux Rigidus patient information" and "Big Toe Arthritis patient information." The first 25 websites from each search were analyzed. The Readability Scoring System Plus was used to assess the Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, SMOG Index, Automated Readability Index, and Linsear Write scores. Descriptive statistics were reported.ResultsFor "Hallux Rigidus patient information" and "Big Toe Arthritis patient information" respectively, the results were: Average Reading Level 10.2 (±1.7) and 10.3 (±1.9), Flesch-Kincaid Reading Ease score 9.95 (±2.3) and 10.1 (±2.7), Gunning Fog score 54.6 (±10.9) and 55.6 (±11.5), Flesch-Kincaid Grade Level 11.4 (±1.7) and 11.2 (±1.8), Coleman-Liau 9.41 (1.9) and 9.39 (2.3), SMOG 11.1 (2.0) and 11.1 (2.0), Automated Readability Index 9.17 (1.5) and 9.28 (1.7), and Linear Write 74.5 (7.8) and 74.4 (7.9). None of the analyzed PEMs met the recommended sixth-grade reading level. Of the 50 websites reviewed, 11 provided general health information. No significant difference was found in readability between clinical practice patient information and general health information.ConclusionAccessible and appropriately written PEMs are crucial for improving health literacy and ensuring patients understand their diagnoses and treatment options. Our findings indicate that online information about Hallux Rigidus is written at a level too advanced for the average patient, highlighting the need for more readable resources.Levels of Evidence:IV.

Tarsal coalitions are a rare inherited condition believed to be failure of mesenchymal differentiation. Although often asymptomatic, microfracturing at the level of a coalition is believed to be a cause of ongoing midfoot pain in the adolescent. Cuboid-navicular coalitions are even more rare with roughly few reported cases to date. We present a case of symptomatic cuboid-navicular fibrocartilaginous coalition in adolescent sisters with a chief complaint of chronic midfoot pain originally treated at an outside facility. Following exhaustion of conservative modalities, surgical resection of the tarsal coalition was performed leading to alleviation of symptoms. The purpose of this report is to add to the body of literature on this rare type of coalition as well as detail the challenges and management.

IntroductionThis study evaluates the impact of implementing body mass index (BMI) cutoff points on 6-month postoperative outcomes following total ankle replacement (TAR).MethodsThe Nationwide Readmissions Database (NRD) was queried from 2015 to 2020 to identify 5865 patients undergoing primary elective TAR, stratified into groups by 5 BMI point intervals. Preoperative demographics, comorbidities, postoperative outcomes, and total length of stay (LOS) were analyzed between cohorts, with additional multivariate regression analyses conducted to control for predictors other than BMI.ResultsMultivariate regression analysis of 180-day postoperative outcomes found that preoperative BMI of 40 to 44.9 and ≥45 kg/m² was significantly predictive of increased risk of overall complication, adverse discharge, and LOS greater than 4 days.ConclusionA BMI above 40 kg/m² is associated with a significantly increased risk of complications (odds ratio [OR] = 1.960; P < .001), adverse discharge (OR = 2.030; P < .001), and extended LOS (OR = 2.171; P < .001).Levels of Evidence:Level III, Retrospective Cohort Study.

BackgroundThe aim of this study is to describe the surgical technique, outcomes, and complications associated with fourth-generation percutaneous hallux valgus correction using a guided system.MethodsProspective case series of 28 patients, aged 16 and older (5 men and 23 women), averaging 56.89 years, who underwent surgery for hallux valgus with at least 12 months of follow-up.ResultsThe preoperative American Orthopaedic Foot & Ankle Society (AOFAS)-hallux score increased from 63.8 to 89.7 (P < .001) at 12 months post-surgery. The visual analog scale (VAS) score decreased from 6 to 0.16 (P < .001) in the same period. The preoperative intermetatarsal angle (IMA) decreased from 13.38° to 2.72° (P < .001) post-surgery, while the Hallux valgus angle (HVA) decreased from 23.01° to 5.2° (P < .001). There were 3 complications including 1 superficial wound infection, 1 malpositioning of the screws and 1 hypertrophic non-union.ConclusionThe described percutaneous hallux valgus surgery appears to be reliable, with consistent improvements in clinical outcomes and radiological results. The guided technique is promising in order to reduce common complications.Level of Evidence:Level IV, prospective case series.

First metatarsophalangeal joint arthrodesis is a common surgical intervention for end-stage hallux rigidus and valgus. Such cases can be complicated by disruptions in the metatarsal parabola, particularly an elongated second metatarsal. Some experts advocate for a shortening osteotomy of long metatarsals to restore forefoot balance. However, the present investigators question the benefit of second metatarsal shortening procedures when the first metatarsal is effectively lengthened with arthrodesis. Thus, the current study sought to compare first metatarsophalangeal joint arthrodesis with and without second metatarsal shortening osteotomy. After study criteria, 24 patients undergoing first MTPJ arthrodesis with adjacent Weil osteotomy were matched to 48 patients who underwent first MTPJ arthrodesis alone. Patients were matched for age, sex, indication (hallux rigidus or hallux valgus), metatarsal parabola, body-mass index (BMI), laterality, bone supplementation, fixation type (interfragmentary screw and dorsal locking plate), diabetes, tobacco use, and inflammatory arthropathies. No significant demographic differences were found between the groups (P > .1). At the mean follow-up of 25.5 months, the Weil osteotomy group had twice as many reoperations compared with the control group, at a rate of 25 and 6.3%, respectively (P = .053; OR: 4.9; CI: 1.1-21.7). There were 4 nonunions in each group, with nonunion rates of 16% in the Weil osteotomy group versus 8.3% in the arthrodesis-alone group (P = .43; OR: 2.15; CI: 0.49-9.5). Subsecond metatarsal pain was observed in 16.7% of the Weil osteotomy group (n = 4) and 6.3% of the control group (p= 0.23, OR: 2.8; CI: 0.57-13.6). In this first metatarsophalangeal joint arthrodesis series, no benefit was found when an adjacent second metatarsal shortening osteotomy was completed for preoperative metatarsalgia. Further research is needed to determine if such osteotomies benefit patients undergoing first metatarsophalangeal joint arthrodesis.Levels of Evidence: III.

IntroductionThe purpose of this study is to assess the effect of race and ethnicity on the length of stay in hospitals following elective foot and ankle procedures. We aimed to determine whether (1) there are differences in the amount of time spent in a hospital following surgery between black, Hispanic, and white patients and (2) to assess for differences in complications.MethodsA retrospective review of the National Inpatient Sample (NIS) was conducted for 14 different foot and ankle procedures between 2016 and 2021. International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) and International Classification of Diseases, 10th Revision (ICD-10) codes guided the inclusion and exclusion criteria. Patient demographics, comorbidities, and postoperative outcomes and length of stay in hospitals were collected. A biostatistician was used to conduct all analyses. Regression analyses were used to assess differences between length of stay between races. Demographic variables, comorbidities and outcomes were analyzed using χ² and Fisher exact tests.ResultsThe database search yielded 16,126 patients with a weighted sum of 84,085. White patients were older on average (61.98 years) than black patients (52.30), with an average length of stay of 3.08 days and black patients had an average of 3.35 days (P < .0001). Prevalence of pulmonary embolism, pneumonia, myocardial infarction, and stroke were not significantly different between the groups (P > .05).ConclusionOur study found that minority patients experience longer stays in the hospital following elective foot and ankle procedures. No differences were found between complication rates among the 2 groups. These findings suggest a need for further research into reasons for longer stays in this patient population.

Orthobiologics continues to advance in medicine due to its regenerative capabilities. In fact, there is a vast indication of use with regenerative medicine options such as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) within the human body for various musculoskeletal conditions. While both options are different, the purpose of each is to promote a natural healing response with specific growth factors, proteins, or cells to aid in this. In this concept review, we present a current update on the literature surrounding these regenerative medicine options specifically with utilization in the foot and the ankle. We have found in our practice that regenerative medicine options offer our patients a nonoperative as well as operative biologic supplemental option for treatment on various foot and ankle conditions with relatively high success rates and overall high patient satisfaction. We hope this review educates the foot and ankle surgeon on this rapidly evolving treatment to enhance patient outcomes and improve quality of care.Levels of Evidence:4.