Foot & ankle specialist最新文献

PurposeHaglund deformity, a painful prominence of the superior calcaneus, can result in significant disability and difficulty with shoe wear. Once nonoperative treatments have failed, surgical options, including endoscopic or open techniques, can help improve the patient's quality of life. Open techniques have a higher rate of wound healing complications, while endoscopic techniques can be technically challenging and result in increased surgical time. Recently, the use and indications for minimally invasive surgery (MIS) techniques in foot and ankle surgery have expanded. This study reports outcomes of a MIS technique for treating Haglund deformity.MethodsData were retrospectively collected on 34 consecutive patients who underwent an isolated calcaneal exostectomy without bursectomy through a fluoroscopically guided minimally invasive approach via a single lateral portal.ResultsAt a minimum of 24 months follow-up, there was improvement in preoperative to postoperative Foot Function Index (mean 53.6 + 3.8 to 9.3 + 1.4, P < .001) and visual analogue scores (VAS) (mean 6.6 + 0.65 to 0.9 + 0.29, P < .001). The average return to sports was 2.5 weeks (+0.6 weeks), and 100 percent of patients were satisfied with the procedure. There were no major complications, including wound infections or delayed healing concerns, nerve injury, or deep vein thrombosis.ConclusionThe results suggest the described MIS technique for Haglund deformity is safe and effective in reducing pain and allowing for rapid return to activities.Level of Clinical Evidence:Level 4.

BackgroundThis study aims to analyze the effect of preoperative 5-factor modified frailty index (mFI-5) on 30-day complication, readmission, reoperation, and mortality rates following ankle fracture open reduction and internal fixation (ORIF).MethodsThe American College of Surgeons (ACS NSQIP) database was queried to identify 44 838 patients undergoing ankle fracture ORIF. Patients were stratified into groups based on preoperative mFI-5 scores.ResultsThe cohort was predominantly male (59.0%), and the mean age was 49.52 (range = 16-89) years. The mFI-5 score was statistically significantly predictive of any complication (P < .001), serious medical complication (P < .001), surgical site infection (P <.001), readmission (P <.001), reoperation (P <.001), mortality (P <.001), adverse discharge (P <.001), and increased hospital length of stay (LOS) (P <.001).ConclusionOur results indicate that mFI-5 score is a useful predictive measure for postoperative complications, adverse discharge, readmission, reoperation, mortality, and increased LOS in patients undergoing ankle fracture ORIF.Levels of Evidence:Level III, Retrospective cohort study.

The medial collateral ligament (MCL) of the first metatarsophalangeal (MTP) joint is key in maintaining joint stability and function. Evidence-based conservative management strategies for partial tears of the first MTP MCL are lacking. Historically, athletes experiencing persistent pain despite conservative management have required surgical intervention as the next step. In this case, a 34-year-old principal ballet dancer with a partial proximal MCL tear of the first MTP joint failed to improve with conservative treatment, including physical therapy. Treatment with leukocyte-rich platelet-rich plasma to the injured MCL and leukocyte-poor platelet-rich plasma to the first MTP joint was pursued, leading to an improvement of valgus laxity from 5.5 to 3.0 mm on dynamic ultrasound assessments. A full return to dance was achieved at 12 weeks post-injection, and the patient remained symptom-free at 22-month follow-up.

BackgroundThe accessory navicular is a common anatomical variant of the foot that may become symptomatic and occasionally require treatment, particularly in younger individuals. Recent evidence indicates that accessory navicular may be associated with posterior tibial tendon dysfunction in middle-aged and elderly individuals, potentially affecting physical function. However, research on its impact in this demographic remains limited. This study aims to assess the epidemiology and impact of accessory navicular, particularly type 2, on physical function in the general population.MethodsData from the fifth Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study were analyzed, including foot radiographs and physical examinations from 1995 participants. The presence and type of accessory navicular were determined, and physical function was assessed through stabilometer measurements, walking speed tests, and locomotive syndrome risk tests. In addition, the relevant items related to balance and falls were extracted from the structured interviews and analyzed for the relationship with the accessory navicular.ResultsThe prevalence of accessory navicular was higher in females (49.9%) than in males (43.2%), with type 2 being the most frequent type. The analysis revealed a high degree of bilateral symmetry, with 79.5% of males and 76.7% of females showing the same type of accessory navicular or absence thereof on both sides. No significant differences were found in physical performance measurements between feet with and without type 2 accessory navicular. Notably, a higher history of falls was associated with bilateral type 2 accessory navicular.ConclusionsThis study provides insights into the prevalence and type distribution of accessory navicular in the general population. While type 2 accessory navicular did not show significant impacts on physical performance, its association with a history of falls suggests potential implications for dynamic balance ability, warranting further investigation.Levels of Evidence:Level III retrospective case-control study.

ObjectivesThe aim of this study is to retrospectively analyze patients who underwent hallux valgus correction surgery using the Minimally Invasive Chevron and Akin (MICA) technique and assess the degree of metatarsal head translation, preoperative and postoperative inter-metatarsal angle (IMA), and postoperative diaphyseal-intermetatarsal angle (D-IMA). The hypothesis of this study is that, following hallux valgus correction using the MICA technique, an undesired increase in D-IMA may occur and that this increase is directly correlated with the percentage of first metatarsal head translation.Materials and MethodsIn total, 20 patients who underwent hallux valgus correction with the MICA technique were analyzed. Preoperative and postoperative dorso-plantar weight-bearing x-rays of the feet were evaluated: preoperative and postoperative IMA, postoperative D-IMA, and the percentage of metatarsal head translation were calculfasated. The Pearson correlation coefficient was calculated to assess the relationship between metatarsal head translation and the increase in postoperative D-IMA.ResultsThe difference between preoperative IMA and postoperative D-IMA was statistically significant with P < .0001. From preliminary analysis, it has emerged that the relationship is linear and the increase in D-IMA is directly correlated with the degree of metatarsal head translation, r = .83.ConclusionFrom this initial retrospective analysis, it emerges that despite the recognized effectiveness of the MICA technique in correcting hallux valgus and reducing IMA, a portion of metatarsal head translation does not lead to a decrease in IMA but rather to an increase in D-IMA. This study suggests a positive linear correlation between the percentage of metatarsal head translation and the increase in D-IMA.

BackgroundChronic ankle instability (CAI) is characterized by recurrent lateral instability, restricted mobility, and a heightened risk of degenerative osteoarthritis. Elevated BMI further exacerbates these challenges by increasing joint loading, impairing balance, and predisposing individuals to falls and re-injury. Persistent pain reinforces inactivity, perpetuating a cycle of functional decline. This study investigates the efficacy of mat exercises combined with ankle neuromuscular training in addressing ankle instability.MethodsA parallel-arm randomized controlled trial was conducted with 36 overweight and obese individuals aged 21-40 with chronic ankle instability, selected through purposive sampling. Participants were randomly assigned to 2 groups. Group A performed a combination of mat exercises and ankle neuromuscular exercises, while group B performed only ankle neuromuscular exercises. The 4-week supervised intervention was conducted 5 days per week, with each session lasting 40 minutes. Outcome measures, including Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT), and body composition, were assessed at baseline, postintervention, and at an 8-week follow-up. Statistical analysis was done using repeated measures ANOVA for within-group comparisons, while a non-parametric test was used for between-group analysis.ResultsOut of 200 individuals screened, 36 met the inclusion criteria. Significant improvements were observed in both groups across all outcome measures (P < .001). CAIT scores showed greater improvement in group A postintervention and at follow-up (P < .0006, P < .0004). BMI reduction was also more pronounced in group A (P < .001). Balance improvements were significant in all directions, with group A showing superior gains in anterior, posterior, medial, lateral, anteromedial, anterolateral, posteromedial, and posterolateral directions (P < .01). Group A demonstrated greater overall improvements, making the intervention statistically significant in Favor of combined mat and neuromuscular exercises.ConclusionThe integration of mat and neuromuscular exercises markedly enhanced stability and BMI, underscoring their clinical utility in optimizing functional recovery in overweight individuals with chronic ankle instability.Levels of Evidence:Randomized Controlled Trial (RCT).

BackgroundVarious techniques using different implants with or without bone grafts have been described in tibiotalocalcaneal arthrodesis (TTCA). However, which reconstructive method and fixation device results in better outcomes remains unclear. The purpose of this study was to compare the surgical outcomes of TTCA performed with ipsilateral distal fibular autograft as intramedullary strut and lateral plating (FAISP) or retrograde intramedullary nail (RIMN).MethodsWe retrospectively reviewed the records of patients who underwent TTCA between 2010 and 2021 performed by a single surgeon. The surgery was performed with FAISP prior to January 2017 and with RIMN from January 2017 onward. Outcome assessments included radiographic evaluation, functional evaluation with American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHFS) and visual analogue scale (VAS) for pain, and occurrence of complications.ResultsAmong 30 patients who underwent TTCA, 11 cases were performed with FAISP and 19 cases with RIMN. Mean follow-up was 51.0 and 44.4 months in the FAISP group and the RIMN group, respectively. In the FAISP group, union was successfully achieved in 9 (81.8%) ankle arthrodesis and 7 (63.6%) subtalar arthrodesis. In the RIMN group, union was successfully achieved in 15 (79.0%) ankles arthrodesis and 12 (63.2%) subtalar arthrodesis. No significant difference was found between groups in ankle and subtalar union rate or in time to union. Functional evaluation revealed that mean AOFAS-AHFS score and mean VAS pain score improved significantly after TTCA in both groups, but there was no significant between-group difference in mean AOFAS-AHFS score or mean VAS pain score both preoperatively and at last follow-up. The occurrence of complications was similar between groups.ConclusionsBoth FAISP and RIMN yielded favorable functional and radiographic outcomes for TTCA. FAISP may serve as a viable alternative in select clinical situations.Level of Clinical Evidence:Level III: Retrospective cohort study.

Background: Concentrated bone marrow aspirate (CBMA) has become increasingly popular in the management of osteochondral lesions of the talus (OLT) due to its rich content of mesenchymal stem cells (MSCs) and bioactive substances that promote chondrogenesis and articular cartilage repair. However, comprehensive evaluations of clinical outcomes regarding the use of CBMA in OLT have yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following the utilization of CBMA in the surgical management of OLT.

Methods: Using the search terms: ([CBMA] OR [concentrated bone marrow aspirate] OR [bone marrow aspirate] OR [bone marrow-derived mesenchymal stem cells]) AND ([talus] OR [ankle] OR [osteochondral lesion]), we systematically reviewed PubMed/Medline, Scopus, and Cochrane databases in February 2025. Inclusion criteria consisted of clinical studies published in English within the past 10 years that examined ankle pain or functional outcomes after treating OLT in adults with CBMA. Animal studies and studies including patients aged <18 years were excluded, as were systematic reviews and meta-analyses.

Results: Fifteen articles met inclusion criteria. CBMA showed beneficial effects in functional and pain outcomes across different applications: as a standalone therapy, in conjunction with debridement, and alongside reparative or replacement techniques. However, results varied, with some studies noting superior outcomes with CBMA compared to controls, while others found no significant differences. Radiologic outcomes assessed by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring and complications were also mixed, suggesting benefits in some reparative techniques but not in others.

Conclusions: CBMA shows promise in the management of OLT, particularly when used as an adjunct to surgical intervention. However, the evidence is limited by the predominance of non-randomized studies. The heterogeneity in study design, follow-up, and outcome measures across the literature highlights the need for more standardized research protocols to definitively assess CBMA's efficacy and optimize its clinical use.Level of Evidence: III.

ObjectiveTo compare patient-reported outcomes and reintervention rates after open vs arthroscopic fusion of the ankle (TT-tibiotalar) or subtalar (ST) joint over a 10-year period in a cohort of patients from a single center.MethodsIn total, 129 patients (142 joints) underwent surgery for isolated TT or ST osteoarthritis between 2010 and 2020: 40 TT fusions (11 arthroscopic, 29 open) and 102 ST fusions (25 arthroscopic, 77 open). The course of treatment was followed clinically using patient-reported outcome measures (PROMs) for ankle function: Foot and Ankle Outcome Score-FAOS, general quality of life (European Quality of Life in Five Dimensions 3-level time-trade-off-EQ-5D 3L-TTO) and activity level (Tegner Activity Scale-TAS), and by tracking revision procedures.ResultsThe median follow-up time was 8 (3-13) years. The mean age at the time of surgery was 52 (14) years. Most subjective scores showed significant improvement; cumulative FAOS improved from 41 to 57 in the TT group and from 41 to 67 in the ST group and EQ-5D from 0.40 to 0.55 (TT group) and from 0.38 to 0.60 (ST group), while TAS remained at 2. The ST fusion patients had better subjective outcomes than TT fusion patients. There were no significant differences in PROMs between arthroscopic and open procedures. Older age and preoperative FAOS pain were found to be negative predictors for the postoperative FAOS subscales. Overall, there was an 18% revision rate: 17 non-unions and 8 infections. In addition, 20 hardware removals were performed.ConclusionIsolated TT or ST fusions performed open or arthroscopically were safe and significantly improved function and quality of life and reduced joint-related pain but did not increase patients' activity levels. Patients with ST fusion had a better subjective outcome. Older age and lower preoperative FAOS pain were associated with a worse postoperative subjective outcome.Level of Evidence:Level III.