Foot & ankle specialist最新文献

BackgroundThe purpose of this study is to evaluate the effect of the different surgical treatments for hallux valgus on various radiographic measures of bunion correction.MethodsA retrospective cohort study was conducted at a single academic medical center involving 2 fellowship-trained foot and ankle surgeons. One hundred and nineteen feet (110 patients) were included. Procedures included first metatarsophalangeal (MTP) arthrodesis (n = 88), Chevron and/or Scarf osteotomy (n = 23), and Lapidus (n = 8). Overall, 78.2% of patients were female, mean age was 60.49 (range, 16-81) years, and mean follow-up was 1.20 (range, 0.25-3.92) years.ResultsHallux valgus angle (HVA) significantly differed preoperatively (MTP = 33.33°, Chevron/Scarf = 27.03°, Lapidus = 32.56°; P = .026). There was no difference in distal metatarsal articular angle (DMAA) preoperatively (MTP = 18.87°, Chevron/Scarf = 17.80°, Lapidus = 14.39°; P = .629). At final follow-up, DMAA was significantly greatest among the Lapidus bunionectomy cohort (MTP = 9.63°, Chevron/Scarf = 13.51°, Lapidus = 17.45°; P = .005). There was no difference in infection (MTP = 6.8%, Chevron/Scarf = 4.4%, Lapidus = 0.0%; P = 1.00) or reoperation (MTP = 19.3%, Chevron/Scarf = 21.7%, Lapidus = 12.5%; P = .921) rates between cohorts, although both rates were highest in the first MTP arthrodesis group.ConclusionAmong the 3 hallux valgus corrections studied, Lapidus bunionectomy fared the worst regarding DMAA correction at first follow-up and final follow-up, compared with MTP fusion and distal metatarsal osteotomies. Other radiographic measures showed no significant difference among the groups.Level of Evidence:Level III: Retrospective cohort study.

There remains a paucity of literature on musculoskeletal dysfunction, biomechanics, and pathologies of the lower extremity during pregnancy. There are a multitude of physiologic changes that affect a large percentage of patients throughout pregnancy. Podiatric pathologies observed during gestation can be debilitating for this population, ranging from musculoskeletal and biomechanical causes to traumatic injuries and thromboembolic events. This literature review aims to provide an updated review of lower extremity considerations during pregnancy. The authors seek to provide guidance to clinicians based on a review of the available evidence today, and we aim to address deficiencies in research involving the pregnant population.Levels of Evidence: Level V.

BackgroundFibula stress fractures are moderately common injuries among athletes and military recruits. Most of the available data for treatment come from case reports with a limited number of large studies. This systematic review aims to evaluate and present the current literature on fibula stress fractures to help set evidence-based goals and establish realistic expectations for return to activity and sport in injured patients.MethodsSystematic literature search using 3 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. The terms "fibula stress fracture" or "fibular stress fracture" were searched. Date range for inclusion was 2010-2022. Pediatric, non-English, lack of full text available, and studies lacking differentiating fibula stress fracture versus other types of fractures in their data were excluded.ResultsA total of 3 studies with 10 987 subjects were included. Among 521 stress fractures in all 3 studies, there were 45 (8.6% of all fractures) cases involving the fibula. All fibular stress fractures healed successfully with nonoperative measures and non-weight-bearing precautions, on average, by 7 weeks and patients resumed activity, on average, by 9 weeks. Among the 3 studies, there were no reported cases of nonunion or delayed union.ConclusionThis review found that fibula stress fractures have a relatively moderate incidence among stress fracture injuries with a frequency up to 8.6%. Despite this high number, there is sufficient healing in fibula stress fractures when managed nonoperatively with activity modification in a weight-bearing foot to allow for resumption of baseline activities, on average, by 9 weeks. This review can be used to help set evidence-based goals and establish realistic expectations for return to activity and sport in patients who suffer from fibula stress fractures.Levels of Evidence:Level II.

This study reports the clinical outcomes and evolution of 4 patients with subungual glomus tumor (GT) of the hallux treated with tumor excision. Preoperatively, all patients had pain of intensity 9 or 10. Three were sensitive to cold and had stabbing pain, and one reported pulsatile pain. No patient presented nail alterations. There were no bone alterations on radiographic images and diagnostic suspicion of GT was supported by magnetic resonance images. Surgical treatment was indicated due to severe pain and functional limitation. The GT excision was performed by removing the nail through an L-shaped incision in the nail bed. After surgery, they all showed clinical improvement with return to previous activities and had no difficulty in wearing regular shoes. Three patients were pain-free and one had occasional stabbing pain of intensity 2. Half of them had nail changes. There has been no recurrence so far. Thus, we found that resection of subungual GT of the hallux was effective for the clinical improvement of patients.Level of Evidence: IV, case reports.

Background: The purpose of this systematic review is to evaluate outcomes following surgical intervention for accessory navicular (AN).

Methods: The Medline, Embase, and Cochrane Library databases were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies examining outcomes following surgical management of patients with AN were included.

Results: Twenty-three studies comprising 625 patients were operatively treated for AN. The most frequently performed procedure was the Kidner or modified Kidner procedure (n = 403, 51.9%), followed by simple excision (n = 167, 21.5%), arthrodesis (n = 88, 11.3%), arthroeresis (87, 11.2%), and percutaneous drilling (n = 31, 4.0%). The Kidner procedure involves resection of the AN with reattachment of the posterior tibial tendon (PTT) to the navicular, while simple excision involves only resection of the AN. Similar improvements in subjective clinical outcomes were observed across all procedures. The complication rate in the Kidner cohort was 11%, while the arthrodesis cohort demonstrated the highest complication rate (25%) and failure rate (3%). The highest rate of radiographic nonunion was identified in the percutaneous drilling cohort (42%). Age did not appear to influence either clinical outcomes or radiographic outcomes.

Conclusions: This systematic review demonstrated satisfactory clinical and radiological outcomes following surgical intervention for symptomatic accessory navicular with moderate complication and failure rates. The most frequently utilized surgical technique was the Kidner procedure and its modifications, which demonstrated excellent clinical and radiological outcomes and is, therefore, the recommended surgical technique for the management of all subtypes of symptomatic AN. Concerning non-union rates were found in the arthrodesis, arthroeresis, and percutaneous drilling cohorts, which may predispose these techniques to failure in the long-term and, thus, are not recommended for the treatment of symptomatic AN. The lack of high-quality studies with a low level of evidence emphasizes the need for better quality comparative studies.Levels of Evidence: IV.

Introduction: Several types of fifth metatarsal (MT) fractures exist and are treated with various methods of immobilization, weight bearing restrictions, and occasionally operative procedures. This study evaluated the differences in clinical and radiographic outcomes among pseudo-Jones fractures (Zones 1 and 2), true Jones fractures (Zone 3), and fifth metatarsal shaft and neck fractures.

Methods: A retrospective review of a consecutive series of patients presenting to a single academic medical center with a fifth metatarsal fracture between 2012 and 2022 was conducted. Radiographs obtained at the initial presentation were reviewed, and fracture patterns were categorized as either Zone 1, Zone 2, Zone 3, shaft, neck, or head fractures.

Results: In total, 1314 patients with isolated fifth metatarsal fractures were treated (mean age = 49.6 ± 18.0 years). In total, 1217 fractures (92.5%) were initially treated nonoperatively, and 97 fractures (7.5%) were treated operatively. The overall time to clinical and radiographic healing for all fifth metatarsal fractures treated nonoperatively was 9.9 ± 8.7 weeks and 17.9 ± 15.6 weeks, respectively (P = .245, P = .088). Immediate weightbearing led to a faster time to clinical healing by (P = .035). There was no statistically significant difference in time to clinical or radiographic union among the different fracture types (P = .496, P = .400). Likewise, there was no evidence of any difference in time to clinical or radiographic union for patients treated operatively versus nonoperatively (P > .05).

Conclusion: This study demonstrates all closed isolated fifth metatarsal fractures can be successfully treated nonoperatively with immediate weightbearing and similar times to clinical and radiographic healing.Levels of Evidence: III.

Objectives: The purpose of our study is to offer further insight in the decision-making for surgical timing to better minimize risk of post operative soft tissue complications.

Design: Our retrospective study evaluated 296 patients who had an ankle open reduction internal fixation (ORIF) that met our inclusion and exclusion criteria.

Methods: We attempted to exclude other factors that would influence outcomes of soft tissue complications such as comorbidities, age, open injuries or any prior surgeries to the same region. Outcomes of interest included surgical site infections (superficial and deep) as well as wound healing delay. In addition, we also evaluated complications of ankle fracture surgery based on the type of ORIF.

Results: Our average time to surgical intervention was 4.4 days with 85 patients (28.7%) having surgery less than 2 days from injury, 144 patients (48.6%) having surgery between 2 and 6 days, and 67 patients (22.6%) having surgery 7 days or greater from injury. We found a lack of significant difference in surgical site infection rates or wound healing time between those who had an ankle ORIF less than 2 days, 2 and 6 days or 7 days or greater 7 days from injury. However, patients who had an ORIF of a trimalleolar fracture with posterior malleolar fixation had a significantly higher rate of superficial surgical site infection (13.3%) compared with those who only had a lateral malleolar ORIF (1.4%).

Conclusions: Based on our results, we found a lack of significant difference in soft tissue complications between our time points based on prior literature when the soft tissue envelope is stable. This knowledge can help guide scheduling decisions to avoid unnecessary hospital costs, late night ankle ORIF, and improve surgeon quality of life without compromising patient care. Further randomized controlled trials or larger samples sizes with less variance distribution are needed to validate this topic.Levels of Evidence: 3.

Background: Plantar fasciitis (PF) is a common condition, affecting 10% of adults and accounting for 15% of foot pain consultations. Although 90% of cases resolve within 12 months with conservative treatments, chronic cases require more invasive treatments. Risk factors include a high body mass index and anatomical foot disorders. There is no standard treatment; options range from nonsteroidal anti-inflammatory drugs (NSAIDs) to surgery. Corticosteroids, while effective short term, can cause severe side effects. Platelet-rich plasma (PRP) has shown long-term effectiveness, alleviating pain and improving functionality.

Methods: This study, registered in PROSPERO and following PRISMA guidelines, searched for randomized clinical trials in PubMed, Scopus, Cochrane, and Web of Science comparing PRP with corticosteroids from 2019 to April 2024. It focused on patients with PF treated with PRP versus corticosteroids and their improvement in visual analog scale (VAS) pain scores. Randomized clinical trials were included, and the risk of bias was assessed using the Cochrane tool. Visual analog scale pain scores were analyzed using mean differences and a 95% CI. Heterogeneity was assessed with Q and I² tests. A random-effects model was used if significant heterogeneity was present; otherwise, a fixed-effects model was applied. Analysis was conducted with Review Manager 5.4.

Results: Thirteen trials met the inclusion criteria, involving 901 subjects (497 with PRP and 404 with corticosteroids). In the short term, there were no significant differences in pain reduction (P = .85). In the medium term, PRP showed better results in VAS pain scores (P < .00001).

Conclusion: PRP is a safe and effective alternative for treating PF pain, with better results than corticosteroids in the medium term. Platelet-rich plasma is recommended as the preferred option in the management of chronic PF.

BackgroundBilling and coding for orthopaedic procedures is a complex process with thousands of procedure codes and associated modifiers in existence. Foot and ankle faces an additional challenge as it is among the highest variability regarding procedures performed compared with other orthopaedic subspecialities. This study aimed to investigate the capabilities of the top AI search engines in accurately identifying Current Procedural Terminology (CPT) codes for common foot and ankle procedures.MethodsA comparative analysis of 3 publically available AI search engines (ChatGPT, Bing, and Google Gemini) was performed investigating their accuracy in generating CPT codes for common orthopaedic foot and ankle procedures. The generated CPT codes were recorded and compared with the codes generated by 3 fellowship trained foot and ankle surgeons, serving as the reference standard. Cohen kappa coefficient was used to determine agreement across AI platforms regarding the surgeon coding reference standard. ResultsThe AI search engines were able to correctly generate the appropriate CPT codes 44% of the time, with Bing being the most accurate in generating the correct CPT codes for 8 of the 13 procedures (62%) and partially correct codes 3 of the 13 procedures (23%). ChatGPT demonstrated the worst accuracy, generating the correct CPT codes only 23% of the time (3/13). AI platforms demonstrated an overall Fair Agreement with the reference standard (kappa = 0.201). Individually, Bing demonstrated Moderate Agreement (kappa = 0.405), Google Gemini demonstrated Fair Agreement (kappa = 0.255), and ChatGPT demonstrated Poor Agreement with the reference standard (kappa = 0.171).ConclusionAlthough the capabilities of AI show great promise for many industries, the results of this study bring caution to relying on AI for accurately generating orthopaedic foot and ankle procedure CPT codes.Level of Evidence:III, Comparative Study.

Purpose: This study aimed to evaluate the stability of bimalleolar ankle fracture fixation techniques (bicortical and unicortical lag screw) in simulated progressive rehabilitation with a walking boot.

Methods: Five matched pairs of lower extremities underwent simulated bimalleolar ankle fracture and were randomly assigned into these 2 repair groups. Each specimen was tested under an axial compression cyclic load test for 10000 cycles at a rate of 1 Hz while the ankle was held in 30° inclination. Radiographic assessments (screw attached lengths [length from screw head to far cortex], fracture gap, and joint clear space [medial, superior, and lateral]) by 3 examiners were performed at 0th, 5000th, and 10000th cycles. Three repeated measurements by each examiner.

Results: The overall level of intra-rater reliability for all 3 raters and all measurements were found to be within "moderate" to "excellent" agreement. For radiographic screw loosening and fracture displacement, evaluation found that at no time point did either the bicortical group or the unicortical group meet the minimal threshold of clinical failure which defined as 2-mm of screw displacement or 2-mm of fracture displacement.

Conclusion: Both bicortical and traditional unicortical lag screw fixation techniques provide equivalent stability for medial malleolar fractures in a bimalleolar ankle fracture during simulated progressive rehabilitation with a walking boot. This could potentially have clinical benefits in patient care with earlier return to function, prevention of stiffness and loss of range of motion, and decreased muscle atrophy during the postoperative rehabilitation period.Level of Evidence: Level V: bench top testing.