Foot & ankle surgery (New York, N.Y.)最新文献

Our aim is to illustrate a rare case report of a painful benign spindle cell neoplasm of fibroma within the tendon sheath in the great toe of a 14 year old female that aggressively infiltrated the EHL tendon. Our patient reported one year after noticing the lesion on her foot after she was stepped on during physical education class and over the course of the year the mass continued to progress and expand making it painful and difficult to wear shoe gear. An MRI was completed which showed concern for a giant cell tumor, although surgical pathology determined it to be a benign spindle cell neoplasm of the tendon sheath. Of note, some pathologists believe that the precursor to said lesion is a giant cell tumor, which may be the reason the tumor aggressively infiltrated the long extensor tendon of the great toe. A staged procedure was carried out, first with complete surgical excision of the tumor followed by reconstruction of the tendon with a split peroneus longus autograft.

Traumatic periprosthetic fractures around total ankle replacements (TARs) are not well documented in the literature, with less than 13 total cases described. These injuries present reconstructive challenges to the treating surgeon. TAR usage continues to rise, and thus traumatic periprosthetic ankle fractures will likely become more frequent. Current literature discussing the classification, treatment, and outcomes of this pathology is lacking and mostly discusses intra-operative and or stress fractures. The authors retrospectively reviewed 419 patients sustaining ankle fractures at a level 1 trauma center. Two (0.004 %) patients suffered a traumatic periprosthetic ankle fracture and were treated operatively via minimally invasive open reduction internal fixation (ORIF). These patients were followed for a year at the time of publication. Patient outcomes including the union rate, time to union and need for revision were reviewed. Results included 100 % (2/2) fracture union at an average of 5 months. The patients have returned to their pre-operative function level, ambulating unassisted. No re-operations or post-operative complications were noted. To the best of the authors’ knowledge, we report the first case report detailing patient outcomes of post-traumatic periprosthetic fractures after TAR, utilizing the INBONE Total Ankle System ( Wright Medical Group, Memphis, TN).

Artificial intelligence (AI) has gained traction in scientific research, but concerns about plagiarism and fraud have surfaced. This study explores AI detection tools' capacity to distinguish AI-generated from human-generated text in foot and ankle surgery literature. Six publicly available AI detection tools were employed, and 12 abstracts were analyzed, including 6 AI-generated and 6 human-generated. Copyleaks demonstrated the highest raw accuracy (83 %). Overall, the tools exhibited 63 % accuracy, with a 25 % false positive rate. GPTZero, retested after three months, showed increased sensitivity (24.5 %) in identifying AI-generated content. To assess countermeasures, AI-generated abstracts were reworded using ChatGPT 3.5. The rewording led to a 54.83 % decrease in AI content detection. These findings highlight the challenges in reliably detecting AI-generated content in scientific literature, emphasizing the need for robust countermeasures and continued vigilance against potential fraudulent research. The study sheds light on the evolving landscape of AI detection technologies and emphasizes the urgency of adapting journal policies to safeguard against emerging threats.

Lacerations leading to rupture of the extensor hallucis longus (EHL) can occur, subsequently leading to an attenuated or fully dysfunctional tendon. Primary repair can be performed if the tendinous ends are in close enough proximity for reattachment. Nonetheless, utilization of a tendon graft or tendon transfer may be advantageous in restoring EHL function. Depending on the environmental setting, injuries to the foot caused by animals are relatively common. For purposes related to our case report, we will focus our attention on stingrays. Stingrays reside in temperate coastal areas and live on the bottom of the ocean. Injuries due to stingrays frequently occur after a defensive strike to the lower extremity when an individual steps on the fish. Consequences of stingray attacks may include embedded fragments, subsequent infection, envenomation, and skin lacerations. In this article, we describe a case of a 69-year-old male who reported to the podiatry clinic after suffering a stingray strike to his left foot, which left him with a dysfunctional left great toe and the inability to dorsiflex. The purpose of our report was twofold: to increase awareness and knowledge of animal-related injuries of the foot, including options for treatment, and to describe a rare case of a repaired EHL tendon using a semitendinosus tendon allograft. To our knowledge, the use of a semitendinosus allograft has not been reported. We describe the use of this free tendon allograft for the primary repair of a ruptured EHL tendon in one patient.

The purpose of this study was to evaluate the results of traditional posterior tibial tendon transfer (PTT) surgery in adult patients with spastic equinovarus foot (SVEF) after a stroke, in order to identify the effectiveness of the surgical procedure.

A total of twelve patients with systolic ventricular ejection fraction (SVEF) were subjected to percutaneous tenotomy and tenodesis (PTT) surgery, wherein the tendon was removed from its original attachment point and redirected anteriorly via the interosseous membrane without any division. The surgical results were evaluated during the six-month and twelve-month follow-up assessments. The functional scores were examined using the Stanmore questionnaire, and the range of motion of the affected foot was evaluated for dorsiflexion and plantarflexion at the six-month follow-up. Furthermore, radiological X-rays were acquired from every patient. A year after the operation, a thorough analysis of the patients' walking patterns in three dimensions was conducted. The measurements obtained were then compared to the initial data collected from each patient before the surgery.

The patients' functional scores exhibited a substantial enhancement, rising from a low average score of fifty-three to an outstanding average score of eighty-five. Plantarflexion and ankle dorsiflexion both showed improvement, with ankle dorsiflexion demonstrating a statistically significant improvement (P < 0.001) compared to plantarflexion (P = 0.06). The Equinus and varus abnormalities were effectively corrected (P = 0.016) without any instances of under- or over-correction. The gait analysis revealed enhancements in the overall gait, as well as increased flexibility in the ankle and knee joints during the swinging phase of walking. The gait analysis included dynamic electromyography (EMG), which showed a substantial improvement in the gastrocnemius muscle after therapy (p = 0.025). Therefore, this initial phase investigation offers preliminary proof that the provided treatment can successfully enhance specific spatio-temporal gait metrics and muscle activation.

The goal of this randomized, controlled, single-blind clinical trial was to compare the efficacy of synthetic electrospun fiber matrix (SEFM) with standard of care (SOC) in the treatment of diabetic foot ulcers (DFUs). Patients with DFUs ≤30 cm² were randomized to receive either SEFM (RESTRATA®, Acera Surgical, Inc., St. Louis, MO) or SOC weekly for up to 12 weeks. SOC included foam or alginate dressing changes. The primary endpoint measure was the percentage of wounds achieving 100 % re-epithelialization at 12 weeks. Secondary endpoints included decrease in wound area, time to closure, and number of applications. Forty-six subjects were enrolled and randomized into two groups. In the per protocol (PP) population, 14/19 wounds (74 %) in the SEFM Group demonstrated 100 % re-epithelialization, compared with 6/18 wounds (33 %) in the SOC Group. The proportion of wounds closed and the persistence of wound closure in the SEFM Group was statistically superior to the SOC Group (90 % CI: 0.14, 0.62 / 0.12, 0.65) (Farrington-Manning) in the PP population. Time to complete healing in the SEFM Group (6.6 ± 3.0 weeks) was significantly reduced compared to the SOC Group (p = 0.046, 0.026) (Cox regression) in both the ITT and PP populations. This study represents the first randomized controlled trial to evaluate SEFM in the treatment of chronic DFUs and demonstrates superiority to SOC in achieving 100 % re-epithelialization within 12 weeks.

Clinical trial registry

NCT04918784.

Fusion of the second and third tarsometatarsal joints is utilized for various arthritic pathologies and traumatic conditions. A cadaveric study using 20 fresh-frozen transtibial specimens were used for a stimulated arthrodesis study. Half of the specimens underwent drilling via drill guide for a respective 15 mm and 20 mm dorsal bridge length staples. Each drill guide was placed equidistant from each joint at 7.5 mm for the 15 mm bridge length and 10 m for the 20 m bridge length, then drilled bicortically in parallel with the joint line. For the 15 mm bridge length on the second metatarsal, the mean depth was 22.5 mm ± 2.2, and was 26.7 mm ± 3.8 proximal on the intermediate cuneiform. For the 20 mm bridge length on the second metatarsal, the mean depth was 22.3 mm ± 2.2 and was 27.2 mm ± 2.0 proximal on the intermediate cuneiform. For the 15 mm bridge length for the third metatarsal mean depth was 21.5 mm ± 3.2, and was 24.2 mm ± 2.9 proximal on the lateral cuneiform. For the 20 mm bridge length on the third metatarsal, the mean depth was 20.3 mm ± 2.4 and was 24.6 mm ± 2.4 proximal on the lateral cuneiform. A student's two tailed homoscedastic t-Test was calculated for the 7.5 mm vs 10 mm distal and proximal distances for both second and third TMT data sets and found there was no significant differences in depth.

The current study found that for both 15 mm and 20mm bridge lengths for 2^nd TMT fusions a 22 mm leg length can be used appropriate and similarly for 3^rd TMT fusions, a 20 m leg length appears to be appropriate fixation. Although variations will exist, advances towards indication specific fixation may allow for varied leg length for optimal boney purchase.

We report the use of sodium fluorescein (SF) as an additional visualization tool during resection of a schwannoma of the foot. A 56-year-old woman presented with excruciating left foot pain that was aggravated by standing and associated with paresthesia under her foot. Magnetic resonance imaging (MRI) revealed a contrast-enhancing lesion in the region of the medial plantar nerve. Microsurgical excision of the lesion was performed with intraoperative neurological monitoring and sodium fluorescein (SF) as a visual aid. Following administration of SF intravenously, under the Yellow-560 filter lens of the operating microscope, the schwannoma demonstrated a bright green fluorescence that distinguished it from adjacent normal structures. A complete resection of the tumor was achieved and the patient's symptoms resolved completely. No complications were noted due to the SF administration. The patient remains symptom-free at a 1.5-year follow-up with no evidence of tumor recurrence. SF is a safe and effective tool to assist visualization of schwannomas of the foot.