Pub Date : 2025-10-09DOI: 10.1016/j.fastrc.2025.100578
Susanna Oppong B.S. PMS-3, Amber del Rosario B.S. PMS-3, Steffi Casimir B.S. M.S. PMS-3, Jasmine Atri B.S. PMS-3, Dr. Mark Razzante DPM
This study investigates titanium (Ti) hypersensitivity in surgical implants, which can cause complications like implant failure and inflammation. The goal is to evaluate diagnostic methods, particularly skin patch testing versus the Memory Lymphocyte Immunostimulation Assay (MELISA), to improve outcomes for patients with metal sensitivities. A literature search using databases such as Google Scholar and PubMed identified 18 peer-reviewed studies from 2006 to 2024, focusing on titanium implant reactions. Inclusion criteria involved studies with clinical or experimental data on Ti hypersensitivity, excluding non-metallic implant failures and unrelated hypersensitivity reactions. Titanium hypersensitivity, though rare, can result in chronic inflammation and implant failure in foot and ankle surgeries. Patch testing often fails to detect deep tissue reactions, while MELISA testing shows greater accuracy. Alternative materials, such as ceramic or niobium, may be better for patients with metal allergies. MELISA testing is a more reliable tool for diagnosing metal hypersensitivity than patch testing. Surgeons should consider preoperative MELISA testing and alternative implants to reduce hypersensitivity risks, improving patient outcomes. Preoperative MELISA testing should be standard for titanium implant patients to minimize allergic reactions.
{"title":"Titanium implants and type IV hypersensitivity reactions: A systematic literature review","authors":"Susanna Oppong B.S. PMS-3, Amber del Rosario B.S. PMS-3, Steffi Casimir B.S. M.S. PMS-3, Jasmine Atri B.S. PMS-3, Dr. Mark Razzante DPM","doi":"10.1016/j.fastrc.2025.100578","DOIUrl":"10.1016/j.fastrc.2025.100578","url":null,"abstract":"<div><div>This study investigates titanium (Ti) hypersensitivity in surgical implants, which can cause complications like implant failure and inflammation. The goal is to evaluate diagnostic methods, particularly skin patch testing versus the Memory Lymphocyte Immunostimulation Assay (MELISA), to improve outcomes for patients with metal sensitivities. A literature search using databases such as Google Scholar and PubMed identified 18 peer-reviewed studies from 2006 to 2024, focusing on titanium implant reactions. Inclusion criteria involved studies with clinical or experimental data on Ti hypersensitivity, excluding non-metallic implant failures and unrelated hypersensitivity reactions. Titanium hypersensitivity, though rare, can result in chronic inflammation and implant failure in foot and ankle surgeries. Patch testing often fails to detect deep tissue reactions, while MELISA testing shows greater accuracy. Alternative materials, such as ceramic or niobium, may be better for patients with metal allergies. MELISA testing is a more reliable tool for diagnosing metal hypersensitivity than patch testing. Surgeons should consider preoperative MELISA testing and alternative implants to reduce hypersensitivity risks, improving patient outcomes. Preoperative MELISA testing should be standard for titanium implant patients to minimize allergic reactions.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100578"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.fastrc.2025.100575
Lucian M. Feraru DPM, FACFAS , Mikhail Samchukov MD
Diabetic foot ulcers (DFUs), particularly in the Achilles region, pose significant challenges for limb salvage due to poor perfusion and high infection risk. Transverse tibial bone transport (TTBT), utilizing distraction osteogenesis, enhances local blood flow and promotes tissue regeneration(1, 2). This case report describes a high-risk 60- year-old female patient with a chronic Achilles tendon ulcer refractory to standard treatments who underwent TTBT. The procedure successfully resulted in complete wound healing and limb salvage, avoiding major amputation. This report discusses the clinical details and implications of TTBT as an effective intervention in managing recalcitrant diabetic foot ulcers.
Background: Diabetic foot ulcers at the posterior heel/Achilles are difficult to heal due to limited soft tissue, high stress, and microvascular disease, often ending in major amputation.
Purpose: To describe limb salvage using transverse tibial bone transport (TTBT) for a recalcitrant Achilles‑region ulcer in a high‑risk patient.
Study Design: Single‑patient case report.
Methods: A 60‑year‑old woman with type 2 diabetes, peripheral arterial disease, renal disease, and calcaneal osteomyelitis had a chronic 16 × 8 cm posterior heel/Achilles ulcer refractory to revascularization, antibiotics, and advanced wound care. After radical debridement, a circular external fixator was applied with a tibial corticotomy and TTBT module. Following a 7‑day latency, distraction was performed at 0.25 mm twice daily for 28 days, then compression 0.25 mm four times daily for 14 days until redocking. External fixation continued for consolidation.
Results: Granulation developed during distraction; ulcer dimensions decreased ∼50 % by frame removal. Complete epithelialization occurred by 20 weeks with infection control and limb preservation. Postoperative CT angiography showed a patent anterior tibial artery with collateral reconstitution of the peroneal and posterior tibial arteries, consistent with improved microcirculation. A superficial plantar heel ulcer related to calcaneal‑gait biomechanics after Achilles resection healed with offloading and local care. At 12‑month follow‑up the limb remained salvaged with functional recovery.
Conclusion: TTBT may augment local perfusion and support healing of intractable Achilles‑region diabetic ulcers in selected patients. When macro‑revascularization is insufficient or contraindicated, TTBT offers a driven limb‑salvage option that targets distal microcirculatory failure while avoiding free‑tissue transfer in compromised hosts.
{"title":"Limb salvage with transverse tibial bone transport in a high-risk patient with a Chronic Achilles Tendon Ulcer: a case report","authors":"Lucian M. Feraru DPM, FACFAS , Mikhail Samchukov MD","doi":"10.1016/j.fastrc.2025.100575","DOIUrl":"10.1016/j.fastrc.2025.100575","url":null,"abstract":"<div><div>Diabetic foot ulcers (DFUs), particularly in the Achilles region, pose significant challenges for limb salvage due to poor perfusion and high infection risk. Transverse tibial bone transport (TTBT), utilizing distraction osteogenesis, enhances local blood flow and promotes tissue regeneration(1, 2). This case report describes a high-risk 60- year-old female patient with a chronic Achilles tendon ulcer refractory to standard treatments who underwent TTBT. The procedure successfully resulted in complete wound healing and limb salvage, avoiding major amputation. This report discusses the clinical details and implications of TTBT as an effective intervention in managing recalcitrant diabetic foot ulcers.</div><div>Background: Diabetic foot ulcers at the posterior heel/Achilles are difficult to heal due to limited soft tissue, high stress, and microvascular disease, often ending in major amputation.</div><div>Purpose: To describe limb salvage using transverse tibial bone transport (TTBT) for a recalcitrant Achilles‑region ulcer in a high‑risk patient.</div><div>Study Design: Single‑patient case report.</div><div>Methods: A 60‑year‑old woman with type 2 diabetes, peripheral arterial disease, renal disease, and calcaneal osteomyelitis had a chronic 16 × 8 cm posterior heel/Achilles ulcer refractory to revascularization, antibiotics, and advanced wound care. After radical debridement, a circular external fixator was applied with a tibial corticotomy and TTBT module. Following a 7‑day latency, distraction was performed at 0.25 mm twice daily for 28 days, then compression 0.25 mm four times daily for 14 days until redocking. External fixation continued for consolidation.</div><div>Results: Granulation developed during distraction; ulcer dimensions decreased ∼50 % by frame removal. Complete epithelialization occurred by 20 weeks with infection control and limb preservation. Postoperative CT angiography showed a patent anterior tibial artery with collateral reconstitution of the peroneal and posterior tibial arteries, consistent with improved microcirculation. A superficial plantar heel ulcer related to calcaneal‑gait biomechanics after Achilles resection healed with offloading and local care. At 12‑month follow‑up the limb remained salvaged with functional recovery.</div><div>Conclusion: TTBT may augment local perfusion and support healing of intractable Achilles‑region diabetic ulcers in selected patients. When macro‑revascularization is insufficient or contraindicated, TTBT offers a driven limb‑salvage option that targets distal microcirculatory failure while avoiding free‑tissue transfer in compromised hosts.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100575"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-27DOI: 10.1016/j.fastrc.2025.100574
Levi Smith DPM , Hughes Ackom DPM , Rachel A Murphy MS , Andrew Elliott DPM, FACFAS
Background
With the increasing use of minimally invasive surgical (MIS) techniques in the field of hallux abductovalgus (HAV) correction, foot and ankle surgeons are utilizing third-generation techniques, such as the minimally invasive chevron Akin (MICA) osteotomy, to repair bunions ranging in severity from mild to severe. Literature identifying the correction of severe HAV deformities with MIS techniques is sparse.
Purpose
A systematic review is presented of peer-reviewed sources to analyze complications, pre- and postoperative radiographic analysis, and patient-reported outcomes in correction of severe HAV deformity with the MICA surgical approach.
Study Design/Methods
After review of multiple databases, 4 articles were obtained matching our inclusion criteria, with 236 total feet.
Results
Complication rates ranged from 18.8 % to 24.2 %, while recurrence rates ranged from 3.8 % to 7.5 %. Average intermetatarsal angle improved from 17.81 degrees to 6.59 degrees, and hallux valgus angle improved from 42.18 degrees to 8.94 degrees. Improvements in the two radiographic angles were statistically significant. Improvement in patient-reported outcomes was appreciated among studies but unable to be analyzed statistically owing to low sample size and heterogeneity in reporting.
Conclusion
Thissystematic review revealed that the use of the MICA technique to correct severe HAV deformity showed significant improvement of radiographic angles, acceptable patient-reported outcomes, and complication and recurrence rates similar to those reporting on less severe deformity correction.
{"title":"Surgical correction of severe hallux abducto-valgus deformity with minimally invasive chevron akin osteotomy: A systematic review","authors":"Levi Smith DPM , Hughes Ackom DPM , Rachel A Murphy MS , Andrew Elliott DPM, FACFAS","doi":"10.1016/j.fastrc.2025.100574","DOIUrl":"10.1016/j.fastrc.2025.100574","url":null,"abstract":"<div><h3>Background</h3><div>With the increasing use of minimally invasive surgical (MIS) techniques in the field of hallux abductovalgus (HAV) correction, foot and ankle surgeons are utilizing third-generation techniques, such as the minimally invasive chevron Akin (MICA) osteotomy, to repair bunions ranging in severity from mild to severe. Literature identifying the correction of severe HAV deformities with MIS techniques is sparse.</div></div><div><h3>Purpose</h3><div>A systematic review is presented of peer-reviewed sources to analyze complications, pre- and postoperative radiographic analysis, and patient-reported outcomes in correction of severe HAV deformity with the MICA surgical approach.</div></div><div><h3>Study Design/Methods</h3><div>After review of multiple databases, 4 articles were obtained matching our inclusion criteria, with 236 total feet.</div></div><div><h3>Results</h3><div>Complication rates ranged from 18.8 % to 24.2 %, while recurrence rates ranged from 3.8 % to 7.5 %. Average intermetatarsal angle improved from 17.81 degrees to 6.59 degrees, and hallux valgus angle improved from 42.18 degrees to 8.94 degrees. Improvements in the two radiographic angles were statistically significant. Improvement in patient-reported outcomes was appreciated among studies but unable to be analyzed statistically owing to low sample size and heterogeneity in reporting.</div></div><div><h3>Conclusion</h3><div>Thissystematic review revealed that the use of the MICA technique to correct severe HAV deformity showed significant improvement of radiographic angles, acceptable patient-reported outcomes, and complication and recurrence rates similar to those reporting on less severe deformity correction.</div></div><div><h3>Level of Evidence</h3><div>Level 4</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100574"},"PeriodicalIF":0.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.fastrc.2025.100573
Jan MA Mens MD, PhD
Background
Treatment of Achilles tendinopathy (AT) typically consists of progressive exercise, load management, and patient education. The use of paratendinous administration is controversial. Improvement with conventional measures is often insufficient, creating a need for alternative solutions.
Purpose
Purpose is to describe the outcomes of patients treated with intramuscular corticosteroid-injections in combination with exercises.
Study design
retrospective analysis of a case series.
Methods
Baseline data and short-term outcomes were collected from patient records treated in our clinic. Follow-up results were gathered by means of structured telephonic interviews. AT was defined as pain in the Achilles tendon during activities with at least two of the following criteria: pain on tiptoe standing, swelling and/or tenderness 2–7 cm above the insertion, ultrasound signs of tendinopathy.
Results
Ten patients were included. The median duration of symptoms was 12 months (IQR 23). Patients reported improvement after 5.6 days (SD 4.8).The treatment reached its maximum effect at 6.2 weeks (SD 3.4). At the end of the 2–12 week intervention, six patients felt completely recovered and four reported feeling much better. At follow-up (23 months, SD 17), seven patients felt completely recovered and three much better. The median NRS pain score changed from 8 at baseline to 0 (p = 0.002), and the mean VISA-A score from 37 to 95 (p < 0.0001). No major adverse events were observed.
Conclusion
one or two intramuscular corticosteroid injections combined with concentric–eccentric exercises may offer rapid and sustained relief for patients with midportion AT.
{"title":"Intramuscular corticosteroids combined with exercise for refractory midportion achilles tendinopathy: A case series","authors":"Jan MA Mens MD, PhD","doi":"10.1016/j.fastrc.2025.100573","DOIUrl":"10.1016/j.fastrc.2025.100573","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of Achilles tendinopathy (AT) typically consists of progressive exercise, load management, and patient education. The use of paratendinous administration is controversial. Improvement with conventional measures is often insufficient, creating a need for alternative solutions.</div></div><div><h3>Purpose</h3><div>Purpose is to describe the outcomes of patients treated with intramuscular corticosteroid-injections in combination with exercises.</div></div><div><h3>Study design</h3><div>retrospective analysis of a case series.</div></div><div><h3>Methods</h3><div>Baseline data and short-term outcomes were collected from patient records treated in our clinic. Follow-up results were gathered by means of structured telephonic interviews. AT was defined as pain in the Achilles tendon during activities with at least two of the following criteria: pain on tiptoe standing, swelling and/or tenderness 2–7 cm above the insertion, ultrasound signs of tendinopathy.</div></div><div><h3>Results</h3><div>Ten patients were included. The median duration of symptoms was 12 months (IQR 23). Patients reported improvement after 5.6 days (SD 4.8).The treatment reached its maximum effect at 6.2 weeks (SD 3.4). At the end of the 2–12 week intervention, six patients felt completely recovered and four reported feeling much better. At follow-up (23 months, SD 17), seven patients felt completely recovered and three much better. The median NRS pain score changed from 8 at baseline to 0 (<em>p</em> = 0.002), and the mean VISA-A score from 37 to 95 (<em>p</em> < 0.0001). No major adverse events were observed.</div></div><div><h3>Conclusion</h3><div>one or two intramuscular corticosteroid injections combined with concentric–eccentric exercises may offer rapid and sustained relief for patients with midportion AT.</div></div><div><h3>Level of Clinical Evidence</h3><div>4</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100573"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.fastrc.2025.100572
Gil Genuth , Martin Keith Ulrich , Markus Damrau , Lukas D Iselin
Background
Patients with spinal cord injury (SCI), particularly those with paraplegia, often develop rigid foot deformities such as spastic pes cavovarus due to unopposed muscle activity and chronic spasticity. These deformities compromise seating alignment, hinder passive standing programs, and significantly increase the risk of pressure ulcers (PUs), especially at the heel, lateral border, first metatarsal head, and lateral malleolus. Conservative treatments often fail in severe, fixed deformities, necessitating surgical intervention.
This study aimed to evaluate the clinical and radiographic outcomes of hindfoot arthrodesis using intramedullary nail (IMN) fixation in paraplegic patients with spastic foot deformities, focusing on fusion rates, PU recurrence, and improvements in wheelchair positioning.
Methods
This retrospective case series included eight paraplegic patients (mean age: 34 years) with fixed pes cavovarus deformities treated between 2015 and 2019. All underwent percutaneous soft tissue release and open hindfoot joint preparation, followed by IMN fixation using a hindfoot nail. Radiographic fusion was assessed at 3, 6, and 9 months via standard radiographs and selected CT scans. Clinical follow-up lasted at least 12 months.
Results
Radiographic fusion was achieved in 75 % of cases. All patients showed clinical improvement in seating alignment and tolerance to gravity-loading protocols. Two patients had asymptomatic non-union. Postoperative complications included two superficial infections, one new PU, and two cases of symptomatic screw protrusion requiring hardware removal.
Conclusion
Hindfoot arthrodesis using IMN offers a promising surgical option for SCI patients with rigid foot deformities. It enables plantigrade alignment, supports pressure redistribution, and improves functional seating. Despite a small sample size, the outcomes justify further prospective studies to confirm its role in this complex, underserved population.
{"title":"Managing complex foot deformities in paraplegia: Outcomes of intramedullary hindfoot arthrodesis for spastic pes cavovarus; A case series review","authors":"Gil Genuth , Martin Keith Ulrich , Markus Damrau , Lukas D Iselin","doi":"10.1016/j.fastrc.2025.100572","DOIUrl":"10.1016/j.fastrc.2025.100572","url":null,"abstract":"<div><h3>Background</h3><div>Patients with spinal cord injury (SCI), particularly those with paraplegia, often develop rigid foot deformities such as spastic pes cavovarus due to unopposed muscle activity and chronic spasticity. These deformities compromise seating alignment, hinder passive standing programs, and significantly increase the risk of pressure ulcers (PUs), especially at the heel, lateral border, first metatarsal head, and lateral malleolus. Conservative treatments often fail in severe, fixed deformities, necessitating surgical intervention.</div><div>This study aimed to evaluate the clinical and radiographic outcomes of hindfoot arthrodesis using intramedullary nail (IMN) fixation in paraplegic patients with spastic foot deformities, focusing on fusion rates, PU recurrence, and improvements in wheelchair positioning.</div></div><div><h3>Methods</h3><div>This retrospective case series included eight paraplegic patients (mean age: 34 years) with fixed pes cavovarus deformities treated between 2015 and 2019. All underwent percutaneous soft tissue release and open hindfoot joint preparation, followed by IMN fixation using a hindfoot nail. Radiographic fusion was assessed at 3, 6, and 9 months via standard radiographs and selected CT scans. Clinical follow-up lasted at least 12 months.</div></div><div><h3>Results</h3><div>Radiographic fusion was achieved in 75 % of cases. All patients showed clinical improvement in seating alignment and tolerance to gravity-loading protocols. Two patients had asymptomatic non-union. Postoperative complications included two superficial infections, one new PU, and two cases of symptomatic screw protrusion requiring hardware removal.</div></div><div><h3>Conclusion</h3><div>Hindfoot arthrodesis using IMN offers a promising surgical option for SCI patients with rigid foot deformities. It enables plantigrade alignment, supports pressure redistribution, and improves functional seating. Despite a small sample size, the outcomes justify further prospective studies to confirm its role in this complex, underserved population.</div></div><div><h3>Level of evidence</h3><div>4</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100572"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-20DOI: 10.1016/j.fastrc.2025.100571
Michael A. Coyer DPM FACFAS , James C. Connors DPM FACFAS , Mark A. Hardy DPM FACFAS , Victoria Suggs BS , Kasra Karamlou DPM
A high number of gunshot injuries occur in the lower extremities, making it likely that foot and ankle surgeons will encounter these wounds when involved in lower extremity trauma care. Understanding current thought processes and standards of care regarding high and low velocity wounds is imperative for surgeons to appropriately manage these unique and challenging traumatic injuries. Additionally, it is crucial to consider legal ramifications related to evidence collection, interaction with law enforcement, and witness testimony. This article discusses treatment guidelines that are crucial for patient care as well as preservation of evidence and appropriate documentation for law enforcement.
{"title":"Gunshot wounds in the lower extremities: Treatment review","authors":"Michael A. Coyer DPM FACFAS , James C. Connors DPM FACFAS , Mark A. Hardy DPM FACFAS , Victoria Suggs BS , Kasra Karamlou DPM","doi":"10.1016/j.fastrc.2025.100571","DOIUrl":"10.1016/j.fastrc.2025.100571","url":null,"abstract":"<div><div>A high number of gunshot injuries occur in the lower extremities, making it likely that foot and ankle surgeons will encounter these wounds when involved in lower extremity trauma care. Understanding current thought processes and standards of care regarding high and low velocity wounds is imperative for surgeons to appropriately manage these unique and challenging traumatic injuries. Additionally, it is crucial to consider legal ramifications related to evidence collection, interaction with law enforcement, and witness testimony. This article discusses treatment guidelines that are crucial for patient care as well as preservation of evidence and appropriate documentation for law enforcement.</div></div><div><h3>Level of Evidence</h3><div>5</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100571"},"PeriodicalIF":0.0,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Schwannomas can present as soft tissue masses in the foot and ankle that mimic other conditions. This report presents a rare case of schwannoma arising within the abductor hallucis muscle belly in a 53-year-old female with past medical history of rheumatoid arthritis. The patient presented with a year-long history of left foot pain and a slowly enlarging, palpable mass on the plantar medial aspect of the foot. Initial evaluation and imaging revealed a well-circumscribed soft tissue mass with internal vascularity. However, due to medical history and overlapping clinical and imaging features, the differential diagnosis, among others, included rheumatoid nodules. Surgical excision of the mass was performed, and histopathology confirmed the diagnosis of traditional schwannoma. This report underlines the diagnostic challenge of distinguishing schwannomas from rheumatoid nodules and other types of soft tissue masses, specifically in patients with autoimmune disease. We discuss the clinical, radiological, and pathological aspects of this rare tumor. Definitive diagnosis requires histological analysis, as imaging alone may be inconclusive.
{"title":"A rare presentation of an abductor hallucis soft tissue mass: A case report","authors":"Ksenja Llazar DPM , Nayab Khan DPM , Michael Loshigian DPM, FACFAS","doi":"10.1016/j.fastrc.2025.100570","DOIUrl":"10.1016/j.fastrc.2025.100570","url":null,"abstract":"<div><div>Schwannomas can present as soft tissue masses in the foot and ankle that mimic other conditions. This report presents a rare case of schwannoma arising within the abductor hallucis muscle belly in a 53-year-old female with past medical history of rheumatoid arthritis. The patient presented with a year-long history of left foot pain and a slowly enlarging, palpable mass on the plantar medial aspect of the foot. Initial evaluation and imaging revealed a well-circumscribed soft tissue mass with internal vascularity. However, due to medical history and overlapping clinical and imaging features, the differential diagnosis, among others, included rheumatoid nodules. Surgical excision of the mass was performed, and histopathology confirmed the diagnosis of traditional schwannoma. This report underlines the diagnostic challenge of distinguishing schwannomas from rheumatoid nodules and other types of soft tissue masses, specifically in patients with autoimmune disease. We discuss the clinical, radiological, and pathological aspects of this rare tumor. Definitive diagnosis requires histological analysis, as imaging alone may be inconclusive.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100570"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-14DOI: 10.1016/j.fastrc.2025.100568
Derek A. Swanson PMSIII , Robert Lee PMSIII , Annie Phan OMSIII, MA , Janna Kroleski DPM, MS
Lipofibromatosis-like neural tumors (LPF-NTs) are a rare form of mesenchymal tumors generally found in children and young adults1. LPF-NTs are a novel tumor type, only recently identified and named with the first case being <10 years ago2. These tumors tend to occur in the distal extremities, presenting as slow-growing benign non-metastatic masses. They display a lipofibromatosis-like structure with an immunophenotype positive for CD34/S100 and NTRK1 gene abnormalities2. Due to LPF-NTs rarity and a lack of pain until significant mass expansion, they are often challenging to diagnose making treatment options more challenging3. Conservative treatment will not stop tumor growth or pain long term, causing a need for surgical excision. LPF-NTs, if improperly excised, demonstrate a high rate of local recurrence2. The rarity and diagnostic difficulty of LPF-NTs complicate patient care and increase the risk of misdiagnosis. This case report details a successful surgical removal of an LPF-NT and reviews the literature to improve recognition, diagnosis, and treatment by explicitly focusing on key characteristics, common diagnostic failures, and optimal treatment approaches for an LPF-NT located in the foot.
{"title":"Lipofibromatosis-like neural tumor of the foot: A case study","authors":"Derek A. Swanson PMSIII , Robert Lee PMSIII , Annie Phan OMSIII, MA , Janna Kroleski DPM, MS","doi":"10.1016/j.fastrc.2025.100568","DOIUrl":"10.1016/j.fastrc.2025.100568","url":null,"abstract":"<div><div>Lipofibromatosis-like neural tumors (LPF-NTs) are a rare form of mesenchymal tumors generally found in children and young adults<sup>1</sup>. LPF-NTs are a novel tumor type, only recently identified and named with the first case being <10 years ago<sup>2</sup>. These tumors tend to occur in the distal extremities, presenting as slow-growing benign non-metastatic masses. They display a lipofibromatosis-like structure with an immunophenotype positive for CD34/S100 and NTRK1 gene abnormalities<sup>2</sup>. Due to LPF-NTs rarity and a lack of pain until significant mass expansion, they are often challenging to diagnose making treatment options more challenging<sup>3</sup>. Conservative treatment will not stop tumor growth or pain long term, causing a need for surgical excision. LPF-NTs, if improperly excised, demonstrate a high rate of local recurrence<sup>2</sup>. The rarity and diagnostic difficulty of LPF-NTs complicate patient care and increase the risk of misdiagnosis. This case report details a successful surgical removal of an LPF-NT and reviews the literature to improve recognition, diagnosis, and treatment by explicitly focusing on key characteristics, common diagnostic failures, and optimal treatment approaches for an LPF-NT located in the foot.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100568"},"PeriodicalIF":0.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-14DOI: 10.1016/j.fastrc.2025.100569
Avvi Shabat DPM , Vinay Hosuru Siddappa MD , Sam Lai Huat Lo MD
Bony regrowth following digital amputation in adult diabetic patients is rarely observed. This case report presents a 60-year-old man with diabetes and peripheral neuropathy who underwent partial distal phalanx amputation of the hallux due to osteomyelitis. Radiographic imaging 15 months later revealed unexpected regeneration of approximately 1 cm of bone at the amputation site. We hypothesize that preserved periosteal structures and the patient’s physically active lifestyle contributed to osteogenesis. This case highlights the potential for spontaneous bone regeneration in adults under specific biomechanical and surgical conditions.
{"title":"Unexpected bony regrowth following partial hallux amputation in a diabetic neuropathic foot: A case report","authors":"Avvi Shabat DPM , Vinay Hosuru Siddappa MD , Sam Lai Huat Lo MD","doi":"10.1016/j.fastrc.2025.100569","DOIUrl":"10.1016/j.fastrc.2025.100569","url":null,"abstract":"<div><div>Bony regrowth following digital amputation in adult diabetic patients is rarely observed. This case report presents a 60-year-old man with diabetes and peripheral neuropathy who underwent partial distal phalanx amputation of the hallux due to osteomyelitis. Radiographic imaging 15 months later revealed unexpected regeneration of approximately 1 cm of bone at the amputation site. We hypothesize that preserved periosteal structures and the patient’s physically active lifestyle contributed to osteogenesis. This case highlights the potential for spontaneous bone regeneration in adults under specific biomechanical and surgical conditions.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100569"},"PeriodicalIF":0.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/j.fastrc.2025.100566
Drishti Dhawan , Emily Pugh
Synovial sarcoma is a rare, high-grade soft tissue malignancy that most commonly affects the extremities of adolescents and young adults, with a predilection for the foot and ankle. We present the case of a 47-year-old male with a 12-month history of progressive left foot dorsal swelling and pain. Initial imaging suggested a soft tissue hemangioma; however, surgical excision and subsequent histopathologic and molecular analysis revealed a monophasic synovial sarcoma with SS18-SSX gene fusion. The patient underwent wide re-excision of the tumor bed in coordination with orthopedic oncology. Final pathology confirmed negative margins, and no metastatic disease was identified on PET or chest CT. Given the complete resection and absence of residual disease, adjuvant radiation therapy was deferred. The patient remains disease-free on surveillance imaging at follow-up. This case highlights the diagnostic challenges of synovial sarcoma in the foot and ankle and emphasizes the importance of early biopsy, multidisciplinary coordination, and adherence to oncologic principles for optimal outcomes. Malignancy should remain a consideration in the differential diagnosis of persistent soft tissue masses.
{"title":"Rare presentation of synovial sarcoma in the foot: A case study","authors":"Drishti Dhawan , Emily Pugh","doi":"10.1016/j.fastrc.2025.100566","DOIUrl":"10.1016/j.fastrc.2025.100566","url":null,"abstract":"<div><div>Synovial sarcoma is a rare, high-grade soft tissue malignancy that most commonly affects the extremities of adolescents and young adults, with a predilection for the foot and ankle. We present the case of a 47-year-old male with a 12-month history of progressive left foot dorsal swelling and pain. Initial imaging suggested a soft tissue hemangioma; however, surgical excision and subsequent histopathologic and molecular analysis revealed a monophasic synovial sarcoma with SS18-SSX gene fusion. The patient underwent wide re-excision of the tumor bed in coordination with orthopedic oncology. Final pathology confirmed negative margins, and no metastatic disease was identified on PET or chest CT. Given the complete resection and absence of residual disease, adjuvant radiation therapy was deferred. The patient remains disease-free on surveillance imaging at follow-up. This case highlights the diagnostic challenges of synovial sarcoma in the foot and ankle and emphasizes the importance of early biopsy, multidisciplinary coordination, and adherence to oncologic principles for optimal outcomes. Malignancy should remain a consideration in the differential diagnosis of persistent soft tissue masses.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100566"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号