Pub Date : 2025-05-27DOI: 10.1016/j.fastrc.2025.100512
Mohammed A. Farhan DPM, AACFAS, DABPM , Callie Morlock DPM AACFAS , Saloni Buch DPM , Anna L. Hronek DPM, FACFAS, DABPM, CWSP
Arteriovenous malformation (A-V malformations) are rare malformations that occur in the vascular system. They are often asymptomatic and difficult to diagnose clinically when they are deep. Symptoms usually occur following injury. This case discusses a 28-year-old female who presented with a A-V malformation following a history of stress fracture and the surgical treatment of the condition.
{"title":"Surgical management of a deep arteriovenous malformation in the foot: Case report","authors":"Mohammed A. Farhan DPM, AACFAS, DABPM , Callie Morlock DPM AACFAS , Saloni Buch DPM , Anna L. Hronek DPM, FACFAS, DABPM, CWSP","doi":"10.1016/j.fastrc.2025.100512","DOIUrl":"10.1016/j.fastrc.2025.100512","url":null,"abstract":"<div><div>Arteriovenous malformation (A-V malformations) are rare malformations that occur in the vascular system. They are often asymptomatic and difficult to diagnose clinically when they are deep. Symptoms usually occur following injury. This case discusses a 28-year-old female who presented with a A-V malformation following a history of stress fracture and the surgical treatment of the condition.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 3","pages":"Article 100512"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290963","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 : 2025-05-27DOI: 10.1016/j.fastrc.2025.100510
William Stallings DPM , Uzair Amjad DPM , Timothy P. Cheung DPM, PhD, CPT , Michael I. Gazes DPM, MPH , Fernando Pinero DPM
Plexiform schwannomas are rare benign tumors originating from Schwann cells on the basal lamina in both the peripheral nervous system and the central nervous system. Less common is their presence in the foot and ankle, but when they are found, they usually present on the plantar foot. Although these tumors do not typically metastasize, they can cause serious local complications affecting neural structures, vascular structures, and nearby osseous structures. This case study describes a rare case of plexiform schwannoma of the ankle originating from the superficial peroneal nerve in a 54-year-old woman. Radiographic analysis and persistent symptomatology led to surgical excision and pathologic confirmation of the lesion. Meticulous removal of the tumor alleviated the symptoms without causing any distal neural deficits, highlighting the importance of treatment with careful surgical resection.
{"title":"Benign plexiform schwannoma of the superficial peroneal nerve: A case study","authors":"William Stallings DPM , Uzair Amjad DPM , Timothy P. Cheung DPM, PhD, CPT , Michael I. Gazes DPM, MPH , Fernando Pinero DPM","doi":"10.1016/j.fastrc.2025.100510","DOIUrl":"10.1016/j.fastrc.2025.100510","url":null,"abstract":"<div><div>Plexiform schwannomas are rare benign tumors originating from Schwann cells on the basal lamina in both the peripheral nervous system and the central nervous system. Less common is their presence in the foot and ankle, but when they are found, they usually present on the plantar foot. Although these tumors do not typically metastasize, they can cause serious local complications affecting neural structures, vascular structures, and nearby osseous structures. This case study describes a rare case of plexiform schwannoma of the ankle originating from the superficial peroneal nerve in a 54-year-old woman. Radiographic analysis and persistent symptomatology led to surgical excision and pathologic confirmation of the lesion. Meticulous removal of the tumor alleviated the symptoms without causing any distal neural deficits, highlighting the importance of treatment with careful surgical resection.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 3","pages":"Article 100510"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223465","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 : 2025-05-23DOI: 10.1016/j.fastrc.2025.100511
Kayla Curlis DPM , Quinn Schroeder DPM AACFAS , Bailey Lervick DO , Miranda Montion B.S. , Kyle McKray Smith DPM, FACFAS
Introduction
Arterial vasospasms occurring from foot and ankle trauma, such as severe fracture dislocations, are under-reported throughout the foot and ankle literature. The tunica media of blood vessels is highly sensitive to external stimuli, such as trauma, compression, or traction, which can induce vasospasm.
Body
Here we describe a 25-year-old male who sustained a traumatic injury to the left ankle eliciting a posterior dislocation with associated fractures who subsequently had absent pedal pulses and unobtainable signal on a handheld doppler. CT-angiography revealed reduced vessel caliber along the course of the anterior tibial artery. Following bedside reduction and prior to scheduled surgical intervention, the patient spontaneously regained vascular flow to the lower extremity.
Conclusion
There are very limited reports of posterior ankle fracture dislocation creating an acute limb ischemia from vasospasms in the anterior tibial artery. This case report stands to portray the need for further reporting, follow up, and peri-operative management of patients with vascular compromise to the foot and ankle. A guideline was developed to assist clinicians in the inpatient setting with selecting appropriate imaging modalities to assess vascular status and identify potential compromise.
{"title":"Acute limb ischemia after posterior ankle dislocation with impingement and vasospasm of the anterior tibial artery: a case report and inpatient clinical algorithm","authors":"Kayla Curlis DPM , Quinn Schroeder DPM AACFAS , Bailey Lervick DO , Miranda Montion B.S. , Kyle McKray Smith DPM, FACFAS","doi":"10.1016/j.fastrc.2025.100511","DOIUrl":"10.1016/j.fastrc.2025.100511","url":null,"abstract":"<div><h3>Introduction</h3><div>Arterial vasospasms occurring from foot and ankle trauma, such as severe fracture dislocations, are under-reported throughout the foot and ankle literature. The tunica media of blood vessels is highly sensitive to external stimuli, such as trauma, compression, or traction, which can induce vasospasm.</div></div><div><h3>Body</h3><div>Here we describe a 25-year-old male who sustained a traumatic injury to the left ankle eliciting a posterior dislocation with associated fractures who subsequently had absent pedal pulses and unobtainable signal on a handheld doppler. CT-angiography revealed reduced vessel caliber along the course of the anterior tibial artery. Following bedside reduction and prior to scheduled surgical intervention, the patient spontaneously regained vascular flow to the lower extremity.</div></div><div><h3>Conclusion</h3><div>There are very limited reports of posterior ankle fracture dislocation creating an acute limb ischemia from vasospasms in the anterior tibial artery. This case report stands to portray the need for further reporting, follow up, and peri-operative management of patients with vascular compromise to the foot and ankle. A guideline was developed to assist clinicians in the inpatient setting with selecting appropriate imaging modalities to assess vascular status and identify potential compromise.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 3","pages":"Article 100511"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241813","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 : 2025-05-16DOI: 10.1016/j.fastrc.2025.100504
Michael J. Radcliffe DPM, AACFAS , Ramez Sakkab DPM, AACFAS , Jeffrey E. McAlister DPM, FACFAS
Minimally invasive bunion surgery (MIBS) is an increasingly popular choice in the treatment of hallux valgus. While it is not a new concept, advancements in surgical technique and equipment have reinvigorated the excitement around the procedure. The fourth generation of MIBS traditionally consists of two screws oriented parallel in a transverse or horizontal relationship. The aim of this study is to describe a technical variation in MIBS screw orientation with a sagittal or vertical orientation and evaluate the potential benefits.
The authors performed MIBS on 50 feet across 48 patients according to the fourth generation technique with both standard horizontal screw orientation and a vertical screw orientation variation. Patient outcomes, VAS scores, radiographic foot widths, and complications were recorded and compared between the two groups.
Vertical screw orientation demonstrated similar results compared to horizontal screw orientation in all categories. Vertical screw orientation had the additional benefit of maintaining or decreasing the midshaft width. The authors believe fourth generation MIBS performed with a vertical screw orientation variant is a viable technique with additional benefits compared to traditional horizontal screw orientation, although further follow up studies are required.
{"title":"Fourth generation minimally invasive hallux valgus surgery: A technical variation on two-screw fixation and case series","authors":"Michael J. Radcliffe DPM, AACFAS , Ramez Sakkab DPM, AACFAS , Jeffrey E. McAlister DPM, FACFAS","doi":"10.1016/j.fastrc.2025.100504","DOIUrl":"10.1016/j.fastrc.2025.100504","url":null,"abstract":"<div><div>Minimally invasive bunion surgery (MIBS) is an increasingly popular choice in the treatment of hallux valgus. While it is not a new concept, advancements in surgical technique and equipment have reinvigorated the excitement around the procedure. The fourth generation of MIBS traditionally consists of two screws oriented parallel in a transverse or horizontal relationship. The aim of this study is to describe a technical variation in MIBS screw orientation with a sagittal or vertical orientation and evaluate the potential benefits.</div><div>The authors performed MIBS on 50 feet across 48 patients according to the fourth generation technique with both standard horizontal screw orientation and a vertical screw orientation variation. Patient outcomes, VAS scores, radiographic foot widths, and complications were recorded and compared between the two groups.</div><div>Vertical screw orientation demonstrated similar results compared to horizontal screw orientation in all categories. Vertical screw orientation had the additional benefit of maintaining or decreasing the midshaft width. The authors believe fourth generation MIBS performed with a vertical screw orientation variant is a viable technique with additional benefits compared to traditional horizontal screw orientation, although further follow up studies are required.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 2","pages":"Article 100504"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139405","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 : 2025-05-13DOI: 10.1016/j.fastrc.2025.100505
Hadiya Khan DPM , Lawrence Fallat DPM FACFAS
Talar osteochondral defects (OCD) are debilitating lesions that can involve both the articular cartilage and underlying bone of the talus, often resulting from trauma or repetitive stress. These defects can cause significant pain, joint instability and limited mobility. This case report discusses the successful surgical treatment of an adolescent talar OCD using a distal tibial metaphyseal autograft through a medial malleolar osteotomy in a young patient with closed growth plates. Postoperatively, the patient exhibited full consolidation of the defect, complete resolution of pain, and regained full range of motion in the ankle joint, with a return to unrestricted physical activity. At the three-year post-operative visit, the patient remained asymptomatic, maintained radiographic consolidation of both the tibia and talus, had no limitations in activity and was able to make a full return to sports at six months.
{"title":"Treatment of adolescent talar osteochondral defect with a distal tibial metaphyseal autograft: A case study","authors":"Hadiya Khan DPM , Lawrence Fallat DPM FACFAS","doi":"10.1016/j.fastrc.2025.100505","DOIUrl":"10.1016/j.fastrc.2025.100505","url":null,"abstract":"<div><div>Talar osteochondral defects (OCD) are debilitating lesions that can involve both the articular cartilage and underlying bone of the talus, often resulting from trauma or repetitive stress. These defects can cause significant pain, joint instability and limited mobility. This case report discusses the successful surgical treatment of an adolescent talar OCD using a distal tibial metaphyseal autograft through a medial malleolar osteotomy in a young patient with closed growth plates. Postoperatively, the patient exhibited full consolidation of the defect, complete resolution of pain, and regained full range of motion in the ankle joint, with a return to unrestricted physical activity. At the three-year post-operative visit, the patient remained asymptomatic, maintained radiographic consolidation of both the tibia and talus, had no limitations in activity and was able to make a full return to sports at six months.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 2","pages":"Article 100505"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090428","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 : 2025-05-13DOI: 10.1016/j.fastrc.2025.100507
Payal Sethi DPM PGY , Lawrence M. Fallat DPM, FACFAS
Charcot neuroarthropathy poses a surgical challenge in individuals of all populations. We report a case of a 79-year-old male with Charcot neuroarthropathy and a painful rearfoot varus deformity of the left rearfoot and ankle, who underwent a novel reconstructive procedure. The patient had previously failed conservative treatment and deferred a below-knee amputation in favor of surgical correction. The surgical approach included left ankle arthrodesis, subtalar joint arthrodesis, talectomy, insertion of a tibiotalocalcaneal nail (TTC), and placement of a custom poly-ether-ketone-ketone (PEKK) spacer implant. The surgical approach aimed to stabilize the joint, restore length and alignment, and facilitate healing through autogenous bone grafting and advanced biological materials. No intraoperative or postoperative complications occurred, and postoperative plain film radiographs confirmed correct implant placement and improved rearfoot alignment. Three years postoperatively, the patient had no pain and was able to bear weight on his stable, plantigrade foot without difficulty. This case provides an insight of the applicability of multi-component surgical reconstruction in challenging Charcot deformities with bone loss and rearfoot involvement.
{"title":"Use of custom 3D polyethylene-ether ketone ketone (PEKK) spacer in the treatment of Charcot neuroarthropathy: A case report","authors":"Payal Sethi DPM PGY , Lawrence M. Fallat DPM, FACFAS","doi":"10.1016/j.fastrc.2025.100507","DOIUrl":"10.1016/j.fastrc.2025.100507","url":null,"abstract":"<div><div>Charcot neuroarthropathy poses a surgical challenge in individuals of all populations. We report a case of a 79-year-old male with Charcot neuroarthropathy and a painful rearfoot varus deformity of the left rearfoot and ankle, who underwent a novel reconstructive procedure. The patient had previously failed conservative treatment and deferred a below-knee amputation in favor of surgical correction. The surgical approach included left ankle arthrodesis, subtalar joint arthrodesis, talectomy, insertion of a tibiotalocalcaneal nail (TTC), and placement of a custom poly-ether-ketone-ketone (PEKK) spacer implant. The surgical approach aimed to stabilize the joint, restore length and alignment, and facilitate healing through autogenous bone grafting and advanced biological materials. No intraoperative or postoperative complications occurred, and postoperative plain film radiographs confirmed correct implant placement and improved rearfoot alignment. Three years postoperatively, the patient had no pain and was able to bear weight on his stable, plantigrade foot without difficulty. This case provides an insight of the applicability of multi-component surgical reconstruction in challenging Charcot deformities with bone loss and rearfoot involvement.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 2","pages":"Article 100507"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098663","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 : 2025-05-12DOI: 10.1016/j.fastrc.2025.100506
Melody John DPM , Henna Akbarzai DPM , Michael Subik DPM, FACFAS
The treatment of large bony defects secondary to osteomyelitis in the lower extremity continues to be a challenge in reconstructive surgery. Surgical treatment for osteomyelitis in long bones commonly entails resection of the infected portion of bone, but this often leaves a large bony defect. Masquelet technique has been successfully used in the treatment of osteomyelitis through the concept of induced membrane and the use of antibiotic impregnated polymethylmethacrylate (PMMA) cement. This retrospective case study evaluates the clinical and radiographic outcomes of using a staged approach in the treatment of lower extremity osteomyelitis in 14 patients using an intramedullary antibiotic coated threaded rod. Measured outcomes include time to radiographic fusion (5.1 weeks), time to weight bearing (3.2 weeks), hardware removal (7.14 %), need for revision surgery (7.14 %), and complications (35.71 %). Our findings support the use of a staged approach using a large antibiotic rod prior to definitive fixation as a mode of successfully treating lower extremity osteomyelitis and aiding in joint fusion.
{"title":"Outcomes following use of large diameter antibiotic coated threaded rod for treatment of osteomyelitis","authors":"Melody John DPM , Henna Akbarzai DPM , Michael Subik DPM, FACFAS","doi":"10.1016/j.fastrc.2025.100506","DOIUrl":"10.1016/j.fastrc.2025.100506","url":null,"abstract":"<div><div>The treatment of large bony defects secondary to osteomyelitis in the lower extremity continues to be a challenge in reconstructive surgery. Surgical treatment for osteomyelitis in long bones commonly entails resection of the infected portion of bone, but this often leaves a large bony defect. Masquelet technique has been successfully used in the treatment of osteomyelitis through the concept of induced membrane and the use of antibiotic impregnated polymethylmethacrylate (PMMA) cement. This retrospective case study evaluates the clinical and radiographic outcomes of using a staged approach in the treatment of lower extremity osteomyelitis in 14 patients using an intramedullary antibiotic coated threaded rod. Measured outcomes include time to radiographic fusion (5.1 weeks), time to weight bearing (3.2 weeks), hardware removal (7.14 %), need for revision surgery (7.14 %), and complications (35.71 %). Our findings support the use of a staged approach using a large antibiotic rod prior to definitive fixation as a mode of successfully treating lower extremity osteomyelitis and aiding in joint fusion.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 2","pages":"Article 100506"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124242","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 : 2025-05-11DOI: 10.1016/j.fastrc.2025.100502
Ryan Stone DPM, AACFAS , Trevor Page DPM , Thomas Chang DPM, FACFAS , Byron Hutchinson DPM, FACFAS
Tibiotalocalcaneal (TTC) arthrodesis and tibiocalcaneal (TC) arthrodesis are salvage procedures indicated to maintain stability and ambulation in the setting of various debilitating lower extremity conditions. Intramedullary nail fixation has proven to be highly effective in achieving stable union when performing TTC and TC arthrodesis procedures. Newer generation intramedullary nail implants feature dynamic compression technology, offering continuous compression across the desired fusion interfaces. Although published data is scarce, emerging literature suggests use of dynamic compression implants may be favorable to static implants, particularly in patients with increased risk of non-union. The primary aim of this paper is to review clinically relevant mechanical testing data that outlines specific mechanical properties of a particular TTC implant (Phantom ActivCore). Specifically, we describe various properties of the implant through objective testing data and describe these findings in a clinically relevant format to provide surgeons with closer insight into dynamic compression technology. Secondarily, we feature three case examples in which this flex coil intramedullary nail was employed by the senior authors (BH &TC) to achieve functional TTC arthrodesis in salvage scenarios.
{"title":"Clinical and biomechanical analysis of a dynamic compression intramedullary nail for hindfoot and ankle arthrodesis","authors":"Ryan Stone DPM, AACFAS , Trevor Page DPM , Thomas Chang DPM, FACFAS , Byron Hutchinson DPM, FACFAS","doi":"10.1016/j.fastrc.2025.100502","DOIUrl":"10.1016/j.fastrc.2025.100502","url":null,"abstract":"<div><div>Tibiotalocalcaneal (TTC) arthrodesis and tibiocalcaneal (TC) arthrodesis are salvage procedures indicated to maintain stability and ambulation in the setting of various debilitating lower extremity conditions. Intramedullary nail fixation has proven to be highly effective in achieving stable union when performing TTC and TC arthrodesis procedures. Newer generation intramedullary nail implants feature dynamic compression technology, offering continuous compression across the desired fusion interfaces. Although published data is scarce, emerging literature suggests use of dynamic compression implants may be favorable to static implants, particularly in patients with increased risk of non-union. The primary aim of this paper is to review clinically relevant mechanical testing data that outlines specific mechanical properties of a particular TTC implant (Phantom ActivCore). Specifically, we describe various properties of the implant through objective testing data and describe these findings in a clinically relevant format to provide surgeons with closer insight into dynamic compression technology. Secondarily, we feature three case examples in which this flex coil intramedullary nail was employed by the senior authors (BH &TC) to achieve functional TTC arthrodesis in salvage scenarios.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 2","pages":"Article 100502"},"PeriodicalIF":0.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935775","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 : 2025-04-27DOI: 10.1016/j.fastrc.2025.100501
David Kalambet , Lawrence Fallat
Brachymetatarsia is a condition of congenital shortening of the metatarsal. Surgical intervention traditionally consists of lengthening procedures of the metatarsal utilizing techniques such as distraction osteogenesis and bone allograft/autograft implantation. These procedures can lead to a variety of complications including stiffness, malalignment, resorption of bone, and delayed consolidation. Intervention consisting of a custom 3D printed implant can maintain metatarsal length following an osteotomy without risk of bone graft resorption. To our knowledge, we are presenting the first case of using a 3D printed custom implant used to restore metatarsal length. The patient is a 56-year-old female with painful brachymetatarsia involving the fourth metatarsal of her left foot and complaining of 8/10 pain. The patient’s fourth metatarsal was 11.8 mm shorter than the fifth metatarsal. The patient underwent fourth metatarsal osteotomy with distraction and insertion of 3D printed custom implant. The length of the patient’s fourth metatarsal was successfully maintained with insertion of the implant and stabilization with a plate and screws. At 36 months post-operatively, there was no evidence of resorption, malalignment, or delayed consolidation.
{"title":"Novel surgical correction of brachymetatarsia using 3D printed custom implant","authors":"David Kalambet , Lawrence Fallat","doi":"10.1016/j.fastrc.2025.100501","DOIUrl":"10.1016/j.fastrc.2025.100501","url":null,"abstract":"<div><div>Brachymetatarsia is a condition of congenital shortening of the metatarsal. Surgical intervention traditionally consists of lengthening procedures of the metatarsal utilizing techniques such as distraction osteogenesis and bone allograft/autograft implantation. These procedures can lead to a variety of complications including stiffness, malalignment, resorption of bone, and delayed consolidation. Intervention consisting of a custom 3D printed implant can maintain metatarsal length following an osteotomy without risk of bone graft resorption. To our knowledge, we are presenting the first case of using a 3D printed custom implant used to restore metatarsal length. The patient is a 56-year-old female with painful brachymetatarsia involving the fourth metatarsal of her left foot and complaining of 8/10 pain. The patient’s fourth metatarsal was 11.8 mm shorter than the fifth metatarsal. The patient underwent fourth metatarsal osteotomy with distraction and insertion of 3D printed custom implant. The length of the patient’s fourth metatarsal was successfully maintained with insertion of the implant and stabilization with a plate and screws. At 36 months post-operatively, there was no evidence of resorption, malalignment, or delayed consolidation.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 2","pages":"Article 100501"},"PeriodicalIF":0.0,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912141","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}
Progressive Collapsing Foot Deformity (PCFD), or Adult Acquired Flatfoot Deformity (AAFFD), leads to medial longitudinal arch collapse and ankle instability, with deltoid ligament insufficiency exacerbating valgus talar tilt. Despite multiple reconstruction methods, an optimal approach remains elusive.
Technique
This study presents a novel technique for deltoid ligament repair and augmentation using the posterior tibial tendon (PTT) in patients undergoing hindfoot arthrodesis for PCFD. A medial approach is used for both hindfoot fusion and PTT harvesting. The tendon is split into superior and inferior arms, which are utilized to reinforce the tibionavicular and tibiocalcaneal bands. Nonabsorbable sutures and suture anchors secure fixation, while hindfoot fusion is completed using cannulated screws. Postoperative weight-bearing is gradually advanced.
Discussion
This technique improves medial ankle stability while preserving native deltoid ligament tissue. By augmenting the ligament with the PTT, it avoids the risks associated with allografts and donor site morbidity. Preliminary intraoperative and radiographic findings show enhanced coronal and sagittal stability, indicating potential benefits in restoring ankle alignment and function. This novel augmentation strategy offers a promising alternative for managing medial ankle instability in PCFD patients undergoing hindfoot fusion. However, further studies comparing its long-term outcomes to other techniques are essential to validate its efficacy.
{"title":"Deltoid ligament repair and augmentation using the posterior tibial tendon during hindfoot arthrodesis in Progressive Collapsing Foot Deformity: A novel technique","authors":"Turki Almugren MBBS , Sulaiman Alrefai MB, BCh, BAO , Shahin Kayum MD, ABOS, MRCS , Jasim Alsaei MD, FRCSC , Timothy Daniels MD, FRCSC","doi":"10.1016/j.fastrc.2025.100500","DOIUrl":"10.1016/j.fastrc.2025.100500","url":null,"abstract":"<div><h3>Introduction</h3><div>Progressive Collapsing Foot Deformity (PCFD), or Adult Acquired Flatfoot Deformity (AAFFD), leads to medial longitudinal arch collapse and ankle instability, with deltoid ligament insufficiency exacerbating valgus talar tilt. Despite multiple reconstruction methods, an optimal approach remains elusive.</div></div><div><h3>Technique</h3><div>This study presents a novel technique for deltoid ligament repair and augmentation using the posterior tibial tendon (PTT) in patients undergoing hindfoot arthrodesis for PCFD. A medial approach is used for both hindfoot fusion and PTT harvesting. The tendon is split into superior and inferior arms, which are utilized to reinforce the tibionavicular and tibiocalcaneal bands. Nonabsorbable sutures and suture anchors secure fixation, while hindfoot fusion is completed using cannulated screws. Postoperative weight-bearing is gradually advanced.</div></div><div><h3>Discussion</h3><div>This technique improves medial ankle stability while preserving native deltoid ligament tissue. By augmenting the ligament with the PTT, it avoids the risks associated with allografts and donor site morbidity. Preliminary intraoperative and radiographic findings show enhanced coronal and sagittal stability, indicating potential benefits in restoring ankle alignment and function. This novel augmentation strategy offers a promising alternative for managing medial ankle instability in PCFD patients undergoing hindfoot fusion. However, further studies comparing its long-term outcomes to other techniques are essential to validate its efficacy.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 2","pages":"Article 100500"},"PeriodicalIF":0.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902423","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}
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