Foot & ankle international最新文献

Background: To investigate the efficacy of extracorporeal shock wave therapy (ESWT), high-intensity laser therapy (HILT), and exercise therapy in patients diagnosed with plantar fasciitis.

Methods: A total of 84 patients diagnosed with plantar fasciitis were randomized into 3 groups: ESWT combined with a home exercise program (n = 28), HILT combined with a home exercise program (n = 30), and a home exercise program alone (control) (n = 26). The ESWT group underwent a total of 3 ESWT sessions, performed once a week, whereas the HILT group underwent a total of 15 HILT sessions over 3 weeks. All 3 groups were evaluated at the beginning of the treatment, at the end of the treatment (week 3), and at the 12th week for pain levels (measured using the visual analog scale [VAS]), plantar fascia thickness, and the Foot Function Index (FFI). Because of the nature of the interventions, participant masking was not possible; however, assessor masking was strictly adhered to.

Results: Eighty-four patients completed the study. Significant reductions in plantar fascia thickness, VAS scores, and FFI values were observed in all 3 groups (P < .05). However, baseline-adjusted analyses detected no meaningful between-group differences at 12 weeks (P > .05; small effect sizes).

Conclusion: Our study demonstrated that ESWT, HILT, and exercise therapy each effectively reduced pain levels and improved functional capacity in the treatment of plantar fasciitis. Adding ESWT or HILT to a structured home exercise program did not provide an incremental clinical benefit during the follow-up period. The findings support exercise therapy as a practical first-line option.

Background: Osteochondral lesions (OCLs) of the talus involve damage to both the articular cartilage and underlying subchondral bone, which may range from compression injury to complete fragment separation. Treating large lesions may necessitate osteochondral allograft transplantation (OCA) to ensure cartilage congruence and minimize articular step-off. However, current allograft selection techniques rely largely on gross size estimation rather than precise contour matching, which may increase the risk of graft incongruity and suboptimal clinical outcomes. This study evaluates the correlations between the talar dome posteromedial (PM) and central lateral (CL) radii of curvature (ROC) with age, articular width (AW), and articular length (AL) in a young patient group to optimize graft selection and matching.

Methods: Twenty-nine patients, aged 9-18 years, and 30 ankles were included. Magnetic resonance imaging was used to measure talar dome ROC, AW, and AL. The ROC was measured on sagittal images at the PM and CL regions, whereas AW and AL were measured on coronal and sagittal planes, respectively. Three independent reviewers assessed all measurements using Sectra PACS software. Reliability was evaluated using intraclass correlation coefficients (<0.50, poor; 0.50-0.75, moderate; 0.75-0.90, good; >0.90, excellent). Correlations (R²) between ROC with age, AW, and AL were assessed.

Results: The mean PM ROC was 20.55 mm and CL ROC 17.20 mm. The mean AW and AL were 27.84 mm and 36.25 mm, respectively. Intraobserver reliability was good to excellent for PM ROC and AW, and moderate to excellent for CL ROC and AL. Interobserver reliability was good to excellent for PM ROC and AW, and moderate to good for CL ROC and AL. For PM ROC, R² values were 0.29 (age), 0.18 (AW), and 0.62 (AL); for CL ROC, R² values were 0.06 (age), 0.54 (AW), and 0.78 (AL).

Conclusion: Articular length demonstrated stronger correlations with talar dome PM and CL ROCs compared with AW and age. AL may be a useful parameter for optimizing graft selection, particularly contour and size matching, in OCA.

Background: Radionuclide bone scintigraphy in combination with computed tomography (CT) is increasingly used as a diagnostic tool to evaluate the painful total ankle arthroplasty (TAA). However, uptake patterns following uncomplicated TAA have not been investigated. In this study, we aimed to establish normative data on periprosthetic metabolic activity following TAA.

Methods: Thirty-two asymptomatic patients who underwent TAA with a modern fixed-bearing prosthesis for posttraumatic arthritis were included. Patients underwent ¹⁸F-NaF positron emission tomography (PET) at 1 of 4 time intervals following TAA: 6, 12, 18, or 24 months, with 8 different patients enrolled at each time point. Standard uptake values (SUVs) were measured at the bone-implant interface in regions of interest (ROIs) defined on axial CT scan slices. Periprosthetic bone blood flow (K₁) and bone turnover (k_i, flux) were quantified from dynamic 18F-NaF PET/CT.

Results: Tracer uptake in the talus increased from 6 to 12 months postoperatively, subsequently declining from 12 to 24 months. Uptake in the tibia was similar at 6 and 12 months, and steadily decreased thereafter. SUVs, K₁, and k_i in both the tibia and talus decreased significantly between 12 and 24 months (P-adj < .05). SUVs, K₁, and k_i in the talus exceeded those measures in the tibia at 12, 18, and 24 months postoperatively (P-adj < .05).

Conclusion: The present study demonstrates that in asymptomatic patients, periprosthetic tracer uptake peaks at 12 months and remains elevated up to 24 months following modern fixed-bearing TAA. In both the tibia and talus, uptake decreased between 12 and 24 months. Talar uptake was higher than tibial uptake at 12, 18, and 24 months. Our findings suggest that radionuclide bone scintigraphy should be cautiously interpreted especially when performed within 2 years of TAA.

Background: Charcot neuroarthropathy (CN) of the hindfoot often requires internal fixation (IF), external fixation (EF), or hybrid constructs. This descriptive systematic review and single-arm meta-analysis summarizes outcomes of these strategies, focusing on amputation, fusion, ambulation, and complications.

Methods: Following PRISMA guidelines, 30 studies with 957 patients undergoing hindfoot or ankle reconstruction were included. A single-arm meta-analysis assessed amputation and fusion rates; qualitative analysis examined ambulation, infection, ulceration, hardware failure, and revision. Heterogeneity was quantified with I² and τ².

Results: Under random effects models, the overall amputation rate across all fixation methods was 4.76% (95% CI: 1.79%-8.62%), and the pooled fusion rate was 80.8% (95% CI: 73.6%-87.1%). By fixation type, EF cohorts showed numerically higher amputation rates (8.11%; 95% CI: 2.32%-15.91%) than IF (4.53%; 95% CI: 0.98%-9.69%) and hybrid fixation (2.94%; 95% CI: 0.00%-12.63%). EF demonstrated a lower fusion rate (68.2%; 95% CI: 55.8%-79.6%) than IF (84.9%; 95% CI: 75.8%-92.5%) and hybrid constructs (85.8%; 95% CI: 75.1%-94.4%). Return to ambulation was comparable between fixation strategies. IF cohorts reported fewer soft tissue complications but higher hardware failure (24.1%) and revision (21.9%) rates, whereas EF cohorts experienced frequent pin tract problems (24.0%). Hybrid constructs showed higher infection (23.2%), hardware complications (33.3%), and revision (18.8%). Substantial between-study heterogeneity and likely selection bias were present.

Conclusion: Across 30 observational studies (957 patients; 970 feet), pooled single-arm estimates indicate that limb salvage and osseous fusion were achieved in most cases across internal, external, and hybrid fixation. External fixation was typically selected for infected or more complex reconstructions and was associated with higher amputation and lower fusion proportions, whereas internal and hybrid constructs showed higher fusion with more hardware-related reoperations. Given substantial heterogeneity and confounding by indication, these patterns should be viewed as descriptive rather than comparative; they do not establish indications or superiority.

Background: Midfoot osteoarthritis (OA) is commonly treated with intraarticular corticosteroid injections before surgical fusion. However, the impact of preoperative injection timing on postoperative outcomes remains unclear. This study evaluates the association between the timing of corticosteroid injections and postoperative 90-day complications and 1-year revision following midfoot arthrodesis.

Methods: We conducted a retrospective cohort study using the PearlDiver Mariner database (2015-2024), identifying 82 144 patients who underwent midfoot arthrodesis. Patients were stratified into 5 groups based on the timing of corticosteroid injection before surgery: ≤1 month, >1-2 months, >2-3 months, ≥3 months (reference), and no preoperative injection (control). Outcomes included 90-day postoperative complications and revision surgery within 1 year of the procedure. Multivariable logistic regression and Cox proportional hazards models were used to evaluate adjusted odds and time-to-event outcomes, respectively.

Results: Unadjusted 90-day complication rates were higher among injection cohorts than controls; however, in adjusted logistic models, odds of complications did not differ significantly vs the ≥3-months reference (unmatched and propensity-matched). In time-to-event analyses, preoperative injections administered within 3 months of surgery were associated with a significantly higher hazard of 1-year revision vs ≥3 months (HRs ~1.25-1.49). Older age, male sex, and greater comorbidity burden were also associated with higher risk.

Conclusion: Preoperative corticosteroid injections administered within 3 months of midfoot arthrodesis were associated with increased rates of 1-year revision compared with injections given ≥3 months preoperatively, whereas adjusted odds of 90-day complications were similar across timing groups. These timing-related risks may inform preoperative planning for elective midfoot fusion but should be interpreted cautiously given the limitations of administrative claims data and residual confounding by indication.

Level of evidence: Level III, retrospective cohort study.

Background: Patient-specific instrumentation (PSI) has been proposed to improve accuracy and efficiency in total ankle arthroplasty (TAA). Although cadaveric studies suggest improved precision, the clinical value of PSI over standard instrumentation (SI) remains uncertain.

Methods: A systematic review and meta-analysis following PRISMA guidelines was performed using PubMed, Embase, and Cochrane databases through July 2025. Comparative studies evaluating PSI vs SI in TAA were included. Outcomes analyzed included patient-reported outcome measures (PROMs), radiologic alignment, intraoperative efficiency, complication and revision rates, and cost. Random effects models were used to pool standardized or mean differences (MDs) or risk ratios with 95% CIs.

Results: Eleven studies comprising 802 implants (438 PSI, 364 SI) were included, with follow-up ranging from 3 months to 2 years, representing short-term outcomes. No statistically significant differences were detected between PSI and SI in postoperative American Orthopaedic Foot & Ankle Society score or Ankle Osteoarthritis Scale scores, or in pooled functional improvements. Radiographic analysis showed no difference in coronal alignment, whereas PSI demonstrated slightly greater deviation from intended sagittal alignment compared with SI (MD 0.37 degrees, 95% CI 0.03-0.70; P = .03). Across studies using PSI, preoperative planning showed high agreement between planned and implanted tibial component size (92%), but lower agreement for talar sizing (69%). Operative and tourniquet times were comparable between groups; however, PSI significantly reduced fluoroscopy time (MD -38.35 seconds, 95% CI -59.33 to -17.36; P < .001). No statistically significant differences were detected in complication and revision rates. Cost analysis produced conflicting results, with one study suggesting potential savings and another finding PSI more expensive after accounting for preoperative imaging.

Conclusion: PSI in TAA reduces fluoroscopy time but does not appear to enhance functional outcomes, complication rates, or revision risk compared with SI in the short term. PSI may result in greater deviation from sagittal alignment, and its cost-effectiveness remains uncertain. High-quality prospective studies with long-term follow-up are needed to clarify its role in routine and complex cases.

Background: Nonunion is a common complication after arthrodesis that often necessitates additional surgery. Augmentation with autograft is the standard of care, but nonunion rates remain high. Recombinant platelet-derived growth factor (rhPDGF-bb) is another adjuvant commonly used for ankle fusion and has shown similar effectiveness to autograft. To our knowledge, no study has investigated the effect of PDGF-bb on a representative cell population of an arthrodesis and in the fibrin-rich fusion environment. This study tested the hypothesis that PDGF-bb, as a standalone treatment, induces osteogenesis of this representative population of cells in 2D and 3D.

Methods: Mesenchymal stem cells (MSCs) or marrow-derived cells (MDCs) were cultured in 2D monolayer or 3D fibrin cultures, and were evaluated for temporal osteogenesis via mineralization assays, gene expression, micro-CT, and histology.

Results: PDGF-bb enhanced mineralization of both MSCs and MDCs in monolayer culture; however, PDGF-bb downregulated osteogenic gene expression in 2D. Within 3D hMSCs, PDGF-bb increased bone volume but significantly reduced radiopacity, and within 3D hMDCs there was no significant difference from the control.

Conclusion: This study demonstrates the context- and cell population-dependent ability of PDGF-bb to induce osteogenic mineralization in 2 distinct in vitro models. The findings suggest that PDGF-bb's mitogenic activity promotes proliferation and matrix deposition in 2D environments, but its effects may be limited in 3D fibrin constructs where we postulate that spatial constraints restrict proliferation. The evaluation of PDGF-bb, and other newly developed adjuvants, in both 2D and 3D in vitro assays is required to determine context-dependent osteogenesis. This understanding provides a basis for future experiments to assist in determining the ideal patients for utilization of PDGF-bb and determine if there are instances when other adjuvants may be considered.

Background: Hallux valgus (HV) is a common forefoot deformity that may compromise lower-extremity biomechanics, particularly during turnout movements in ballet. However, the kinematic consequences of dynamic high-load, turnout-specific dance tasks remain unclear. This study investigated the relationship between the degree of HV and lower-extremity joint kinematics in ballet dancers.

Methods: Fourteen female ballet dancers with visible HV (mean HV angle: 26.5 ± 8.6 degrees) performed 3 tasks: demi-plié, sauté, and grand jeté. A 10-camera motion capture system and a force plate were used to assess foot and knee kinematics during task-specific peak-load phases.

Results: Across tasks, the mean medial longitudinal arch angle ranged from approximately 136 to 141 degrees. Significant positive correlations were observed between HV angle and midfoot-forefoot inversion during all tasks (r = 0.61-0.76, P < .05). During the grand jeté, a greater degree of HV was also associated with an increased medial longitudinal arch angle (r = 0.64, P = .04), greater knee valgus (r = 0.64, P = .04), and reduced hindfoot-midfoot inversion (r = -0.64, P = .04), reflecting a pronated foot posture and altered kinetic chain alignment.

Conclusion: In this small case series, greater HV was correlated with altered foot and knee kinematics, particularly under high-load, single-leg conditions. These results underscore the importance of task-specific assessments in dancers.

Level of evidence: Level IV, case series.