Foot最新文献

{"title":"Differences in muscle activity of extrinsic and intrinsic foot muscles in toe grip and push-down movements of the great toe","authors":"Yuki Ogawa ,&nbsp;Toshihiro Maemichi ,&nbsp;Ryusei Yamaguchi ,&nbsp;Takumi Okunuki ,&nbsp;Osamu Kinoshita ,&nbsp;Hideaki Nagamoto ,&nbsp;Tsukasa Kumai","doi":"10.1016/j.foot.2024.102111","DOIUrl":"10.1016/j.foot.2024.102111","url":null,"abstract":"<div><p>Toe flexor strength is generated primarily by the flexor hallucis longus (FHL) of the extrinsic foot muscles (EFMs) and the plantar intrinsic foot muscles (PIFMs) of the great toe. Toe flexion methods can be broadly classified into toe grip (TG) and toe push-down (TP). Additionally, TP's interphalangeal joint (IPJ) position may influence the FHL and PIFMs activity ratios. This study aimed to elucidate the differences in the muscle activity and muscle activity ratios of the FHL and AbdH during TG, TP with IPJ flexion (TPIF), and TP with IPJ extension (TPIE).</p><p>Surface electromyography and a custom-made instrument were used to measure the FHL and AbdH muscle activity during TG, TPIF, and TPIE of the great toe in 28 healthy men. The muscle activity and AbdH/FHL muscle activity ratio in the three conditions were statistically compared.</p><p>The FHL activity was significantly higher during TG and TPIF than during TPIE. The AbdH muscle activity was significantly higher during TPIF and TPIE than that during TG. The AbdH/FHL muscle activity ratio was significantly higher for TPIE, TPIF, and TG in that order.</p><p>This study showed that the FHL and AbdH muscle activity differed depending on the TG and TP of the great toe, and that the AbdH/FHL muscle activity ratio was different in the IPJ position. These results suggest that selecting a toe flexion method according to the target muscle when measuring and training the great toe flexor strength is important.</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"60 ","pages":"Article 102111"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141400747","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}

{"title":"Foot radiologic morphology as a predictor of pseudo-jones fractures: A retrospective case-control study","authors":"Erdi Imre ,&nbsp;Bilgin Bozgeyik ,&nbsp;Onur Kaya","doi":"10.1016/j.foot.2024.102103","DOIUrl":"https://doi.org/10.1016/j.foot.2024.102103","url":null,"abstract":"<div><h3>Background</h3><p>Fifth metatarsal basis fractures are common injuries. Zone 1 fractures are also known as pseudo-jones fractures. This study aimed to elucidate the impact of foot radiologic morphology on pseudo-Jones fractures.</p></div><div><h3>Methods</h3><p>Patients with pseudo-Jones fractures formed the case group and individuals with ankle sprains but no fractures formed control group. Weight-bearing anteroposterior and lateral radiographs were evaluated for pre-determined measurements: metatarsus adductus angle (MAA), intermetatarsal angles (1−2, 4−5), calcaneal inclination (CI) angle, and fifth metatarsal base angle. All measurements were performed by a single investigator using digital PACS tools. Statistical analysis compared these radiographic parameters between the groups.</p></div><div><h3>Results</h3><p>The fracture group demonstrated a significantly lower 4–5 intermetatarsal and calcaneal inclination angles than the control group (p &lt; 0.05). Notably, no statistically significant difference was found in the metatarsus adductus angle.</p></div><div><h3>Conclusion</h3><p>This study demonstrates a potential association between foot radiographic morphology and pseudo-Jones fractures. Patients with a lower 4–5 IMA and calcaneal inclination angle may be at a higher risk for developing pseudo-Jones fractures. However, these requires future prospective studies.</p></div><div><h3>Level of evidence</h3><p>Level III case control study</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"60 ","pages":"Article 102103"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141292018","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}

{"title":"First metatarsal shortening after hallux valgus surgery: Benefits of treatment with distraction osteogenesis","authors":"Frans-Jozef Vandeputte ,&nbsp;Fernando Garcia-Barrado ,&nbsp;Giovanni Matricali ,&nbsp;Johan Lammens","doi":"10.1016/j.foot.2024.102117","DOIUrl":"10.1016/j.foot.2024.102117","url":null,"abstract":"<div><h3>Introduction</h3><p>Iatrogenic shortening and elevation of the first metatarsal (MT1) is a common complication of hallux valgus surgery, inducing metatarsalgia underneath the lesser rays, a reason for patient dissatisfaction. For resolving this problem, different types of revision surgery are described, of which lengthening MT1 by distraction osteogenesis is underreported and therefore undervalued.</p></div><div><h3>Materials and methods</h3><p>We present three cases with iatrogenic shortening after hallux valgus surgery treated by distraction osteogenesis of MT1 using a custom-made frame, made of Ilizarov equipment. To evaluate the amount of lengthening, the length of the first and second metatarsal (MT2) and the parabolic distribution of the metatarsal heads were compared before and after distraction. To evaluate correction in the sagittal plane, Meary’s angle was measured pre- and post-lengthening. Pain was noted by a visual analogic score during follow-up.</p></div><div><h3>Results</h3><p>In our series of three cases, lengthening of MT1 between 7 mm and 18 mm, resulted in an improved parabolic distribution of the MT heads. The average difference between the second and first MT-head, relative to the SM4 axis (M2–M1) improved from 9.4 mm (<span><math><mo>±</mo></math></span> 0.9 mm) to 2.8 mm (<span><math><mo>±</mo></math></span> 0.7 mm) resolving corresponding pain in all patients. Meary’s angle was normalized in one case. The average duration of treatment was 116 days (<span><math><mo>±</mo></math></span> 9 days). Minimal follow up was 11 years.</p></div><div><h3>Conclusion</h3><p>Using Ilizarov equipment for distraction osteogenesis of MT1 is a low-cost and effective method. Over time, this technique has proven its utility in pronounced iatrogenic shortening of MT1. The possibility to lengthen more than 1 cm, to correct in multiple planes, as well as early mobilization and weight bearing are additional advantages, but one must be careful to avoid overcorrection. The need for strict follow-up with multiple radiographs and rigorous patient selection is mandatory.</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"60 ","pages":"Article 102117"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602334","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}

{"title":"Whipping or tearing? The biomechanics of Achilles tendinopathy in rearfoot strike runners","authors":"Kevin G. Aubol,&nbsp;Clare E. Milner","doi":"10.1016/j.foot.2024.102082","DOIUrl":"10.1016/j.foot.2024.102082","url":null,"abstract":"<div><h3>Background</h3><p>Two biomechanical mechanisms for the development of Achilles tendinopathy in runners have been proposed: A whipping mechanism characterized by prolonged and excessive rearfoot eversion, and a tearing mechanism characterized by high eccentric plantar flexor forces. The purpose of this pilot study was to determine if runners with and without a history of Achilles tendinopathy exhibited gait biomechanics consistent with either of these mechanisms.</p></div><div><h3>Methods</h3><p>Seven male runners with previous or current Achilles tendinopathy and seven healthy male control runners were evaluated by three-dimensional gait analysis. Peak rearfoot eversion angle, rearfoot eversion excursion, duration of rearfoot eversion, and peak rearfoot inversion angle were compared between groups to evaluate the whipping mechanism of injury. Peak dorsiflexion angle, peak dorsiflexion velocity, and peak ankle power absorption were compared between groups to evaluate the tearing mechanism. Additionally, rearfoot eversion angle and sagittal plane ankle power waveforms were compared between groups using statistical parametric mapping.</p></div><div><h3>Findings</h3><p>There were no differences in any rearfoot eversion, inversion, or dorsiflexion variables or waveforms during running in the Achilles tendinopathy group compared to controls.</p></div><div><h3>Interpretation</h3><p>Rearfoot strike runners with Achilles tendinopathy do not exhibit running biomechanics consistent with either the whipping or tearing mechanisms of injury.</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"59 ","pages":"Article 102082"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0958259224000154/pdfft?md5=cd9a9d8248e2306add89d8cb0069f551&pid=1-s2.0-S0958259224000154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of foot somatosensory loss in postural control during Functional reach test in patients with diabetic polyneuropathy: A controlled study","authors":"Abdulvahap Kahveci ,&nbsp;Berat Can Cengiz ,&nbsp;Veysel Alcan ,&nbsp;Senih Gürses ,&nbsp;Murat Zinnuroğlu","doi":"10.1016/j.foot.2024.102097","DOIUrl":"https://doi.org/10.1016/j.foot.2024.102097","url":null,"abstract":"<div><h3>Background</h3><p>In patients with diabetic polyneuropathy (DPN), differences in postural control due to losing the lower limb somatosensory information were reported. However, it is still unclear by which mechanisms the dynamic postural instability is caused.</p></div><div><h3>Objectives</h3><p>This study aimed to investigate postural control differences and neuromuscular adaptations resulting from foot somatosensory loss due to DPN.</p></div><div><h3>Methods</h3><p>In this controlled cross-sectional study, fourteen DPN patients and fourteen healthy controls performed the Functional Reach Test (FRT) as a dynamic task. The postural control metrics were simultaneously measured using force plate, motion capture system, and surface electromyography (sEMG). The main metrics including reach length (FR), FR to height ratio (FR/H), displacement of CoM and CoP, moment arm (MA), and arch height ratio. Also, kinematic (range of motion of ankle, knee, and hip joints), and sEMG metrics (latencies and root mean square amplitudes of ankle and hallux muscles) were measured. To compare variables between groups, the independent sample <em>T</em>-test for (normally distributed) and the Mann-Whitney <em>U</em> test (non-normally distributed) were used.</p></div><div><h3>Results</h3><p>The subjects' reach length (FR), FR to height ratio, absolute MA, and displacement of CoM were significantly shorter than controls, while displacement of CoP was not significant. Arch height ratio was found significantly lower in DPN patients. We observed that CoM was lagging CoP in patients (MA = + 0.89) while leading in controls (MA = -1.60). Although, the muscles of patients showed significantly earlier activation, root mean square sEMG amplitudes were found similar. Also, DPN patients showed significantly less hip flexion, knee extension, and ankle plantar flexion.</p></div><div><h3>Conclusions</h3><p>This study presented that decreasing range of motion at lower limbs’ joints and deterioration in foot function caused poor performance at motor execution during FRT in DPN patients.</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"59 ","pages":"Article 102097"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140549473","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}

{"title":"Locking vs. non-locking plate fixation in comminuted talar neck fractures: a biomechanical study using cadaveric specimens","authors":"Luke Maxwell ,&nbsp;Tobia Nava ,&nbsp;Alan Norrish ,&nbsp;Tamas Kobezda ,&nbsp;Marc Pizzimenti ,&nbsp;Cecilia Brassett ,&nbsp;Chandra Pasapula","doi":"10.1016/j.foot.2024.102084","DOIUrl":"https://doi.org/10.1016/j.foot.2024.102084","url":null,"abstract":"<div><h3>Background</h3><p>Talar neck fractures are rare but potentially devastating injuries, with early reduction and rigid fixation essential to facilitate union and prevent avascular necrosis. Even small degrees of malunion will alter load transmission and subtalar joint kinematics. Changes in fixation techniques have led to dual plating strategies. While locked plating has perceived advantages in porotic bone and comminution, its biomechanical benefits in talar neck fractures have not been shown.</p></div><div><h3>Aim</h3><p>To compare the strength of locking <em>vs.</em> non-locking plate fixation in comminuted talar neck fractures.</p></div><div><h3>Method</h3><p>Seven pairs of cadaveric tali were randomised to locking or non-locking plate fixation. A standardised model of talar neck fracture with medial comminution was created, and fixation performed. The fixed specimens were mounted onto a motorised testing device, and an axial load applied.</p></div><div><h3>Results</h3><p>Peak load to failure, deformation at failure, work done to achieve failure, and stiffness of the constructs were measured. No statistically significant difference was found between locking and non-locking constructs for all parameters.</p></div><div><h3>Conclusions</h3><p>Both constructs provide similar strength to failure in talar neck fracture fixations. Mean peak load to failure did not exceed the theoretical maximum forces generated of 1.1 kN when weight-bearing. We would advocate caution with early mobilisation in both fixations.</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"59 ","pages":"Article 102084"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0958259224000178/pdfft?md5=fadd706f1b3bed60104c31046be203c1&pid=1-s2.0-S0958259224000178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140163858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of clinical, radiological and device-driven tests for the detection of First Ray Instability: A systematic review","authors":"Georgios Solomou ,&nbsp;Andrey Bilyy ,&nbsp;Pranav Tadikonda ,&nbsp;Brian Gurdas ,&nbsp;Chandra Pasapula","doi":"10.1016/j.foot.2024.102080","DOIUrl":"10.1016/j.foot.2024.102080","url":null,"abstract":"<div><h3>Introduction</h3><p>First Ray Instability (FRI) and especially hypermobility leads to the collapse of the medial longitudinal arch's structural framework, which reduces the foot's ability to become a rigid lever for propulsion, resulting in progressive foot deformities. Early detection of FRI with prompt intervention helps prevent degenerative foot deformities. Various manual, device-based and radiographic diagnostic tests for FRI quantification have been described in the literature. We aim to conduct an up-to-date, comprehensive, systematic review of the literature reporting on diagnostic tests to evaluate FRI.</p></div><div><h3>Methodology</h3><p>Electronic databases (Medline, Embase and PubMed) and bibliography lists were searched until May 2021 for studies evaluating diagnostic tests for FRI. MeSH terms were used to conduct the literature search. The authors screened all produced abstracts. Selected articles were further assessed in full based on inclusion and exclusion criteria. The relevant studies were qualitatively assessed and grouped into tables based on tests.</p></div><div><h3>Results</h3><p>18,176 studies were identified. Thirty-two full-text articles were included for assessment. Ten articles were excluded based on evaluation criteria. 18 studies were included for qualitative assessment: two studies describing manual diagnostic tests, three evaluating device-driven tests, six image-guided studies and seven comparison studies assessing a new test versus an established one.</p></div><div><h3>Conclusion</h3><p>Gold standard tests in defining FRI need to be improved. Manual tests exhibit significant subjective variability. Radiographic tests, while accurate, are complex and cumbersome to perform and, therefore, are not widely applied. Dorsal rulers have demonstrated mixed results and shown variability when compared to instruments. The focus has been on assessing FRI in hallux valgus (HV). More studies are needed to investigate FRI in the absence of HV.</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"59 ","pages":"Article 102080"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0958259224000130/pdfft?md5=a7e756e63d025545bbb665c70a32656b&pid=1-s2.0-S0958259224000130-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gait and muscle activity measures after biomechanical device therapy in subjects with ankle instability: A systematic review","authors":"Hanieh Khaliliyan ,&nbsp;Arash Sharafatvaziri ,&nbsp;Zahra Safaeepour ,&nbsp;Mahmood Bahramizadeh","doi":"10.1016/j.foot.2024.102083","DOIUrl":"https://doi.org/10.1016/j.foot.2024.102083","url":null,"abstract":"<div><h3>Introduction</h3><p>Health specialists suggest a conservative approach comprising non-pharmacological interventions as the initial course of action for individuals with repetitive ankle sprain due to ankle instability. This systematic review aimed to assess the effectiveness of biomechanical devices (Foot Orthoses, Ankle Orthoses, and Taping) on gait and muscle activity in individuals with ankle instability.</p></div><div><h3>Methods</h3><p>A systematic search was performed on electronic databases, including PubMed, EMBASE, Clinical Trials.gov, Web of Science, and Scopus. The PEDro scoring system was used to evaluate the quality of the included studies. We extracted data from population, intervention, and outcome measures.</p></div><div><h3>Results</h3><p>In the initial search, we found 247 articles. After following the steps of the PRISMA flowchart, only 22 reports met the inclusion criteria of this study. The results show that biomechanical device therapy may increase swing time, stance time, and step. Additionally, studies suggest that these devices can reduce plantar flexion, inversion, and motion variability during gait. Biomechanical devices have the potential to optimize the subtalar valgus moment, push-off, and braking forces exerted during walking, as well as enhance the activity of specific muscles including the peroneus longus, peroneus brevis, tibialis anterior, gluteus medius, lateral gastrocnemius, rectus femoris, and soleus.</p></div><div><h3>Conclusion</h3><p>Biomechanical devices affect gait (spatiotemporal, kinetic, and kinematic variables) and lower limb muscle activity (root mean square, reaction time, amplitude, reflex, and wave) in subjects with ankle instability.</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"59 ","pages":"Article 102083"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179845","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}

{"title":"Reliability and measurement error of a maximal voluntary toe plantarflexion measurement process","authors":"Enrico Roma ,&nbsp;Antoine Michel ,&nbsp;Romain Tourillon ,&nbsp;Guillaume Y. Millet ,&nbsp;Jean-Benoît Morin","doi":"10.1016/j.foot.2024.102095","DOIUrl":"https://doi.org/10.1016/j.foot.2024.102095","url":null,"abstract":"<div><p>Despite the growing interest, information regarding the psychometric properties of maximal voluntary isometric toe plantarflexion force and rate of force development (RFD) is lacking. Hence, we investigate the test-retest reliability and measurement error of these outcome measurement instruments measured with a custom-built dynamometer. Twenty-six healthy adults participated in a crossed design with four sessions separated by 5–7 days. RFD was quantified using manual onset and calculating the impulse and the slope in the following time windows: 0–50 ms, 0–100 ms, 0–150 ms, 0–200 ms, 0–250 ms. We estimated the systematic bias of the mean, the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) from the agreement and consistency models. The ICC and the SEM agreement for maximal voluntary isometric toe plantarflexion force along the perpendicular axis were respectively 0.87 (95%CI: 0.76, 0.93) and 27 N (22, 32), while along the resultant of the perpendicular and anterior posterior axis they were 0.85 (0.73, 0.92) and 29 N (23, 35). The results of the consistency model were similar as the estimated variance for session was closer to zero. A systematic bias of the mean between session 1 and 3 was found. For the RFD variables, the ICC agreement ranged from 0.35 to 0.65. The measurement process was found to be reliable to assess maximal voluntary isometric toe plantarflexion force but not RFD. However, a familiarization session is mandatory and these results need to be confirmed in less coordinated (e.g. aging population) individuals.</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"59 ","pages":"Article 102095"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0958259224000282/pdfft?md5=e26ac8e3722ed685a93a11514153e8be&pid=1-s2.0-S0958259224000282-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140546331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten year outcomes after non-fixation of the smaller posterior malleolar fragment: A retrospective cohort study","authors":"Leo Swee Liang Chong,&nbsp;MohammadAli Khademi,&nbsp;Kundam Murali Reddy,&nbsp;Geoffrey Hunter Anderson","doi":"10.1016/j.foot.2024.102091","DOIUrl":"https://doi.org/10.1016/j.foot.2024.102091","url":null,"abstract":"<div><h3>Introduction</h3><p>Treatment of posterior malleolar (PM) ankle fractures remains controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation.</p></div><div><h3>Material and methods</h3><p>A retrospective cohort study was performed on PM ankle fracture patients aged 18–55 years old admitted under our orthopaedic unit between 1st of April 2009 and 31st of October 2013. Inclusion criteria were ASA 1 and 2, independent mobility pre-trauma, no pre-existing ankle pathologies, with satisfactory bimalleolar and syndesmotic stabilisation. Open fractures, talar fractures, calcaneal fractures, pilon fractures, subsequent re-injury and major complications were excluded. All PM fragments were unfixated. Clinical outcomes were evaluated using visual analogue scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sports subscale for function, and patient satisfaction ratings. Osteoarthritis was assessed using modified Kellgren-Lawrence scale on follow-up weightbearing ankle radiographs.</p></div><div><h3>Results</h3><p>Sixty-one participants were included. Mean follow-up was 10.26 years. Average PM size was 16.2 ± 7.39%. All participants were evaluated for clinical outcomes. Mean score of FAAM-ADL was 95.5 ± 7.13, FAAM-Sports 86.4 ± 15.5, patient satisfaction 86.2 ± 14.4% and pain score 1.13 ± 1.65. Radiographical outcomes were evaluated in 52 participants, showing no-to-minimal osteoarthritis in 36/52 (69%), mild osteoarthritis in 14/52 (27%) and moderate osteoarthritis in 2/52 (4%). Pain and functional scores were independent of PM fragment size, post-reduction step-off, dislocation, malleoli fractured or syndesmotic injury. PM step-off more than 1 mm and traumatic dislocation/subluxation were associated with worse radiographical osteoarthritis.</p></div><div><h3>Conclusion</h3><p>After controlling for confounders, the unfixated smaller posterior malleolus fragment at 10-year follow-up demonstrated largely satisfactory clinical outcomes with some radiographical progression of osteoarthritis.</p></div><div><h3>Level of evidence</h3><p>Level III – Retrospective cohort study</p></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"59 ","pages":"Article 102091"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179638","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}