Foot & Ankle Orthopaedics最新文献

{"title":"Realignment Using Supramalleolar Osteotomy Is Associated With Improved Tibiotalar Congruity Without Fibular or Syndesmotic Reconstruction in Chronic Post-Traumatic Ankle Deformity With Tibiofibular Incongruity.","authors":"Hansol Moon, InHwa Baek, Dongug Kim, Woo-Chun Lee","doi":"10.1177/24730114261472452","DOIUrl":"10.1177/24730114261472452","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic ankle deformity associated with tibiofibular incongruity has traditionally been managed with anatomical reconstruction of the fibula and syndesmosis to restore talar position. However, such reconstruction is often not feasible in chronic deformities with distorted anatomy. We hypothesized that realignment using supramalleolar osteotomy (SMO), without fibular or syndesmotic reconstruction, would improve tibiotalar congruity.</p><p><strong>Methods: </strong>A retrospective study included 11 patients (11 ankles) who underwent SMO for chronic post-traumatic ankle deformity with tibiofibular incongruity. Patients were included if they had persistent symptoms refractory to nonoperative treatment and underwent SMO as the primary realignment procedure. Anatomical reconstruction of the fibula or syndesmosis was not attempted. Radiographic outcomes included whole limb and distal tibial alignment, tibiotalar congruity, and hindfoot alignment. Clinical outcomes were assessed using the visual analog scale (VAS) and the Foot Function Index (FFI).</p><p><strong>Results: </strong>The mean follow-up was 33.1 months. Eight ankles underwent medial closing wedge SMO, and 3 underwent dome-type SMO. Postoperative tibiotalar congruity improved, with significant correction of mediolateral talar translation (<i>P</i> < .05). Hindfoot valgus alignment improved toward neutral. VAS and FFI improved (<i>P</i> < .05), whereas sagittal alignment showed no significant difference. All cases achieved union and no patient required conversion to ankle arthrodesis or total ankle arthroplasty.</p><p><strong>Conclusion: </strong>In selected patients with chronic post-traumatic ankle deformity associated with tibiofibular incongruity in whom anatomical fibular or syndesmotic reconstruction is not feasible, realignment using supramalleolar osteotomy was associated with improved tibiotalar alignment and congruity, with favorable clinical outcomes. This realignment-based strategy represents a viable joint-preserving alternative in complex chronic ankle deformities with tibiofibular incongruity.</p><p><strong>Level of evidence: </strong>Level IV, prognostic.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261472452"},"PeriodicalIF":0.0,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864368","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":"Reconstruction of Extensive Talar Bone Loss Using a Trabecular Metal Metaphyseal Cone Following Giant Cell Tumor Excision.","authors":"Bashar Reda, Anas Nooh, Raed M Sharaf, Abdulraheem A Almokhtar","doi":"10.1177/24730114261471509","DOIUrl":"10.1177/24730114261471509","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261471509"},"PeriodicalIF":0.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857210","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":"Association Between Hypothyroidism and Postoperative Complications Following Operative Ankle Fracture Fixation: A Retrospective Cohort Study.","authors":"Deen B Sari, Shawn K Monteiro, Nabeel A Khatri, Christopher Sanford","doi":"10.1177/24730114261472895","DOIUrl":"10.1177/24730114261472895","url":null,"abstract":"<p><strong>Background: </strong>Hypothyroidism has been associated with altered bone metabolism, impaired mineralization, and increased fracture risk, but its relationship with postoperative complications after operative ankle fracture fixation remains poorly defined. This study evaluated whether preexisting hypothyroidism is associated with increased complications following surgical treatment of ankle fractures.</p><p><strong>Methods: </strong>Adults undergoing operative ankle fracture fixation or related ankle fracture surgery in TriNetX were stratified by hypothyroidism diagnosed within 6 months before or on surgery vs no recorded hypothyroidism history. Propensity score matching was performed 1:1 using demographic factors, diagnosis-coded obesity/overweight, hemoglobin A_1c, tobacco-related variables, diabetes, chronic kidney disease, cardiovascular disease, chronic obstructive pulmonary disease, peripheral vascular disease, and osteoporosis. No single primary outcome was designated; all 6 outcomes were assessed on an equal, exploratory basis at 3 months, 6 months, and 1 year.</p><p><strong>Results: </strong>After matching, 10 406 patients per cohort were included in the 3- and 6-month analyses, and 10 407 per cohort were included at 1 year. With the numbers available, no significant difference could be detected for any 3-month outcome. At 6 months, nonunion/malunion (RR, 1.305; 95% CI, 1.065-1.600; RD <i>P</i> = .010) and hardware failure (RR, 1.302; 95% CI, 1.058-1.602; RD <i>P</i> = .013) were higher in hypothyroid patients. At 1 year, nonunion/malunion (RR, 1.407; 95% CI, 1.166-1.698; RD <i>P</i> < .001) and hardware failure (RR, 1.264; 95% CI, 1.065-1.500; RD <i>P</i> = .007) remained higher. Infection, hardware removal, wound dehiscence, and broad procedure-related complications were not significant at any time point.</p><p><strong>Conclusion: </strong>In this propensity-matched retrospective cohort study, preexisting hypothyroidism was associated with modest but statistically significant increases in delayed osseous and hardware-related complications after operative ankle fracture surgery (<i>P</i> < .05 for both outcomes at 6 months and 1 year). These findings should be interpreted as associative and warrant prospective validation.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261472895"},"PeriodicalIF":0.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857256","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 Impact of Hinge Position and Wedge Orientation in Zadek Osteotomy across Different Foot Morphologies: A Virtual Surgical Simulation Study.","authors":"Giammarco Gardini, Carla Carfì, Wolfram Grün, Jonathan Kaplan, Gustavo Araujo Nunes, Emily J Luo, Tommaso Forin Valvecchi, Roberto Zambelli, Cesar De Cesar Netto","doi":"10.1177/24730114261472894","DOIUrl":"10.1177/24730114261472894","url":null,"abstract":"<p><strong>Background: </strong>The Zadek osteotomy (ZO) is a well-established surgical option for insertional Achilles tendinopathy. By modifying the position of the posterior calcaneal tuberosity, ZO may reduce posterosuperior calcaneal prominence, mechanical conflict at the Achilles insertion, and tensile stress on the tendon. Nevertheless, the biomechanical impact of wedge orientation and hinge position-and their relationship with underlying foot morphology-has not been clearly defined.</p><p><strong>Methods: </strong>A weightbearing computed tomography (WBCT)-based virtual simulation was performed on 60 asymptomatic feet, categorized as cavus (n = 20), neutral (n = 20), or planus (n = 20) based on the calcaneal inclination angle. Nine ZO configurations were modeled by combining 3 hinge positions (posterior, A; mid-tuberosity, B; anterior, C) with 3 wedge inclinations. Pre- and post-simulation measurements were compared for calcaneal inclination angle (CIA), talocalcaneal angles, hindfoot moment arm (HMA), hindfoot alignment angle (HAA), Fowler-Philip (FP) angle, X/Y ratio, and plantar fascia (PF) length.</p><p><strong>Results: </strong>Wedge inclination showed no significant influence on any variable (<i>P</i> ≈ .99). Hinge position, however, markedly affected sagittal alignment. Hinges B and C significantly reduced CIA (hinge B -0.5° [95% CI -0.66° to -0.4°]; hinge C -2.1° [95% CI -2.26° to -1.96°], both <i>P</i> < .001). Hinge B showed the largest reduction in FP angle (-7.6° [95% CI -8.63° to -6.59°], <i>P</i> = .16) and produced the greatest increase in X/Y ratio (+0.57 [95% CI +0.46 to +0.68], <i>P</i> = .007). In the pre- to post-simulation analysis, HMA increased slightly with hinge B (<i>P</i> = .03), and PF length increased only with hinge C (<i>P</i> < .001). Subgroup analysis revealed that cavus feet exhibited the greatest sagittal correction, particularly with hinge C.</p><p><strong>Conclusion: </strong>ZO significantly affected the Fowler-Philip angle, the primary radiographic outcome, with its overall foot alignment corrective power depending principally on hinge position rather than wedge inclination. These changes occurred predominantly in the sagittal plane while sparing coronal and axial alignment.</p><p><strong>Clinical relevance: </strong>WBCT-based virtual simulation may help surgeons tailor Zadek osteotomy hinge position to baseline foot morphology and anticipate morphology-specific alignment changes before surgery.</p><p><strong>Level of evidence: </strong>Level IV, pre-clinical simulation case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261472894"},"PeriodicalIF":0.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857189","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":"Variability of Visual Assessment in Determining Tibial Component Alignment in Total Ankle Arthroplasty.","authors":"Cesar A Ramirez, Seif El Masry, Gabrielle M Meli, Patrick Baki, Krysta Caudle, Edward Haupt","doi":"10.1177/24730114261469185","DOIUrl":"10.1177/24730114261469185","url":null,"abstract":"<p><strong>Background: </strong>Accurate implant positioning is essential for long-term success in total ankle arthroplasty (TAA). Although patient-specific instrumentation (PSI) and advanced imaging have improved technical precision, intraoperative alignment assessment still relies heavily on visual interpretation of fluoroscopy. The reliability of visual assessment remains poorly understood. This study evaluated the accuracy and reliability of visual assessment of tibial component alignment in TAA.</p><p><strong>Methods: </strong>Seventeen raters assessed 21 TAA cases (15 unique, 6 duplicated) using standardized anteroposterior (AP) and lateral fluoroscopic or radiographic images. True implant alignment was defined by postoperative computed tomography (CT) measurements from a previously published PSI cohort. Raters classified angular alignment as neutral (0° to 2°), 2° to 4°, or greater than or equal to 5° of deviation in varus/valgus or dorsiflexion/plantarflexion. Interobserver agreement was assessed using Fleiss κ; and intraobserver reliability was evaluated using Cohen κ and intraclass correlation coefficients (ICCs). Accuracy, mean absolute error, and perceptual thresholds were analyzed using mixed-effects models and segmented logistic regression.</p><p><strong>Results: </strong>Overall classification accuracy was modest (48.3% AP; 52.5% lateral), with low interobserver agreement (κ = 0.14-0.21). Mean absolute error ranged from 2.0° to 2.2°. Intraobserver repeatability demonstrated moderate agreement (ICC(2,1) 0.43-0.48). Observer performance was most variable near neutral alignment and improved with larger deviations. Years of experience did not improve accuracy and demonstrated a small inverse association with correct classification.</p><p><strong>Conclusion: </strong>Visual assessment of tibial component alignment in TAA demonstrated substantial variability, particularly when evaluating small angular deviations. Imaging characteristics, including view orientation and modality, were associated with measurement error, whereas surgeon experience had minimal impact on overall accuracy. These findings highlight the limitations of visual assessment under standard fluoroscopic and radiographic imaging conditions and support continued investigation of other strategies, such as computer-assisted navigation, 3-dimensional imaging, and robotic-assisted technologies, to improve intraoperative alignment assessment.</p><p><strong>Level of evidence: </strong>Level III, diagnostic reliability study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261469185"},"PeriodicalIF":0.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857175","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":"Association Between Talar Morphology and Subchondral Bone Sclerosis in the Medial Gutter of Patients With Chronic Lateral Ankle Instability.","authors":"Shunsuke Nakamura, Naohiro Uezono, Kento Shimanoe, Takayuki Ide, Shogo Tsutsumi, Suguru Saho, Masaki Dogomori, Yusuke Fujimoto, Toshiro Ijuin, Noboru Taniguchi","doi":"10.1177/24730114261471905","DOIUrl":"10.1177/24730114261471905","url":null,"abstract":"<p><strong>Background: </strong>Chronic lateral ankle instability (CLAI) is associated with an increased risk of posttraumatic osteoarthritis, with early degenerative changes often beginning in the medial gutter. Although altered loading toward the anteromedial talus has been reported, the contribution of talar morphology to early subchondral adaptation remains unclear. This study aimed to investigate the association between talar morphology and subchondral bone sclerosis in the medial gutter using quantitative computed tomography (QCT).</p><p><strong>Methods: </strong>Twenty-seven patients with CLAI (34 ankles) who underwent arthroscopic ligament repair and 30 control patients (34 feet) without ankle trauma or deformity were retrospectively analyzed. QCT was used to quantify volumetric bone mineral density (BMD). The talar side of the medial gutter was divided into 8 subregions, and BMD ratios were calculated by normalizing regional BMD to fibular BMD. Radiographic and axial computed tomography-based morphologic parameters, including anterior opening angle of the talus (AOT), posterior width (PW), anterior width, and trochlea tali length, were measured. Group comparisons and Spearman correlation analyses were performed.</p><p><strong>Results: </strong>BMD ratios in the medial gutter were significantly greater in the CLAI group than in controls, particularly in anterior regions (areas 1, 2, and 5; all <i>P</i> < .05). Compared with controls, CLAI patients demonstrated a larger AOT and smaller PW, as well as significantly greater talar tilt angle (11.6° vs 4.6°; <i>P</i> < .01) and anterior drawer distance (7.2 mm vs 5.1 mm; <i>P</i> < .01). In the CLAI group, significant positive correlations between BMD ratio and AOT (<i>r</i> = 0.48-0.60) and significant negative correlations with PW (<i>r</i> = -0.41 to -0.49) were observed after false-discovery-rate correction. No consistent morphology-BMD associations were observed in controls.</p><p><strong>Conclusion: </strong>In CLAI, subchondral bone density is increased in the anterior medial gutter and is associated with a larger AOT and smaller PW, suggesting anteriorly biased loading patterns and localized subchondral adaptation. These findings suggest an association between talar morphology and region-specific subchondral adaptation in CLAI.</p><p><strong>Level of evidence: </strong>Level III, comparative study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261471905"},"PeriodicalIF":0.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839707","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":"Early Experience with Force-Modulating Tissue Bridges (FMTB, Brijjit) for Skin Closure in Foot and Ankle Surgery: A Single-Surgeon Case Series.","authors":"Nicholas Stamatos, Eric Giza, Alexandra Ernst, Christopher D Kreulen","doi":"10.1177/24730114261471165","DOIUrl":"10.1177/24730114261471165","url":null,"abstract":"<p><strong>Background: </strong>Wound complications following foot and ankle surgery remain challenging, with rates of 4% to 36% depending on procedure complexity. Mechanical tension contributes to dehiscence through mechanotransduction pathways. The force-modulating tissue bridge (FMTB) reduces tissue-interface pressure from approximately 4000 mm Hg (sutures) to 20 mm Hg. Randomized controlled trial evidence in breast surgery demonstrates 89% relative risk reduction in wound complications; however, data specific to foot and ankle surgery are lacking.</p><p><strong>Methods: </strong>Retrospective case series of consecutive foot and ankle operations closed with FMTBs by a single fellowship-trained surgeon (March-October 2025). Primary outcome was any wound complication within 90 days. Each event was retrospectively classified using a framework consistent with ISO 14155:2020 to distinguish FMTB application-site reactions from other causes.</p><p><strong>Results: </strong>Twenty-nine patients were included (mean age 57.2 years; 66% male; mean body mass index [BMI] 30.9). Most procedures involved the ankle (62%), with complex reconstructions predominating (mean tourniquet time 104 minutes). The 90-day wound complication rate was 41.4% (12/29; 95% CI: 25.5%-59.3%), consistent with published rates for complex foot and ankle procedures when all wound events are captured. Major complications occurred in 3 patients (10.3%); all were attributable to severe patient-level confounding factors (pre-existing osteomyelitis, morbid obesity with heavy smoking history, and chlorhexidine allergy) rather than the FMTB device. After applying this classification framework, FMTB application-site skin reactions occurred in 2 patients (6.9%). Notable among those without complications was 1 patient with BMI 48.5 and only 1 remaining lower limb.</p><p><strong>Conclusion: </strong>This case series describes the feasibility and acceptable tolerance of FMTB closure in a consecutive cohort of foot and ankle procedures spanning the full clinical spectrum. The 90-day wound complication rate (41.4%, 95% CI 25.5%-59.3%) is consistent with published rates for high-complexity foot and ankle surgery when all wound events are captured; device-application-site skin reactions occurred in 6.9% of patients (2/29) and resolved with local wound care. These descriptive data do not establish comparative efficacy. Prospective controlled studies are needed to determine whether FMTB-mediated tension offloading provides incremental wound-healing benefit over conventional closure in this anatomically challenging region.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261471165"},"PeriodicalIF":0.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839759","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":"Anatomical Comparative Study of Cutaneous Nerve Injury Risk in Minimally Invasive Calcaneal Osteotomy: Four-Quadrant Sliding Osteotomy vs the Rising Sun Technique.","authors":"Constantin Rump, Juliane Beschauner, Felix Werneburg, Maria Felsberg, Raoul Werner, Heike Kielstein, Karl-Stefan Delank, Natalia Gutteck","doi":"10.1177/24730114261471429","DOIUrl":"10.1177/24730114261471429","url":null,"abstract":"<p><strong>Background: </strong>Calcaneal osteotomy plays a central role in the correction of hindfoot axis deformities, with minimally invasive techniques becoming increasingly established in recent years. For minimally invasive calcaneal osteotomy (MICO), V-shaped osteotomy and the 4-quadrant sliding osteotomy (4Q) are widely used techniques. Toepfer et al recently introduced the so-called rising sun (RS) technique for MICO. In this surgical technique, perforating drillings are performed instead of a sliding osteotomy. The present cadaveric study aimed to compare the risk of cutaneous nerve injury between the RS technique and the established 4Q technique.</p><p><strong>Methods: </strong>A total of 24 human anatomical specimens were used. Eight specimens underwent osteotomy using the 4Q technique. In 16 specimens, the RS technique was performed. Allocation was randomized. Subsequently, the cutaneous nerves of the foot were dissected and stained. The osteotomy plane was then exposed, distances to the dissected nerves were measured using standardized methods. All nerve injuries were recorded.</p><p><strong>Results: </strong>In the osteotomies performed using the 4Q technique, nerve injury occurred in 6 of 45 evaluable nerves (13.3 %). In the osteotomies performed using the RS technique, a total of 3 nerve injuries were identified in the anatomical dissections of 90 evaluable nerves (3.3%). A statistically significant difference was not found (<i>P</i> = .06). The lateral dorsal cutaneous nerve was the most frequently injured nerve with a total of 4 lesions (44.4%).</p><p><strong>Conclusion: </strong>The new RS technique appears to be a safe method for MICO; however, based on the available numbers, no statistically significant difference in nerve injury rates between the 2 techniques was detected. Complete avoidance of nerve injury does not seem achievable with percutaneous techniques. Further studies, especially in clinically evaluable patients, are desirable to better assess this technique and its potential for broader clinical application.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261471429"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839711","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":"Quantification of Infant Distress Across Serial Clubfoot Casting Visits: A Prospective Pilot Study.","authors":"Ruth H Jones, Olivia C Tracey, Patrick P Nian, Joshua T Bram, Samuel A Beber, Sarah Lu, Keza R Levine, John S Blanco, Emily R Dodwell, David M Scher, Shevaun M Doyle","doi":"10.1177/24730114261471169","DOIUrl":"10.1177/24730114261471169","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic clubfoot is typically corrected with the Ponseti method, involving foot manipulation and serial casting followed by possible Achilles tenotomy and bracing. This process causes distress, but the quantification of infant distress during longitudinal casting visits has not been evaluated. The primary aim of this pilot study was to assess infant distress longitudinally across weekly casting sessions among children with clubfeet. Secondary aims included identifying patient characteristics associated with infant distress.</p><p><strong>Methods: </strong>Ten patients with idiopathic clubfoot were prospectively enrolled in this pilot study. Prenatal counseling, family history, baseline parental anxiety, and demographic data were recorded at the initial visit. The patient's pain response was assessed by the Neonatal Infant Pain Scale (NIPS) and heart rate (HR) at 5 designated casting steps during each visit. The primary outcome measures were NIPS score and HR at each casting step throughout the entire course of casting (ie, longitudinally across casting visits). HR range for each casting step was also recorded at every visit. Additionally, univariable and multivariable analyses were performed to identify predictors of infant distress.</p><p><strong>Results: </strong>There was a significant increase in NIPS across visits at casting steps 1, 2, and 3 (<i>P</i> = .03, <i>P</i> = .01, <i>P</i> = .05) and in HR at each of the 5 casting steps (<i>P</i> < .001, <i>P</i> < .001, <i>P</i> < .001, <i>P</i> < .001, <i>P</i> = .003). With the numbers available, no significant difference in HR range could be detected across visits (<i>P</i> = .51). Multivariable analysis demonstrated that visit number was independently associated with infant distress.</p><p><strong>Conclusion: </strong>This pilot study suggests that infant distress at certain casting steps increases from mild at the first visit to moderate at subsequent visits. The magnitude of heart rate elevation within each visit did not significantly change across visits in this pilot cohort, although whether this reflects infant acclimation or other factors warrants further investigation.</p><p><strong>Level of evidence: </strong>Level IV, prospective pilot study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261471169"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839738","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":"Needle-Assisted Minimally Invasive Repair of Achilles Tendon Rupture: The Namira Technique.","authors":"Andi Praja Wira Yudha Luthfi, Filbert Nathaniel Winoto, Rendi Kurniawan, Karina Sylvana Gani, Mitchel Mitchel, Erica Kholinne","doi":"10.1177/24730114261471522","DOIUrl":"10.1177/24730114261471522","url":null,"abstract":"<p><p>Graphical AbstractThis is a visual representation of the abstract.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 3","pages":"24730114261471522"},"PeriodicalIF":0.0,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818016","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}