Foot & Ankle Orthopaedics最新文献

{"title":"Comparison of Clinical and Radiographic Outcomes Between Solid Headless and Headed Screws in the Treatment of Zone II and III Fifth Metatarsal Fractures in Elite Athletes.","authors":"David Cho, Stephanie Eble, Saanchi Kukadia, Oliver Hansen, Martin O'Malley, Mark Drakos","doi":"10.1177/24730114241281452","DOIUrl":"https://doi.org/10.1177/24730114241281452","url":null,"abstract":"<p><strong>Background: </strong>Zone II and III fifth metatarsal (5-MT) fractures among athletes are typically managed with percutaneous fixation following anatomic reduction. However, screw head discomfort and refracture after bone union can occur because of the loads placed on the foot during play. Several hardware systems that use a smaller screw head compared to traditional hardware systems have been developed to minimize the rate of postoperative hardware complications. This study compares clinical and radiographic outcomes of 5-MT fractures in elite athletes treated with a solid headless screw vs a solid headed screw. We hypothesized that the headless screw would be associated with faster union rates, faster clearance times, and lower incidence of symptomatic hardware compared to the headed screw.</p><p><strong>Methods: </strong>Athletes competing at a collegiate level or higher treated for a zone II or III 5-MT fracture between 2016 and 2022 by 2 surgeons fellowship-trained in foot and ankle orthopaedics were screened. Operative notes were reviewed to determine the hardware system used. Subjects were divided based on the hardware system used during operation: headed screw and headless screw. Time to radiographic union, time to full clearance, and return to competition were determined. Postoperative complications, including nonunions, need for revision, need for hardware removal, and refractures were also noted.</p><p><strong>Results: </strong>Forty eligible patients (44 feet) were identified. The solid headed screw group included 20 patients (21 fractures), and the solid headless screw group included 20 patients (23 fractures). Average time to union for the headed screw group was 11.78 (range, 5.86-19.00) weeks; average time to union for the headless screw group was 11.65 (range, 6.00-22.57) weeks (<i>P</i> = .93). Nineteen out of twenty (95%) patients were able to return to competition in both groups. Average time to return to competition for the headed screw group was 26.9 (range, 10.00-47.86) weeks, while average time for the headless screw group was 21.2 (range, 6.86-55.00) weeks (<i>P</i> = .55). The overall complication rate for the headed screw was 23.8%, which was not statistically different from the overall complication rate for the headless screw of 13.0% (<i>P</i> = .35).</p><p><strong>Conclusion: </strong>In this relatively small sample of elite athletes undergoing operative fixation of a 5-MT fracture, fixation using either a headless or headed screw system had similar good outcomes in regard to times to union, return to competition, and complication rate regardless of solid screw head type used.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241281452"},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498011","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":"Primary Arthrodesis or Open Reduction and Internal Fixation for Lisfranc Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Lachlan Mactier, Genevieve Cox, Rajat Mittal, Mayuran Suthersan","doi":"10.1177/24730114241286892","DOIUrl":"https://doi.org/10.1177/24730114241286892","url":null,"abstract":"<p><strong>Background: </strong>Lisfranc injuries are often managed surgically with primary arthrodesis (PA) or open reduction and internal fixation (ORIF); however, neither approach has been shown to be superior. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) to compare the functional and surgical outcomes of PA and ORIF in the treatment of Lisfranc injuries.</p><p><strong>Methods: </strong>This study was performed as per the PRISMA protocol. Database searches were conducted on Cochrane, Embase, and PubMed libraries. Five RCTs were identified for inclusion involving 241 patients, of which 121 underwent PA and 120 underwent ORIF.</p><p><strong>Results: </strong>Statistically significant differences in visual analog scale pain score at 2 years (mean difference 0.89, 95% CI 0.18-1.59), patient satisfaction (OR 10.04, 95% CI 1.78-56.76), and all-cause return to surgery (OR 27.31, 95% CI 12.72-58.63) were observed, all favoring PA. There were no statistically significant differences between PA and ORIF with regard to American Orthopaedic Foot & Ankle Society midfoot scores at 2 years, 36-Item Short Form Health Survey (SF-36) scores, and unplanned return to surgery.</p><p><strong>Conclusion: </strong>This study showed significant improvement in pain at 2 years, patient satisfaction, and all-cause return to surgery favoring PA in all instances. Given ORIF often necessitates a second operation for hardware removal, it is to be expected that all-cause return to surgery is higher in ORIF groups. Overall, these results do not have the power to confer an advantage to a particular approach because of significant heterogeneity. Further studies should focus on larger patient cohorts and longer follow-up, or analysis stratified by patient demographics and injury presentation. In the absence of clinically significant differences, cost-benefit analyses should be considered to answer the question of whether to \"fix or fuse\" for Lisfranc injuries.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241286892"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498012","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":"Ultrasound Shear Wave Elastography of the Arch-Supporting Structures in Symptomatic Flatfoot: A Pilot Study.","authors":"L Daniel Latt, Wonsuk Kim, Chelsea C Caruso, Elizabeth A Krupinski, Andres Angel Nuncio Zuniga, Amit Syal, Mihra S Taljanovic","doi":"10.1177/24730114241281894","DOIUrl":"10.1177/24730114241281894","url":null,"abstract":"<p><strong>Background: </strong>The posterior tibial tendon (PTT), deltoid ligament, and spring ligament are often torn or attenuated in patients with progressive collapsing foot deformity. The goal of this pilot study was to measure the ultrasound shear wave velocity (SWV) of these arch-supporting structures in feet with varying degrees of deformity to improve our understanding of their role in the progression of deformity.</p><p><strong>Methods: </strong>Two observers measured the SWV of the supramalleolar and inframalleolar PTT in long and short axes, in the tibiospring portion of the deltoid ligament, and in the superomedial band of the spring ligament in 8 neutrally aligned feet, 5 asymptomatic flatfeet, and 7 symptomatic flatfeet. Each measurement was repeated 3 times both with and without an applied eversion stress.</p><p><strong>Results: </strong>Average SWV was lower at all locations in the symptomatic flatfeet compared with normal feet, but these differences were statistically significant only for the inframalleolar PTT and the spring ligament. Externally applied stress led to an increase in the SWV of the ligaments but a paradoxical decrease in the SWV in the supramalleolar PTT. The SWV of the PTT was lower along the short axis compared with the long axis.</p><p><strong>Conclusion: </strong>SWV may be useful in evaluating the severity of degenerative disease of arch-supporting structures, but further study is needed before this technique can be applied clinically.</p><p><strong>Level of evidence: </strong>Level III, case-control study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241281894"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461918","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":"Surgical Treatment of Insertional Achilles Tendinopathy Augmented With Human Acellular Dermal Matrix: A Retrospective Case Series.","authors":"Bryce Corlee, Mitchell Bloomquist, Branden Brantley, Curtis Hamilton, Vytautas Ringus","doi":"10.1177/24730114241284019","DOIUrl":"https://doi.org/10.1177/24730114241284019","url":null,"abstract":"<p><strong>Background: </strong>Insertional Achilles tendinopathy (IAT) is often surgically treated with Achilles tendon partial or total detachment, debridement and repair of the Achilles tendon, excision of retrocalcaneal exostosis, and suture anchor reattachment. To date, there is no report that examines the use of acellular dermal matrix (ADM) augmentation in this procedure without the use of suture anchor reattachment.</p><p><strong>Methods: </strong>Thirty-two female and 10 male patients (mean age 52 years) with IAT underwent surgical treatment including partial detachment of the Achilles tendon, excision of the retrocalcaneal exostosis, debridement and repair of the Achilles tendon, and augmentation with human acellular dermal matrix allograft. Outcomes measured were the visual analog scale (VAS) score, time to weightbearing, major and minor complications.</p><p><strong>Results: </strong>Forty-two patients were followed for a mean of 20.8 months. The VAS score improved from a mean of 5.1 to 1.9 at final follow-up. The mean time to weightbearing was 4.4 weeks. Eleven patients (26.2%) experienced complications. One patient (2.4%) suffered a rupture of the Achilles in the early postoperative period. Three patients (7.1%) had delayed wound healing, with 1 (2.4%) requiring surgical debridement. Two (4.8%) experienced continued pain requiring further surgical treatment.</p><p><strong>Conclusion: </strong>This protocol for surgical treatment of IAT with the use of human ADM allograft augmentation resulted in improved VAS scores and was associated with a low risk of postoperative infection without a prolonged nonweightbearing period.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241284019"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461917","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":"Is the Diagnosis of fifth Metatarsal Fracture Type Consistent? An Interobserver Reliability Study.","authors":"James Chapman, Shubhi Gupta, Zain Choudhary, Thomas Davies, Grace Airey, Lyndon Mason","doi":"10.1177/24730114241278712","DOIUrl":"https://doi.org/10.1177/24730114241278712","url":null,"abstract":"<p><strong>Background: </strong>Treatment pathways of fifth metatarsal fractures are commonly directed based on fracture classification, with particular proximal fractures typically requiring closer observation and possibly more aggressive management. Our aim is to investigate the interobserver reliability of assessment of subtypes of fifth metatarsal fractures.</p><p><strong>Methods: </strong>We included all patients referred to our virtual fracture clinic with a suspected or confirmed fifth metatarsal fracture. Plain anteroposterior radiographs were reviewed by 2 novice observers, initially trained on the fifth metatarsal classification identification. Eight different zones were defined based on anatomical location. Patients were excluded from analysis if neither observer could identify a fracture. An interobserver reliability analysis using Cohen κ coefficient was carried out, and degree of observer agreement described using Landis and Koch's description. All data were analyzed using IBM SPSS, version 27.</p><p><strong>Results: </strong>A total of 1360 patients who met the inclusion criteria were identified. The 2 observers had moderate agreement when identifying fractures in all zones, apart from zone 1.2 and distal metaphysis (DM) fractures, which only achieved fair agreement (κ = 0.308 and 0.381 respectively). Zone 3 has slight agreement with zone 2 proximally, and there is an apparent difficulty with distal diaphyseal shaft (DS) fractures, resulting in a lot of crossover with DM, achieving a fair level of agreement (DS 312 vs 196; DM 120 vs 237; κ = .398, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>Reliability of subcategorizing fifth metatarsal fractures using standardized instructions conveys moderate agreement in most cases. If the region of the fracture is going to be used in an algorithm to guide a management plan and clinical follow-up during a virtual clinic review, defining fractures of zones 1-3 needs careful consideration.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241278712"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389268","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":"Clinical and Radiographic Outcomes After Hindfoot and Ankle Arthrodesis Using Cellular Bone Allograft Augmentation: A Short Report.","authors":"Jeffrey R Ruland, Anna Sumpter, Eric McVey, Wendy Novicoff, Jennifer Pierce, Minton T Cooper, Venkat Perumal, Joseph S Park","doi":"10.1177/24730114241281325","DOIUrl":"10.1177/24730114241281325","url":null,"abstract":"<p><strong>Background: </strong>Nonunion after ankle or hindfoot arthrodesis is associated with poor outcomes. Cellular bone allograft is an alternative to autograft for use in these procedures. The purpose of this study was to prospectively evaluate the early efficacy and safety of cellular bone allograft use in hindfoot and ankle arthrodesis procedures.</p><p><strong>Methods: </strong>Fourteen patients undergoing hindfoot or ankle arthrodesis supplemented with cellular bone allograft were prospectively enrolled. Computed tomography (CT) scans were obtained postoperatively at set time points and reviewed by 3 fellowship-trained foot and ankle surgeons as well as 1 musculoskeletal radiologist. Primary outcome was CT-verified union, defined as >25% of joint surface. Complications were recorded and revision procedures offered as indicated.</p><p><strong>Results: </strong>CT-verified union rate during the study period was 76.7% (23 of 30 joints). Union was 100% for the ankle joint (2 of 2), 50% for the talonavicular joint (5 of 10), 100% for the calcaneocuboid joint (8 of 8), and 80.0% for the subtalar joint (8 of 10). One patient underwent revision fusion procedure, and 1 patient underwent hardware removal during the study period.</p><p><strong>Conclusion: </strong>Our initial experience suggests that use of cellular bone allograft augmentation in hindfoot and ankle arthrodesis may offer an alternative to autograft without potential of donor site morbidity.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241281325"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344622","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":"Suitability of Minced Cartilage From Osteochondral Lesions of the Talus for Immediate Autograft Reimplantation.","authors":"Emilie R C Williamson, Zijun Zhang, Morgan Motsay, Maggie Manchester, John T Campbell, Rebecca A Cerrato, Patrick J Maloney, Lew C Schon, Clifford L Jeng","doi":"10.1177/24730114241278967","DOIUrl":"https://doi.org/10.1177/24730114241278967","url":null,"abstract":"<p><strong>Background: </strong>Particulated autograft cartilage implantation is a surgical technique that has been previously described for the repair of osteochondral lesions of the talus (OLT). It uses cartilage fragments harvested from the OLT that are minced into 1-2-mm³ fragments and then immediately reimplanted back into the chondral defect and sealed with fibrin glue during a single-stage surgery. The purpose of this study was to characterize the suitability of these minced cartilage fragments as immediate autograft for the treatment of OLTs.</p><p><strong>Methods: </strong>Thirty-one patients undergoing primary arthroscopic surgery for their OLT consented to have their loose or damaged cartilage fragments removed and analyzed in the laboratory. Harvested specimens were minced into 1- to 2-mm³ fragments and cell count, cell density, and cell viability were determined. In addition, physical characteristics of the OLT lesion were recorded intraoperatively and analyzed including size, location, Outerbridge chondromalacia grade of the surrounding cartilage, density of underlying bone, and whether the surgeon thought the OLT was primarily hyaline or fibrocartilage.</p><p><strong>Results: </strong>An average of 419 000 cells was able to be obtained from the harvested OLT fragments. The cells were 71.2% viable after mincing. Specimens from younger patients and from lesions with worse chondromalacia adjacent to the OLT had significantly higher cell numbers. Those from lateral lesions and with worse neighboring chondromalacia had a significantly higher cell density. None of the remaining physical OLT characteristics studied seemed to significantly affect cell number or viability.</p><p><strong>Conclusion: </strong>A large number of viable cells are available for immediate autografting by removing the loose or damaged cartilage from an OLT and mincing it into 1- to 2-mm³ fragments. These can be reimplanted into the chondral defect in a single-stage surgery. Future clinical studies are needed to determine if the addition of these live autologous cells either alone or in conjunction with other techniques significantly improves the quality of the repair tissue and clinical outcomes.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241278967"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389269","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 Microbial Diversity and Antimicrobial Susceptibility Profile Underlying Diabetic Foot Osteomyelitis: A Retrospective Study Conducted in North Queensland, Australia.","authors":"Nandini Kulasegaran, Venkat Vangaveti, Robert Norton, Usman Malabu","doi":"10.1177/24730114241281503","DOIUrl":"https://doi.org/10.1177/24730114241281503","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot osteomyelitis (DFO) commonly occurs secondary to ulcerations of the skin. Empirical antibiotic agents are a key element of treatment and their use is dependent on local knowledge of the microbial spectrum of diabetic foot infections. This study aimed to retrospectively analyze the local microbiological profile, including bacterial culture/sensitivity results of DFO, and compare findings with literature. This study also aimed to review the concordance of microbiology results with national guidelines for the future treatment of DFO.</p><p><strong>Methods: </strong>A retrospective review of clinical records was performed on patients who presented to the high-risk foot clinic, Townsville University Hospital, between 2018 and 2022. All patients older than 18 years and diagnosed with DFO were included. Our exclusion criteria included all other foot presentations, including trauma, vasculitis, and neoplasms.</p><p><strong>Results: </strong>On the basis of the inclusion and exclusion criteria, 124 patients with DFO were selected. Most patients in the cohort were males (70.2%), non-Indigenous (68.5%), aged 50-69 years (55.6%), and with elevated HbA_1c levels (>8.6). Chronic kidney disease (39.5%) and ischemic heart disease (41.9%) were common comorbidities. Of the pertinent microbial results, <i>Staphylococcus aureus</i> (~76%) was the most commonly isolated Gram-positive organism. Gram-positive bacteria were significantly increased in the elderly population with DFO (<i>P</i> < .05). All methicillin-resistant <i>S aureus</i> isolates were vancomycin- and cotrimoxazole-sensitive. <i>Pseudomonas aeruginosa</i> was the predominant Gram-negative organism isolated (39.3%). <i>P aeruginosa</i> exhibited low sensitivity to ciprofloxacin.</p><p><strong>Conclusion: </strong>This study has enhanced our understanding of the various microbial species underlying DFO at our center and may be generalizable.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241281503"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389270","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":"Effect of Height and Weight on Heel Fat Pad Movements Between Microchamber and Macrochamber Layers in Loading and Unloading.","authors":"Toshihiro Maemichi, Masatomo Matsumoto, Toshiharu Tsutsui, Shota Ichikawa, Takumi Okunuki, Hirofumi Tanaka, Tsukasa Kumai","doi":"10.1177/24730114241278927","DOIUrl":"10.1177/24730114241278927","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to clarify the differences in the movement of the superficial microchambers and deep macrochambers of the heel fat pad during loading and unloading movements, and to clarify the influence of height and weight on this movement.</p><p><strong>Methods: </strong>The subjects were 21 healthy adults. The right foot was placed on an evaluation instrument stand made of polymethylpentene (PMP) resin plate, and the left foot was placed on a scale stand used to adjust the amount of load. When measuring, the heel fat pad is divided into the superficial microchamber layer and the deep macrochamber layer, and the thickness due to loading from 0% to 100% of the body weight and unloading from 100% to 0% is measured. Measurement was performed every 20% using an ultrasound imaging device. We also examined the rate of change in the thickness of the superficial and deep layers of the heel fat pad when applying 100% load (end load) from 0% load (unload).</p><p><strong>Results: </strong>No changes were observed in the superficial layer of the heel fat pad during unloading, but significant changes were observed in the deeper layers. Additionally, the thickness of the microchamber and macrochamber layers tended to increase under each loading condition as the height and weight increased. On the other hand, the rate of change in the thickness of the macrochamber layer tended to decrease.</p><p><strong>Conclusion: </strong>The microchamber layer and the macrochamber layer of the heel fat pad may have different functions. As height and weight increase, the thickness of the microchamber and macrochamber layers may increase, and the rate of change in the thickness of the macrochamber layer appears to decrease. Although the thickness increases as the load increases, we found that the related elasticity decreases.</p><p><strong>Level of evidence: </strong>Level Ⅳ, cross-sectional survey study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241278927"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380467","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 of Race With Referral Disparities for Patients With Diabetic Foot Ulcers at an Institution Serving Rural and Urban Populations.","authors":"Mubinah Khaleel, Ashwin Garlapaty, Sam Hawkins, James L Cook, Kyle Schweser, Kylee Rucinski","doi":"10.1177/24730114241281335","DOIUrl":"10.1177/24730114241281335","url":null,"abstract":"<p><strong>Background: </strong>Racial minorities are more likely to develop type 2 diabetes and experience associated microvascular complications. Non-Hispanic Blacks and Hispanics initially present with more severe diabetic foot ulcers (DFUs) and peripheral artery disease (PAD), with an associated 10-fold increase in risk for lower extremity amputation within the first year after diagnosis. This study was designed to determine if race is associated with a failure to refer to specialists for DFU treatment, and the severity of DFU at the time of initial presentation.</p><p><strong>Methods: </strong>Patients were identified from the medical record based on a diagnosis related to diabetic foot complications between January 1, 2018, and June 1, 2023, in the family medicine, endocrinology, orthopaedic, or emergency clinics at a Midwest Academic Hospital serving rural and urban populations. Patients self-reported race, demographics, severity of ulcer based on Wagner ulcer scale at time of referral, eventual amputation status, and measures of social determinants of health including the national Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes were manually extracted and analyzed for correlations with referral status.</p><p><strong>Results: </strong>A total of 597 patients were eligible for inclusion. Race was not associated with lower referral rates (<i>P</i> > .99) or source of referral (<i>P</i> = .58) to specialty clinic and ulcer severity at initial examination (<i>P</i> = .34). Patients who initially presented to the emergency department had more severe ulcers (<i>P</i> = .016), and higher severity was significantly associated with lower limb amputation vs mild ulcers (odds ratio = 38.8, <i>P</i> = .02). No significant differences in referral source or severity of ulcer at presentation were seen for sex, age, marital status, insurance type, rural status, ADI, time from referral to appointment, or eventual amputation.</p><p><strong>Conclusion: </strong>In this study, we found that patient race was not associated with severity of DFU at presentation or subsequent referral to a Midwest academic specialty orthopaedic clinic for care.<b>Level of Evidence:</b> Level III, retrospective review.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241281335"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380466","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}