Foot & Ankle Orthopaedics最新文献

{"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}

{"title":"Comparing the Clinical Outcomes of Percutaneous Cheilectomy to Open Cheilectomy With Moberg Osteotomy for the Treatment of Hallux Rigidus.","authors":"Grace M DiGiovanni, Seif El Masry, Rami Mizher, Agnes Jones, A Holly Johnson, Scott J Ellis, Matthew S Conti","doi":"10.1177/24730114241264557","DOIUrl":"https://doi.org/10.1177/24730114241264557","url":null,"abstract":"<p><strong>Background: </strong>Both an open cheilectomy with a Moberg osteotomy and percutaneous cheilectomy have been successfully used to treat hallux rigidus and preserve motion.However, there have been no studies that have compared these 2 procedures using validated patient-reported outcomes such as the Patient Reported Outcome Measurement Information System.</p><p><strong>Methods: </strong>A retrospective review of hallux rigidus patients between January 2016 and July 2021 collected 48 percutaneous cheilectomy (PC) patients and 71 open cheilectomy with Moberg (OCM) patients. Preoperative and minimum 1-year postoperative PROMIS scores were collected.</p><p><strong>Results: </strong>The OCM and PC cohorts did not have significant differences in their postoperative PROMIS scores. Both cohorts had modest but significant improvements postoperatively in the physical function, pain interference, and pain intensity domains. The OCM group had a larger degree of improvement in physical function, pain interference, and pain intensity (<i>P</i> = .015, .011, .001, respectively). No significant difference was identified in the reoperation rate.</p><p><strong>Conclusion: </strong>Patients undergoing an OCM had worse preoperative PROMIS scores and a modestly greater change in patient-reported outcomes than patients undergoing a PC.</p><p><strong>Level of evidence: </strong>Level III, retrospective review.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241264557"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11401145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142283049","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":"Response to \"Letter Regarding: Percutaneous Fixation of Posterior Malleolar Fractures: A Contemporary Review\".","authors":"Jafet Massri-Pugin, Sergio Morales, Javier Serrano, Pablo Mery, Jorge Filippi, Andrés Villa","doi":"10.1177/24730114241278710","DOIUrl":"10.1177/24730114241278710","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241278710"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125282","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":"Letter Regarding: Percutaneous Fixation of Posterior Malleolar Fractures: A Contemporary Review.","authors":"Adrian J Talia","doi":"10.1177/24730114241278725","DOIUrl":"10.1177/24730114241278725","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241278725"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125281","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":"Hydrodissection Facilitates Open Resection of Morton's Neuroma Through a Plantar Approach: Technique Tip.","authors":"Sufyan Faridi, Amanda Vandewint, Jacob Matz","doi":"10.1177/24730114241274778","DOIUrl":"10.1177/24730114241274778","url":null,"abstract":"<p><p>Visual AbstractThis is a visual representation of the abstract.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241274778"},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119300","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":"A Characteristic Magnetic Resonance Imaging Finding to Identify Morton Neuroma: The Slug Sign.","authors":"Masahiro Horita, Kenta Saiga, Tomohiro Fujiwara, Eiji Nakata, Toshifumi Ozaki","doi":"10.1177/24730114241268285","DOIUrl":"10.1177/24730114241268285","url":null,"abstract":"<p><strong>Background: </strong>Morton neuroma is a common cause of forefoot pain and sensory disturbances, but it is difficult to identify on magnetic resonance imaging (MRI). The aim of this study was to verify the usefulness of a characteristic MRI finding (slug sign) for identifying Morton neuroma and to clarify the relationship between excised neuroma characteristics and preoperative MRI findings.</p><p><strong>Methods: </strong>Twenty-two web spaces were retrospectively assessed from the second and third intermetatarsal spaces of 11 feet of 10 patients (7 women and 3 men, aged average 59.5 years) who underwent surgical excision of Morton neuroma between 2017 and 2022. Asymptomatic web spaces were used as control. Neuromas with 2 branches of the plantar digital nerves on axial T1-weighted MRI (MRI-T1WI) were considered the slug sign. We investigated the preoperative presence of the slug sign in Morton neuroma and asymptomatic control web spaces. We also investigated the relationship between the maximum transverse diameter of the excised specimen and that estimated on coronal MRI-T1WI.</p><p><strong>Results: </strong>A total of 15 Morton neuromas were excised and assessed. The slug signs were present in 10 intermetatarsal spaces in 15 web spaces with Morton neuroma whereas the sign was found in 1 intermetatarsal space in 7 asymptomatic web spaces. The sensitivity and specificity for the slug sign to diagnose Morton neuroma was 66.7% and 85.7%, respectively. The positive and negative predictive values were 90.9% and 54.5%, respectively. The mean maximum transverse diameter of excised neuromas was 4.7 mm. The mean maximum transverse diameter of neuromas on coronal MRI-T1WI was 3.4 mm. A significant positive correlation was found between the maximum transverse diameters of excised specimens and diameters estimated on coronal MRI-T1WI (<i>r</i> = 0.799, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>The slug sign may be a useful indicator of Morton neuroma on MRI to confirm nerve involvement after bifurcation.</p><p><strong>Level of evidence: </strong>Level IV, retrospective series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241268285"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079842","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":"Efficiency of Foot and Ankle Surgeries Completed on the Preoperative Stretcher vs Operating Room Table: A Randomized Controlled Trial.","authors":"Emily B Parker, Jeremy T Smith, Gregory Lausé, Eric M Bluman","doi":"10.1177/24730114241270272","DOIUrl":"10.1177/24730114241270272","url":null,"abstract":"<p><strong>Background: </strong>Extremity surgeons frequently operate on the preoperative stretcher rather than the operating room (OR) table. This study sought to identify differences between stretcher-based (SB) and OR table-based (TB) procedures with regard to time efficiency and OR team member preferences.</p><p><strong>Methods: </strong>We conducted a prospective randomized controlled trial comparing the efficiency of SB vs OR TB foot and ankle procedures. Fifty-two patients undergoing a hardware removal, isolated gastrocnemius recession, soft tissue procedure, or foreign body removal at our day surgery unit were included. Start time and exit time were recorded. \"Start time\" was the number of minutes between the patient entering the OR and first incision. \"Exit time\" was the number of minutes between the procedure ending and the patient exiting the OR. Surveys were disseminated to OR staff who participated in the included cases.</p><p><strong>Results: </strong>The total measured time in the OR was an average 6 minutes shorter in the Stretcher group compared to the OR Table group (10 minutes vs 16 minutes, <i>P</i> < .001). SB procedures were associated with a significantly shorter start time (median difference = 4 minutes, <i>P</i> = .001), but not exit time (median difference = 1 minute, <i>P</i> = .058). No difference was found in actual surgical time. Thirty (96.8%) OR team members perceived SB procedures as enhancing OR efficiency, and 30 (96.8%) respondents considered SB procedures to be equal or superior to OR TB procedures in terms of patient safety. All would recommend or strongly recommend SB procedures.</p><p><strong>Conclusion: </strong>We found SB foot and ankle procedures to require less room time than OR TB procedures. Particularly for high-volume specialties, an average 6 minutes saved per case may meaningfully improve overall OR efficiency. Most OR team members believed that SB surgery improves OR efficiency and is the safer option for OR team members.</p><p><strong>Level of evidence: </strong>Level II, randomized controlled trial, survey.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241270272"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079845","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":"First-Ray Distal Metatarsal and Proximal Phalangeal Osteotomies Without Soft Tissue Procedure for Severe Hallux Valgus: A Case Series.","authors":"Kenichiro Nakajima","doi":"10.1177/24730114241274772","DOIUrl":"10.1177/24730114241274772","url":null,"abstract":"<p><strong>Background: </strong>This case series reported the outcomes of severe hallux valgus treated with first-ray distal metatarsal and proximal phalangeal osteotomies without soft tissue procedure.</p><p><strong>Methods: </strong>The medical records of patients who underwent this surgery from February 2018 to December 2021 were reviewed, including patients with a hallux valgus angle (HVA) ≥40 degrees who were followed up for >2 years. The analyzed data included age, sex, height, weight, and body mass index at the surgery, HVA and intermetatarsal angle (IMA) on the weighted anteroposterior radiograph of the affected foot, the Japanese Society for the Surgery of the Foot score, visual analog scale (VAS) score, and passive plantarflexion and dorsiflexion angles of the first metatarsophalangeal joint 1 month before surgery and at final follow-up.</p><p><strong>Results: </strong>The study group included 35 feet in 29 patients (26 females) with a mean age of 67 ± 10.6 years and mean follow-up of 3.5 ± 0.8 years. Average preoperative and final follow-up measures were HVA, 46.8 to 7.7 degrees; IMA, 18.8 to 9.5 degrees; and VAS score, 61.5 ± 29.6 to 2.7 ± 4.6. Range of motion decreased on average: dorsiflexion, 83.6 ± 14.7 to 71.3 ± 12.0 degrees; and plantarflexion, 63.0 ± 14.7 to 53.0 ± 11.8. All changes were statistically significant (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>This surgery achieved good correction and clinical outcomes for severe hallux valgus, but the postoperative range of motion decreased.<b>Level of Evidence</b>: Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241274772"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079887","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":"Additional Procedures at the Time of Total Ankle Replacement Do Not Increase Risk of Short-term Complications: A Matched Cohort Analysis.","authors":"Maria I Peri, Sarah Whitaker, Sarah Cole, Albert Anastasio, James R Satalich, Conor N O'Neill, Tejas T Patel, James A Nunley, Mark E Easley, Karl M Schweitzer","doi":"10.1177/24730114241268150","DOIUrl":"10.1177/24730114241268150","url":null,"abstract":"<p><strong>Background: </strong>This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), alone or with concomitant procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes.</p><p><strong>Methods: </strong>The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using <i>Current Procedural Terminology</i> (<i>CPT</i>) codes to identify patients who underwent TAA (27702) between 2010 to 2021. Patients were divided into cohorts based on the presence or absence of ancillary procedures. Propensity score matching was employed to account for demographic differences, and statistical analyses were performed to compare short-term complication rates between matched cohorts.</p><p><strong>Results: </strong>A total of 2225 patients were identified, with 1432 (64.4%) receiving TAA alone and 793 (35.6%) with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times (<i>P</i> < .001) and length of hospital stay (LOS) (<i>P</i> < 0.001). Rates for extended LOS were significantly higher in the ancillary cohort than in the simple cohort (<i>P</i> = .01). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). American Society of Anesthesiologists classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, <i>P</i> = .04). Matched subgroup analysis excluding tendon lengthening as a concomitant procedure found that the ancillary cohort still had longer operative time (<i>P</i> < .001) and LOS (<i>P</i> < .05) than patients undergoing simple TAA.</p><p><strong>Conclusion: </strong>Without significant difference in rates of AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring additional corrective procedures at the time of TAA.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 3","pages":"24730114241268150"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079843","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}