Foot & Ankle Orthopaedics最新文献

{"title":"Preoperative Ankle Swelling and the Effect On Postoperative Wound Complications Following Ankle Fracture Surgery.","authors":"Anthony M Silva, Helena Franco, Tom P Walsh, Albert Hohuynh, Simon Platt","doi":"10.1177/24730114251342252","DOIUrl":"10.1177/24730114251342252","url":null,"abstract":"<p><strong>Background: </strong>Swelling following an ankle fracture is commonly believed to preclude surgical fixation; swelling is thought to be associated with increased wound complications. Delaying surgery until swelling subsides is thought to secure better outcomes, although no guidelines exist to direct surgeons when an appropriate time to intervention is or whether a visual inspection of the swelling is correlated to quantitative measurement. This study aimed to identify whether preoperative ankle swelling influences postoperative wound complications following ankle fracture surgery.</p><p><strong>Methods: </strong>This prospective cohort study recruited patients undergoing operative management of closed rotational ankle fractures on a single side (unilateral injury). Individual surgeons determined the time to surgery based on their usual practice. Ankle swelling was measured on a subjective visual scale and then quantitatively using the validated figure-of-8 technique. Follow-up was standardized at 2, 6, and 12 weeks postoperatively. Between-group participant, surgical, and wound characteristics were recorded and analyzed, in addition to the agreement between qualitative and quantitative ankle-swelling measures.</p><p><strong>Results: </strong>Eighty participants were recruited. The wound complication rate was 8.75% (n = 7), with only 1 deep infection requiring operative intervention and antibiotic therapy. Wound complication rates were not associated with quantitative ankle swelling (<i>P</i> = .76), visual assessment of ankle swelling (<i>P</i> = .65), or time to operative intervention (<i>P</i> = .27). Increasing age (<i>P</i> = .006) and female gender (<i>P</i> = .034) were associated with wound complications. Between-group body mass index, experience level of the operating surgeon, and tourniquet time were not statistically significant. Visual assessment of ankle swelling had a poor to moderate correlation to \"figure-of-8' ankle swelling measurements (intraclass correlation = 0.507, 95% CI = 0.325-0.653).</p><p><strong>Conclusion: </strong>In this prospective and underpowered study, we did not find that time to surgical intervention or residual swelling at the time of surgery was associated with increased wound complications following fixation of closed unilateral malleolar ankle fractures, including those involving multiple malleoli. Although surgeon discretion was used in determining readiness for surgery, all cases had some delay, which may have influenced results. Visual assessment of swelling showed only moderate correlation with objective measurement, questioning its reliability as a surgical readiness tool.These findings suggest that in carefully selected cases, delaying surgery beyond initial clinical readiness for reasons of residual swelling may not be necessary.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 3","pages":"24730114251342252"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625747","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":"Time to Radiographic Union Following Minimally Invasive META Procedure for Hallux Valgus.","authors":"Taylor Schnepp, Kyle Lorenzo, Chase Burzynski, Jason Mirharooni, Wade Massey, Thomas San Giovanni, Christopher W Hodgkins, Cary B Chapman","doi":"10.1177/24730114251343549","DOIUrl":"10.1177/24730114251343549","url":null,"abstract":"<p><strong>Background: </strong>The use of fourth-generation minimally invasive hallux valgus surgery with metaphyseal extra-articular transverse and Akin osteotomy, recently dubbed \"META,\" is a new generation of minimally invasive surgical (MIS) technique and a recent focus of foot and ankle orthopaedic literature associated with good functional outcomes and low complication rates. Literature in orthopaedic trauma has indicated that 2 or 3 neocortices on postoperative radiographs are associated with high likelihood of union. In this study, we conducted a retrospective analysis to investigate the time to bony union for patients undergoing fourth-generation MIS hallux valgus repair as well as the relationship between intraoperative degree of first-metatarsal displacement and time to bony union.</p><p><strong>Methods: </strong>We retrospectively analyzed 217 consecutive patients with moderate to severe hallux valgus who underwent fourth-generation MIS first distal metatarsal and Akin osteotomy between 2020 and 2023 and were followed for up to 1 year. Radiographic measurements included the scale of displacement between the proximal and distal portions of the first metatarsal as a percentage and the number of neocortical bridge formations at the osteotomy site. Postoperative weightbearing radiographs were recorded at 6 weeks, 3 months, 6 months, and 1 year to assess time to union and patient clinical outcomes. Two orthopaedic surgeons independently reviewed the radiographs to assess progression to bony union. Any discrepancy in analysis was resolved by a third-party clinician. Complete union was defined as the presence of at least 2 new cortical bridge formations on postoperative X-ray films. Patients were divided into 3 groups based on the percentage of shift on the first metatarsal head (≤50%, 51%-75%, ≥76%) for the purpose of our analysis.</p><p><strong>Results: </strong>Union (≥2 cortices) was observed in 17%, 70%, and 90% of patients at 6 weeks, 3 months, and 6 months, respectively. At final follow-up (mean 13 ± 6.9 weeks), 92% achieved union. No significant differences in time to union were observed across metatarsal shift groups.Complications include 3 nonunions, 3 revisions, 16 cases that necessitated removal of hardware, 1 case of superficial wound infection, 1 case of deep wound infection, and 6 deformity recurrences.</p><p><strong>Conclusion: </strong>Time to union after META procedure typically occurred by 13 weeks, independent of shift magnitude. Surgeons may consider ≥2 cortices and absence of symptoms as sufficient indicators for advancing weightbearing. These findings may assist in patient counseling and postoperative planning.<b>Level of Evidence:</b> Level IV, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 3","pages":"24730114251343549"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625748","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":"Preliminary Radiographic Classification of First Metatarsal Osteotomy Healing Following Minimally Invasive Hallux Valgus Surgery.","authors":"Thomas L Lewis, Sanjana Mehrotra, Jonathan Kaplan, Tyler Gonzalez, Sergio Morales, Thomas J Goff, Vikramman Vignaraja, Ayla Claire Newton, Robbie Ray, Peter Lam","doi":"10.1177/24730114251345818","DOIUrl":"10.1177/24730114251345818","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive or percutaneous surgery (MIS) for hallux valgus correction has seen increased adoption because of a growing evidence base of positive clinical and radiographic outcomes following surgery. However, no standardized or validated radiographic classification exists to evaluate the first metatarsal osteotomy healing following MIS hallux valgus surgery. The aim was to develop a new radiographic classification system for assessing bone healing following MIS distal transverse osteotomy for hallux valgus.</p><p><strong>Methods: </strong>A 4-domain radiographic classification system based on callus formation, anteroposterior (AP) osteotomy line, lateral osteotomy line, and remodeling for MIS osteotomy healing was developed and tested on a cohort of 27 feet that underwent percutaneous transverse osteotomy for hallux valgus correction. Patients had simultaneous postoperative weightbearing computed tomography (WBCT) and standard radiographs following surgery. Five surgeons reviewed anonymized radiographs to evaluate interobserver reliability. WBCT was used to confirm union status and classification interpretation.</p><p><strong>Results: </strong>The classification system demonstrated substantial interobserver reliability for lateral osteotomy line (Fleiss kappa = 0.671, 95% CI 0.505-0.814) and AP osteotomy line assessment (Fleiss kappa = 0.664, 95% CI 0.459-0.811), with moderate agreement for callus formation (κ = 0.465) and remodeling (κ = 0.439). The classification showed strong correlation with WBCT findings, with an optimal threshold of 8 points identified to differentiate union from nonunion, achieving an overall classification accuracy of 85.2%. This finding was supported by the area under the receiver operating characteristic (ROC) curve of 0.832. At the optimal threshold, the classification demonstrated 90.0% sensitivity and 71.4% specificity for detecting union.</p><p><strong>Conclusion: </strong>This preliminary classification provides a reliable tool for assessing first metatarsal bone healing following MIS hallux valgus osteotomies, with substantial interobserver reliability. It offers a standardized approach for radiographic evaluation, which may enhance comparability across studies and serve as a radiographic research tool pending further validation. Its clinical applicability remains to be determined.</p><p><strong>Level of evidence: </strong>Level III, diagnostic study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251345818"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552803","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":"MicroCT Advanced Imaging of the Foot and Ankle: Technique Guide.","authors":"Jonathan Day","doi":"10.1177/24730114251351633","DOIUrl":"10.1177/24730114251351633","url":null,"abstract":"<p><strong>Background: </strong>Recent advances in micro-computed tomography (MicroCT) imaging have enabled detailed investigations of human microvascular anatomy, providing new insights that may influence treatment options and optimize local reparative potential. This article describes a reproducible cadaveric perfusion technique for visualizing foot and ankle microvasculature using MicroCT, designed to support anatomical research and surgical planning studies.</p><p><strong>Methods: </strong>Ten matched pairs of fresh-frozen cadaveric lower limbs were used to develop this protocol. An 18-gauge angiocatheter was used to cannulate the anterior and posterior tibial arteries for perfusion of the foot and ankle, or the popliteal artery for perfusion of the entire lower leg. Clearing was performed sequentially with 0.9% saline, 3% hydrogen peroxide, and water. Perfusion was performed with a 50% barium sulfate/2.5% gelatin solution. Confirmatory images were obtained using mini c-arm fluoroscopy. Final images were obtained for microvascular assessment using a commercial MicroCT scanner. Integrity of the perfusate was visually evaluated on MicroCT over the course of 4 freeze-thaw cycles spanning 2 months.</p><p><strong>Results: </strong>All intraosseous and extraosseous microvascular structures were successfully visualized using MicroCT of the cadaveric lower extremities. Microvasculature was perfused in continuity without incidence of contrast extravasation. When present, intraosseous nutrient arteries of the first and fifth metatarsal, and branches of the tarsal sinus artery were appreciated. Contrast material remained visually consistent even after preforming surgical resections and undergoing multiple freeze-thaw cycles.</p><p><strong>Conclusion: </strong>This standardized perfusion technique was effective in the visualization of microvasculature in the foot and ankle. In addition to 3-dimensional mapping using MicroCT, this reproducible protocol can be used in numerous advanced imaging applications, including microvascular assessment following surgical reconstructions and instrumentation.</p><p><strong>Clinical relevance: </strong>A refined understanding of the microvascular anatomy of the foot and ankle using MicroCT perfusion imaging can potentially guide surgical techniques to minimize iatrogenic injury and optimize healing.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251351633"},"PeriodicalIF":0.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527068","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 Epidemiology of Sports and Recreation Related Toe Fractures in the United States.","authors":"Dogerno Norceide, Gabriel I Onor, Oluwatomi Akingbola, William Justice, Nana F Amponsah, Abimbola Okulaja, Ifeanyichukwu Onor, Michael Okoronkwo, Chibuikem Nwizu, David Pedowitz","doi":"10.1177/24730114251342797","DOIUrl":"10.1177/24730114251342797","url":null,"abstract":"<p><strong>Background: </strong>Fractures of the toes are among the most frequently diagnosed lower extremity fractures. In sports, toe fractures may present after diverse mechanisms of injury, varying severity, and varying implications for management. This study aimed to discern trends in toe fractures presenting to US emergency departments (EDs) particularly in association with sports and recreational activities. An additional aim of the study was to identify if rates of toe fracture presentation significantly decreased during the year 2020 at the height of the COVID-19 pandemic.</p><p><strong>Methods: </strong>We queried the National Electronic Injury Surveillance System (NEISS) database to identify toe fractures presented to US EDs from 2013 to 2022. The data outputs were analyzed by age group, sex, sport/recreational activity, and year. US Census data were used for calculation of incidence rates (IR) in 100,000 person-years. χ² tests and regression analyses were performed to determine significance. Grubbs's test was performed to determine significant yearly outliers with particular attention to the year 2020.</p><p><strong>Results: </strong>A total of 921,033 toe fractures were identified across US EDs, with 175,864 cases associated with sports and recreation. Exercise (IR = 140.3) had the leading IR among sports/recreation followed by cycling (IR = 136.8), basketball (IR = 136.8), and football (IR = 94.9). Males accounted for 40.8% of fractures (IR = 23.0), whereas females contributed 59.2% (IR = 32.8). Toe fractures peaked in the 10- to 14-year-old age group in both males and females. Sports- and recreation-related toe fractures did not significantly decrease from 2013 to 2022, although all-cause toe fractures did significantly decrease as shown by a <i>P</i> value of .0037 from linear regression analysis of yearly trend in all toe fractures. The year 2020 was a significant outlier with a decrease in sports-related toe fractures though there was no significant decrease in all-cause toe fractures in 2020.</p><p><strong>Conclusion: </strong>Sports- and recreation-related toe fractures did not significantly decrease from 2013 to 2022, although a significant decrease in all-cause toe fractures was observed. Toe fractures continue to peak in the pediatric age groups, particularly 10-14 year-olds. Youth sports and recreation officials should be aware of the risks of toe fractures to aid in prevention.<b>Level of Evidence:</b> Level III, epidemiologic database, retrospective cohort studies.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251342797"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527070","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":"Achilles Tendon Scraping With Plantaris Tendon Removal for Achilles Tendinopathy: A Systematic Review and Meta-analysis.","authors":"Jimmy Wen, Meraj Alam, Romteen Sedighi, Burhaan Syed, Ramy Khalil, Mouhamad Shehabat, Bethany Joy, Daniel Razick, Adam Razick, Eldo Frezza","doi":"10.1177/24730114251346791","DOIUrl":"10.1177/24730114251346791","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendinopathy (AT) patients who are refractory or have a suboptimal response to traditional tendon loading rehabilitation may have an additional component of pain with the plantaris tendon. This systematic review aims to evaluate the efficacy and safety of the combination of Achilles tendon scraping (ATS) and plantaris tendon removal (PTR) for AT.</p><p><strong>Methods: </strong>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Embase, and Cochrane Library for studies reporting on concurrent ATS with PTR for AT. Study variables included the number of patients, mean age, mean follow-up time, return to activity (RTA) or sport (RTS), pre- and postintervention patient-reported outcomes (PROs), and complications. A meta-analysis was performed for pre- and postintervention Victorian Institute of Sports Assessment-Achilles (VISA-A) scores.</p><p><strong>Results: </strong>Seven studies including 235 patients (291 tendons) with a mean age of 40.8 years (27.2-52) and a mean follow-up time of 23.2 months (6-69.6) were analyzed. Mean preoperative score VISA-A (5 studies), and visual analog scale (VAS) scores (2 studies) were 43.4 (0-74.1) and 6.6 (5.8-7.4), respectively. RTA (1 study) and RTS (4 studies) were 100% and 95.5%. Mean postoperative VISA-A and VAS scores were 92.7 (61-100) and 0.8 (0.8-0.8). Pooled VISA-A mean differences were statistically significant at 43.6 (95% CI: 41.0-46.3, <i>P</i> < .00001). The complication and revision rates were 11 (3.8%) and 5 (1.7%), respectively.</p><p><strong>Conclusion: </strong>ATS with PTR demonstrated promising preliminary results, with improved postoperative PROs, high reported rates of RTA/RTS, and low complication and revision rates. These findings should be interpreted cautiously given the limited available evidence and high study heterogeneity.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251346791"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527067","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":"Outcomes of Combined Proximal Medial Gastrocnemius Release and Achilles Tendon Debridement and Reinsertion for Calcified Insertional Achilles Tendinopathy.","authors":"Daniel Saraiva, Markus Knupp, Daniel Freitas, André Sá Rodrigues, Tiago Pato, José Tulha, Tiago Mota Gomes, Xavier Martín Oliva","doi":"10.1177/24730114251348194","DOIUrl":"10.1177/24730114251348194","url":null,"abstract":"<p><strong>Background: </strong>Gastrocnemius tightness has been implicated in the pathogenesis of calcified insertional Achilles tendinopathy (IAT), Haglund deformity, and Achilles intratendinous calcifications (IC). The aims of this study were to determine long-term clinical and radiographic results of combined proximal medial gastrocnemius release (PMGR) and Achilles tendon debridement and reattachment (ATDR) for patients presenting with symptomatic calcified IAT.</p><p><strong>Methods: </strong>A retrospective cohort study was performed in order to determine clinical and radiographic outcomes of PMGR and ATDR for patients presenting with symptomatic calcified IAT, at a minimum follow-up of 30 months. Patient satisfaction was assessed at last available follow-up as very satisfied, satisfied, and unsatisfied. Clinical assessment was performed evaluating preoperative and last available follow-up visual analog scale for pain (VAS-P) and the Foot and Ankle Outcome Score (FAOS). Radiographic evaluation included Fowler-Phillip angle, calcification length, calcification width, and presence of Achilles IC, measured on standard weightbearing lateral calibrated radiograph of the foot preoperatively and last available follow-up evaluation for each patient.</p><p><strong>Results: </strong>The mean follow-up was 46 (range, 30-72) months. We registered 45 \"very satisfied\" patients (84.91%), 6 \"satisfied\" patients (11.32%), and 2 \"unsatisfied\" patients (3.77%), as well as statistically significant improvement on both clinical scores tested. We found statistically significant differences between the initial evaluation and last available follow-up on all radiographic measurements. There was no significant radiographic recurrence of calcified IAT, whereas minor Achilles intratendinous calcifications were found in 10 patients (18.87%).</p><p><strong>Conclusion: </strong>Combined PMGR and ATDR provides significant clinical and radiographic improvement for patients presenting with symptomatic calcified IAT and, although not preventing radiographic recurrence of minor Achilles IC, may reduce the rate of radiographic recurrence of calcified IAT, though the lack of a control group limits causal inference.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251348194"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527069","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":"Topical <i>Bixa orellana</i> for Postoperative Wound Healing: A Prospective Randomized Controlled Trial.","authors":"Joshua T Chew, Joshua J Xu, Thomas A J Goff, Karen A Fogarty, Michael J Symes, Brahman S Sivakumar, Andrew P Wines","doi":"10.1177/24730114251345821","DOIUrl":"10.1177/24730114251345821","url":null,"abstract":"<p><strong>Background: </strong>Numerous ointments may be applied to surgical incisions in the postoperative period to minimize scar formation. There is little evidence assessing their efficacy on wound healing following foot and ankle procedures. This trial was conducted to assess the efficacy of <i>Bixa orellana</i> (Urucu) ointment in the treatment of postoperative elective foot and ankle incisions, compared with conventional postoperative wound care using a control ointment.</p><p><strong>Methods: </strong>A prospective, single-center, randomized controlled trial of adults who had undergone elective foot and ankle surgery was performed. Participants were randomized into receiving either a protocol of <i>B orellana</i> ointment application or conventional postoperative wound care with a control ointment. These ointments were applied 2 weeks postoperatively for a 4-week duration. The primary outcome assessed was the Patient and Observer Scar Assessment Scale (POSAS) 6 weeks postoperatively.</p><p><strong>Results: </strong>Significant improvements were noted in observer-reported wound vascularity, pigmentation, thickness, relief, pliability, and surface area with the use of Urucu, when compared to the control ointment. Overall, observers reported that scars treated with Urucu cream were found to more closely resemble normal skin with an overall POSAS score of 2.56 compared with 3.33 for the control ointment (<i>P</i> < .01). Lower scores in this instance indicate a more favorable result. Similarly, patients also reported a similar finding with an overall POSAS score of 3.70 for Urucu compared with a control ointment, 4.80 (<i>P</i> = .012). No difference was noted in terms of antibiotic use, delayed wound healing, or return to theatre. Two patients had adverse effects on the application of Urucu ointment in the form of a localized reaction and pruritis that improved with treatment cessation (<i>P</i> = .08). Neither patient required any further intervention.</p><p><strong>Conclusion: </strong>Topical Urucu ointment demonstrated promising early improvements in POSAS scores from both patients and observers, particularly in pigmentation and pliability domains, but findings should be interpreted cautiously because of the small sample size and short follow-up.</p><p><strong>Level of evidence: </strong>Level I, randomized controlled trial.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251345821"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527071","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":"Medial Gastrocnemius Recession.","authors":"Irvin Oh, Jeremy Ansah-Twum, Arianna Gianakos, Kinjal Vasavada","doi":"10.1177/24730114251347265","DOIUrl":"10.1177/24730114251347265","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251347265"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474504","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":"Biomechanical Comparison of Two Plantar Lapidus Plating Systems.","authors":"Felix Werneburg, Maria Felsberg, Juliane Beschauner, Christin Arnold, Darius Arbab, Heike Kielstein, Alexander Zeh, Karl-Stefan Delank, Natalia Gutteck","doi":"10.1177/24730114251342799","DOIUrl":"10.1177/24730114251342799","url":null,"abstract":"<p><strong>Background: </strong>Hallux valgus (HV) is a common forefoot deformity that often leads to foot pain and functional limitations, requiring surgical intervention when conservative treatments fail. Tarsometatarsal arthrodesis is a widely used procedure for severe HV deformities, with plantar plate fixation demonstrating superior biomechanical outcomes. However, the biomechanical equivalence of different plantar plate designs remains unclear. Specifically, there is a lack of biomechanical studies comparing how design variations affect load distribution, durability, and the risk of material failure postoperatively. This study aims to address this gap by evaluating the biomechanical performance of 2 commonly used plantar plate designs.</p><p><strong>Methods: </strong>This study involved a biomechanical analysis of 2 widely used plantar Lapidus plating designs: U-shaped plates and straight-shaped plates. A total of 20 fresh frozen cadaveric feet from 10 donors were included. The plates were assigned randomly to each specimen, and tarsometatarsal arthrodesis was performed according to the manufacturers' guidelines. Mechanical testing was conducted using a universal testing machine, focusing on cyclic loading and maximum load capacity to assess the mechanical stability of each system. Cyclic loads were systematically applied in 4 increments, culminating in a ramp test to ascertain the maximum load to material failure.</p><p><strong>Results: </strong>Both the U-shaped and the straight-shaped plantar Lapidus plates demonstrated commendable mechanical stability under cyclic loading, with nearly no significant differences in stiffness across the 4 cyclic loading force cycles. In the maximum load capacity test, the straight-shaped plate showed a higher mean load capacity (540.6 N, SD = 36.09) compared with the U-shaped plate (446.6 N, SD = 91.32), with a statistically significant difference (<i>P</i> = .03) and a large effect size (Cohen <i>d</i> = 1.56).</p><p><strong>Conclusion: </strong>This biomechanical study demonstrated that both U-shaped and straight-shaped plantar Lapidus plating systems provided comparable mechanical performance under stepwise cyclic loading conditions. The straight-shaped plates showed a higher failure rate during cyclic loading but achieved a significantly greater maximum load capacity in the final load-to-failure test. In contrast, the U-shaped plates were more consistent under repeated loading, suggesting potential advantages in fatigue resistance. These findings may reflect a trade-off between repetitive load endurance and maximum load-bearing capacity. Although these results offer biomechanical insight into the design-specific behavior of 2 commonly used plantar plating systems, their clinical relevance should be interpreted with caution, given the limitations of cadaveric testing, the absence of biological bone healing, and small sample sizes. Further clinical and long-term outcome studies are needed to confirm whe","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251342799"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474502","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}