Foot & Ankle Orthopaedics最新文献

{"title":"Impact of Diagnosed Mental Health Disorders on Postoperative Outcomes After Achilles Tendon Repair.","authors":"Ahad A Kesaria, Saadi M Irfan, Tristan X Nguyen, Jeffrey L Shi, Verdinand C B Ruelos, William M Weiss","doi":"10.1177/24730114261457093","DOIUrl":"10.1177/24730114261457093","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the association between diagnosed mental health disorders and postoperative outcomes following Achilles repair.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the TriNetX database over a 20-year period. Patients were divided into 2 cohorts based on whether they had a documented mental health disorder (eg, anxiety or depression) 1 year preceding surgery. Cohorts were propensity score matched by demographics such as age, gender, body mass index, diabetes, and hypertension. Outcomes were measured 90 days, 3 years, and up to 10 years using odds ratios with 95% CIs. χ² analysis was performed with significance noted at <i>P</i> <.05.</p><p><strong>Results: </strong>Matched cohorts had a mean age of 48.5 years in the mental health cohort and 49.6 years in the control cohort, with 47.4% vs 47.1% female patients, respectively. A total of 1841 patients were included in each cohort. Within 90 days postoperative, patients with diagnosed mental health disorders demonstrated several significant outcomes such as higher odds of orthopaedic aftercare (<i>P</i> = .032), infection following a procedure (<i>P</i> < .0001), postoperative pain (<i>P</i> < .0001), emergency department visit (<i>P</i> < .0001), ankle pain (<i>P</i> = .004), cellulitis of lower limb (<i>P</i> < .0001), and foot pain (<i>P</i> = .009). Within 3 years postoperative, these patients had significantly higher odds of knee pain (<i>P</i> = .008), ankle osteoarthritis (<i>P</i> = .003), Achilles tendonitis (<i>P</i> = .008), and abnormalities of gait and mobility (<i>P</i> = .020). Within 10 years postoperative, these patients had significantly higher odds of ankle osteoarthritis (<i>P</i> = .006).</p><p><strong>Conclusion: </strong>Diagnosed mental health disorders are associated with increased short- and long-term adverse postoperative outcomes in patients who underwent Achilles repair at a population level. These associations included increased infection rates and pain, as well as later musculoskeletal diagnoses such as ankle osteoarthritis and abnormalities with gait.</p><p><strong>Level of evidence: </strong>Level III, retrospective, comparative cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261457093"},"PeriodicalIF":0.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367694","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":"PROMIS Computerized Adaptive Testing Demonstrates Strong Convergent Validity and Lower Patient Burden Compared With Legacy Instruments in Foot and Ankle Fracture Care.","authors":"Michiel A J Luijten, Lotte Haverman, Martijn Poeze, Diederik O Verbeek","doi":"10.1177/24730114261454983","DOIUrl":"10.1177/24730114261454983","url":null,"abstract":"<p><strong>Background: </strong>Despite its advantages, Patient-Reported Outcomes Measurement Information System (PROMIS) remains underused in patients recovering from foot and ankle fractures, and it is unclear whether condition- and region-specific PROs, such as the Foot and Ankle Outcome Score (FAOS), offer additional clinical insight over PROMIS in this cohort. Therefore, PROMIS Computerized Adaptive Test (CAT) measurement properties were evaluated and compared with region-specific and lower-extremity instruments. Also, variables associated with poorer outcomes were identified.</p><p><strong>Methods: </strong>In this prospective, cross-sectional study, patients with foot or ankle fractures completed questionnaires. PROMIS Mobility (MOB) and Pain Interference (PI) CATs were compared with FAOS, Lower Extremity Functional Scale (LEFS), and Short Musculoskeletal Function Assessment (SMFA). Convergent validity (correlations), reliability (SE, Cronbach α), efficiency (number of items/completion time), and floor/ceiling effects of each instrument were assessed. Multivariable linear regression was used to evaluate factors associated with PROMIS outcomes.</p><p><strong>Results: </strong>Seventy-three patients were included (mean age 50 [SD 17] years, 60% female). PROMIS-MOB showed particularly high correlations with domains focused on lower extremity functioning (FAOS-Sport, <i>r</i> = 0.74; FAOS-ADL, <i>r</i> = 0.76; LEFS, <i>r</i> = 0.86; and SMFA-dysfunction index, <i>r</i> = -0.83). PROMIS-PI showed particularly high correlations with pain-focused domains (FAOS-Pain, <i>r</i> = -0.78; SMFA-bother index, <i>r</i> = 0.72). PROMIS CATs and (most) other legacy instruments showed excellent reliability (SE = 2.1, α = 0.81-0.96). PROMIS CATs required fewer items (mean 6 and 4 items, respectively, vs 20-46) and less time to complete (mean 56 and 36 seconds, respectively, vs 118-295 seconds; <i>P</i> < .001). No floor or ceiling effects were observed for PROMIS CATs; a limited proportion of patients reached score extremes on some FAOS subscales (up to 12%), remaining below the 15% threshold. Greater pain intensity and depressive symptoms were independently associated with worse mobility and greater pain interference.</p><p><strong>Conclusion: </strong>Condition- and region-specific instruments may provide limited information beyond that obtained with PROMIS CATs. PROMIS (MOB, PI) CATs captured comparable constructs of functional recovery and pain interference, as demonstrated by high correlations with commonly used instruments, while substantially reducing patient burden. The relation between depressive symptoms and worse outcomes underscores the significance of psychological factors in recovery in patients with foot and ankle fractures.</p><p><strong>Levels of evidence: </strong>Level II, diagnostic study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261454983"},"PeriodicalIF":0.0,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351204","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":"Percutaneous Debridement and Double-Row Repair for Insertional Achilles Tendinopathy With Immediate Postoperative Weightbearing: A Consecutive Case Series.","authors":"Kevin D Martin, Srihan Anand, W Alexander Cantrell","doi":"10.1177/24730114261457084","DOIUrl":"10.1177/24730114261457084","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous treatment of insertional Achilles tendinopathy is gaining popularity. The objectives of this study were to show that a percutaneous double-row repair technique with immediate postoperative weightbearing (1) allows safe access to both the Haglund deformity and the Achilles enthesophyte with radiographic resolution of pathology and (2) was associated with clinical outcomes with no early weightbearing-related complications.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of consecutive patients. Correction was accomplished with an MIS burr and double-row repair technique through percutaneous incisions with fluoroscopic assistance. Patients were allowed to immediately weight-bear in a pneumatic walking boot with four 5° wedges (totaling 20° wedge) with progressive near-weekly wedge removal until return to normal shoes at 5.5 weeks. Patient demographic data and intraoperative data were recorded, as were pre- and postoperative patient-reported outcomes, radiographic measures, and short-term complications.</p><p><strong>Results: </strong>Sixty-one consecutive patients were included with a mean follow-up of 12.1 ± 5.7 months (range, 1.5-24 months). Preoperative mean spur length and width improved from 14.29 (SD 7.38) mm and 5.88 (SD 2.49) mm to 0 mm postoperatively in all patients (<i>P</i> < .05). Spur-to-skin distance improved from 7.38 (SD 2.00) mm to 14.76 (SD 3.57) mm (<i>P</i> < .05). Mean FADI increased from 56.30 (95% CI, 52.9-59.7) to 96.82 (95% CI, 95.3-98.3) (<i>P</i> < .05) at the 12-month follow-up, and mean VAS decreased from 7.25 (95% CI, 7.01-7.49) preoperatively to 0.47 (95% CI, 0.17-0.77) at 12 months. No patients required repeat surgery, and there were no postoperative Achilles tendon ruptures. Eleven patients reported minor complications within 3 months of surgery.</p><p><strong>Conclusion: </strong>The findings of this study suggest that percutaneous insertional Achilles debridement and repair using a double-row repair technique with immediate weightbearing was associated with improvement in radiographic parameters and patient-reported outcomes through 12 months, with no postoperative tendon ruptures, no revision surgery, and a low overall complication rate.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261457084"},"PeriodicalIF":0.0,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351189","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":"Metatarsus Adductus Association With Fifth Metatarsal Fractures: Radiographic Analysis.","authors":"Caitlin Curtis Crocker, Delaney Lagrew, Chris Lamprecht, Alex Barnett, Miqi Wang","doi":"10.1177/24730114261453078","DOIUrl":"10.1177/24730114261453078","url":null,"abstract":"<p><strong>Background: </strong>Metatarsus adductus is a congenital forefoot deformity associated with pathologies including proximal fifth metatarsal fractures. The aim of this study is to assess the presence of metatarsus adductus and alignment in patients with proximal fifth metatarsal fractures. We hypothesize that there is an increased incidence of metatarsus adductus in patients with proximal fifth metatarsal fractures.</p><p><strong>Methods: </strong>A retrospective analysis was performed of patients who were treated for fifth metatarsal fractures from 2022 to 2024. Radiographic measurements including metatarsus adductus angle (MAA), lateral Meary angle, fracture zone, and foot alignment were recorded for each fracture.</p><p><strong>Results: </strong>Forty-nine patients were included. Patients with a zone 1 fracture had an average MAA of 14.2°. Of these patients, 10% had a cavus and 18% had a planus midfoot. Patients with a zone 2 fracture had an average MAA of 19.9°. Of these patients, none were cavus and 4% were planus. Patients with a zone 3 fracture had an average MAA of 26.8°. Four percent of patients had a cavus midfoot, whereas 4% had planus. Patients with a dancer's fracture had an average MAA of 15°. Of these patients, 8% were cavus and 4% were planus. A significant difference (<i>P</i> < .001) was detected between the average MAA of zone 1 vs zone 3 fractures and between zone 3 and dancer's fractures, suggesting an association between increasing metatarsus adductus severity and more proximal diaphyseal fracture location.</p><p><strong>Conclusion: </strong>Cavovarus deformity was infrequent in our cohort, whereas most patients had some degree of metatarsus adductus. Twenty-two percent in zone 1 and 6% in zone 2 were mild metatarsus adductus. Six percent in zone 2 and zone 3 were moderate, whereas 10% in zone 3 were severe. The authors recommend assessing for the presence of metatarsus adductus in patients with fifth metatarsal fractures, particularly zone 2 and 3, although further study in larger cohorts is needed to confirm these findings.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261453078"},"PeriodicalIF":0.0,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351481","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":"Depth of the Dorsalis Pedis Artery Distal to the First and Second Tarsometatarsal Joints: A Cadaveric Anatomical Study.","authors":"Taro Fujimaki, Hiroaki Kurokawa, Yuki Ueno, Takahide Sasaki, Kouhei Mitsui, Akira Taniguchi, Hirotaka Haro, Pasuk Mahakkanukrauh, Yasuhito Tanaka","doi":"10.1177/24730114261461267","DOIUrl":"10.1177/24730114261461267","url":null,"abstract":"<p><strong>Background: </strong>Surgical procedures involving the region between the first and second metatarsals distal to the tarsometatarsal (TMT) joints are common. However, detailed quantitative information regarding the depth of this arterial axis, encompassing the dorsalis pedis artery proximal to the branching point and the first dorsal metatarsal artery distally, remains limited. This study aimed to characterize the depth of the dorsalis pedis artery distal to the first and second TMT joints.</p><p><strong>Methods: </strong>Nineteen feet from 12 cadavers were analyzed. The first and second metatarsals were marked at 10-mm intervals distal to each TMT joint. The arterial depth at each point was expressed as a percentage of total metatarsal height, measured from the dorsal cortical surface (0%) toward the plantar cortex.</p><p><strong>Results: </strong>The deep plantar branch originated 11.0 ± 3.5 mm distal to the first TMT joint and 22.3 ± 4.5 mm distal to the second TMT joint. At 30 mm distal to the TMT joints, the arterial depth corresponded to 52% ± 18% of the metatarsal height in the first metatarsal and 67% ± 19% in the second metatarsal. Mean metatarsal lengths were 61.2 ± 3.1 mm (first) and 74.5 ± 3.7 mm (second).</p><p><strong>Conclusions: </strong>Distal to the TMT joints, the dorsalis pedis artery initially courses plantarly and gradually returns dorsally. These findings provide quantitative anatomical information regarding the trajectory of the dorsalis pedis artery in the intermetatarsal region distal to the TMT joints. Awareness of this depth trajectory may help surgeons minimize unnecessary arterial contact, particularly during screw placement across the intermetatarsal space.</p><p><strong>Level of evidence: </strong>Level V, cadaveric anatomical study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261461267"},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344440","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":"Implications of Size and Gender for Implant Fit and Coverage in Total Ankle Replacement.","authors":"Benjamin R Wesorick, Kira Lu, John Spivack, Elena Karas, Scott J Ellis, Constantine A Demetracopoulos, Jensen Henry","doi":"10.1177/24730114261455297","DOIUrl":"10.1177/24730114261455297","url":null,"abstract":"<p><strong>Background: </strong>Success after total ankle replacement (TAR) requires accurate implant sizing so the tibial component achieves adequate cortical support. Implant fit is challenging in smaller and female patients because medial-lateral (ML) constraints may force selection of tibial components undersized in the anterior-posterior (AP) dimension, although this has not been investigated in arthritic ankles. This study sought to quantify distal tibia morphology in TAR patients and compare those measurements to implant dimensions.</p><p><strong>Methods: </strong>Ninety-nine consecutive TAR patients with preoperative weightbearing computed tomographic (CT) scan were retrospectively reviewed. Multiplanar reformatting aligned axial slices orthogonal to the tibial anatomical axis. Tibial AP length and ML width were measured at 8 and 10 mm resection depths. Manufacturer specifications for the implanted tibial tray were used to obtain AP and ML dimensions. Dimensional mismatch was defined as anatomic measurement minus implant dimension (negative = overhang, positive = undercoverage). Sex-based comparisons used unequal-variance <i>t</i> tests; multiple linear regression evaluated predictors of mismatch.</p><p><strong>Results: </strong>There were significant differences in implant coverage between genders. Tibial implants took up significantly greater amounts of the ML plane in women (mean 2.3 mm difference), <i>P</i> < .01; meanwhile, with the numbers available, no statistically significant difference in AP mismatch between sexes could be detected (<i>P</i> = .81). In multiple regression analysis, these differences were primarily explained by body size, but gender had a statistically significant effect on implant coverage (1.15, 95% CI 0.28-2.02, <i>P</i> < .01).</p><p><strong>Conclusion: </strong>In this cohort, we found that tibial trays consistently exceeded native AP dimensions while leaving limited ML clearance, particularly in smaller and female tibiae. These constraints may approach thresholds associated with medial malleolar fracture and gutter impingement. Implant systems decoupling AP and ML sizing or offering narrower ML options may better accommodate distal tibial morphology. Clinical implications remain to be established.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261455297"},"PeriodicalIF":0.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344489","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 GLP-1RAs and Postoperative Complications Following Operative Ankle Fracture Fixation: A Retrospective Cohort Study.","authors":"Shawn K Monteiro, Nabeel A Khatri, Deen B Sari, Christopher Sanford","doi":"10.1177/24730114261453350","DOIUrl":"10.1177/24730114261453350","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures occur at an estimated rate of 4.22 per 10 000 person-years, occurring most frequently within the 21- to 30-year-old demographic. This retrospective cohort study used the TriNetX research network to evaluate the association between perioperative glucagon-like peptide-1 receptor agonist (GLP-1RA) use and postoperative complications following operative ankle fixation.</p><p><strong>Methods: </strong>Adults were stratified by GLP-1RA exposure (n = 1199 for the 3-month cohort and n = 1397 for both the 6- and 12-month cohorts). These cohorts were balanced via 1:1 propensity score matching for age, race, sex, wound healing risk factors, and diabetes; matching was attempted for body mass index (BMI) and glycated hemoglobin (HbA_1c) but was not obtained. The 6 complications were assessed from 1 day to 3 months, 6 months, and 1 year postoperatively.</p><p><strong>Results: </strong>Results demonstrated that GLP-1RA therapy was significantly associated with increased risk of hardware failure, beginning at 3 months (log rank test [LRT] χ² = 3.838, <i>P</i> = .050) and persisting through 12 months (LRT χ² = 5.527, <i>P</i> = .019; risk difference [RD] = 0.017, <i>P</i> = .018). Nonunion/malunion rates in the GLP-1RA cohort were more common, with significance found at 6 months (RD = 0.010, <i>P</i> = .047) and 12 months postoperatively (RD = 0.014, <i>P</i> = .008). No association was observed with postoperative infection across any time point. Furthermore, a neutral significance was established for wound dehiscence and procedural complications. Although test statistics suggested potential variance, primary longitudinal measures did not demonstrate significant divergence between cohorts (12-month LRT <i>P</i> = .131 and <i>P</i> = .482, respectively).</p><p><strong>Conclusion: </strong>These findings suggest that perioperative GLP-1RA use is associated with increased rates of hardware failure and nonunion/malunion, identifying a risk profile localized to osseous integrity. No association was found with postoperative infection, and a neutral significance was established for soft tissue complications. Interpreted in the context of residual imbalance in BMI and HbA_1c, these findings are hypothesis-generating rather than confirmatory.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261453350"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328080","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":"Talus Fracture-Dislocations With Talar Body Extrusion Have High Complication Rates, With Uneventful Outcomes in a Minority of Patients After Open Reduction Internal Fixation.","authors":"David Dallas-Orr, Westin Mace, Jacob C Wilson, Abby Viglione, Shannon Tse, Ellen P Fitzpatrick, Gillian L S Soles, Mark A Lee, Augustine M Saiz, Sean T Campbell","doi":"10.1177/24730114261452668","DOIUrl":"10.1177/24730114261452668","url":null,"abstract":"<p><strong>Background: </strong>Talus fracture-dislocations with talar body extrusion (TBE) are a rare subtype of talus fracture that have been reported to occur in 1.2% of talus fractures. There is limited evidence on the outcomes of these injuries. The purpose of this study was to characterize injury patterns, operative management, and radiographic and reoperation outcomes of TBE.</p><p><strong>Methods: </strong>A retrospective review of talus fractures treated at a level 1 trauma center from 2016 to 2024 was performed. Radiographs and computed tomography scans were screened for TBE. Demographics, injury characteristics, operative details, reoperations, and radiographic complications were recorded. Outcomes were reported descriptively for patients with at least 6 months of follow-up, with a nested subanalysis of those with at least 12 months. Uneventful outcome was defined as no reoperation, no avascular necrosis (AVN) or nonunion, and no greater than grade 2 posttraumatic arthritis (PTA) at final follow-up.</p><p><strong>Results: </strong>Among 178 talus fractures, 18 TBEs were identified. Seventeen patients had at least 6 months of follow-up and 15 had at least 12 months. In the 6-month cohort, mean follow-up was 1.72 years; 15 patients (88%) underwent temporizing reduction with external fixation and/or percutaneous fixation, 16 underwent definitive ORIF, and 1 underwent primary TTC fusion. Reoperation occurred in 7 (41%), AVN in 6 (35%), nonunion in 4 (24%), and grade 3 or 4 PTA in 10 (59%); 4 (24%) had an uneventful outcome. In the 12-month subgroup, reoperation occurred in 7 (47%), AVN in 5 (33%), nonunion in 4 (27%), and grade 3 or 4 PTA in 10 (67%); 3 (20%) had an uneventful outcome.</p><p><strong>Conclusion: </strong>Complications and reoperations were common after open reduction and internal fixation for TBE, although a minority of patients achieved uneventful radiographic and surgical outcomes. Follow-up stratified reporting showed persistently high complication burden at 12 months, although a small subset maintained uneventful radiographic and surgical outcomes, including 3 of 15 patients with at least 12 months of follow-up.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261452668"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328155","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":"Pain-Related Impairment and Talar Tilt as Predictors of Surgical Decision Making in Advanced Varus Ankle Osteoarthritis.","authors":"Hiroaki Kurokawa, Akira Taniguchi, Chika Nakaniwa, Norihiro Tsujimoto, Yoshiyuki Kamatani, Yinghao Li, Nan Mei, Takuma Miyamoto, Yasuhito Tanaka, Kenji Kawamura","doi":"10.1177/24730114261454964","DOIUrl":"10.1177/24730114261454964","url":null,"abstract":"<p><strong>Background: </strong>Varus-type ankle osteoarthritis (OA) is often managed conservatively; however, surgical intervention is required in some patients. Identifying factors associated with transition to surgery may help optimize treatment timing.</p><p><strong>Methods: </strong>This retrospective study included 53 ankles in 45 patients with Takakura-Tanaka stage ≥3a varus ankle OA who newly initiated conservative treatment with lateral wedge insoles. Patients were classified into nonsurgery or surgery groups based on treatment choice. Multivariate logistic regression was performed using 12 clinical and radiographic variables, including Self-Administered Foot Evaluation Questionnaire (SAFE-Q) subscales and weightbearing radiographic parameters.</p><p><strong>Results: </strong>At baseline, lower pain-related SAFE-Q scores (odds ratio [OR], 0.854; 95% CI, 0.738-0.989; <i>P</i> = .035) and greater talar tilt in the tibial plafond-talar dome angle (TTW) (OR, 1.506; 95% CI, 1.025-2.214; <i>P</i> = .037) were, in multivariable logistic regression, independently associated with surgical selection. The cutoff values for predicting surgery were ≤68 for pain-related SAFE-Q and ≥5° for TTW. With the numbers available, no significant difference could be detected in radiographic parameters at the final assessment. Neither group showed significant longitudinal changes in SAFE-Q or radiographic parameters with the numbers available. Pain-related SAFE-Q scores at the final assessment were significantly better in the nonsurgery than surgery groups.</p><p><strong>Conclusion: </strong>Baseline pain-related impairments and TTW deformities were associated with subsequent surgical selection in patients with advanced varus ankle OA.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261454964"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328146","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":"Use of an Extended-Length Tibial Tray in Total Ankle Arthroplasty: Rate of Subsidence, Loosening, Heterotopic Bone Formation, and Clinical Outcomes.","authors":"Christopher J Traynor, Hui Zhang, Carissa C Dock, Rebecca Stone McGaver, J Chris Coetzee, Jeffrey D Seybold, Kayla J Seiffert, Paul M Cammack, Bryan D Den Hartog","doi":"10.1177/24730114261452667","DOIUrl":"10.1177/24730114261452667","url":null,"abstract":"<p><strong>Background: </strong>Total ankle arthroplasty (TAA) has continued to increase in popularity as a treatment for ankle arthritis. Despite popularity, continual updates to implant designs strive for improved outcomes which has led to different implant design changes including an extended-length tibial tray to offer more distal tibia cortical coverage. The purpose of this study was to compare radiographic findings (tibial component subsidence, tibial component loosening, heterotopic ossification [HO]) and patient-reported outcome measures (PROMs) between 2 age-, gender-, and body mass index-matched TAA groups.</p><p><strong>Methods: </strong>This study was a retrospective review of TAA patients matched into 2 groups: group 1 patients received the extended tibial tray implant, and group 2 received the standard tibial tray implant. Pre- and postoperative lateral radiographs and PROMs (Veterans-RAND 12 [VR-12] Item Health Survey, Ankle Osteoarthritis Scale [AOS], visual analog scale [VAS], and patient satisfaction) were analyzed.</p><p><strong>Results: </strong>Seventy-eight patients were allocated to each group. The mean age was 66.7 years in group 1 and 66.9 years in group 2, with a mean follow-up of 44.6 months and 50.7 months, respectively. There were no significant differences between the groups for pre- and postoperative PROMs. Group 1 had higher patient satisfaction with overall care (95.4 vs 89.8, <i>P</i> = .019). Radiographically, the rate of HO formation was significantly lower in group 1 (38.5% vs 62.8%, <i>P</i> < .001), and group 1 also had greater plantarflexion (<i>P</i> = .096) and significantly less dorsiflexion (<i>P</i> = .008).</p><p><strong>Conclusion: </strong>Results appear to indicate that using TAA implants with an extended-length tibial tray is associated with more complete distal tibia cortical coverage, a numerically lower but statistically nonsignificant rate of tibial component subsidence, less heterotopic ossification formation, a trend toward greater postoperative plantarflexion, and higher patient satisfaction with overall care.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261452667"},"PeriodicalIF":0.0,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328075","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}