Foot & Ankle Orthopaedics最新文献

{"title":"Late Bone Marrow Edema Associated With Use of a Bioresorbable Polymer Suture Anchor in Foot and Ankle Surgery.","authors":"Amanda I Zeng, Philip G Colucci, Constantine A Demetracopoulos, Elizabeth A Cody","doi":"10.1177/24730114261448203","DOIUrl":"10.1177/24730114261448203","url":null,"abstract":"<p><strong>Background: </strong>Bioresorbable orthopaedic implants have proliferated in recent years, including suture anchors, soft tissue scaffolds, and screws. At our institution, we anecdotally noticed late inflammatory-type reactions in the bone surrounding a particular bioresorbable polymer suture anchor. This bioresorbable anchor (BRA) uses ultrasonic technology to liquefy its tip, allowing interdigitation with surrounding cancellous bone. The polymer is designed to resorb around 2-3 years. In this study, we aimed to characterize complications associated with its use.</p><p><strong>Methods: </strong>A retrospective review was conducted of foot and ankle procedures using the BRA between 2018 and 2023, using a prospectively collected foot and ankle registry. Of the 62 patients who received at least 1 of these implants, 42 (68%) were female. Chart review was used to identify postoperative complications, particularly pain with bone marrow edema (BME) surrounding the anchor(s), as detected on magnetic resonance imaging (MRI). Patients were classified according to their primary diagnoses and level of physical activity. Patients with and without BME were compared to each other.</p><p><strong>Results: </strong>Twenty (32%, 95% CI 22%-45%) patients developed an inflammatory response at a mean of 27 months postoperatively. Four patients (20%) developed BME less than 1 year postoperatively, whereas the remaining 16 patients (80%) developed BME more than 2 years postoperatively. BME occurred more often in females (<i>P</i> = .047), and when used in the setting of trauma (<i>P</i> = .039). Symptoms resolved with nonoperative treatment in all but 3 cases (15%). No revision surgeries were performed.</p><p><strong>Conclusion: </strong>Nearly one third of the patients developed symptomatic bone marrow edema localized to the bioresorbable anchor. Female sex and ankle fracture were variables significantly associated with development of BME. Not all symptoms resolved with nonoperative treatment. These findings suggest caution should be exercised when using bioresorbable anchors.</p><p><strong>Level of evidence: </strong>Level IV, retrospective review.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261448203"},"PeriodicalIF":0.0,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987001","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":"Posterior Malleolar Fragment Size as a Predictor of Ligamentous Injuries in Trimalleolar and Quadrimalleolar Ankle Fractures: A Novel Correlative Cohort Study in a South Indian Population.","authors":"Jillella S R G Saran, Shiv M Ajoy, Rahul Panduranga, Rajesh Simon","doi":"10.1177/24730114261445093","DOIUrl":"10.1177/24730114261445093","url":null,"abstract":"<p><strong>Background: </strong>Posterior malleolar (PM) fractures are critical components of complex ankle injuries, particularly in tri- and quadrimalleolar fracture patterns. Although traditionally assessed by fragment size and displacement, emerging evidence suggests a more intricate relationship between PM morphology and associated ligamentous injuries. Aim was to evaluate the association between PM fragment size and concomitant soft tissue injuries, particularly deltoid and syndesmotic involvement in tri- and quadrimalleolar ankle fractures.</p><p><strong>Methods: </strong>This ambispective cohort study included 45 adult patients with tri- or quadrimalleolar fractures treated via a posterolateral approach. PM fragments were classified using computed tomography-based systems (Haraguchi, Bartonicek-Rammelt, Mason-Molloy). The presence of ligamentous injuries was assessed intra-operatively and correlated with fragment size. Syndesmotic and deltoid ligament involvement were analysed in relation to PM morphology. Statistical analysis was performed using SPSS version 22.</p><p><strong>Results: </strong>Most PM fractures were Haraguchi type 1 (66.7%), Bartonicek-Rammelt type 2 (62.2%), and Mason-Molloy type 2A (60%). Although syndesmotic injury showed no statistically significant association with PM fragment size (<i>P</i> = .135), a novel finding was identified: PM fragments larger than 8 mm were significantly associated with deltoid ligament injuries (<i>P</i> = .01). This correlation suggests a potential predictive role of fragment size in identifying medial-sided instability.</p><p><strong>Conclusion: </strong>Posterior malleolar fragment size, particularly fragments exceeding 8 mm may serve as a surrogate marker for deltoid ligament injury in tri- and quadrimalleolar ankle fractures, whereas no significant association was identified with syndesmotic injury. This finding highlights the importance of comprehensive pre-operative imaging and intra-operative assessment to guide fixation strategies and address associated ligamentous pathology.</p><p><strong>Level of evidence: </strong>Level III, evidence from non-experimental descriptive studies.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261445093"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986993","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":"Comparison of Radiographic Outcomes and Risk of First Metatarsal Shortening Between different Hallux Valgus Surgeries: An Asian Perspective.","authors":"Bryan Hon Keng Pui, Teddy Cheong Yao Wen, Png Wenxian, Inderjeet Singh Rikhraj, Eric Cher Wei Liang","doi":"10.1177/24730114261445962","DOIUrl":"10.1177/24730114261445962","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of hallux valgus is up to 22% in Asia, making it the second-highest in the world. Iatrogenic transfer metatarsalgia is a known complication of hallux valgus correction from excessive shortening of the first metatarsal. Most studies show that first metatarsal shortening should be less than 4.0 mm to avoid such complications. This study aims to compare the risk of first metatarsal shortening, radiologic, and clinical outcomes among surgical procedures used to treat symptomatic hallux valgus.</p><p><strong>Methods: </strong>A retrospective study was conducted at a single tertiary hospital using data on patients who underwent minimally invasive metaphyseal extra-articular transverse and Akin osteotomy (META), Lapidus, and scarf procedures. Radiologic outcomes collected include the hallux valgus angle (HVA), intermetatarsal angle (IMA), and first metatarsal shortening measured using the Maestro method. The visual analog scale (VAS) was used to evaluate improvement in patients' symptoms. Analyses were performed using IBM SPSS version 25.0.</p><p><strong>Results: </strong>A total of 134 feet were included in this study, with 66 META, 37 Lapidus, and 31 scarf procedures performed. All 3 techniques demonstrated significant improvements in VAS, HVA, and IMA compared with their preoperative measurements (<i>P</i> < .05). In terms of first metatarsal shortening, both META and Lapidus were significantly less than that of scarf (<i>P</i> < .05). In our study, both META and Lapidus demonstrated the least first metatarsal shortening. A significant first metatarsal shortening of more than 4 mm was observed in 7 cases who underwent scarf, whereas none were observed in the META and Lapidus groups.</p><p><strong>Conclusion: </strong>All 3 surgical techniques have been shown to provide adequate correction of hallux valgus deformity. Based on our study, scarf has the highest risk of radiologic metatarsal shortening among the 3 procedures, which may potentially lead to transfer metatarsalgia. Care should be taken during the scarf procedure to minimize shortening of the first metatarsal.<b>Level of Evidence</b>: Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261445962"},"PeriodicalIF":0.0,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971639","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 Management of Charcot Neuroarthropathy Involving the Hindfoot and Midfoot: A Case Series.","authors":"Rajesh Simon, Ani Susan Abraham, Dennis P Jose, Pratik Vishavadia","doi":"10.1177/24730114261445393","DOIUrl":"10.1177/24730114261445393","url":null,"abstract":"<p><strong>Background: </strong>Charcot neuroarthropathy (CN) involving both the hindfoot and midfoot represents a severe form of the disease and is often associated with significant instability, deformity, and an increased risk of ulceration. Although early-stage midfoot CN may be managed conservatively, combined hindfoot-midfoot involvement typically necessitates complex surgical reconstruction.</p><p><strong>Methods: </strong>This retrospective longitudinal case series included 21 consecutive patients with combined hindfoot and midfoot CN treated surgically at a tertiary care center in South India between 2019 and 2024. All procedures were performed by a single senior foot and ankle surgeon. Primary outcome was defined as limb salvage, operationalized as the achievement of an ulcer-free, plantigrade foot with autonomous ambulation at 12 months postoperatively.</p><p><strong>Results: </strong>The mean age of the cohort was 57.2 ± 8.2 years, with 14 of 21 patients (66.7%) being male. All patients (21/21, 100%) had Brodsky IV CN. Combined hindfoot-midfoot reconstruction was undertaken in 12 (57.1%), whereas 9 patients (42.9%) underwent isolated hindfoot reconstruction, with preservation of a stable or minimally involved midfoot to function as a pseudo joint at the level of the Chopart joint. Overall, metal hardware failure occurred in 2 (9.5%), with a mean time to implant breakage of 15.5 ± 3.5 months. Radiologic bony union was achieved in 16 of 21 hindfoot (76.2%) and 6 of 21 midfoot (28.6%). Recurrence of CN occurred in 1 (4.8%), contralateral CN in 3 (14.3%), and ulcer recurrence in 5 (23.8%). Limb salvage was achieved in all patients (21/21, 100%).</p><p><strong>Conclusion: </strong>Surgical reconstruction of combined hindfoot and midfoot CN was associated with 100% limb salvage and clinical outcomes in this single-center series; however, these findings should be interpreted cautiously given the small sample size and the high rates of surgical site infection (38.1%) and low midfoot bony union (28.6%) observed. Future research with larger cohorts and extended follow-up focusing on functional outcomes is needed to enhance understanding and optimize treatment strategies.</p><p><strong>Level of evidence: </strong>Level IV, retrospective observational case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261445393"},"PeriodicalIF":0.0,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971599","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":"Bilateral External Rotation Torque CT Remains Reliable in Syndesmotic Assessment Despite Lateral Ligament Injury, but Reveals Increased Tibiotalar Rotational Instability.","authors":"Pascal R Furrer, Jeroen Grigioni, Anna-Katharina Calek, Lukas Comolli, Arnd F Viehöfer, Jess G Snedeker, Stephan H Wirth, Silvan Beeler","doi":"10.1177/24730114261443310","DOIUrl":"10.1177/24730114261443310","url":null,"abstract":"<p><strong>Background: </strong>Understanding syndesmotic injury in conjunction with lateral ligament disruption is essential for accurate diagnosis and treatment. Although the influence of deltoid ligament injury on syndesmotic evaluation during bilateral external torque computed tomography (BET-CT) has been examined, the effect of concurrent lateral ligament lesion remains unclear and is rarely examined in the literature. This leads to the question of whether a lateral ligament lesion influences the previously established measurement parameters of syndesmosis instability in BET-CT and whether it results in a quantifiable increase in tibiotalar instability.</p><p><strong>Methods: </strong>Seven paired cadaveric lower limbs (n = 14; mean age 78.6 years) with pre-existing iatrogenic syndesmotic transection underwent sequential lateral ligament sectioning: anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular ligaments (PTFL). BET-CT imaging was performed under applied external rotation torques of 0, 2.5, 5.0, and 7.5 Nm. Outcome measurements included the anterior tibiofibular distance, tibiofibular clear space, posterior tibiofibular distance, medial tibiotalar gutter angle, and lateral fibulotalar gutter angle for each ligament condition and torque level.</p><p><strong>Results: </strong>The anterior tibiofibular distance remained stable despite progressive lateral ligament dissection and increasing torque (<i>P</i> > .05). Tibiofibular clear space and posterior distance measurements showed inconsistent trends and did not reach statistical significance. In contrast, the medial tibiotalar gutter angle increased significantly from 22.9° in isolated syndesmotic injury to 27.6° (±6.3°) following complete disruption of the lateral complex (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>Concurrent lateral ligament injury does not impair the assessment of syndesmotic widening in BET-CT, as tibiofibular alignment remains preserved. However, disruption of the lateral complex exacerbates rotational tibiotalar instability.</p><p><strong>Clinical relevance: </strong>In this cadaveric model, BET-CT remains reliable for assessing syndesmotic lesions even in the presence of lateral ligament injury. However, the increase in rotational tibiotalar instability with combined injuries highlights the need for comprehensive evaluation of ankle ligament injuries, pending clinical validation.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261443310"},"PeriodicalIF":0.0,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971663","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":"Dynamic Weight-Bearing Lateral Radiographs to Detect Occult Nonunion After Ankle Arthrodesis: A Diagnostic Technical Tip and Case Series of 2 Patients.","authors":"Ryutaro Takeda, Munetaka Ueda, Shinya Adachi, Taro Kasai, Song Ho Chang, Takumi Matsumoto, Sakae Tanaka","doi":"10.1177/24730114261446321","DOIUrl":"10.1177/24730114261446321","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261446321"},"PeriodicalIF":0.0,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and Mid-term Effects of Ankle and Hindfoot Arthrodesis on Quality of Life.","authors":"Yen Chin Jeremy Tan, Jeremy Lim, Ramesh Radhakrishnan, Zongxian Li, Kizher Shajahan Mohamed Buhary, Rui Xiang Toh, Kae Sian Tay","doi":"10.1177/24730114261446315","DOIUrl":"10.1177/24730114261446315","url":null,"abstract":"<p><strong>Background: </strong>Hindfoot fusion is commonly performed to relieve pain in patients with end-stage ankle and hindfoot arthritis. However, its impact on specific aspects of health-related quality of life (HrQoL) and the trajectory of improvement is not well established. This study aimed to evaluate the effect of hindfoot fusion on HrQoL at both short- and mid-term follow-up.</p><p><strong>Methods: </strong>A retrospective review was conducted on a prospective database of patients who underwent hindfoot fusion for severe pain, including ankle, subtalar, and tibiotalocalcaneal arthrodeses. Clinical outcomes were assessed using the visual analog scale (VAS) for pain and the 36-Item Short Form Health Survey (SF-36) scores for HrQoL: Physical Functioning (SFPF), Role Physical (SFRP), Bodily Pain (SFBP), General Health (SFGH), Vitality (SFVI), Social Functioning (SFSF), Role Emotional (SFRE), and Mental Health (SFMH). Patient satisfaction was assessed using a Likert scale. Scores were recorded preoperatively, 6 months postoperatively, and 2 years postoperatively. Although optimal deformity correction was desired, alleviation of pain was the main goal and deformity angles were not analysed in this study.</p><p><strong>Results: </strong>At 6 months, ankle fusion patients reported significant improvements in SFPF (+21.00, <i>P</i> < .001), SFRP (+23.33, <i>P</i> < .020), SFBP (+30.73, <i>P</i> < .001) and SFSF (+20.38, <i>P</i> = .022) whereas tibiotalocalcaneal patients reported improvements from baseline SFPF (+28.18, <i>P</i> < .001), SFRP (+43.18, <i>P</i> < .001), SFBP (+42.32, <i>P</i> < .001), and SFSF (+35.25, <i>P</i> < .001). Subtalar fusion patients recorded improvements in SFBP (+17.09, <i>P</i> = .014). All 3 fusion groups demonstrated sustained improvements in HrQoL at 2 years postoperatively. VAS scores reduced by 3.8-5.9 points across all fusion groups. Patient satisfaction was high at both 6 months and 2 years postoperatively.</p><p><strong>Conclusion: </strong>Hindfoot fusion was associated with significant gains in functional and pain-specific patient-reported outcomes. Improvements were mainly observed within the first 6 months for ankle and tibiotalocalcaneal fusion, with subtalar fusion demonstrating a slower but comparable trajectory of recovery. High patient satisfaction was reported across all groups at 2 years.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261446315"},"PeriodicalIF":0.0,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940734","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 MRI-Based Cartilage Repair Morphology and Clinical Outcomes After Osteochondral Autograft Transfer of the Talus.","authors":"İbrahim Halil Rizvanoglu","doi":"10.1177/24730114261445398","DOIUrl":"10.1177/24730114261445398","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral lesions of the talus (OLT) represent a challenging ankle pathology that may lead to persistent pain, functional impairment, and progressive joint degeneration. Open transmalleolar osteochondral autograft transfer (OAT) is a well-established treatment option for selected lesions; however, the relationship between postoperative magnetic resonance imaging (MRI)-based cartilage repair morphology and clinical outcomes remains incompletely understood.</p><p><strong>Methods: </strong>A retrospective review was performed of 17 patients who underwent open transmalleolar OAT for symptomatic OLT between May 2021 and March 2025, with a mean follow-up of 20.8 months (range, 6-34 months). Clinical outcomes were assessed using the visual analogue scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Postoperative cartilage repair morphology was evaluated using MRI and graded according to the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART 2.0) scoring system. MRI examinations were independently reviewed by 2 blinded musculoskeletal radiologists, and the mean MOCART 2.0 score was used for final analysis. Associations between clinical and radiologic parameters were analyzed using Spearman rank correlation.</p><p><strong>Results: </strong>Significant postoperative clinical improvement was observed. Mean VAS scores decreased from 6.6 ± 1.5 preoperatively to 1.7 ± 1.3 at final follow-up (<i>P</i> < .001), whereas mean AOFAS scores increased from 58.4 ± 8.0 to 88.3 ± 9.3 (<i>P</i> < .001). Postoperative MRI demonstrated a mean MOCART 2.0 score of 70.4 ± 9.7, indicating satisfactory structural cartilage repair. Interobserver reliability for MOCART 2.0 scoring was excellent (ICC = 0.92). No significant correlations were identified between MOCART 2.0 scores and clinical outcome measures or patient-related variables.</p><p><strong>Conclusion: </strong>Open transmalleolar OAT provides significant clinical improvement in carefully selected patients with OLT. However, postoperative MRI-based cartilage repair morphology assessed by MOCART 2.0 does not appear to directly correlate with clinical outcomes, suggesting that structural repair and patient-reported recovery may represent distinct dimensions of treatment response.</p><p><strong>Level of evidence: </strong>Level IV, retrospective review.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261445398"},"PeriodicalIF":0.0,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940658","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 Zadek Osteotomy for Calcific Insertional Achilles Tendinopathy: An Exploratory Comparison of Outcomes With and Without Retrocalcaneal Calcification.","authors":"Dhivakaran Gengatharan, Inderjeet Singh Rikhraj, Hon Keng Pui Bryan, Eric Wei Liang Cher, Wen Xian Png","doi":"10.1177/24730114261445097","DOIUrl":"10.1177/24730114261445097","url":null,"abstract":"<p><strong>Background: </strong>Calcific insertional Achilles tendinopathy (CIAT) may remain symptomatic despite prolonged nonoperative treatment. Minimally invasive (MIS) Zadek osteotomy unloads the Achilles insertion biomechanically, but whether calcific deposits require excision remains unclear.</p><p><strong>Methods: </strong>This exploratory comparative case series included 20 consecutive patients undergoing MIS Zadek osteotomy. Patients were grouped based on the presence (n = 10) or absence (n = 10) of calcification. Outcomes included visual analog scale (VAS) and European Foot & Ankle Society (EFAS) scores. Non-parametric statistical analysis was performed.</p><p><strong>Results: </strong>Both groups demonstrated substantial improvement, with median VAS decreasing from 7 (IQR 2) to 0 (IQR 1) at 1 year. EFAS scores improved from 12 (IQR 6) preoperatively to 24 (IQR 2) at final follow-up. With the numbers available, no significant between-group difference could be detected in VAS (<i>P</i> = .349), EFAS at 6 months (<i>P</i> = .939), or EFAS at 1 year (<i>P</i> = .932).</p><p><strong>Conclusion: </strong>MIS Zadek osteotomy was associated with substantial clinical improvement regardless of calcification. Excision of calcific deposits may not be necessary in all cases, although larger studies are required.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261445097"},"PeriodicalIF":0.0,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940677","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":"Long-term Associations Impact of Axial Alignment, Sesamoid Position, and Joint Degeneration and Recurrence and Clinical Outcomes After Hallux Valgus Correction.","authors":"Lizzy Weigelt, Noah Davolio, Carlos Torrez, Florian Haug, Nathalie Kühne, Stephan H Wirth","doi":"10.1177/24730114261427473","DOIUrl":"10.1177/24730114261427473","url":null,"abstract":"<p><strong>Background: </strong>The influence of postoperative axial alignment on long-term recurrence and clinical outcome after hallux valgus correction has not been well characterized. Degenerative changes within the metatarsosesamoid and first metatarsophalangeal (MTPJ) joints are common, but their association with long-term function is not well defined. This retrospective study evaluated associations between axial alignment, recurrence, joint degeneration, and long-term outcomes after distal metatarsal reversed-L (ReveL) osteotomy.</p><p><strong>Methods: </strong>Seventy-four patients (110 feet) with mild to moderate hallux valgus deformity who underwent ReveL osteotomy between 2004 and 2012 were retrospectively evaluated at a mean follow-up of 14.4 years. Weightbearing radiographs were reviewed preoperatively and at final follow-up. Axial sesamoid radiographs obtained at long-term follow-up assessed sesamoid position, sesamoid rotation angle (SRA), and metatarsal pronation (α angle). First MTPJ and metatarsosesamoid arthritis were graded using a modified Coughlin and Shurnas classification. Clinical outcomes were assessed using Foot and Ankle Outcome Score (FAOS) and visual analog scale. Logistic regression identified predictors of recurrence, arthritis, and functional outcome.</p><p><strong>Results: </strong>Hallux valgus recurrence occurred in 11.8% of cases and was associated with residual sesamoid displacement (<i>P</i> < .001) and increased SRA (<i>P</i> < .01), whereas the α angle showed no relationship. In multivariable analysis, SRA greater than 6.2° demonstrated an odds ratio of 6.9 for recurrence, although this association was not statistically significant (<i>P</i> = .07). All axial parameters demonstrated univariate associations with metatarsosesamoid arthritis, but none correlated with MTPJ arthritis. Recurrence (odds ratio [OR] 4.8; <i>P</i> = .03) and SRA greater than 6.2° (OR 3.7; <i>P</i> = .04) independently predicted metatarsosesamoid arthritis. Higher grades of MTPJ arthritis were associated with significantly poorer FAOS scores, whereas metatarsosesamoid arthritis selectively affected the quality-of-life domain.</p><p><strong>Conclusion: </strong>First MTPJ arthritis was most strongly associated with long-term pain and function after hallux valgus correction. Postoperative axial malalignment was not statistically significantly associated with recurrence in this cohort. Although hallux valgus recurrence and residual axial malalignment were associated with metatarsosesamoid degeneration, these factors did not adversely affect overall clinical outcomes.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261427473"},"PeriodicalIF":0.0,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940653","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}