Foot and Ankle Surgery最新文献

{"title":"Effect of chronic heavy tobacco smoking on ankle fracture healing","authors":"Waseem Jerjes ,&nbsp;Daniele Ramsay ,&nbsp;Harvey Stevenson ,&nbsp;Aamr Yousif","doi":"10.1016/j.fas.2024.02.003","DOIUrl":"10.1016/j.fas.2024.02.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Tobacco smoking is linked to an elevated risk of osteomyelitis and delayed healing in long bone fractures. However, the impact of smoking on bone union and soft tissue recovery following ankle fractures remains unclear. This study presents a retrospective comparative analysis evaluating the effects of chronic heavy tobacco smoking on the healing process and outcomes of ankle fractures after surgical interventions.</p></div><div><h3>Materials and Methods</h3><p>We examined 220 consecutive cases of chronic heavy smokers (CHS) with closed ankle fractures who were referred to our unit for further treatment. A control group, consisting of 220 age- and sex-matched individuals (non-smokers with closed ankle fractures), was identified for comparative analysis. We collected clinical data, including pre-existing comorbidities, Lauge-Hansen fracture classification, necessity for surgery, and the surgical procedures performed.</p><p>The primary outcomes investigated were the time required for fracture union and wound healing. Secondary outcomes included postoperative complications such as prolonged pain, bleeding, swelling, infection, compartment syndrome, and neurovascular impairment, as well as the incidence of delayed union, non-union, and the need for further intervention. Both cohorts were monitored for a minimum of 24 months.</p></div><div><h3>Results</h3><p>Our analysis revealed that the surgical cohort of chronic heavy smokers exhibited a statistically significant delay in fracture union compared to both the conservatively managed smokers and the control group.</p><p>Further scrutiny of the surgical cohort of chronic smokers indicated a significant correlation between smoking and extended postoperative pain duration, persistent swelling at the fracture site, and both superficial and deep wound infections. Additionally, these patients experienced delays in both fracture union and wound healing when compared to the control group.</p><p>Similarly, the conservatively managed chronic smokers showed a marginal increase in the incidence of post-injury pain duration, extended swelling at the fracture site, and delayed union compared to the control group.</p></div><div><h3>Conclusion</h3><p>Patients who are chronic heavy smokers and require surgical intervention for ankle fractures should be made aware of their increased risk for delayed fracture union and poor wound healing. Orthopedic surgeons should proactively encourage these patients to participate in smoking cessation programs.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139826709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of first metatarsophalangeal hemiarthroplasty for hallux rigidus","authors":"Serhat Akcaalan ,&nbsp;Abdurrahim Kavaklilar ,&nbsp;Ceyhun Caglar ,&nbsp;Mehmet Emin Simsek ,&nbsp;Safa Gursoy ,&nbsp;Mustafa Akkaya","doi":"10.1016/j.fas.2024.02.002","DOIUrl":"10.1016/j.fas.2024.02.002","url":null,"abstract":"<div><p>Hallux rigidus (HR) is arthritis of the first metatarsophalangeal joint.First metatarsophalangeal joint hemiarthroplasty surgery is one of the treatment options for end stage hallux rigidus.The aim of this study is to evaluate the long-term outcomes of hemiarthroplasty of the first MTPJ with a metallic implant in patients with end-stage HR. Patients who underwent hemiarthroplasty surgery with the diagnosis of HR were included in the study. Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and Foot and Ankle Disability Index (FADI) scores were used in pre-operative and post-operative final follow-ups to evaluate the clinical status of the patients. Post-operative 1st metatarsophalangeal joint range of motion was measured and recorded separately for each patient. The intra-hospital and follow-up complications and revision surgeries of the patients were recorded. Thirty-five patients with a mean follow-up of 8.1 years were included in the study. There was a statistically significant positive change in both FADI and SAFE-Q scores compared to the pre-operative process(p = 0.0001). The average dorsiflexion angle at the final follow-up was 22.0 ± 8.2. Thus, it was determined that the 5-year and 8-year survival rates of patients in this study were 97.1% and 87.8%, respectively. In conclusion, the long-term results show that the use of hemiarthroplasty in the treatment of end-stage HR leads to high patient satisfaction, increased range of motion and a high survival rate.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139827786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixed-bearing versus mobile-bearing total ankle replacement survivorship. A meta-analysis","authors":"Marcos González-Alonso ,&nbsp;Ana R. Trapote-Cubillas ,&nbsp;Francisco J. Madera-González ,&nbsp;Óscar Fernández-Hernández ,&nbsp;Jaime A. Sánchez-Lázaro","doi":"10.1016/j.fas.2024.02.001","DOIUrl":"10.1016/j.fas.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Main objective of this research is to know if there is a different survival rate between fixed bearing (FB) and mobile bearing (MB) total ankle replacement (TAR). We hypothesized that there are no differences between the survival rates of both implants.</p></div><div><h3>Methods</h3><p>A systematic search was performed in PubMed, Cochrane, EMBASE and ClinicalTrials.gov databases‎ to identify published studies from August 2018 to September 2022 including results for FB and MB TAR survivorship. Inclusion criteria included 1) primary TAR in one or both feet in which implant could be identified‎, 2) a minimum of 20 procedures reported, 3) reported implant survivorship or calculable and 4) a minimum of 12 months follow-up for level 1–3 studies or 60 months for level 4 studies.</p></div><div><h3>Results</h3><p>3902 ankles in 28 studies were included. 719 were FB and 3104 MB with an overall survivorship of 94% (95% CI [0.89; 0.97]) and 89% (95% CI [0.86; 0.92]) respectively. After subgroup analysis, we did not find differences among both groups (p = ‎0.429‎). Meta-regression analysis showed that longer follow-up was associated with lower survival rates in MB group (p = 0.000) while no other relationships were found with other factors (age, level of evidence or conflict of interests).</p></div><div><h3>Conclusions</h3><p>No differences in survival rates between both groups were found. Age and other studied confounders were not found to be related with implant survivorship. However, longer follow-up was found to be related with lower survival rates. Studies with longer follow-up and higher level of evidence are needed to confirm results.</p></div><div><h3>Level of evidence</h3><p>IV, systematic review of level I to IV studies.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139875841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From jargon to clarity: Improving the readability of foot and ankle radiology reports with an artificial intelligence large language model","authors":"James J. Butler ,&nbsp;Michael C. Harrington ,&nbsp;Yixuan Tong ,&nbsp;Andrew J. Rosenbaum ,&nbsp;Alan P. Samsonov ,&nbsp;Raymond J. Walls ,&nbsp;John G. Kennedy","doi":"10.1016/j.fas.2024.01.008","DOIUrl":"10.1016/j.fas.2024.01.008","url":null,"abstract":"<div><h3>Background</h3><p><span>The purpose of this study was to evaluate the efficacy of an Artificial Intelligence Large Language Model (AI-LLM) at improving the readability foot and ankle orthopedic </span>radiology reports.</p></div><div><h3>Methods</h3><p>The radiology reports from 100 foot or ankle X-Rays, 100 computed tomography (CT) scans and 100 magnetic resonance imaging (MRI) scans were randomly sampled from the institution’s database. The following prompt command was inserted into the AI-LLM: “Explain this radiology report to a patient in layman's terms in the second person: [Report Text]”. The mean report length, Flesch reading ease score (FRES) and Flesch-Kincaid reading level (FKRL) were evaluated for both the original radiology report and the AI-LLM generated report. The accuracy of the information contained within the AI-LLM report was assessed via a 5-point Likert scale. Additionally, any “hallucinations” generated by the AI-LLM report were recorded.</p></div><div><h3>Results</h3><p>There was a statistically significant improvement in mean FRES scores in the AI-LLM generated X-Ray report (33.8 ± 6.8 to 72.7 ± 5.4), CT report (27.8 ± 4.6 to 67.5 ± 4.9) and MRI report (20.3 ± 7.2 to 66.9 ± 3.9), all p &lt; 0.001. There was also a statistically significant improvement in mean FKRL scores in the AI-LLM generated X-Ray report (12.2 ± 1.1 to 8.5 ± 0.4), CT report (15.4 ± 2.0 to 8.4 ± 0.6) and MRI report (14.1 ± 1.6 to 8.5 ± 0.5), all p &lt; 0.001. Superior FRES scores were observed in the AI-LLM generated X-Ray report compared to the AI-LLM generated CT report and MRI report, p &lt; 0.001. The mean Likert score for the AI-LLM generated X-Ray report, CT report and MRI report was 4.0 ± 0.3, 3.9 ± 0.4, and 3.9 ± 0.4, respectively. The rate of hallucinations in the AI-LLM generated X-Ray report, CT report and MRI report was 4%, 7% and 6%, respectively.</p></div><div><h3>Conclusion</h3><p>AI-LLM was an efficacious tool for improving the readability of foot and ankle radiological reports across multiple imaging modalities. Superior FRES scores together with superior Likert scores were observed in the X-Ray AI-LLM reports compared to the CT and MRI AI-LLM reports. This study demonstrates the potential use of AI-LLMs as a new patient-centric approach for enhancing patient understanding of their foot and ankle radiology reports. Jel Classifications: IV</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic assisted flexor digitorum longus transfer in flexible flatfoot","authors":"Marc Elkaim ,&nbsp;Marine Ankri ,&nbsp;Jean-Charles Giunta","doi":"10.1016/j.fas.2023.10.001","DOIUrl":"10.1016/j.fas.2023.10.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Posterior tibial tendon<span> insufficiency is the commonest cause of adult flexible flatfoot. Transfer of the flexor </span></span>digitorum longus (FDL) has been described a therapeutic arsenal in flexible flat feet and posterior tibial tendon disorders. It is often combined with bony procedure (open or percutaneous calcaneal osteotomy).</p></div><div><h3>Methods</h3><p>We describe a technique and the steps endoscopic approach of FDL transfer.</p></div><div><h3>Results</h3><p>The procedure is able to be performed safely and reproducible under perfect viewing</p></div><div><h3>Conclusion</h3><p>In the future with a clinical study investigating, we purpose the results of such surgery in a cohort of patients with flexible flatfoot. Level IV Therapeutic study: case serie. No funding was received for this research project.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61565615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What’s the clinical significance of VAS, AOFAS, and SF-36 in progressive collapsing foot deformity","authors":"Cheng Chen ,&nbsp;ZhenDong Li ,&nbsp;Yi Zhang ,&nbsp;HaiChao Zhou ,&nbsp;YongQi Li ,&nbsp;WenBao He ,&nbsp;TianBao Ye ,&nbsp;YunFeng Yang","doi":"10.1016/j.fas.2023.10.002","DOIUrl":"10.1016/j.fas.2023.10.002","url":null,"abstract":"<div><h3>Background</h3><p><span>This study aimed to ascertain the minimal clinically important difference<span> (MCID), and substantial clinical benefit (SCB) of the American Orthopedic Foot and Ankle Society (AOFAS) scale, </span></span>visual analog scale<span> (VAS) for pain, and Short Form-36 Health Survey (SF-36) in progressive collapsing foot deformity (PCFD) surgery.</span></p></div><div><h3>Methods</h3><p>In this retrospective cohort study<span>, a total of 84 patients with PCFD (84 feet) who underwent surgery between July 2015 and April 2021 were included. The study assessed the patients' subjective perception, as well as their VAS, AOFAS, and SF-36 scores at a minimum two-year follow-up, and these data were subjected to statistical analysis. The study utilized Spearman correlation analysis to determine the degree of correlation between patients' subjective perception and their VAS, AOFAS, and SF-36 scores. The minimal detectable change (MDC), MCID, and SCB for VAS, AOFAS, and SF-36 were calculated using both distribution- and anchor-based methods. The classification outcomes obtained from the distribution- and anchor-based methods were assessed using Cohen’s kappa.</span></p></div><div><h3>Results</h3><p>Based on the subjective perception of the patients, a total of 84 individuals were categorized into three groups, with 7 in the no improvement group, 14 in the minimum improvement group, and 63 in the substantial improvement group. Spearman's correlation analysis indicated that the patients' subjective perception exhibited a moderate to strong association with VAS, AOFAS, SF-36 PCS, and SF-36 MCS, with all coefficients exceeding 0.4. The MCID of VAS, AOFAS, SF-36 PCS, and SF-36 MCS in PCFD surgery were determined to be 0.93, 5.84, 4.15, and 4.10 points using the distribution-based method and 1.50, 10.50, 8.34, and 3.03 points using the anchor-based method. The SCB of VAS, AOFAS, SF-36 PCS, and SF-36 MCS in PCFD surgery were 2.50, 18.50, 11.88, and 6.34 points, respectively. Moreover, the preliminary internal validation efforts have demonstrated the practical application and clinical utility of these findings. With the exception of the distribution-based MCID of SF-36 PCS, which showed fair agreement, all other measures demonstrated moderate to almost perfect agreement.</p></div><div><h3>Conclusions</h3><p>The MDC, MCID, and SCB intuitively enhance the interpretation of VAS, AOFAS, and SF-36 in PCFD surgery, assisting all stakeholders to better understand the therapeutic benefits and limitations of clinical care, and thus to make a more rational decision. Each of these parameters has its own emphasis and complements the others. These parameters are recommended for evaluating the clinical relevance of the results, and their promotion should extend to other areas of foot and ankle surgery.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Botulinum toxin A versus platelet rich plasma ultrasound-guided injection in the treatment of plantar fasciitis: A randomised controlled trial","authors":"Isabel M. Ruiz-Hernández ,&nbsp;Javier Gascó-Adrien ,&nbsp;Carmen Buen-Ruiz ,&nbsp;Laura Perelló-Moreno ,&nbsp;Carmen Tornero-Prieto ,&nbsp;Gonzalo Barrantes-Delgado ,&nbsp;Mireia García-Gutiérrez ,&nbsp;JM. Rapariz-González ,&nbsp;S. Tejada-Gavela","doi":"10.1016/j.fas.2023.10.004","DOIUrl":"10.1016/j.fas.2023.10.004","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Platelet-rich plasma (PRP) and botulinum toxin type A (BTX-A) injections have proven effective in </span>clinical trials for </span>plantar fasciitis<span><span> treatment but have not been directly compared. We aimed to compare clinical outcomes </span>in patients undergoing PRP or BTX-A injections.</span></p></div><div><h3>Methods</h3><p><span>We performed a randomised controlled trial<span> (59 patients; 1-year follow-up) to assess efficacy, using pain and functional scales (VAS, AOFAS Hindfoot-scale and FAAM questionnaire) and </span></span>fascia thickness reduction, in control and single ultrasound-guided BTX-A or PRP injection groups.</p></div><div><h3>Results</h3><p>The BTX-A group showed better results at 1-month after treatment. Conversely, the PRP injection was more effective in the long-term, with significant pain reduction and functional improvement. Plantar fascia thickness significantly reduced from months 1 and 3 in the PRP and BTX-A groups, respectively.</p></div><div><h3>Conclusion</h3><p>PRP and BTX-A injections are effective in patients with plantar fasciitis with BTX-A achieving better short-term pain reduction and PRP better long-term results.</p></div><div><h3>Level of Evidence</h3><p><strong>Level</strong> I; Randomised Controlled Trial</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72211461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using machine learning in the prediction of symptomatic venous thromboembolism following ankle fracture","authors":"Nour Nassour ,&nbsp;Bardiya Akhbari ,&nbsp;Noopur Ranganathan ,&nbsp;David Shin ,&nbsp;Hamid Ghaednia ,&nbsp;Soheil Ashkani-Esfahani ,&nbsp;Christopher W. DiGiovanni ,&nbsp;Daniel Guss","doi":"10.1016/j.fas.2023.10.003","DOIUrl":"10.1016/j.fas.2023.10.003","url":null,"abstract":"<div><h3>Background</h3><p>Venous thromboembolism<span> (VTE) is a major cause of morbidity and mortality in the trauma setting, and both prediction and prevention of VTE have long been a concern for healthcare providers in orthopedic surgery. The purpose of this study was to evaluate the use of novel statistical analysis and machine-learning in predicting the risk of VTE and the usefulness of prophylaxis following ankle fractures.</span></p></div><div><h3>Methods</h3><p>The medical profiles of 16,421 patients with ankle fractures were screened retrospectively for symptomatic VTE. In total, 238 patients sustaining either surgical or nonsurgical treatment for ankle fracture with subsequently confirmed VTE within 180 days following the injury were placed in the case group. Alternatively, 937 patients who sustained ankle fractures managed similarly but had no documented evidence of VTE were randomly chosen as the control group. Individuals from both the case and control populations were also divided into those who had received VTE prophylaxis and those who had not. Over 110 variables were included. Conventional statistics and machine learning methods were used for data analysis.</p></div><div><h3>Results</h3><p>Patients who had a motor vehicle accident, surgical treatment, increased hospital stay, and were on warfarin were shown to have a higher incidence of VTE, whereas patients who were on statins had a lower incidence of VTE. The highest Area Under the Receiver Operating Characteristic Curves (AUROC) showing the performance of our machine learning approach was 0.88 with 0.94 sensitivity and 0.36 specificity. The most balanced performance was seen in a model that was trained using selected variables with 0.86 AUROC, 0.75 sensitivity, and 0.85 specificity.</p></div><div><h3>Conclusion</h3><p>By using machine learning, this study successfully pinpointed several predictive factors<span> linked to the occurrence or absence of VTE in patients who experienced an ankle fracture. Training these algorithms using larger, more granular, and multicentric data will further increase their validity and reliability and should be considered the standard for the development of such algorithms.</span></p></div><div><h3>Level of evidence</h3><p>Case-Control study – 3</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135762710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alteration of the calf strength by heel cord lengthening, gastrocnemius recession through tenotomy or fasciotomy. A retrospective clinical force analysis before and after surgery","authors":"Tonio Gottlieb ,&nbsp;Kaj Klaue","doi":"10.1016/j.fas.2023.10.006","DOIUrl":"10.1016/j.fas.2023.10.006","url":null,"abstract":"<div><h3>Background</h3><p><span>Indications for surgical corrections about the Achilles tendon are increasing as additional measures in reconstructive interventions about the foot. These indications include shortened </span>gastrocnemii<span>, which cause a so-called ‘functional pes equinus’ and secondary forefoot<span> imbalances, as well as corrections of pes planus<span> and cavus. Surgery about the heel cord may also be indicated for achillodynia and diabetic pressure ulcers. However, there is a lack of evidence that quantifies the results of lengthening procedures about the heel cord. The aim of this study was to quantify the exact changes in calf strength one year after elongating the triceps surae, by measuring flexion forces in 90 degrees knee flexion and knee extension.</span></span></span></p></div><div><h3>Methods</h3><p>This study involves 69 patients who were examined for calf strength preoperatively and 1 year after gastrocnemius release. A new device, the Leonardo Mechanograph® (Novotec Medical) was used to measure calf strength. Measurements were performed with the knee flexed and extended.</p></div><div><h3>Results</h3><p>The operated leg had an overall statistically significant reduction in strength after surgery. Changes were similar on the contralateral leg. The difference in force reduction between the operated and non-operated leg was not statistically significant</p></div><div><h3>Conclusion</h3><p>A correlation between measured plantar flexion forces of the foot after a reconstructive foot operation with or without a lengthening procedure about the calf musculature could not be established.</p></div><div><h3>Level of evidence</h3><p>Level III: retrospective cohort study.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-based five-segment classification in Freiberg's infarction: Evaluation of its intraobserver and interobserver reliability","authors":"Yi Ren ,&nbsp;Yu Chen ,&nbsp;Ting-Jiang Gan ,&nbsp;Hui Zhang ,&nbsp;Xi Liu","doi":"10.1016/j.fas.2023.10.008","DOIUrl":"10.1016/j.fas.2023.10.008","url":null,"abstract":"<div><h3>Background</h3><p>According to the location and frequency of osteonecrosis zone of metatarsal head, a map of osteonecrosis zone was drawn for Freiberg’s infarction. The objective of the current study is to develop a new computed tomography-based Five-Segment classification system for Freiberg's infarction and testify if it has good intra- and interobserver reliability or not.</p></div><div><h3>Methods</h3><p><span>According to the location and its frequency of osteonecrosis zone of metatarsal head, a map of osteonecrosis zone was drawn. According to the distribution of osteonecrosis zones of metatarsal heads, we proposed the Five-Segment classification system. Four evaluators evaluated each radiography and computed tomography (CT) twice at 8-week intervals. To test the reproducibility of the Five-Segment classification system, the interobserver and intraobserver reliability of this classification system comparing with that of the Smillie classification by four observers using the </span>kappa statistic.</p></div><div><h3>Results</h3><p>The 80 cases were classified into five reproducible types by using Five-Segment classification system: type Ⅰ, two (2.5%) cases; type Ⅱ, ten (12.5%) cases; type Ⅲ, 42 (52.5) cases; type Ⅳ, 24 (30.0%) cases; type Ⅴ, two (2.5%) cases. The mean kappa value for interobserver reliability using Smillie classification systems was 0.562 (95% CI: 0.531–0.585), whereas the mean kappa value was 0.828 (95% CI: 0.801–0.852), by using Five-Segment classification; the mean kappa values for intraobserver reliability by using Smillie classification and Five-Segment classification were 0.777 (95% CI: 0.762–0.792) and 0.860 (95% CI: 0.843–0.895), respectively.</p></div><div><h3>Conclusions</h3><p>The new Five-Segment classification system demonstrated perfect interobserver and intraobserver agreement between evaluators in the management of Freiberg’s infarction. Prospective studies should be done to evaluate its prognostic value and utility in clinical practice.</p></div><div><h3>Level of evidence</h3><p>Level IV, retrospective</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}