Foot and Ankle Surgery最新文献

{"title":"A game changing tool in the assessment of foot first ray laxity. A clinical reliability study","authors":"Filippo Pierobon ,&nbsp;Quentin Praz ,&nbsp;Spyridon Schoinas ,&nbsp;Elisabeth Schauer ,&nbsp;Laura Peurière ,&nbsp;Antoine Acker ,&nbsp;Maximilian Schindler ,&nbsp;Jeremy Olivier ,&nbsp;Nils Reymond ,&nbsp;Victor Dubois-Ferrière ,&nbsp;Mathieu Assal","doi":"10.1016/j.fas.2025.07.003","DOIUrl":"10.1016/j.fas.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Excessive laxity of the first ray has been implicated in various foot disorders. Accurate assessment is critical to define the most appropriate treatment. However, assessment currently depends largely on clinical examination and lacks objectivity. We evaluated the performance of an automated electromechanical tool developed to measure the relative dorsal mobility of the medial column compared to the lateral rays, and assessed the intra- and inter-examiner reliability of this device.</div></div><div><h3>Methods</h3><div>Two examiners assessed 30 feet of 17 volunteers. Data were collected 15 times on each foot. The intraclass correlation coefficient (ICC), Bland-Altman (B&amp;A) graphical analysis, and the standard error of measurement (SEM) were calculated.</div></div><div><h3>Results</h3><div>Inter-rater and intra-rater ICC values (&gt;0.9) were excellent. The Bland-Altman analysis revealed a mean bias of 0.07 mm between examiners.</div></div><div><h3>Conclusion</h3><div>This novel electromechanical device has demonstrated reliability in measuring first ray laxity, supporting its use in future studies aimed at quantifying first ray hyperlaxity.</div></div><div><h3>Level of evidence</h3><div>Level II, Prospective Reliability Study.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 125-130"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676247","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":"Comparing proximal and distal chevron osteotomy for moderate to severe hallux valgus: A meta-analysis of clinical and radiological outcomes, focusing on hallux valgus angle and intermetatarsal angle","authors":"Zakhira Maye R. Zipagan ,&nbsp;Adrian Joseph C. Tablante ,&nbsp;Daveric T. De Jesus ,&nbsp;Carlos Miguel I. Azucena ,&nbsp;Emiliano B. Tablante","doi":"10.1016/j.fas.2025.07.004","DOIUrl":"10.1016/j.fas.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Moderate to severe hallux valgus deformities are traditionally managed with proximal chevron osteotomy (PCO) due to its ability to correct significant angular deviations. However, distal chevron osteotomy (DCO), either alone or in combination with other interventions, has demonstrated promising radiological outcomes. This meta-analysis is the first to compare PCO and DCO in the treatment of moderate to severe hallux valgus.</div></div><div><h3>Methods</h3><div>Four studies, including 294 cases, compared PCO and DCO. Primary outcomes were Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA). Secondary outcomes included AOFAS scores and postoperative complications.</div></div><div><h3>Results</h3><div>No significant differences were observed between PCO and DCO for HVA (P = 0.41) or IMA (P = 0.10). Similarly, AOFAS scores showed no statistical difference (P = 0.23).</div></div><div><h3>Conclusion</h3><div>Based on data from non-randomized studies, this meta-analysis found no significant clinical and radiological differences between PCO and DCO for moderate to severe hallux valgus. These findings suggest that DCO can be reliably used as an alternative to PCO, but further high-quality, randomized trials are needed to confirm long-term efficacy. Both techniques have low complication rates. The rehabilitation protocols across all studies included similar early mobilization and K-wire removal timing, but differences in weight-bearing, footwear, and post-operative exercise regimens highlight variability.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 101-109"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718937","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":"Analysis of the soft tissue retraction pressures in total ankle arthroplasty: An in-vitro human cadaveric model","authors":"Julia A. McCann ,&nbsp;Kyle W. Zittel ,&nbsp;Patrick J. Burroughs ,&nbsp;Daina M. Brooks ,&nbsp;Lindsey Tully ,&nbsp;Alejandro Quinonez ,&nbsp;Paul S. Cooper ,&nbsp;Bryan W. Cunningham","doi":"10.1016/j.fas.2025.08.008","DOIUrl":"10.1016/j.fas.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Total ankle arthroplasty wound healing complications are likely influenced by intraoperative retraction. The current study compared contact pressures from various retractors at multiple incision lengths in an anterior approach to the ankle. We hypothesized Gelpis created higher contact pressures and longer incisions reduced pressures.</div></div><div><h3>Methods</h3><div>Twelve cadaveric lower extremities were dissected using 12 cm, 15 cm and 20 cm incisions. A TekScan sensor measuring contact pressure and surface area was placed between the Gelpi, Army-Navy (short and long), and Weitlaner retractors and exposed soft tissue structures.</div></div><div><h3>Results</h3><div>Average contact pressures reduced with increasing incision lengths except for Weitlaners. Army-Navy Long showed significantly lower pressures at 15 cm. Gelpis exhibited highest contact pressures except at 20 cm(p &lt; 0.05). No significant differences were observed between retractors at 12 cm(p &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Army-Navy retractors produced the least contact pressure in 12 cm and 15 cm incisions and self-retainers created higher contact pressures. Contact pressures typically decreased as incision lengths increased.</div></div><div><h3>Level of Evidence</h3><div>Level V</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 187-190"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041864","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":"Optimal placement of metatarsal pads for patients with hallux valgus based on plantar pressure measurement","authors":"Satoshi Hakukawa ,&nbsp;Takeshi Hashimoto ,&nbsp;Hiroki Okawara ,&nbsp;Tomonori Sawada ,&nbsp;Kohei Nishizawa ,&nbsp;Masahiro Okuno ,&nbsp;Takashi Koube ,&nbsp;Takeo Nagura","doi":"10.1016/j.fas.2025.07.005","DOIUrl":"10.1016/j.fas.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Increased plantar pressure is common in patients with hallux valgus (HV), and metatarsal pads are often used conservatively, though optimal placement remains unclear.</div></div><div><h3>Methods</h3><div>A crossover trial with 22 female HV patients was conducted. Plantar pressure was measured during a six-meter walk under four conditions: no pad and pad placements at 68 %, 72 %, and 76 % of foot length. Foot alignment was assessed via radiography. The main outcome was the percentage of total plantar pressure in the central metatarsal region.</div></div><div><h3>Results</h3><div>Pad placement at 76 % of foot length significantly reduced central metatarsal pressure compared to the no-pad condition (<em>p</em> &lt; 0.05). A positive correlation was found between the first and fifth metatarsal angle and central pressure (<em>p</em> &lt; 0.05). A cutoff angle of 38.5° predicted effective pressure reduction.</div></div><div><h3>Conclusions</h3><div>Placing a metatarsal pad at 76 % of foot length effectively reduces plantar pressure in HV patients and may offer a beneficial conservative approach.</div></div><div><h3>Level of Evidence</h3><div>Level III</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 131-138"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709587","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":"Letter to the editor to comment on “Diagnostic accuracy of 99mTc-HDP SPECT/CT and MRI for foot and ankle osteoarthritis (ProSPECT-trial): Study protocol”","authors":"Parth Aphale ,&nbsp;Himanshu Shekhar ,&nbsp;Shashank Dokania","doi":"10.1016/j.fas.2025.07.007","DOIUrl":"10.1016/j.fas.2025.07.007","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 191-192"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034461","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":"Acute Achilles tendon rupture and chronic tendinopathy surgery: Same tendon, with sex and ethnicity differences","authors":"Tara Saxena ,&nbsp;Amol Saxena ,&nbsp;Miranda Royds ,&nbsp;Nicola Maffulli","doi":"10.1016/j.fas.2025.08.007","DOIUrl":"10.1016/j.fas.2025.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Although differences in Achilles tendon injuries have been described based on sex and ethnicity, their impact on surgical presentation patterns and outcomes remains underreported. This study aims to compare demographics and complications between patients who underwent surgery for acute Achilles tendon rupture with those for chronic tendinopathy. All patients were operated by a single surgeon in a metropolitan region in the western United States between June 2016 and June 2022.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively collected data was conducted. Data included age, sex, ethnicity, surgical indication, return to activity (RTA), and complications (re-rupture, infection, suture reaction, venous thromboembolism). Statistical analyses included Student’s t-test and Fisher’s exact/Chi-square test, with a significance set at P &lt; .05.</div></div><div><h3>Results</h3><div>A total of 186 patients (121 males, 65 females; mean age: 47.5 ± 14.6 years) were included. Males were significantly more likely to undergo surgery for acute Achilles tendon repair (93 males, 5 females; P &lt; .0001). Females were more likely to undergo surgery for chronic Achilles tendon pathology (76 %). There were no significant sex-based differences in complications or return to activity. There were variations in ethnicity, with Asian patients having a higher likelihood of acute tendon repair (87 %) whereas White patients were more likely to undergo surgical intervention for chronic tendinopathy (89 %; P &lt; .00001).</div></div><div><h3>Conclusion</h3><div>Males were significantly more likely to have operative intervention for acute Achilles rupture, while females more often underwent surgery for chronic tendinopathy. There were ethnic differences in presentation patterns. Complication rate postoperatively and return to activity following surgical intervention did not vary between sex or ethnicity.</div></div><div><h3>Level of evidence</h3><div>III; Retrospective comparative study</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 183-186"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041846","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":"Minimally invasive and open posterior calcaneal displacement osteotomy for pediatric hindfoot deformity: A comparative study","authors":"Madeleine Willegger ,&nbsp;Caroline Cristofaro ,&nbsp;Maryse Bouchard","doi":"10.1016/j.fas.2025.08.004","DOIUrl":"10.1016/j.fas.2025.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive posterior displacement calcaneal osteotomy (PDCO) is often used in hindfoot deformity correction in the adult population, but there is a paucity on its use in children. The aim of this study was to compare the clinical and radiographic outcomes of open versus minimally invasive PDCO (MI-PDCO) approach in children.</div></div><div><h3>Methods</h3><div>This is a consecutive series of PCDOs performed as a component of a complex foot and ankle reconstruction.</div></div><div><h3>Results</h3><div>Twenty-nine calcaneal osteotomies in 23 patients aged 13.0 ± 3.0 years were included. Eleven osteotomies were performed open (O-PDCO) and 18 MI-PDCO. Mean follow-up was 35.4 ± 19.1 months. No delayed union, non-union, or apophyseal growth disturbance was observed. Seven nerve paresthesias were observed, two in the O-PDCO (18.1 %) and five in the MI-PDCO (27.7 %) group, all improved.</div></div><div><h3>Conclusion</h3><div>These results support MI-PDCO as a safe and effective alternative technique to conventional O-PDCO to correct pediatric hindfoot deformities.</div></div><div><h3>Level of Clinical Evidence</h3><div>Level 3 (retrospective comparative study)</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 164-169"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975152","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":"Advancing diagnostics: A systematic review and meta-analysis of conventional and weight-bearing CT in lisfranc injuries","authors":"Alejandro Lorente Gómez ,&nbsp;Marcela Gómez Cuenca ,&nbsp;Carmen Victoria Rojas Moreno ,&nbsp;Pablo Palacios Cabezas ,&nbsp;Gonzalo Mariscal ,&nbsp;Ibrahim Khalil ,&nbsp;Rafael Lorente Moreno ,&nbsp;Leire Pelaz Berdullas","doi":"10.1016/j.fas.2025.08.009","DOIUrl":"10.1016/j.fas.2025.08.009","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review and meta-analysis evaluated the diagnostic accuracy of conventional computed tomography (CT) and weight-bearing computed tomography (WBCT) in assessing Lisfranc injuries, comparing their sensitivity, specificity, and reliability for detecting structural abnormalities between injured and uninjured cases.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Scopus, WOS, and Medline databases identified 736 articles, of which 16 studies met the inclusion criteria. Seven studies were included in the meta-analysis. The analysis examined measurements such as M1-M2 and M2-C1 base distances, TMT1 and TMT2 dorsal step-offs, axial joint area and volume, and alignment parameters. Subgroup analyses compared conventional CT and WBCT methods.</div></div><div><h3>Results</h3><div>The injured group showed significantly greater M1-M2 and M2-C1 Base Distances than the uninjured group (M1-M2: MD = 0.88 mm; M2-C1: MD = 2.61 mm; p-value &lt; 0.0001), with no significant differences between imaging modalities. The injured group had greater TMT2 dorsal step-offs (MD = 0.81 mm; p &lt; 0.001), while TMT1 dorsal step-off differences varied between modalities. Injured joints demonstrated significantly larger Axial Joint Area and Volume (MD = 16.26 mm²) and volumes (MD = 189.1 mm³; p &lt; 0.0001). Additionally, WBCT demonstrated high sensitivity and specificity for Lisfranc injuries, particularly for parameters like axial joint volume (AUC = 0.91). Conventional CT showed variable diagnostic performance, with sensitivity and specificity ranging from 69 % to 97.9 % and 39.3–100 %, respectively. The \"Mercedes sign\" (a three-pointed star appearance on axial CT indicating C1-M2 diastasis) and \"Peeking cuneiform sign\" (visible medial cuneiform between first and second metatarsals on AP view) showed over 92 % sensitivity and specificity.</div></div><div><h3>Conclusions</h3><div>Both conventional CT and WBCT effectively identify Lisfranc injuries when comparing injured and uninjured cases, with WBCT demonstrating superior sensitivity, specificity, and diagnostic accuracy in certain parameters. Conventional CT remains reliable but exhibits variability in specific assessments. Future research should focus on standardizing imaging protocols and refining diagnostic thresholds to enhance consistency and accuracy.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 110-124"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058806","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":"Functional outcome and complications after surgical treatment of acute navicular fractures","authors":"Esmee W.M. Engelmann ,&nbsp;Jelle Posthuma ,&nbsp;J.C. Goslings ,&nbsp;Jens A. Halm ,&nbsp;Tim Schepers","doi":"10.1016/j.fas.2025.08.003","DOIUrl":"10.1016/j.fas.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Long-term functional outcome and complications following ORIF (Open Reduction Internal Fixation) for acute navicular fractures remain insufficiently investigated. This study aimed to evaluate functional outcome, complications, quality of life, and patient satisfaction after surgical treatment of acute navicular fractures.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at a level 1 trauma center, reviewing patients &gt; 17 years with navicular fractures operated between 2010 and 2023. Functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, the Foot Function Index (FFI), and EQ-5D quality of life questionnaire. Complications, such as nonunion, infection and secondary arthrodesis were recorded. A systematic literature review of studies published between 2000 and 2024 was performed.</div></div><div><h3>Results</h3><div>The cohort included 24 females and 22 males with a median age of 35.9 years and mean follow-up of 69.0 (SD 42.6) months. The majority of patients (n = 44) underwent ORIF, union occurred in 43 patients, three patients had postoperative infection and five patients required secondary arthrodesis. Functional outcome was good (median AOFAS 80.0, median FFI 21.0).</div></div><div><h3>Conclusions</h3><div>Surgical treatment of acute navicular fractures, primarily ORIF using miniplate fixation, resulted in successful union with overall good functional outcome. Nevertheless, residual problems such as painful osteoarthritis and functional limitations, especially in type 2 and 3 injuries, could be expected.</div></div><div><h3>Level of Evidence</h3><div>III</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 156-163"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975157","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":"Use of bony landmarks for more accurate tibiofibular syndesmotic fixation: Validity and safety analysis of the angle bisector method","authors":"Bedri Karaismailoglu ,&nbsp;Julian J. Hollander ,&nbsp;Jiyong Ahn ,&nbsp;Matthias Peiffer ,&nbsp;Siddhartha Sharma ,&nbsp;Gregory R. Waryasz ,&nbsp;Christopher W. DiGiovanni ,&nbsp;Soheil Ashkani-Esfahani","doi":"10.1016/j.fas.2025.08.005","DOIUrl":"10.1016/j.fas.2025.08.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The Angle Bisector Method uses the cortices of the tibia and fibula as reference points and suggests a syndesmotic fixation trajectory through the bisector of the angle formed by two lines tangent to the anterior and posterior aspects of the tibia and fibula. This study aimed to assess whether the Angle Bisector Method can provide a patient- and level-specific syndesmotic fixation angle that is reproducible, safe, and independent of the surgeon in a cadaveric setting.</div></div><div><h3>Methods</h3><div>Twelve matched above-knee leg specimens from six cadavers, underwent syndesmotic fixation (using either screws or suture-buttons) at two levels—2 cm and 3.5 cm proximal to the tibial plafond. The fixations were carried out using the angle bisector method by two surgeons employing an open lateral approach. Subsequently, CT images of the cadavers were obtained. The angle between the true centroidal axis and the axis of the syndesmotic implant trajectory was measured using radiological software. Additionally, distances between fibular entry points of the centroidal axis and the implant trajectory were measured. Distances between the positioned K-wires and major neurovascular structures were measured on cadaver dissections, and any resultant damage was documented.</div></div><div><h3>Results</h3><div>The average angle between the centroidal axis and screw trajectory was 2.7 ± 2.9 degrees at the 2 cm level and 1.8 ± 2.5 degrees at the 3.5 cm level. The average distance between the fibular entry points of the centroidal axis and the screw was 1.7 ± 1.2 mm at the 2 cm level and 1.2 ± 1.0 mm at the 3.5 cm level. The results demonstrated low inter-surgeon variability and high intra- and inter-observer reliability (ICC&gt;0.80). The distance between the placed K-wires and major neurovascular structures was always higher than 5 mm, affirming the safety of the technique.</div></div><div><h3>Conclusion</h3><div>Our data suggests that the angle bisector method can provide a reliable trajectory for syndesmotic fixation and may be safely used in surgical procedures. This approach can be applied with K-wires or a specially designed jig to facilitate syndesmotic fixation.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 170-175"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975174","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}