Kwang Hwan ParK, Dong Woo Shim, Jin Woo Lee, Hak Jun Kim, Dong Hun Suh, Yeong Jeon, Ji Hun Park, Gi Won Choi
{"title":"Comparative performance of large language models for foot and ankle clinical decision support: A multi-rater evaluation of seven models.","authors":"Kwang Hwan ParK, Dong Woo Shim, Jin Woo Lee, Hak Jun Kim, Dong Hun Suh, Yeong Jeon, Ji Hun Park, Gi Won Choi","doi":"10.1016/j.fas.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.fas.2026.08.002","url":null,"abstract":"<p><strong>Background: </strong>This study compared seven large language models (LLMs) to identify the optimal model for foot and ankle clinical decision support.</p><p><strong>Methods: </strong>The LLMs answered 20 multiple-choice questions (MCQs) and 20 open-ended clinical questions. MCQ accuracy was recorded. Three blinded foot and ankle surgeons evaluated the open-ended responses based on accuracy, completeness, and clinical relevance (total score range: 3-21).</p><p><strong>Results: </strong>GPT-o3 and GPT-5 Thinking achieved the highest MCQ accuracy (95%). For open-ended evaluations, mean total scores differed significantly across the models (p < 0.001). GPT-5 Thinking (19.98 ± 0.66) and GPT-o3 (19.67 ± 0.51) attained the highest scores, significantly outperforming the other five models, with no statistical difference between these top two performers.</p><p><strong>Conclusion: </strong>LLM performance for foot and ankle disorders differed substantially across models. GPT-5 Thinking and GPT-o3 exhibited superior performance under the tested conditions, emphasizing the necessity of targeted model selection for clinical decision-making. However, because LLMs evolve rapidly, these findings should be interpreted as a time-specific snapshot rather than as fixed or generalizable rankings of model performance.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764991","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}
Corinne Sommi, Grant M Thomas, Lauren O'Mara, David I Pedowitz, Selene G Parekh, Thomas Dowd
{"title":"Malnutrition is associated with poor outcomes following total ankle arthroplasty.","authors":"Corinne Sommi, Grant M Thomas, Lauren O'Mara, David I Pedowitz, Selene G Parekh, Thomas Dowd","doi":"10.1016/j.fas.2026.07.016","DOIUrl":"https://doi.org/10.1016/j.fas.2026.07.016","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition has been associated with various complications following orthopaedic surgery. This study evaluated the effects of malnutrition on outcomes following total ankle arthroplasty (TAA).</p><p><strong>Methods: </strong>A retrospective review yielded 1542 propensity matched TAA patients. The malnutrition cohort consisted of patients with laboratory evidence of transferrin ≤ 204 mg/dL, leukocyte ≤ 1.5 × 10 ³ /µL, or albumin ≤ 3.5 g/dL within 3 months prior to surgery. Short-term medical complications and long-term mechanical outcomes were evaluated.</p><p><strong>Results: </strong>Within 90 days postoperatively, malnutrition was associated with a significant risk of readmission, wound disruption, sepsis, myocardial infarction, pulmonary embolism, pneumonia, deep vein thrombosis, and infection (p < 0.05). At 5 years, malnutrition was associated with a periprosthetic joint infection, revision arthrodesis, periprosthetic fracture, and below knee amputation (p < 0.05).</p><p><strong>Conclusions: </strong>Adequate preoperative transferrin, albumin, and leukocyte values is a potential modifiable factor to prevent poorer outcomes following TAA.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833808","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}
T L Lewis, S Dellis, G Matheron, M Akinfala, A Nouri, P Lam, S Patel, N Cullen, K Malhotra, M Welck
{"title":"Decompressive first metatarsal osteotomy for the treatment of Hallux rigidus: A systematic review.","authors":"T L Lewis, S Dellis, G Matheron, M Akinfala, A Nouri, P Lam, S Patel, N Cullen, K Malhotra, M Welck","doi":"10.1016/j.fas.2026.07.014","DOIUrl":"https://doi.org/10.1016/j.fas.2026.07.014","url":null,"abstract":"<p><strong>Background: </strong>Hallux rigidus causes first metatarsophalangeal joint pain and limitation. Decompressive first metatarsal osteotomy (DCO) aims to improve joint biomechanics and preserve motion whilst avoiding arthrodesis.</p><p><strong>Methods: </strong>A PRISMA-compliant systematic review of MEDLINE and Cochrane was conducted, assessing patient-reported outcomes and complications.</p><p><strong>Results: </strong>Thirty studies (n = 1293 feet) met inclusion criteria (44-month follow-up). Youngswick osteotomy was commonest (33.3%); 76.7% had concomitant cheilectomy performed. Mean improvements: AOFAS 41 points, VAS 5 points, range of motion 26 °. Most studies showed moderate to serious risk of bias.</p><p><strong>Conclusion: </strong>DCO combined with cheilectomy may improve outcomes in selected patients with early/moderate hallux rigidus. The evidence is predominantly low-quality observational data, and concomitant cheilectomy in most studies confounds the independent benefit of the osteotomy, with outcomes comparable to published cheilectomy series. Patient selection is critical, with greatest benefit likely in grade II-III disease and a long / elevated first metatarsal or functional hallux limitus.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632287","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}
Ece Davutluoğlu, Mete Ozer, Yahya Deniz, Nuri Aydın, Önder Aydıngöz, Soheil Ashkani-Esfahani, Christopher DiGiovanni, Bedri Karaismailoğlu
{"title":"Effects of medializing calcaneal osteotomy and lateral column lengthening osteotomy variations on foot alignment: A three dimensional anatomical model study.","authors":"Ece Davutluoğlu, Mete Ozer, Yahya Deniz, Nuri Aydın, Önder Aydıngöz, Soheil Ashkani-Esfahani, Christopher DiGiovanni, Bedri Karaismailoğlu","doi":"10.1016/j.fas.2026.07.015","DOIUrl":"10.1016/j.fas.2026.07.015","url":null,"abstract":"<p><strong>Background: </strong>This study quantified the isolated effects of medializing calcaneal osteotomy (MCO) and lateral column lengthening osteotomy (LCLO) on three-dimensional alignment in progressive collapsing foot deformity.</p><p><strong>Methods: </strong>Weight-bearing CT-based models from six patients underwent virtual MCO and LCLO corrections of 5, 10, and 15 mm, generating 36 models.</p><p><strong>Results: </strong>LCLO corrected forefoot abduction. Anteroposterior talus-first metatarsal angle improved by 4.1°, 9.3°, and 13.9°, with talonavicular coverage changes of -4.6°, -10.7°, and -14.5°. MCO corrected hindfoot valgus, reducing hindfoot moment arm by 5.3, 10.0, and 15.1 mm and improving hindfoot angle by 4.49°, 9.19°, and 13.74° and AP talocalcaneal angle by 3.5°, 7.3°, and 10.9°, respectively. Changes were approximately linear.</p><p><strong>Conclusion: </strong>These relationships provide a bone-based framework for deformity-guided planning. They reflect intrinsic osseous correction and may be most applicable to rigid deformities, whereas outcomes in flexible PCFD may depend on soft-tissue and biological factors.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726098","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}
Mete Özer, Ece Davutluoğlu, Yahya Deniz, Bedri Karaismailoğlu, Önder Aydıngöz
{"title":"Enhancing orthopaedic resident competency in calcaneal fracture evaluation with Sanders classification: A comparative study of computed tomography, 3D printing and virtual reality.","authors":"Mete Özer, Ece Davutluoğlu, Yahya Deniz, Bedri Karaismailoğlu, Önder Aydıngöz","doi":"10.1016/j.fas.2026.07.013","DOIUrl":"https://doi.org/10.1016/j.fas.2026.07.013","url":null,"abstract":"<p><strong>Background: </strong>Interpretation of intra-articular calcaneal fractures using the Sanders classification remains challenging because of complex three-dimensional morphology. This study compared CT, 3D printing, and virtual reality (VR) for Sanders classification.</p><p><strong>Methods: </strong>Thirty-three calcaneal fractures were assessed by 25 orthopaedic residents using CT, 3D-printed models, and VR. Interobserver agreement and within-observer cross-modality concordance were analysed using Cohen's kappa (κ) and intraclass correlation coefficients (ICC). Accuracy was compared with a composite reference standard.</p><p><strong>Results: </strong>Interobserver agreement was highest with 3D printing (κ = 0.26; ICC = 0.90). CT showed the highest overall classification accuracy (p < 0.001). Agreement and accuracy were not affected by training level or session. VR was the preferred modality (80%).</p><p><strong>Conclusions: </strong>3D visualization improved interobserver agreement, whereas CT remained the most accurate modality. VR showed strong perceived educational value. Modality-dependent differences suggest that 3D methods may complement and refine CT-based Sanders classification.</p><p><strong>Level: </strong>Level II diagnostic evidence.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622138","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}
Arianna L Gianakos, Juliëtte H M Pijnacker, Inger N Sierevelt, Elze J Geurts, Jari Dahmen, Robert Hemke, Sjoerd A S Stufkens, Gino M M J Kerkhoffs
{"title":"Sex differences in osteochondral lesions of the talus: Lesion size reflects patients dimensions, whereas morphology differs between sexes.","authors":"Arianna L Gianakos, Juliëtte H M Pijnacker, Inger N Sierevelt, Elze J Geurts, Jari Dahmen, Robert Hemke, Sjoerd A S Stufkens, Gino M M J Kerkhoffs","doi":"10.1016/j.fas.2026.07.012","DOIUrl":"https://doi.org/10.1016/j.fas.2026.07.012","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated sex differences in radiological lesion characteristics in patients with primary OLTs.</p><p><strong>Materials and methods: </strong>This cross-sectional study included patients with symptomatic primary OLTs. Lesion size, location, and morphology were assessed using computed tomography. Sex differences were evaluated using univariable analyses and multivariable regression analyses adjusted for patient height and lesion etiology.</p><p><strong>Results: </strong>94 female and 156 male patients were included. Male patients presented with larger OLTs across all dimensions compared with female patients (p ≤ 0.01). After adjustment for patient height, these differences were no longer statistically significant. Lesion morphology differed by sex, with females demonstrating higher odds of crater-type lesions (OR 2.5, 95%CI 1.1-5.9).</p><p><strong>Conclusion: </strong>Sex differences in OLT size were attributable to talar dimensions rather than intrinsic sex-related factors. Females presented more frequently with crater lesions than males. Therefore, patient size and sex-specific morphological patterns should be considered in OLT treatment decision-making.</p><p><strong>Level of evidence: </strong>Level III, cross-sectional cohort study.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609055","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 \"Relationships among patient-reported outcome measures, functional performances, and tendon properties in patients with mid-portion Achilles tendinopathy: A cross-sectional study\".","authors":"Xue Shi","doi":"10.1016/j.fas.2026.05.019","DOIUrl":"https://doi.org/10.1016/j.fas.2026.05.019","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632355","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}
Daniel Poggio, Albert Fontanellas, Gerardo Ledermann, Ricardo Vega, Pere Torner, Josep Maria Segur, Albert Baduell
{"title":"Radiographic and clinical outcomes following modified L-reverse joint-preserving osteotomy for grade II hallux rigidus: A minimum 5-year follow-up.","authors":"Daniel Poggio, Albert Fontanellas, Gerardo Ledermann, Ricardo Vega, Pere Torner, Josep Maria Segur, Albert Baduell","doi":"10.1016/j.fas.2026.07.010","DOIUrl":"https://doi.org/10.1016/j.fas.2026.07.010","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate radiographic and clinical outcomes following joint-preserving surgery using a modified L-reverse osteotomy for grade II hallux rigidus, with a minimum 5-year follow-up.</p><p><strong>Methods: </strong>A retrospective review of a prospectively collected cohort treated between 2015 and 2017 was performed. Radiographic assessment included first metatarsal length, declination angle, elevation distance and first metatarsophalangeal joint space width. Clinical outcomes were assessed using the Manchester-Oxford Foot Questionnaire (MOxFQ).</p><p><strong>Results: </strong>Fifty-one patients were included. At 3 months, first metatarsal length decreased by 5.9 mm, declination angle increased by 3.3º, and elevation distance decreased by 2.4 mm (all p < 0.001). These changes remained stable at final follow-up. Median MOxFQ score improved from 42.4 to 16.9 (p < 0.001). Three patients required revision surgery.</p><p><strong>Conclusion: </strong>Joint-preserving surgery using a modified L-reverse osteotomy provided radiographic correction and clinical improvement. Maintenance of postoperative decompression and alignment correction may contribute to outcomes in moderate hallux rigidus.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690044","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":"Does age matter? Outcomes of pilon fracture fixation in patients above and below 40 years: A comparative study.","authors":"Mahmoud El-Desouky, Mohamed Essam Ramzy, Ahmed Amin Galal, Ashraf Abdelkader El-Nahal, Moustafa Alaa Maher, Sherif Hamdy Zawam","doi":"10.1016/j.fas.2026.07.011","DOIUrl":"https://doi.org/10.1016/j.fas.2026.07.011","url":null,"abstract":"<p><strong>Background: </strong>Pilon fractures are complex intra-articular injuries of the distal tibia often caused by high-energy trauma. Although ORIF remains the gold standard for restoring alignment and joint congruity, the influence of patient age on clinical and radiographic outcomes remains unclear. This study aimed to compare healing, complication rates, and functional outcomes between patients below and above 40 years old following ORIF of Pilon fractures.</p><p><strong>Materials and methods: </strong>A prospective comparative study was conducted on 56 tibial Pilon fractures in 55 patients. Patients were stratified into two groups according to age: < 40 years (35 fractures) and ≥ 40 years (21 fractures). Functional outcomes were assessed using the AOFAS and Olerud-Molander scores. Radiographic union, alignment, and complications rates were assessed in both groups.</p><p><strong>Results: </strong>Among 56 included patients, both age groups showed comparable demographics and fracture characteristics. Falls were the most common mechanism of injury, followed by MVA. All fractures healed successfully, with a mean union time of 15.1 ± 2.7 weeks and no significant difference between both groups. Functional outcomes (AOFAS and OMS) were comparable between groups without statistical significance. Although postoperative complications were more frequent in older patients (47.6% vs. 22.9%), no significant difference was detected and no nonunion or implant failure occurred.</p><p><strong>Conclusion: </strong>Age did not significantly influence healing or functional outcomes after ORIF of Pilon fractures. Despite slightly longer union time and a higher rate of complications in older patients, both groups achieved comparable recovery. These findings suggest that satisfactory outcomes can be achieved across different age groups when appropriate staged management and fixation principles are applied.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594314","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}
Shi-Ming Feng, Chong Xue, Chang-Qing Shao, Chao-Fan Su, Shun-Hong Gao
{"title":"Preoperative predictors of arthroscopically confirmed lateral ankle micro-instability and two-year outcomes after arthroscopic repair of the ATFL superior fascicle.","authors":"Shi-Ming Feng, Chong Xue, Chang-Qing Shao, Chao-Fan Su, Shun-Hong Gao","doi":"10.1016/j.fas.2026.07.009","DOIUrl":"https://doi.org/10.1016/j.fas.2026.07.009","url":null,"abstract":"<p><strong>Background: </strong>Lateral ankle microinstability (LAM) caused by anterior talofibular ligament (ATFL) superior fascicle injury is difficult to diagnose preoperatively.</p><p><strong>Methods: </strong>Sixty-seven patients with suspected LAM underwent arthroscopy. Preoperative anterior talar translation (ATT), active joint position sense (AJPS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Karlsson Ankle Functional Score (KAFS) were compared between LAM and non-LAM groups. Logistic regression and Receiver operating characteristic analysis identified predictors. Confirmed LAM cases underwent arthroscopic superior fascicle repair and were followed for 2 years.</p><p><strong>Results: </strong>Forty-five patients had confirmed LAM. ATT and AJPS errors were significantly greater in the LAM group. ATT and AJPS error at 10° plantar flexion were independent predictors. The combined model showed excellent discrimination (AUC, 0.90). At 2 years, ATT, AJPS, AOFAS, and KAFS improved significantly after arthroscopic repair procedure.</p><p><strong>Conclusions: </strong>Combined assessment of ATT and AJPS improves preoperative prediction of LAM. Arthroscopic ATFL superior fascicle repair was associated with improved stability, proprioception, and function.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473399","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}