Journal of Foot & Ankle Surgery最新文献

{"title":"Isolated Endoscopic Flexor Hallucis Longus Transfer Versus Open Primary Repair for Acute Achilles Tendon Ruptures: A Retrospective Comparative Study.","authors":"Vahdet Ucan, Bilal Sulak, Ahmet Can Erdem, Ali Toprak, Gokcer Uzer, Nurzat Elmali","doi":"10.1053/j.jfas.2026.05.003","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.05.003","url":null,"abstract":"<p><strong>Background: </strong>Open primary repair is widely used for acute Achilles tendon rupture but is associated with wound-related complications. Endoscopic flexor hallucis longus (FHL) transfer has been proposed as an alternative strategy to reduce soft-tissue morbidity.</p><p><strong>Purpose: </strong>To compare clinical outcomes and complication rates between open primary repair and isolated endoscopic FHL transfer in acute Achilles tendon ruptures.</p><p><strong>Methods: </strong>Patients who underwent surgical treatment within 7 days of injury between 2023 and 2024 were retrospectively reviewed. All ruptures involved the watershed region. Patients underwent either open primary repair using a Krackow technique or isolated endoscopic FHL transfer. Outcomes included ATRS, AOFAS score, VAS pain score, return to activity, and complications.</p><p><strong>Results: </strong>Fifty-four patients were included (32 open, 22 FHL). No statistically significant differences were detected between groups in functional outcome scores or return-to-activity times. The overall complication rate was significantly higher in the open repair group compared with the FHL group (28.1% vs 4.5%, p = 0.03), mainly due to wound-related complications. Hallux-related complaints did not affect daily activities in the FHL group.</p><p><strong>Conclusion: </strong>Isolated endoscopic FHL transfer was associated with similar functional outcome scores and a lower complication rate compared with open repair. This technique may represent a potential alternative in selected acute Achilles tendon ruptures.</p><p><strong>Study design: </strong></p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of weight-bearing restriction periods using a patellar tendon-bearing brace after arthroscopic and open ankle arthrodesis.","authors":"Taihei Miura, Yasuyuki Jujo, Kai Man Chu, Mary Kathleen Cabling, Norapon Pornsamutsin, Seiji Okada, Masato Takao","doi":"10.1053/j.jfas.2026.05.001","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.05.001","url":null,"abstract":"<p><strong>Background: </strong>After ankle arthrodesis (AA), a postoperative non-weight-bearing period is generally required. A patellar tendon-bearing (PTB) brace allows ambulation while reducing load transmission to the ankle joint; however, its role in supporting early postoperative weight-bearing (within 6 weeks) after AA remains unclear.</p><p><strong>Purpose: </strong>To determine whether early weight-bearing after AA using a PTB brace is feasible in patients with end-stage ankle osteoarthritis by comparing clinical outcomes and bone union between 6-week and 8-week non-weight-bearing protocols.</p><p><strong>Study design: </strong>Retrospective comparative cohort study.</p><p><strong>Methods: </strong>Sixty-seven patients with end-stage ankle osteoarthritis who underwent arthroscopic (n = 41) or open (n = 26) AA were retrospectively reviewed. All patients used a PTB brace postoperatively to allow ambulation with reduced ankle loading. Thirty-six patients followed a 6-week non-weight-bearing protocol, and 31 followed an 8-week protocol. Clinical outcomes were assessed using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) preoperatively and at final follow-up. Complications, including bony nonunion, were evaluated. Outcomes were compared between groups and by surgical approach.</p><p><strong>Results: </strong>Both groups showed significant postoperative improvement in all SAFE-Q domains compared with preoperative scores (all P < 0.001). The 8-week group demonstrated significantly higher SAFE-Q scores and a higher bone union rate than the 6-week group (both P = 0.04). No significant differences in complication rates, including bony nonunion, were observed between arthroscopic and open AA.</p><p><strong>Conclusions: </strong>Ambulation with ankle load reduction using a PTB brace resulted in favorable clinical outcomes; however, early weight-bearing after AA may not be optimal for all patients and should be considered individually.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Feasibility of Percutaneous Flexor Digitorum Longus Needle Tenotomy: A Cadaveric Study Across Surgeon Experience Level.","authors":"Antonella Henson-Vendrell, Devon Niewohner, Hayden Bush, Lindsay LeSavage, Garrett Bullock, Ashleigh Wells Medda, Paula Gangopadhyay","doi":"10.1053/j.jfas.2026.05.002","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.05.002","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous flexor tenotomy is used to correct lesser toe deformities but is frequently performed without direct visualization. This study evaluated the anatomic safety and feasibility of percutaneous flexor digitorum longus needle tenotomy and assessed whether performance and practicability varied by surgeon experience.</p><p><strong>Study design: </strong>Cadaveric study.</p><p><strong>Methods: </strong>Fifty-four toes (digits 2-4) from nine cadaveric specimens underwent standardized percutaneous tenotomy using an 18-gauge needle performed by a podiatric attending, a third-year chief resident, and a first-year resident (18 toes per operator). Post-procedural dissections were performed to assess neurovascular integrity and tendon transection. Tendon widths were measured to calculate absolute and proportional resection. Analysis of covariance compared tendon resection depth across training levels while adjusting for original tendon width. Logistic regression estimated odds of complete transection.</p><p><strong>Results: </strong>All procedures preserved the plantar digital arteries and nerves. Complete tendon transection occurred in 10 of 54 cases (18.5%): 3 attending (16.7%), 3 chief resident (16.7%), and 4 PGY1 (22.2%). Complete misses occurred in 7 attending (38.9%), 3 chief resident (16.7%), and 5 PGY1 (27.8%) cases. Mean tendon resection measured 1.56 ± 1.42 mm for the attending, 2.78 ± 1.80 mm for the chief resident, and 2.61 ± 2.15 mm for the PGY1.</p><p><strong>Conclusion: </strong>Percutaneous flexor digitorum longus tenotomy with an 18-gauge needle demonstrated consistent anatomic safety across experience levels but infrequently achieved complete tendon transection. These findings suggest that complete transections may be difficult to consistently achieve percutaneously and may not be required for clinical correction.</p><p><strong>Level of clinical evidence: </strong>5.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Outcomes of Autograft versus rhPDGF-BB in Rearfoot and Ankle Arthrodesis: A Propensity-Matched TriNetX Analysis.","authors":"David Ahn, Avani Chopra, Abhiram Dawar, Gnaneswar Chundi, Tuckerman Jones, Zachary Fuller, Mark Fisher, Scott Tucker, Michael Aynardi, Sheldon S Lin","doi":"10.1053/j.jfas.2026.04.012","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.04.012","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that recombinant human platelet-derived growth factor (rhPDGF-BB) may enhance fusion and reduce donor-site morbidity in foot and ankle arthrodesis. However, direct large-scale comparisons between those receiving autograft and rhPDGF-BB remain limited, particularly for high-risk or revision procedures.</p><p><strong>Purpose: </strong>To address this gap, we utilized the TriNetX research database to compare fusion outcomes and complication profiles between rhPDGF-BB and autograft in tibiotalocalcaneal (TTC), pantalar, or triple arthrodesis.</p><p><strong>Methods: </strong>The TriNetX database for patients who underwent tibiotalocalcaneal, pantalar, or triple arthrodesis from 2003 to 2023, with at least one-year follow-up. A 1:1 propensity score match controlled for age, sex, body mass index, nicotine dependence, and comorbidities. Postoperative complications included implant-related infection, surgical site infection, superficial skin infection, infection-related reoperation, wound disruption, osteolysis, nonunion, and hardware removal. Statistical analyses were conducted on TriNetX using Z-tests for pairwise comparisons, with significance set at p<0.05.</p><p><strong>Results: </strong>A total of 209 patients in the rhPDGF-BB cohort and 7,109 in the autograft cohort were identified. The rhPDGF-BB cohort was older and had higher rates of diabetes, HIV, and several other comorbidities (all p < 0.05). After propensity matching (n = 208 per cohort), the rhPDGF-BB cohort had a lower nonunion rate (OR 0.36; 95% CI 0.19-0.69; p = 0.001) with no other significant outcome differences.</p><p><strong>Conclusion: </strong>Our findings suggest that rhPDGF-BB may be associated with lower nonunion rates compared with autograft without increased complications. Given the observational design, these results should be considered hypothesis-generating and warrant validation in prospective randomized studies.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal Plane Alignment Influences Medial and Lateral Malleolus Bone Density in Ankle Patients With Arthritis.","authors":"Saul W Fredrickson, David S Clark, Megna Panchbhavi, Vinod K Panchbhavi, Jie Chen","doi":"10.1053/j.jfas.2026.04.017","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.04.017","url":null,"abstract":"<p><strong>Background: </strong>The effect of coronal plane deformity in ankle arthritis on the bone mineral density of the medial and lateral malleolus has not been previously studied.</p><p><strong>Purpose: </strong>We aimed to identify whether the coronal plane deformity has an influence on the medial and lateral malleolus bone mineral density in patients.</p><p><strong>Study design: </strong>Retrospective cohort study METHODS: We performed a retrospective review at our institution from 2013-2023 to identify patients with end-stage ankle arthritis with a preoperative computer tomography (CT) scan undergoing either ankle arthroplasty or ankle arthrodesis. Patients were stratified into varus or valgus (tibiotalar angle > 5 degrees) and neutral ankle alignments. Bone mineral density measurements were taken of the medial and lateral malleolus on CT scan and the medial and lateral ratio was obtained and compared to the tibiotalar angle.</p><p><strong>Results: </strong>There was a statistically significant difference between the medial/lateral bone mineral density ratio in valgus vs neutral patients (P = 0.003) as well as between varus vs valgus patients (P < 0.001). There was no significant difference between medial/lateral malleolus bone mineral density ratio in varus vs neutral patients (P = 0.514).</p><p><strong>Conclusion: </strong>Valgus deformity in patients with ankle arthritis influences bone mineral density in the medial and lateral malleolus.</p><p><strong>Level of evidence: </strong>Level 3, Prognostic.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Maisonneuve Type\" Fracture Patients Return to Activity Quicker than Patients with Other PER III/IV Fractures.","authors":"Natalie H Vu, Jacob Linker, Abhishek Ganta, Sanjit R Konda, Kenneth A Egol, Nirmal C Tejwani","doi":"10.1053/j.jfas.2026.04.010","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.04.010","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical characteristics and outcomes of Maisonneuve fractures, as defined as syndesmotic disruption with or without proximal fibula fracture, to other pronation-external rotation (PER) stage III/IV fractures.</p><p><strong>Methods: </strong>A retrospective review of an IRB-approved database of ankle fractures from a single orthopedic department identified patients with surgically treated PER stage III/IV fractures, including those meeting radiographic criteria for Maisonneuve fracture. Data collected included patient demographics, injury mechanism, surgical details, and Lauge-Hansen classification. Maisonneuve fractures were compared to other PER III/IV fractures requiring fibular fixation with syndesmotic stabilization. Outcomes included total complications, fracture-related infection, hardware removal, and nonunion. Patients were seen for standard follow up for 12 months post-operatively with clinical healing defined as non-tenderness about the ankle. Statistical analyses included Chi square analysis, ANOVA, and multivariable regression analysis.</p><p><strong>Results: </strong>64 patients with operatively repaired Maisonneuve fractures were identified (mean follow-up of 10 months). These patients were more often male compared to other PER III/IV fractures (p < 0.05). Maisonneuve fractures were associated with a faster time to clinical healing and return to full activity, confirmed on multivariable regression analysis (p < 0.05). No significant differences in complications rates or radiographic parameters at six months or later were observed, as all values remained within accepted clinical ranges.</p><p><strong>Conclusion: </strong>Maisonneuve fracture patients experience a more rapid clinical recovery based upon painless ankle motion as well as a return to full activity faster than patients with other types of PER III/IV injuries, with comparable complication rates and radiographic outcomes.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Foot: Proximal Joint Adaptations Following Lisfranc Injury as Suggested by Gait and Pedobarographic Analysis.","authors":"Engin Eceviz, Oğuzhan Özyaman, Hüsnü Yılmaz, Ömer Hekim, Onur Gökmen, Hüseyin Bilgehan Çevik","doi":"10.1053/j.jfas.2026.04.013","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.04.013","url":null,"abstract":"<p><strong>Background: </strong>Anatomic reduction is the gold standard for Lisfranc injuries; however, its relationship with functional recovery remains controversial.</p><p><strong>Purpose: </strong>To evaluate gait and functional parameters in patients with Lisfranc injuries treated with open reduction and internal fixation (ORIF), and determine whether radiographic anatomic alignment ensures full functional recovery.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Thirty patients who underwent ORIF with anatomic reduction for Myerson Type B2 Lisfranc injuries between 2020 and 2024 were retrospectively evaluated. Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score and ankle range of motion (ROM). Three-dimensional gait analysis and pedobarographic measurements were compared between the affected and unaffected sides.</p><p><strong>Results: </strong>The mean AOFAS midfoot score was 93.63, and ankle ROM did not differ between sides (p≥0.05). However, peak plantar flexion (p=0.001), sagittal plane ROM (p≤0.001), and ankle power generation (p≤0.001) were reduced on the affected. Knee joint absorption power also decreased on the affected side, suggesting a compensatory mechanism (p=0.031). Spatiotemporal analysis indicated trends toward reduced step length and shorter stance phase on the affected side (p≤0.05). However, these differences were not statistically significant following Holm-Bonferroni correction.</p><p><strong>Conclusions: </strong>Despite achieving anatomic reduction, full functional recovery after Lisfranc injury may not always be achieved. Objective gait analysis revealed persistent functional deficits despite high clinical scores and radiographic alignment. Reduced ROM and power, along with altered knee mechanics, suggest that Lisfranc injuries may affect not only the foot but also the ankle and knee.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Treatment Options for Tibialis Anterior Tendon Ruptures.","authors":"Cameron Meyer, Lucas Herrington, Julia Tolin, Karissa Badillo, Chase Kiefer, Alissa Parker, Patrick Burns, Jeffrey Manway, Jarrett Cain","doi":"10.1053/j.jfas.2026.04.016","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.04.016","url":null,"abstract":"<p><strong>Background: </strong>Tibialis anterior tendon (TAT) ruptures are rare injuries with limited literature. While operative intervention may improve function and reduce pain, the optimal timing and choice of surgical technique remain unclear.</p><p><strong>Purpose: </strong>To review the management of TAT ruptures across three institutions within the same academic health system and to evaluate surgical management patterns.</p><p><strong>Methods: </strong>Patients greater than 18 years of age with TAT rupture or pathology treated between 2007 and 2024 by three board-certified foot and ankle surgeons were included. Minimum follow-up was three months. Patients without TAT pathology or inadequate follow-up were excluded. Data on demographics, treatment modality, rupture size, time to surgery, and complications were collected.</p><p><strong>Results: </strong>Twenty TAT ruptures in 19 patients were identified. Eleven cases were managed conservatively, and nine surgically (five EHL tendon transfers, four direct tendon repairs). Larger rupture deficits were associated with shorter time to operative intervention. No infections were reported, and one re-rupture occurred in the direct repair group. Postoperative recovery allowed return to full muscle strength in all surgical cases. Both surgical approaches demonstrated favorable functional outcomes, and conservative management was effective in low-demand patients with smaller deficits.</p><p><strong>Conclusion: </strong>Both direct repair and EHL tendon transfer provide reliable restoration of strength and function with low complication rates in appropriately selected patients. Conservative management remains a reasonable alternative for small defects or low-demand individuals. This study contributes to the limited literature on TAT ruptures and supports further prospective research with standardized follow-up to refine indications, timing, and technique for surgical repair.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screw characteristics and intramedullary fixation for Jones fractures and associated outcomes: A systematic review and meta-analysis.","authors":"Daniel Lowe, Sean Grambart, Chin-I Cheng, Vanessa Adelman, Ronald Adelman","doi":"10.1053/j.jfas.2026.04.014","DOIUrl":"10.1053/j.jfas.2026.04.014","url":null,"abstract":"<p><strong>Objective: </strong>A Jones fracture is a common injury in foot and ankle care. Open reduction internal fixation (ORIF) versus conservative treatment has a strong literature background supporting ORIF for the active patients. Standard treatment for fixation of the Jones fracture is intramedullary screw fixation. However, there is limited research on how screw characteristics influence outcomes. This systematic review aimed to compare the outcomes based on screw characteristics in the treatment of Jones fractures.</p><p><strong>Methods: </strong>A search of the Cochrane, EBSCO, Scopus, and PubMed databases from 2000 to 2023 identified six retrospective studies, one prospective study, and one case series that evaluated outcomes of intramedullary screw fixation in Jones fractures.</p><p><strong>Results: </strong>The analysis found no statistically significant difference in return-to-play (RTP) weeks or complication rates when comparing different screw diameters. Additionally, there was no significant difference in complication rates between cannulated and solid screw fixation.</p><p><strong>Conclusions: </strong>In treating Jones fractures with intramedullary screw fixation, neither screw diameter nor screw type (cannulated or solid) appears to impact complication rates or RTP outcomes. Further studies, particularly randomized controlled trials with larger sample sizes, are needed to confirm these findings and achieve greater homogeneity.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Optimized Versus Plain Prefabricated Insoles for Mechanical Foot Pain in Subtle Cavus Foot: A Randomized Controlled Trial.","authors":"Chuan Guan Ng, Trina Wong, Sean Wei Loong Ho, Muhammad Farhan Mohd Fadil","doi":"10.1053/j.jfas.2026.04.011","DOIUrl":"https://doi.org/10.1053/j.jfas.2026.04.011","url":null,"abstract":"<p><strong>Background: </strong>Subtle cavus foot (SCF), identified by the \"peek-a-boo\" sign and a positive Coleman block-test, is frequently associated with mechanical foot pain. While prefabricated insoles are commonly used in clinical practice, evidence supporting their effectiveness in SCF - particularly when modified according to SCF-specific design principles - is limited.</p><p><strong>Purpose: </strong>Study Design: This prospective randomized controlled trial compared Specifically Optimized Prefabricated Insoles (SOPI) with unmodified Plain Prefabricated Insoles (PPI) in individuals with clinically identified SCF and mechanical foot pain.</p><p><strong>Methods: </strong>Twenty-nine participants were randomized; 26 completed the study (13 per group). SOPI were modified in-office using forefoot valgus wedging and first-ray fill reduction, while PPI were provided as-is. The primary outcome was the Foot Function Index (FFI), assessed at baseline and at 1, 2, and 3 months. Baseline FFI total and subscale scores were comparable between groups.</p><p><strong>Results: </strong>At 3 months, the SOPI group demonstrated greater improvements than the PPI group in FFI total scores (mean difference 12.2, 95%CI: 5.2-19.3, P =.002), FFI pain scores (15.0, 95%CI: 5.9-24.1, P =.006), FFI disability scores (13.5, 95%CI: 5.2-21.8, P =.004), and FFI activity limitation scores (4.9, 95%CI: 0.5-9.3, P =.015), with differences exceeding reported minimal clinically important differences.</p><p><strong>Conclusion: </strong>Our preliminary data suggest that SCF-specific optimization of prefabricated insoles may improve pain and function over three months compared to unmodified insoles. However, these findings are inconclusive due to the underpowered sample size and should be interpreted as hypothesis-generating. Confirmation in larger, adequately powered studies with longer follow-up is required.</p><p><strong>Level of clinical evidence: </strong>Level III, randomized controlled trial.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}