Journal of Foot & Ankle Surgery最新文献

{"title":"Clinical application of 3D printing in non-arthroscopic ankle ligament reconstruction: A single-center retrospective study.","authors":"Kai Luo, Liqin Sun, Kang Lu, Zhongbao Du, Yanmei Ren, Yanyan Suo, Yi Xiang","doi":"10.1053/j.jfas.2026.08.003","DOIUrl":"10.1053/j.jfas.2026.08.003","url":null,"abstract":"<p><strong>Background: </strong>Chronic lateral ankle instability (CLAI) often requires anatomic ligament reconstruction after failed conservative treatment. Precise bone tunnel placement remains challenging during traditional open surgery.</p><p><strong>Purpose: </strong>To evaluate the clinical value of three-dimensional (3D) printed personalized guide plates for improving surgical precision and reducing intraoperative radiation exposure during lateral ankle ligament reconstruction.</p><p><strong>Study design: </strong>Retrospective comparative cohort study.</p><p><strong>Methods: </strong>Forty-eight patients with CLAI were consecutively enrolled and allocated by surgery date to a template group (n = 24) or a conventional group (n = 24). Primary outcomes included operation time, intraoperative fluoroscopy frequency, and radiation exposure time. Secondary outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) score, Visual Analog Scale (VAS), and Karlsson score. The VAS, which measures patient-reported pain intensity on a 10-cm line, was completed independently without surgeon interference. Clinical stability was assessed using the Anterior Drawer and Talar Tilt tests.</p><p><strong>Results: </strong>All patients completed 12-20 months of follow-up (mean, 14.5 ± 5.5 months). Compared with the conventional group, the template group had a shorter operation time (35.42 ± 5.23 vs. 44.79 ± 6.85 min, p< 0.001) and fewer fluoroscopic exposures (1.58 ± 0.65 vs. 3.33 ± 0.48, p< 0.001). No significant between-group differences were observed in AOFAS, VAS, or Karlsson scores at the final follow-up (all p > 0.05). Both groups had negative Anterior Drawer and Talar Tilt tests postoperatively, indicating successful stabilization.</p><p><strong>Conclusions: </strong>Compared with conventional surgery, 3D-printed guide-assisted surgery significantly reduced operation time, intraoperative positioning time, and radiation exposure. It is a promising and efficient approach for non-arthroscopic ankle ligament reconstruction.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680769","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":"Dementia and long-term postoperative outcomes after ankle fracture fixation: A national propensity-matched analysis.","authors":"Brendon Wang, Arun Kumar, Irene Wang, Alex Burton, Jonathan Kraus","doi":"10.1053/j.jfas.2026.08.001","DOIUrl":"10.1053/j.jfas.2026.08.001","url":null,"abstract":"<p><strong>Background: </strong>Dementia affects more than one in nine adults aged 65 and older (approximately 10-12%) and has been associated with adverse surgical outcomes, yet its impact following ankle fracture fixation remains poorly characterized.</p><p><strong>Purpose: </strong>This study examined whether pre-existing dementia independently increases the risk of infectious, systemic, and healthcare utilization outcomes compared with matched controls following ankle fracture fixation.</p><p><strong>Study design: </strong>Retrospective cohort study with propensity score matching.</p><p><strong>Methods: </strong>Adult patients undergoing ankle fracture fixation (2006-2026) were identified from the TriNetX® US Collaborative Network. Patients with dementia (N = 3,791) were matched 1:1 to controls, balancing age, race, sex, diabetes, hypertension, and other comorbidities. Outcomes were assessed at 90 days, 2 years, and 5 years and reported as risk ratios (RRs) with 95% confidence intervals.</p><p><strong>Results: </strong>At 5 years, patients with dementia had a significantly higher risk of osteomyelitis (RR 1.613, 95% CI 1.351-1.926) and sepsis (RR 1.956, 95% CI 1.730-2.211) compared with matched controls (both p < 0.001). Pneumonia (RR 1.631, 95% CI 1.466-1.815) and pressure injuries (RR 2.097, 95% CI 1.795-2.450) were also significantly elevated at 5 years (both p < 0.001). Hardware-related infection was significantly more frequent in the dementia cohort at all time points, reaching RR 1.698 (95% CI 1.168-2.468, p = 0.005) at 5 years. Delirium was markedly more common among patients with dementia, with risk ratios ranging from 3.946 (95% CI 2.759-5.644, p < 0.001) at 90 days to 5.124 (95% CI 4.101-6.401, p < 0.001) at 5 years. Hospital readmission was significantly higher at every time point, reaching 71.0% vs. 56.0% at 5 years (RR 1.267, 95% CI 1.223-1.312, p < 0.001). Mortality was significantly elevated at 2 years (RR 1.444, 95% CI 1.266-1.646) and 5 years (RR 1.537, 95% CI 1.397-1.690, both p < 0.001). No significant differences were observed in hardware removal, reoperation, reoperation for nonunion or malunion, or amputation.</p><p><strong>Conclusions: </strong>Dementia independently increases infectious complications, including hardware-related infection, readmission, delirium, and long-term mortality following ankle fracture fixation without elevating most procedure-specific complication rates, suggesting excess morbidity is driven by patient-level vulnerability rather than surgical failure. Enhanced postoperative surveillance and care coordination are warranted for cognitively impaired patients undergoing ankle fracture fixation.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680801","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":"The role of haglund deformity and calcaneal morphology in insertional achilles tendinopathy: Radiographic analysis in a matched surgical cohort.","authors":"Adriel You Wei Tay, Rui Xiang Toh, Kizher Shajahan Mohamed Buhary, Zongxian Li, Kae Sian Tay","doi":"10.1053/j.jfas.2026.08.002","DOIUrl":"10.1053/j.jfas.2026.08.002","url":null,"abstract":"<p><strong>Background: </strong>Insertional Achilles tendinopathy (IAT) is commonly associated with radiographic abnormalities at the Achilles insertion, including Haglund deformity, enthesophytes, and intratendinous calcification. However, the relationship between IAT and these radiographic features remains unclear.</p><p><strong>Purpose: </strong>To compare the radiographic features of patients with surgically treated IAT with those of asymptomatic controls.</p><p><strong>Study design: </strong>Retrospective comparative study METHODS: Thirty-seven patients who underwent surgery for unilateral IAT were matched by age, gender, and BMI to 37 controls with unrelated forefoot or midfoot pathology. Lateral radiographs were assessed for Fowler-Philip angle (FPA), parallel pitch lines (PPL), X/Y ratio, intratendinous calcification, and posterior calcaneal spur.</p><p><strong>Results: </strong>IAT patients showed higher mean FPA (62.3° vs 54.0°, p < 0.001), lower X/Y ratio (2.59 vs 2.76, p = 0.022), and greater PPL positivity (95% vs 57%, p < 0.001). Intratendinous calcification (70% vs 30%, p < 0.001) and posterior calcaneal spur (89% vs 73%, p = 0.037) were more common in IAT.</p><p><strong>Conclusion: </strong>Radiographic indicators of Haglund's deformity, calcaneal morphology and calcific changes are significantly associated with IAT, supporting their diagnostic and etiologic relevance.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671079","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":"The analysis of factors determining the effectiveness of extracorporeal shock wave therapy in patients with calcaneal spur.","authors":"Ayça Uran Şan, Arda Yıldırım, Esra Ülgen Kıratlıoğlu, Arif Kenan Tan, Engin Koyuncu","doi":"10.1053/j.jfas.2026.07.024","DOIUrl":"10.1053/j.jfas.2026.07.024","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal shock wave therapy (ESWT) may improve pain and function in patients with calcaneal spur; however, outcomes may vary according to patient characteristics.</p><p><strong>Purpose: </strong>This study aimed to identify clinical, functional, radiological, and physical activity-related predictors of treatment response in individuals with calcaneal spur who received ESWT and to assess the extent of improvement after treatment.</p><p><strong>Study design: </strong>Retrospective observational study using a single-assessment retrospective pretest-posttest design.</p><p><strong>Methods: </strong>A total of 120 patients who underwent ESWT for heel pain/plantar fasciitis associated with calcaneal spur and who had complete study data were included. Participants completed a single post-treatment telephone interview, reporting their current status and retrospectively recalling their pre-treatment status. Assessments included Numerical Rating Scale scores for first-step pain and total heel pain, Roles and Maudsley Scale scores, Foot Function Index scores, International Physical Activity Questionnaire-Short Form scores, analgesic consumption, calcaneal spur size, and radiological stage.</p><p><strong>Results: </strong>Significant improvements were observed in pain and foot-related functional measures following ESWT. The percentage of patients utilizing analgesics decreased from 64.2% to 31.7%. IPAQ-SF (International Physical Activity Questionnaire-Short Form)/MET (Metabolic Equivalent of Task)-based scores for walking, moderate-intensity activity, vigorous activity, and total physical activity increased significantly after ESWT.</p><p><strong>Conclusions: </strong>ESWT may reduce pain and analgesic use while improving function and physical activity in patients with calcaneal spur. Patient-related, radiological, functional, and physical activity-related factors were associated with the degree of treatment benefit.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654953","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":"Is there an association between socioeconomic factors and hardware failure after ankle fracture fixation? A retrospective study.","authors":"Kayla L Curlis, Gianluca Ianiro, Austen Miller, Nicole Gajowski, Kyle McKray Smith, Khase Wilkinson","doi":"10.1053/j.jfas.2026.07.018","DOIUrl":"10.1053/j.jfas.2026.07.018","url":null,"abstract":"<p><strong>Background: </strong>Hardware failure following ankle fracture fixation is an established complication traditionally attributed to fracture pattern, fixation construct, bone quality, and postoperative weight-bearing status. The relationship between community-level social vulnerability and hardware failure requiring removal after ankle open reduction internal fixation (ORIF) remains poorly defined.</p><p><strong>Purpose: </strong>To evaluate whether patients residing in socioeconomically vulnerable areas experience higher rates of hardware failure following ankle fracture fixation.</p><p><strong>Study design: </strong>Retrospective cohort study METHODS: Patients who underwent unplanned hardware removal after ankle fracture fixation were identified using Current Procedural Terminology (CPT) code 20680. The control group consisted of patients who underwent operative ankle fracture fixation during the study period without subsequent hardware removal. Demographic data and residential zip codes were extracted from the electronic medical record, and zip codes were mapped to counties to assign county-level Social Vulnerability Index (SVI) scores.</p><p><strong>Results: </strong>Patients residing in Lucas County, Ohio, demonstrated greater social vulnerability than those in surrounding counties, particularly within the socioeconomic status and racial and ethnic minority status themes. Age demonstrated a small statistically significant association with hardware removal (OR, 1.014; 95% CI, 1.002, 1.027; P = 0.022), although age was not the primary focus of this analysis.</p><p><strong>Conclusion: </strong>Socioeconomic and environmental factors remain clinically relevant to postoperative care after ankle fracture fixation. The concentration of patients from a higher-socially vulnerable region highlights the need to better characterize how social vulnerability, care access, follow-up adherence, and community-level barriers may affect hardware-related outcomes.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654927","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 following staged management of bimalleolar and trimalleolar ankle fractures.","authors":"Samuel Jin, Sebastian Quiana, Dev Patel, Jamal Revolus, Raj Patel, Rakesh Mashru, Henry Dolch, John E Dibato, Pietro Gentile, Kenneth Graf","doi":"10.1053/j.jfas.2026.07.025","DOIUrl":"10.1053/j.jfas.2026.07.025","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures are among the most common lower extremity fracture types with an incidence rate of 4.22/10,000 person-year, but guidelines for preliminary stabilization remain limited. Currently, few studies compare both splinting and external fixations to how they affect postoperative complications.</p><p><strong>Purpose: </strong>The purpose of this study was to extend the analysis of postoperative complications to include fracture healing outcomes when comparing splinting and external fixation.</p><p><strong>Study design: </strong>A retrospective review of 652 patients with bimalleolar and trimalleolar ankle fractures undergoing preliminary fixation with either splinting or external fixation from 2017 to 2024 was performed.</p><p><strong>Methods: </strong>Fractures were grouped as splint (n = 493) or external fixator (n = 159), with subgroup analysis by open vs. closed fractures. Outcomes included length of stay, days to fixation, infection rates, and non-infectious complications (delayed union, malunion, nonunion, hardware failure). Additional subgroup analyses evaluated complication rates by fracture pattern.</p><p><strong>Results: </strong>External fixation was associated with longer hospital stays (12.2 vs 5.4 days, p < 0.001) and delayed definitive fixation (median 5 days [IQR 3-9] vs 2 days [IQR 1-5], p < 0.001). Infection rates were higher with external fixation (11% vs 6%; p = 0.031). In subgroup analysis, closed bimalleolar fractures had higher complication rates with external fixation (40%, 95% CI: 24-56) compared to splinting (11%, 95% CI: 7-16) where (p < 0.001).</p><p><strong>Conclusions: </strong>Splint immobilization of ankle fractures led to shorter hospital stays and days to definitive fixation. When preliminary fixation was achieved with splinting, complication rates were significantly lower compared to external fixation.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654943","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":"Quantifying the minimal clinically important difference of the self-administered foot evaluation questionnaire (SAFE-Q) in patients undergoing surgery for ankle osteoarthritis.","authors":"Rintaro Harada, Hiroyuki Seki, Tetsuro Kokubo","doi":"10.1053/j.jfas.2026.07.026","DOIUrl":"10.1053/j.jfas.2026.07.026","url":null,"abstract":"<p><strong>Background: </strong>The Self-Administered Foot Evaluation Questionnaire (SAFE-Q) is a validated foot- and ankle-specific patient-reported outcome measure. However, minimal clinically important difference (MCID) values have not been established for SAFE-Q after surgery for ankle osteoarthritis.</p><p><strong>Purpose: </strong>To determine anchor-based and distribution-based MCIDs for SAFE-Q subscales in patients undergoing surgery for ankle osteoarthritis.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>We analyzed 88 patients with ankle osteoarthritis undergoing surgery who completed SAFE-Q preoperatively and ≥12 months postoperatively. The SAFE-Q subscales included pain and pain-related (PP), physical function and daily living (PF), social function (SF), shoe-related problems (SH), and general health and well-being (GH). Anchor-based MCIDs were derived using receiver operating characteristic (ROC) curves, with patient satisfaction as the external anchor. Distribution-based MCIDs were estimated using one-half standard deviation of baseline scores.</p><p><strong>Results: </strong>SAFE-Q scores improved significantly across all domains. Eighty patients (91%) reported satisfaction. Anchor-based MCIDs were +13.9 for PP and +9.1 for PF, with acceptable discriminative accuracy (area under the ROC curve 0.759 and 0.743, respectively). In contrast, GH was affected by ceiling effects, and SF and SH showed limited discriminative ability. Distribution-based MCIDs ranged from 9 to 13 points and closely matched anchor-based values for PP and PF.</p><p><strong>Conclusion: </strong>This study provides the first MCID estimates for SAFE-Q in ankle osteoarthritis surgery. PP and PF demonstrated clinically meaningful MCIDs of approximately 9-14 points, indicating that these subscales are most appropriate for assessing meaningful postoperative improvement. These thresholds offer practical guidance for clinical interpretation and future trial design.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649624","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":"Augmented anterior inferior tibiofibular ligament repair and its short-term postoperative effects on 3D syndesmotic volumes: A randomized clinical pilot study.","authors":"Ashley M B Suttmiller, Brice A Snyder, Stuti Singh, Blake E Moore","doi":"10.1053/j.jfas.2026.07.016","DOIUrl":"10.1053/j.jfas.2026.07.016","url":null,"abstract":"<p><strong>Background: </strong>Dynamic fixation using the TightRope® system has led to improvements in outcomes after complex ankle syndesmotic injuries. Augmenting tightrope fixation with a repair of the anterior inferior tibiofibular ligament has been proposed to reconstruct the syndesmosis more accurately. Clinical studies using this technique are limited.</p><p><strong>Purpose: </strong>To determine if surgical technique influenced immediate postoperative reduction of the syndesmosis and immediate and short-term patient-reported outcomes. We also explored relationships between postoperative volumes and patient-reported outcomes.</p><p><strong>Study design: </strong>Randomized clinical pilot study METHODS: Twenty patients with syndesmotic injuries were blinded and randomly assigned into tightrope (n=11; 50.5±13.3yrs) or tightrope with augmentation (n=9; 55.9±19.3yrs) groups. Our primary outcome, postoperative reduction, was assessed by 3D volumetric ratios measured by weightbearing computed tomography at 6-weeks and 3-months post-operation. Our secondary outcomes, Foot and Ankle Outcome Score and the RAND-36, were collected preoperatively, and at 6-weeks, 3-months, 6-months, and 1-year post-operation.</p><p><strong>Results: </strong>Differences in volumetric ratios and outcomes were evaluated between groups and time periods. No significant differences were found in syndesmotic volumetric ratios between groups at either time point. An increase was observed in postoperative volumes in those with Weber C fractures between 6-weeks and 3-months. Both groups reported improved outcomes after fixation, but surgical technique did not influence them. Additionally, we did not find any relationship between volumetric ratios and outcomes.</p><p><strong>Conclusion: </strong>Both techniques produced similar immediate- and short-term clinical outcomes. Future studies with larger samples and those looking at the potential influence of these techniques in various fracture classifications are warranted.</p><p><strong>Level of clinical evidence: </strong>Level II, therapeutic, pilot randomized controlled trial.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632548","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":"Long-acting narcotic multimodal anesthesia versus standard of care anesthesia for hallux valgus patients undergoing a percutaneous distal metatarsal osteotomy: A multi-center randomized controlled trial.","authors":"Shayan Karimi, Dena Bakhsh, Lucy Luo, Jennifer Mutch, Jordan Gagnon, Marie Gdalevitch","doi":"10.1053/j.jfas.2026.07.023","DOIUrl":"10.1053/j.jfas.2026.07.023","url":null,"abstract":"<p><strong>Background: </strong>Hallux valgus surgery often results in significant post-operative pain, requiring narcotics. Optimizing pain management while minimizing opioid consumption remains an important clinical challenge.</p><p><strong>Purpose: </strong>This study investigates whether multimodal analgesia (acetaminophen, naproxen, and pregabalin) with the use of long-acting tramadol reduces the need for short-acting narcotics following minimally invasive hallux valgus surgery under regional ankle block anesthesia.</p><p><strong>Study design/methods: </strong>A total of 114 patients aged 18-70 with BMI ≤ 40 undergoing hallux valgus surgery were randomized into Experimental (Exp) and Standard (S) groups. The Exp group (n = 56) received acetaminophen, naproxen, pregabalin, and Ralivia (tramadol extended release) pre-operatively, along with a post-operative regimen including rescue hydromorphone. The S group (n = 58) followed standard protocols with hydromorphone as the primary analgesic. Pain (VAS scores) and short-acting narcotic use were recorded post-operatively, alongside steps and sleep using smartwatches. Two-sided t-tests compared VAS scores and narcotic consumption.</p><p><strong>Results: </strong>Exp patients used significantly fewer short-acting narcotics in the first week, averaging 5.24 hydromorphone pills (20.96 MME) vs. 13.53 hydromorphone pills (54.12 MME) in the S group (p < 0.0005), however the Exp group consumed a higher overall MME. Notably, of all patients in the study, 27.2% did not consume any short-acting narcotics post-operatively (43.1% in Exp group and 10.7% in S group). Pain scores at 24 and 48 hours were significantly less in the Exp group (p = 0.001, p = 0.012), but the difference was minimal and not clinically significant. Steps and sleep were comparable between groups.</p><p><strong>Conclusion: </strong>Multimodal analgesia with long-acting narcotics in minimally invasive surgery was associated with reduced short-acting narcotic use, but higher overall MME compared to the standard protocol.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622327","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":"Factors affecting Postural Stability in Patients with Hallux Valgus: Influence of Pain and Deformity.","authors":"Ken Tanaka, Hiroaki Shima, Kosho Togei, Yoshihiro Hirai, Masatoshi Takashima, Toshito Yasuda, Shuhei Otsuki","doi":"10.1053/j.jfas.2026.07.020","DOIUrl":"10.1053/j.jfas.2026.07.020","url":null,"abstract":"<p><strong>Background: </strong>Hallux valgus is associated with impaired postural stability and increased fall risk; however, the influence of pain on postural stability remains unclear.</p><p><strong>Purpose: </strong>This study aimed to examine factors affecting postural stability in patients with hallux valgus, with particular focus on pain intensity and deformity severity.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>Forty-seven female patients who underwent hallux valgus surgery between 2014 and 2024 were evaluated preoperatively. Postural stability was assessed using a stabilometric platform, and total track length was defined as the primary outcome. Evaluated variables included age, body mass index, visual analog scale pain score, first metatarsophalangeal joint range of motion, hallux valgus angle, and foot alignment parameters. Simple and multiple regression analyses were performed to identify factors associated with total track length.</p><p><strong>Results: </strong>Simple regression analysis demonstrated significant associations between total track length and age, visual analog scale pain score, and hallux valgus angle. Multiple regression analysis revealed that visual analog scale pain score (β = 0.43, p = 0.001) and hallux valgus angle (β = 0.32, p = 0.016) were independent predictors of total track length, indicating that higher pain intensity and more severe deformity contributed to increased postural sway.</p><p><strong>Conclusion: </strong>Pain intensity and deformity severity independently affect postural stability in patients with hallux valgus. These findings suggest that both pain control and correction of deformity may be important for improving postural stability in this population.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609593","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}