Journal of Foot & Ankle Surgery最新文献

{"title":"A Magnetic Resonance Imaging Safe Distance Beyond the Flexor Hallucis Longus Tendon and the Application of the Safe Arthroscopic Approach to Prevent Neurovascular Injury in Posterior Ankle Arthroscopy.","authors":"Penpun Lertwattanachai, Thos Harnroongroj, Bavornrit Chuckpaiwong, Theerawoot Tharmviboonsri, Nuntich Singsumpun, Ishthayapong Kanjanakeereewong","doi":"10.1053/j.jfas.2025.09.006","DOIUrl":"https://doi.org/10.1053/j.jfas.2025.09.006","url":null,"abstract":"<p><strong>Background: </strong>The flexor hallucis longus (FHL) tendon is used as a medial landmark for posterior ankle arthroscopy. However, some posterior ankle pathologies require working medial to the FHL. The safe distance beyond the FHL to the neurovascular bundle has never been established.</p><p><strong>Purpose: </strong>To report the safe distances beyond the FHL and neurovascular bundle and the incidence of neurovascular injury after using \"safe arthroscopic approach\".</p><p><strong>Methods: </strong>The 63 MRIs with posterior ankle pathologies were included. Measurements were the FHL-tibial nerve (TN) and FHL-posterior tibial artery (PTA) distances at the level of fibular tip, 1.2 cm above and 1.2 cm below. Twenty FHL tenosynovitis patients underwent arthroscopic debridement utilizing a safe arthroscopic approach developed by the authors based on the MRI findings. The incidence of neurovascular injury and clinical outcomes were assessed.</p><p><strong>Results: </strong>The closest mean (standard deviation, SD) distances of FHL-TN and FHL-PTA were 2.14 (0.81) mm and 5.23 (2.11) mm. The incidence of neurovascular injury after using \"safe arthroscopic approach\" was 1/20. The NRS for pain during activity daily living (ADL) and FAAM for ADL were statistically improved at 6-month follow-up from 6.36 (1.50) to 1.14 (1.29) and 72.4 (5.78) to 89.4 (7.96), p<0.001.</p><p><strong>Conclusion: </strong>This study demonstrated close margins between the FHL and the TN and PTA of 2.14 mm and 5.23 mm. The \"safe arthroscopic approach\" for arthroscopic FHL debridement had a TN injury incidence of 1/20 which was equivalent to previous reported incidences of the arthroscopic surgery which did not go beyond FHL.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182389","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":"More Than Meets the Eye? Evaluating 3D Printing for Progressive Collapsing Foot Deformity Classification.","authors":"Wolfram Grün, Enrico Pozzessere, Emily J Luo, Nacime Salomão Barbachan Mansur, Antoine Acker, Pierre-Henri Vermorel, Francois Lintz, Cesar de Cesar Netto","doi":"10.1053/j.jfas.2025.09.004","DOIUrl":"https://doi.org/10.1053/j.jfas.2025.09.004","url":null,"abstract":"<p><strong>Background: </strong>Progressive collapsing foot deformity (PCFD) is a complex, multiplanar condition involving the ankle, hindfoot, midfoot, and forefoot. The 2020 classification system introduced a structured framework, distinguishing two stages (flexible vs. rigid) and five deformity classes. Diagnosing certain classes, particularly Class D, remains challenging. Three-dimensional (3D) printing provides a novel tool for anatomical assessment. This study evaluated the inter- and intraobserver reliability of PCFD classification using 3D-printed models.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 60 patients (37 females, 23 males; mean age 53 ± 17.2 years; body mass index (BMI) 31.9 ± 7.0) who underwent WBCT prior to surgical correction of PCFD. WBCT data were segmented using Bonelogic™ software, and 3D-printed models were created at 80% scale. Five fellowship-trained foot and ankle surgeons, blinded to clinical data, independently assessed the presence of PCFD classes A-E. Classifications were repeated after several weeks to assess intra-observer reliability. Percent agreement and reliability were analyzed using Fleiss' and Cohen's Kappa.</p><p><strong>Results: </strong>The most frequent class combinations were ABCD (30%) and ABC (23%). Intra-observer reliability was highest for Class A (Kappa = 1.00) and lowest for Class B (Kappa = 0.40). Interobserver reliability ranged from slight (Class B, Kappa = 0.10) to fair (Class D, Kappa = 0.38), with perfect agreement for Class A.</p><p><strong>Conclusions: </strong>3D-printed models demonstrated moderate-to-perfect intraobserver but variable interobserver agreement in PCFD classification. While they enhance spatial understanding, their use without WBCT may limit diagnostic consistency. Further studies should explore the additive value of 3D printing alongside WBCT.</p><p><strong>Level of evidence: </strong>IV, retrospective case series.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182386","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":"FDA Regulation of Orthobiologics and the Foot and Ankle Surgeon.","authors":"Cameron Meyer, Jae Yoon Kim, Orlando Martinez, Julie O'Connell, Gregory Berlet","doi":"10.1053/j.jfas.2025.08.009","DOIUrl":"https://doi.org/10.1053/j.jfas.2025.08.009","url":null,"abstract":"<p><p>Orthobiologics have potential to support clinical practice. Increased use of these products requires the requisite education of the physician for appropriate use in clinical practice. The purpose of this paper was to review current regulation and FDA guidelines on product use as well as design an outline to help guide the foot and ankle surgeon. A literature search including FDA guidelines, industry websites, and relevant product collaterals were reviewed for citations regarding recent orthobiologics and current regulations. These sources were compiled into a current assessment of FDA regulations regarding the use of orthobiologics in the foot and ankle. The Food and Drug Administration (FDA) established general guidelines on product use for clinicians. While controversy exists, the FDA continues to monitor and refine these documents in attempts to clarify and provide updates. We provide a new 5 step tiered classification of orthobiologic materials, based on levels of literature specific to the foot and ankle surgeon. This article outlines the latest rules and regulations with respect to orthobiologics utilized in foot and ankle surgery. We provide a review to assist physicians with understanding these regulations and how to remain compliant with use of orthobiologic products. We provide a system to organize available products based on current data. Although FDA regulation can be overwhelming, foot and ankle surgeons must effectively translate biologic technologies as gatekeepers to the wide array of orthobiologic materials.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071114","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":"Radiographic and Clinical Outcomes Following Single Stage Brachymetatarsia Correction of Greater Than or Equal to 15 mm.","authors":"Shane Sato, Matthew Greenblatt, Noman A Siddiqui","doi":"10.1053/j.jfas.2025.08.011","DOIUrl":"https://doi.org/10.1053/j.jfas.2025.08.011","url":null,"abstract":"<p><strong>Background: </strong>Brachymetatarsia is a shortening of one or more metatarsal bones. This condition can result in pedal complaints of metatarsalgia, calluses, toe deformities, and shoe irritation. When non-surgical treatments fail, surgical options include acute one-stage lengthening with a bone graft or gradual callus distraction with an external fixator. Acute correction is preferred for lengthening under 14 mm, while gradual methods are favored for corrections over 15 mm due to concerns of neurovascular injury and achieving incomplete correction. Gradual correction, however, can be associated with prolonged treatment, malalignment risk, pin tract infections, and patient compliance issues.</p><p><strong>Purpose: </strong>The purpose of this study was to assess the clinical and radiographic outcomes of acute one-stage lengthening of 15 mm or more.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent acute brachymetatarsia correction of greater than or equal to 15 mm at a single institution was performed.</p><p><strong>Results: </strong>Twenty-one patients (26 corrections) underwent an average lengthening of 17.6 mm, with a mean osseous consolidation time of 9.7 weeks. No cases of delayed union, malunion, nonunion, or neurovascular injury occurred. The most common complication was radiographic, asymptomatic fourth metatarsophalangeal joint arthritis (34.6%). Preoperative metatarsal parabola length averaged 12.7 mm and significantly decreased to 0.27 mm postoperatively (P < 0.001).</p><p><strong>Conclusion: </strong>These findings support acute corrections exceeding 15 mm, challenging concerns of neurovascular injury with this approach.</p><p><strong>Level of clinical evidence: </strong>IV.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071174","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":"A retrospective comparison of bone culture techniques.","authors":"Jennifer A Kipp, Lindsay K LeSavage, Greg Russell, Kevin P High, Nicholas S Powers, Cody D Blazek","doi":"10.1053/j.jfas.2025.08.010","DOIUrl":"10.1053/j.jfas.2025.08.010","url":null,"abstract":"<p><strong>Background: </strong>The gold standard test for diagnosing osteomyelitis is bone biopsy, and IDSA 2023 guidelines recommend obtaining a \"bone culture\" for microbiological analysis in the setting of osteomyelitis. However, there is no consensus on the optimal method by which to obtain this bone sample.</p><p><strong>Purpose: </strong>The purpose of this study was to retrospectively compare two intraoperative methods to obtain bone cultures: bone tissue cultures and bone swab cultures.</p><p><strong>Study design: </strong>A retrospective review was performed on one-hundred three patients who underwent 126 surgical procedures for concern of osteomyelitis in the lower extremity.</p><p><strong>Methods: </strong>Intraoperatively, a bone swab culture and a bone tissue culture were obtained following debridement or amputation from the same operative site and submitted for microbiological analysis.</p><p><strong>Results: </strong>Bone swab cultures yielded positive results in 40.5 % (51/126) of procedures, while bone tissue cultures were positive in 32 % (40/126)(p = 0.027). Complete agreement between both methods occurred in 80 % (101/126) cases. In cases of disagreement, bone swab cultures resulted positive more than bone tissue cultures (p = 0.028).</p><p><strong>Conclusion: </strong>These findings suggest that the bone swab is more sensitive overall, and surgeons may even consider the use of both bone tissue and swabs for culture.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071129","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":"Short-Term Risk of Subtalar Joint Arthritis After Stemmed Total Ankle Replacement.","authors":"Jae Yoon Kim, Cameron Meyer, Lauren Christie, Orlando Martinez, Gregory C Berlet","doi":"10.1053/j.jfas.2025.08.012","DOIUrl":"https://doi.org/10.1053/j.jfas.2025.08.012","url":null,"abstract":"<p><strong>Background: </strong>Ankle osteoarthritis (OA) can significantly impact mobility and quality of life. Total ankle replacement (TAR) has emerged as an alternative to ankle arthrodesis due to its potential for preserving natural joint kinematics. However, it remains unclear if this maintained motion also limits progression of adjacent joint degeneration.</p><p><strong>Objective: </strong>This study aims to evaluate the influence of stemmed implants on the progression of subtalar (STJ) osteoarthritis and delayed secondary STJ fusion.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 115 patients who underwent primary Stryker Inbone® fixed-bearing, stemmed TAR between December 2018 and February 2024. Patients with pre-existing STJ fusion or less than one year of postoperative follow-up were excluded. The final cohort of 72 patients, with a mean follow-up of 2.43 years, underwent radiographic and clinical evaluation of STJ osteoarthritis. The Kellgren-Lawrence Score (KLS) was utilized to assess changes in STJ arthritis preoperatively and postoperatively.</p><p><strong>Results: </strong>Radiographic progression of STJ arthritis was seen in 6.94% of patients, with only 1.39% requiring secondary STJ fusion. Only one patient underwent fusion due to avascular necrosis of the talus, resulting in a case of nonunion. Seven patients reported postoperative STJ pain, despite stable radiographic findings, each of which was managed conservatively without additional surgical intervention.</p><p><strong>Conclusion: </strong>These findings support and add to the limited body of literature on the use of stemmed ankle implants in limiting progressive adjacent joint arthritis to the STJ in the short term.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071122","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":"Subtalar arthroereisis correction of adolescents flatfoot combined with pelvic obliquity: A retrospective study","authors":"Yuxin Yan ,&nbsp;Sumeng Chen ,&nbsp;Wen Zhou ,&nbsp;Xintao Zhang ,&nbsp;Lu Bai","doi":"10.1053/j.jfas.2025.04.005","DOIUrl":"10.1053/j.jfas.2025.04.005","url":null,"abstract":"<div><div><span><span>Adolescent flexible flatfoot can result in structural deformities such as medial arch collapse, hindfoot </span>valgus<span>, and forefoot<span> abduction, leading to fatigue and pain. Additionally, some patients develop pelvic obliquity, associated with lower back and hip discomfort. This study evaluates the clinical efficacy of subtalar arthroereisis in treating adolescent flexible flatfoot with pelvic obliquity. Thirty-two patients (mean age 11.0 ± 1.6 years) with flexible flatfoot and pelvic obliquity underwent subtalar arthroereisis. Radiological assessments of pelvic distance, pelvic tilt angle, Meary angle, Pitch angle, and ankle mortise distance were conducted preoperatively and at 3 months, 1 year, and 2 years postoperatively. Statistical analysis included the Wilcoxon rank-sum test and Spearman's correlation. Significant improvements were observed postoperatively in all measured angles and distances (</span></span></span><em>P</em> &lt; 0.001). Notable continued improvements were seen up to 2 years, particularly in pelvic distance (<em>Z</em> = -3.413, <em>P</em> &lt; 0.001) and ankle mortise distance (<em>Z</em> = -2.804, <em>P</em> = 0.003), with no recurrence. Correlations between ankle mortise distance and pelvic parameters were consistently significant across all follow-up periods. Subtalar arthroereisis is effective in treating flexible flatfoot and improves associated pelvic obliquity, with sustained benefits observed over a 2-year follow-up.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 602-607"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996234","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":"Prospective multicenter study assessing radiographic and patient outcomes following an instrumented mini-open triplanar tarsometatarsal arthrodesis with early weightbearing","authors":"Jody Peter McAleer DPM, FACFAS ,&nbsp;Amber M. Shane DPM, FACFAS ,&nbsp;Marque A. Allen DPM, FACFAS ,&nbsp;Avneesh Chhabra MD ,&nbsp;Justin Daigre MD ,&nbsp;Daniel C. Farber MD ,&nbsp;Deidre Kile MS ,&nbsp;Jeffrey E. McAlister DPM, FACFAS ,&nbsp;Abdi Raissi MD ,&nbsp;Paul Steinke DPM, FACFAS ,&nbsp;Robert P. Taylor DPM, FACFAS ,&nbsp;Robert D. Santrock MD","doi":"10.1053/j.jfas.2025.03.018","DOIUrl":"10.1053/j.jfas.2025.03.018","url":null,"abstract":"<div><div>This prospective, multicenter study assessed the radiographic, clinical, and patient-reported outcomes for hallux valgus (HV) correction performed with an instrumented 1st tarsometatarsal (TMT) system through a mini-open incision (≤4cm) with a biplanar plating construct and early return to weightbearing. One hundred and five patients were treated, with 75 and 11 patients completing their 12- and 24-month visits, respectively. The median (min, max) length of the primary dorsal incision was 3.5 cm (3.0, 4.0). Patients underwent an early weightbearing protocol with mean (95 % CI) of 7.9 (6.7, 9.1) days to weightbearing in a CAM boot. Significant improvements from baseline in mean radiographic measurements for Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Tibial Sesamoid Position (TSP), and osseous foot width (OFW) were maintained through 12 months<strong>.</strong> Using recurrence definitions of greater than 15° and 20° postoperative HVA, recurrence rates were 5.5 % (95 % CI: 1.5 %, 13.4 %) and 0.0 % at 12 months and 0.0 % for both thresholds at 24 months, respectively. Significant improvements in patient-reported outcomes [Visual Analog Scale (VAS), Manchester-Oxford Foot Questionnaire (MOxFQ) and Patient-Reported Outcomes Measurement Information System (PROMIS)] were maintained through 12 and 24 months. A clinically meaningful assessment of the scar appearance was observed in the POSAS scores. One (1.0 %) patient in the overall treated cohort of 105 required reoperation for removal of hardware due to pain. The results of this prospective, multicenter study on a mini-open 1st TMT system demonstrated improvements in radiographic correction, low recurrence, early return to activity with low complication rates, and improvements in patient-reported outcomes.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 574-580"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744162","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 association of anterior soft tissue depth (ASTD) with wound dehiscence following total ankle arthroplasty","authors":"Lauren M. Christie DPM, AACFAS ,&nbsp;Avery Thomson DPM, MS ,&nbsp;Charles Korba DPM ,&nbsp;Andreas C. Kaikis DPM, FACFAS ,&nbsp;William M. Wolfe DPM, MPH ,&nbsp;D. Scot Malay DPM, MSCE, FACFAS","doi":"10.1053/j.jfas.2025.03.015","DOIUrl":"10.1053/j.jfas.2025.03.015","url":null,"abstract":"<div><div><span><span><span>Total ankle arthroplasty (TAA) is a common intervention for the treatment of end-stage ankle arthritis. Unfortunately, use of a longitudinal anterior </span>incision to gain access to the ankle is commonly associated with postoperative </span>wound dehiscence<span>. In this retrospective cohort study the incidence of postoperative anterior wound dehiscence following TAA in 100 consecutive patients was 21 %, and 7 (33.33 %) of the dehiscence cases were serious enough to require additional operative treatment. The anterior soft tissue depth (ASTD) at the level of the tibiotalar joint was measured from the anterior margin of the skin to the anterior margin of the ankle as viewed on the standard lateral radiograph. The overall median ASTD for the entire cohort was 21.79 (range 5.7 to 37.3) mm, whereas that in the non-dehiscence group was 22.06 (5.7, 37.3) mm and that in the dehiscence group was 18.6 (12.78, 35.9) mm, and this difference was statistically significant (</span></span><em>p</em> = 0.0240). Receiver operating characteristic (ROC) curve analyses showed that a preoperative ASTD ≤ 16 mm maximized diagnostic sensitivity and specificity and predicted dehiscence.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 559-565"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744163","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":"Morphological analysis of the retrotalar pulley and its role in flexor hallucis longus impingement: Insights from a CT-based study","authors":"Lolita Micicoi MD ,&nbsp;Barbara Piclet-Legré MD ,&nbsp;Tristan Fauchille MD ,&nbsp;Alexandre Rudel MD ,&nbsp;Nicolas Bronsard MD-Ph.D ,&nbsp;Jean-François Gonzalez MD-Ph.D ,&nbsp;Matthieu Ollivier MD-Ph.D","doi":"10.1053/j.jfas.2025.01.002","DOIUrl":"10.1053/j.jfas.2025.01.002","url":null,"abstract":"<div><div>The Flexor Hallucis Longus (FHL) is a muscle that can be subject to multiple conflicts. The most common conflict is due to inflammation of the tendon at the retrotalar pulley. The constraints exerted on the FHL are responsible for a pathology called functional Hallux Limitus.</div><div>The purpose of this anatomical study is to describe morphologic finding about retrotalar pulley, which may account the impingement between FHL and the hindfoot. Using a retrospective approach at a single center, a detailed analysis was conducted on a cohort of 350 patients. Precise measurements were taken to document the angles, areas, and distances that define the relationship between the Flexor Hallucis Longus (FHL) tendon and its surrounding anatomical structures.</div><div>The angle between the retrotalar pulley and the sustentaculum tali exhibited a range of 124 to 170 degrees in profile and 113.3 to 178 degrees in frontal view. The dimensions of the retrotalar pulley varied from 1.1 to 54 mm², while the posterolateral and posteromedial tubercles displayed dimensions ranging from 3.4 to 77.9 mm² and 2.6 to 35.2 mm², respectively. Distances between posterior tubercles further underscored the anatomical diversity, ranging from 4.3 to 17 cm proximally and 10.5 to 18.4 cm distally.</div><div>In unraveling the morphological complexities surrounding FHL impingement, this study provides valuable insights into the biomechanical intricacies of the foot. These findings not only deepen our understanding of musculoskeletal anatomy but also pave the way for future investigations into the dynamic interplay between structure and function in the lower extremities.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 511-515"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069308","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}