Journal of Foot & Ankle Surgery最新文献

{"title":"Clinical and radiographic outcomes of dorsal closing wedge osteotomy for Freiberg disease: a retrospective case series.","authors":"Yekta Furkan Altın, Ali Usta, Lezgin Mert, Bilal Najjarmidani, Sinan Obut, Mehmet Ali Talmaç","doi":"10.1053/j.jfas.2026.10.006","DOIUrl":"10.1053/j.jfas.2026.10.006","url":null,"abstract":"<p><strong>Background: </strong>Freiberg disease is an uncommon osteonecrotic condition of the metatarsal head that may cause forefoot pain, metatarsophalangeal joint stiffness, and functional limitation.</p><p><strong>Purpose: </strong>To evaluate the clinical and radiographic outcomes of dorsal closing wedge osteotomy for Freiberg disease.</p><p><strong>Study design: </strong>Retrospective case series; Level IV.</p><p><strong>Methods: </strong>Twenty-two patients were retrospectively evaluated. First metatarsal length (D1), second metatarsal length (D2), intermetatarsal angle (IMA), and American Orthopaedic Foot & Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scores were compared between preoperative assessment and final follow-up. Interobserver reliability of radiographic measurements was assessed with intraclass correlation coefficients.</p><p><strong>Results: </strong>The mean age was 29.6 ± 13.5 years, and the mean follow-up was 41.8 ± 7.5 months. D1 showed no statistically significant change (58.3 ± 3.7 vs. 57.5 ± 3.9 mm; p = 0.180). D2 decreased significantly (65.8 ± 3.8 vs. 63.4 ± 4.3 mm; mean change, -2.4 mm; p < 0.001). IMA showed no statistically significant change (11.3 ± 2.7° vs. 11.1 ± 2.7°; p = 0.640). AOFAS scores increased from 57.6 ± 16.3 to 87.4 ± 11.5 (p < 0.001).</p><p><strong>Conclusions: </strong>Dorsal closing wedge osteotomy was associated with significant improvement in AOFAS scores and significant shortening of the second metatarsal, while D1 and IMA showed no statistically significant change. These findings describe the observed clinical and radiographic outcomes but do not establish a causal relationship between the magnitude of shortening and clinical improvement.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149344","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":"Dorsiflexion angles following first MTP arthrodesis in adult pes planus: A Retrospective radiographic cohort study.","authors":"William B Dyke, Kwadwo Owusu Ansah, Zohair Zaidi, Abigail Smith, Reyanne Strong, Daniel Whittingslow, Joshua Tennant, Trapper Lalli","doi":"10.1053/j.jfas.2026.10.004","DOIUrl":"10.1053/j.jfas.2026.10.004","url":null,"abstract":"<p><strong>Background: </strong>First metatarsophalangeal (MTP) joint arthrodesis is a well-established treatment for hallux rigidus, but the influence of pes planus on postoperative sagittal-plane alignment remains unclear.</p><p><strong>Purpose: </strong>To determine whether radiographic pes planus influences postoperative hallux dorsiflexion angle following first MTP arthrodesis.</p><p><strong>Study design: </strong>Retrospective radiographic cohort study.</p><p><strong>Methods: </strong>Patients aged 18-90 years undergoing primary first MTP arthrodesis from 2006-2021 at a single academic institution were reviewed. Weight-bearing radiographs obtained ≥12 weeks postoperatively were evaluated by three independent orthopedic residency-trained reviewers. Dorsiflexion angle, Meary's angle, and calcaneal pitch were measured and averaged for analysis. Pes planus was defined as Meary's angle >4° or calcaneal pitch ≤19°. Linear mixed-effects regression with a patient-level random intercept accounted for bilateral procedures.</p><p><strong>Results: </strong>A total of 112 operative feet from 102 patients were included; 93 (83%) met criteria for pes planus. Mean dorsiflexion angle was 23.49° ± 8.59° with pes planus versus 24.61° ± 7.92° without. After adjustment for age, sex, and BMI, pes planus was not independently associated with dorsiflexion angle (β=-0.62°, 95% CI -4.69° to 3.46°, p=.765). Calcaneal pitch was lower with pes planus (18.51° ± 5.84° vs 24.14° ± 3.42°, p<.001). A significant pes planus-calcaneal pitch interaction was identified (β=1.24, 95% CI 0.06-2.41, p=.039). Complication rates did not differ between groups.</p><p><strong>Conclusions: </strong>Pes planus did not independently influence postoperative dorsiflexion angle. However, calcaneal pitch modified this relationship, suggesting hindfoot alignment should be considered during preoperative planning.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129084","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 simplified protocol using septocutaneous perforator-based propeller flaps for concurrent fixation and coverage of complex ankle and hindfoot fractures.","authors":"Pissanu Reingrittha, Areeya Kamphaengkaew, Surasak Jitprapaikulsarn, Artit Manoprasertkul, Pasit Sengpanich, Ployphailin Rungsakaolert","doi":"10.1053/j.jfas.2026.10.001","DOIUrl":"10.1053/j.jfas.2026.10.001","url":null,"abstract":"<p><strong>Background: </strong>Complex fractures of the ankle and hindfoot require timely and reliable soft tissue coverage, challenging in resource-constrained settings.</p><p><strong>Purpose: </strong>To evaluate the clinical outcomes of septocutaneous (SC) perforator-based propeller flaps as a simplified, equipment-independent approach, accessible to non-microsurgeons, for concurrent internal fixation and coverage in a resource-constrained setting STUDY DESIGN: Retrospective cohort study.</p><p><strong>Methods: </strong>A retrospective, single-centered cohort study of 67 eligible patients with complex ankle and hindfoot fractures (mean defect area 45.3 ± 18.0 cm²) treated with concurrent SC perforator-based propeller flap coverage was conducted from January 2020 to December 2023. Level of necrosis, flap survival, revision rates, bone union time, and functional status measured by the Foot Functional Index (FFI) score at a minimum of one-year follow-up were assessed.</p><p><strong>Results: </strong>Concurrent fixation and soft tissue coverage utilizing the SC perforator-based propeller flap achieved complete flap survival across the cohort, with a mean time to definitive surgery of 8.1 ± 4.2 days. Partial necrosis occurred in 19% (13 of 67), all resolving spontaneously by secondary healing. The overall mean FFI score was 14.0 ± 7.6, and the median bone union time was 11 weeks. Partial necrosis significantly delayed bone union (16 vs. 11 weeks; p < 0.001), associated with poorer functional recovery (FFI 22.2 ± 9.9 vs. 12.0 ± 5.4; p < 0.001).</p><p><strong>Conclusions: </strong>SC perforator-based propeller flaps provide a reliable, reproducible approach for concurrent fixation and coverage of complex ankle and hindfoot fractures. Preventing partial necrosis is crucial for optimal union time and functional recovery.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129118","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":"Outcomes of mini-screw fixation following dorsal closing wedge osteotomy for treatment of freiberg's disease.","authors":"Mahmoud Moufeed Baheeg, Hatem Elsayed Ahmed Elgohary, Hany Mohamed Hamed, Morsy Mohamed Basiony, Hisham Gawish, Ahmed Ramadan Elzeiny, Hossam Mohamed Gad","doi":"10.1053/j.jfas.2026.10.003","DOIUrl":"10.1053/j.jfas.2026.10.003","url":null,"abstract":"<p><strong>Background: </strong>Freiberg's disease is an osteochondrosis of the lesser metatarsal heads, most commonly the 2^nd, that predominantly affects adolescent females and causes pain and limited motion; early cases are treated conservatively, while advanced or refractory ones may need dorsal closing wedge osteotomy. This study aimed to evaluate the clinical and radiological outcomes of dorsal closing wedge osteotomy fixed with a single mini-screw in patients aged 13 to 30 years.</p><p><strong>Methods: </strong>This prospective observational case series included 48 consecutive patients with Freiberg's disease, Smillie stage II, III, or IV, who underwent dorsal closing wedge osteotomy with mini-screw fixation after failed conservative treatment. Pain was assessed with a 0-10 visual analogue scale (VAS) preoperatively and at the final 6-month follow-up, radiographs were reviewed for osteotomy union, and complications were recorded.</p><p><strong>Results: </strong>There was a substantial reduction in pain, with the mean VAS score improving from 8.67 ± 0.88 to 1.33 ± 2.01 (P<0.001). Radiographic union was achieved in all patients at a mean of 7.31 ± 1.22 weeks. Intraoperative fragmentation of the metatarsal head occurred in 3 patients (6.25%) and superficial wound infection in 3 (6.25%), and all patients had some loss of metatarsophalangeal joint plantarflexion (mean 11°).</p><p><strong>Conclusions: </strong>In this case series, dorsal closing wedge osteotomy with mini-screw fixation for Freiberg's disease was associated with a substantial reduction in pain and a low complication rate, although some loss of metatarsophalangeal joint motion occurred in all patients.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117735","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 parameters associated with insertional achilles tendinopathy.","authors":"Turan Bilge Kızkapan, Cihan Kunt, Aybars Güzel, Oğulcan Koputan","doi":"10.1053/j.jfas.2026.10.005","DOIUrl":"10.1053/j.jfas.2026.10.005","url":null,"abstract":"<p><strong>Background: </strong>Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain, and calcaneal morphology and hindfoot alignment may contribute to its development.</p><p><strong>Purpose: </strong>To compare ankle and hindfoot alignment parameters between patients with IAT and healthy controls, evaluate their relationship with tendon thickness, and identify independent radiographic predictors.</p><p><strong>Study design: </strong>Retrospective case-control study; Level of Evidence, Level III.</p><p><strong>Methods: </strong>Overall, 313 individuals (116 IAT, 197 controls) were included. Weight-bearing radiographs and magnetic resonance imaging (MRI) were used to measure ankle and hindfoot parameters, including the Fowler-Philip angle, posterior tuberosity inclination angle (PTIA), Chauveaux angle, bump height, and Achilles tendon thickness. Group comparisons, Spearman correlation, and multivariate logistic regression were performed (p < 0.05).</p><p><strong>Results: </strong>The Fowler-Philip angle, PTIA, Chauveaux angle, bump height, X/Y ratio, and Achilles and Achilles-plantar fascia angles were significantly higher in the IAT group; the calcaneal pitch angle and arch height ratio were lower (p = 0.040 and 0.030). Tendon thickness was increased in the IAT group (p < 0.001) and correlated positively with the Fowler-Philip angle (ρ = 0.61) and PTIA (ρ = 0.58), and negatively with the calcaneal pitch angle and arch height ratio. Independent predictors were the Fowler-Philip angle (odds ratio [OR] 1.26; p < 0.001), PTIA (OR 1.15; p = 0.014), bump height (OR 1.21; p = 0.005), and tendon thickness (OR 1.23; p = 0.002).</p><p><strong>Conclusions: </strong>The Fowler-Philip angle, PTIA, bump height, and increased tendon thickness were independently associated with IAT and may enhance radiographic diagnosis and structural characterization.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117764","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 composite deformity score (CDS): Development and preliminary assessment of a radiographic scoring system for assessing osteochondral lesion severity of the talus.","authors":"Moaaz Ali Hamoud, Ahmed Swealem, Mohamed Hatata","doi":"10.1053/j.jfas.2026.10.002","DOIUrl":"10.1053/j.jfas.2026.10.002","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral lesions of the talus (OLTs) vary widely in severity; lower-limb biomechanical alignment may contribute to this variation, but no composite radiographic score exists to capture it. We developed and preliminarily assessed the Composite Deformity Score (CDS), a five-parameter radiographic score designed a priori to summarize multiple alignment domains, with prospective stratification by lesion location.</p><p><strong>Methods: </strong>A prospective cohort of 80 patients with MRI-confirmed OLTs was enrolled (June 2024-June 2025; power analysis minimum n=74). CDS summed five prespecified weight-bearing radiographic parameters (LDTA, HAD, MAD, Meary's Angle, Calcaneal Pitch), each scored 0-2 using an equal-weight sum. A parsimonious logistic regression model assessed the CDS-large lesion (>2 cm²) association after BMI adjustment. Reliability was assessed for both radiographic CDS scoring and MRI lesion measurements; two independent fellowship-trained radiologists measured MRI lesions under blinded conditions, with interobserver ICC 0.91-0.96 and intraobserver reassessment. Patients were stratified into medial, central, and lateral Raikin-zone subgroups.</p><p><strong>Results: </strong>CDS showed excellent reliability (interobserver ICC=0.91; intraobserver ICC=0.92-0.93) and correlated with lesion size (r=+0.74, p<0.001). CDS and lesion size varied significantly by location: medial lesions had the highest CDS (6.1±0.7) and most large lesions (66.7%), while lateral lesions had the lowest CDS (3.4±1.2) and fewest large lesions (5.6%) (p<0.001 for both). CDS remained independently associated with large OLTs after BMI adjustment (OR 3.04, 95% CI 1.71-5.40, p<0.001; AUROC=0.87) and after adjusting for location (OR 2.76, p<0.001). CDS correlated inversely with AOFAS score (ρ=-0.70, p<0.001) across all locations. A CDS>6 cutoff yielded 75% sensitivity and 100% specificity.</p><p><strong>Conclusion: </strong>The CDS is a reliable, reproducible score significantly associated with OLT severity, with higher scores observed in medial lesions. These findings support its biological plausibility; prospective multicentre validation against outcomes is required before any clinical adoption.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117798","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":"Neck vs head interspace ratios in hallux valgus: A reliability analysis of first metatarsal radiographic measurements.","authors":"Miguel Viana Pereira Filho, Gabriel Ferraz Ferreira, Peter Lam, Thomas Lorchan Lewis, Daniel Sonnewend Proença, Paulo Feliciano Sarquis Dias, Mauro Cesar Mattos E Dinato, Rodrigo Pagnano","doi":"10.1053/j.jfas.2026.09.017","DOIUrl":"10.1053/j.jfas.2026.09.017","url":null,"abstract":"<p><strong>Background: </strong>The relationship between the intermetatarsal space and first metatarsal width has been proposed as a radiographic parameter for surgical planning in hallux valgus. However, the reproducibility of the previously described Head Interspace Ratio (HIR) has not been formally evaluated, limiting confidence in its clinical application.</p><p><strong>Purpose: </strong>To compare the intraobserver and interobserver reliability of the Head Interspace Ratio (HIR) and the newly proposed Neck Interspace Ratio (NIR).</p><p><strong>Study design: </strong>Retrospective cross-sectional reliability study.</p><p><strong>Methods: </strong>Fifty standardized weight-bearing anteroposterior radiographs were independently evaluated by three observers with different experience levels during two sessions. Reliability was assessed using intraclass correlation coefficients (ICC). Agreement and measurement precision were evaluated using Bland-Altman analysis, standard error of measurement, and minimal detectable change at the 95% confidence level.</p><p><strong>Results: </strong>NIR demonstrated good to excellent intraobserver reliability (ICC, 0.876-0.963) and good interobserver reliability (ICC = 0.886; 95% CI, 0.826-0.929). HIR showed greater variability, with good reproducibility for the two more experienced observers but poor reliability for the least experienced observer (ICC = 0.236; 95% CI, -0.043 to 0.481). Interobserver reliability was lower for HIR (ICC = 0.464; 95% CI, 0.276-0.633). Measurement error was lower for NIR than HIR (MDC95, 0.167 vs 0.277).</p><p><strong>Conclusions: </strong>Under the conditions evaluated in this study, NIR demonstrated greater reproducibility and lower measurement error than HIR. These findings suggest that NIR may represent a more robust radiographic parameter and support further clinical investigation before its use in surgical decision-making for hallux valgus.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117724","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":"Effect of percutaneous chevron and Akin osteotomies on measured first-ray joint pressures: An exploratory cadaveric study.","authors":"Agathe Yvinou, Fanny Delaigue, Maxime Sadoun, Benoît Rigolot, Thomas Bauer, Grégoire Rougereau","doi":"10.1053/j.jfas.2026.09.015","DOIUrl":"10.1053/j.jfas.2026.09.015","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous chevron and Akin osteotomies may alter first-ray mechanics, but their effects on pressure within the first tarsometatarsal and first metatarsophalangeal joints are unknown.</p><p><strong>Purpose: </strong>To assess immediate changes in measured intra-articular pressure within these joints after percutaneous chevron and Akin (PECA) osteotomies.</p><p><strong>Study design: </strong>Exploratory paired cadaveric biomechanical study.</p><p><strong>Methods: </strong>Sixteen feet from 8 cadaveric donors were tested. Pressure transducer was inserted fluoroscopically into the first tarsometatarsal and first metatarsophalangeal joints. For each joint, hallux position, and loading condition, three consecutive pressure readings were obtained and averaged. Pre- versus post-PECA and rest-versus-manual-loading comparisons were analyzed using paired Wilcoxon signed-rank tests, with Holm adjustment across 40 comparisons. A donor-level sensitivity analysis was performed to address bilateral specimens.</p><p><strong>Results: </strong>No PECA-related change in measured intra-articular pressure at either joint remained statistically significant after Holm adjustment for multiple comparisons. At the first tarsometatarsal joint, all mean paired pre- versus post-PECA changes had 95% confidence intervals that included zero. A donor-level sensitivity analysis accounting for bilateral feet did not alter the overall interpretation.</p><p><strong>Conclusion: </strong>Under the tested conditions, this exploratory study did not detect a multiplicity-adjusted PECA-related change in measured intra-articular pressure at either joint. These findings do not establish equivalence, cartilage contact pressure, joint contact area, first-ray stability, or biomechanical safety.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076516","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":"Artificial intelligence in foot and ankle surgery: Current applications, limitations and future directions.","authors":"Osama M Embaby, Abdulaziz F Aljehani, Mohamed M Elalfy","doi":"10.1053/j.jfas.2026.09.008","DOIUrl":"10.1053/j.jfas.2026.09.008","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is increasingly studied in orthopedics for image interpretation, automated measurement, risk prediction, rehabilitation monitoring, and patient communication. Foot and ankle care is well suited to these applications because decisions often depend on imaging measurements, deformity assessment, wound monitoring, and longitudinal recovery data.</p><p><strong>Purpose: </strong>To summarize current and emerging AI applications in foot and ankle care, distinguish clinically supported uses from experimental concepts, and identify principles likely to remain relevant as individual models evolve.</p><p><strong>Study design: </strong>Current concept review.</p><p><strong>Methods: </strong>A targeted narrative search of PubMed/MEDLINE, recent systematic reviews, reference lists, and relevant United Kingdom guidance was performed for publications available through August 10, 2026. Peer-reviewed studies addressing a defined foot or ankle clinical task and reporting clinically relevant validation were prioritized.</p><p><strong>Results: </strong>The strongest evidence is in image-based applications, including ankle fracture detection and classification, automated deformity measurements, and three-dimensional analysis of weight-bearing computed tomography. Image-based models can assess diabetic foot ulcers, and wearable sensors combined with machine learning show promise for estimating Achilles tendon loading. Perioperative prediction models remain largely retrospective. Large language models may assist with patient information but are not sufficiently reliable for unsupervised diagnosis or triage. The proposed Foot and Ankle AI Assistant remains an unvalidated research concept.</p><p><strong>Conclusions: </strong>AI may support selected aspects of foot and ankle care, particularly imaging and automated measurement, but most applications still require external and prospective validation before routine clinical use. AI should support, rather than replace, clinical judgment and surgeon-led decision-making.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031811","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 value of fifth metatarsal osteotomy in hallux valgus with concomitant bunionette deformity: A symptom-based comparative study.","authors":"Saori Ishibashi, Tomoyuki Nakasa, Yasunari Ikuta, Taro Chujo, Satoru Sakurai, Dan Moriwaki, Nobuo Adachi","doi":"10.1053/j.jfas.2026.09.010","DOIUrl":"10.1053/j.jfas.2026.09.010","url":null,"abstract":"<p><strong>Background: </strong>Hallux valgus is frequently accompanied by bunionette deformity, which may contribute to lateral forefoot pain and increased forefoot width. Although fifth metatarsal osteotomy is an established treatment for symptomatic bunionette deformity, the necessity of this procedure in patients with asymptomatic deformity remains unclear.</p><p><strong>Purpose: </strong>This retrospective cohort study aimed to evaluate the clinical necessity of symptom-based fifth metatarsal osteotomy in patients with hallux valgus and concomitant bunionette deformity.</p><p><strong>Study design: </strong>Retrospective comparative cohort study.</p><p><strong>Methods: </strong>Eighty-one feet in 70 patients who underwent hallux valgus corrective surgery between July 2020 and December 2024 were included, with a mean follow-up period of 16.9 ± 6.8 months. Patients with bunionette-related symptoms, including lateral forefoot pain or shoe conflict localized to the fifth metatarsal head despite conservative treatment, underwent additional fifth metatarsal osteotomy, whereas asymptomatic patients did not. Radiographic parameters and patient-reported outcomes using the Self-Administered Foot Evaluation Questionnaire were assessed preoperatively and at final follow-up.</p><p><strong>Results: </strong>Both groups demonstrated significant postoperative improvements in radiographic alignment and questionnaire subscale scores. Final clinical outcomes did not differ significantly between the groups. The first-to-fifth intermetatarsal angle was significantly smaller postoperatively in the osteotomy group. In the osteotomy group, a greater preoperative fourth-to-fifth intermetatarsal angle was positively associated with greater summed improvement across the SAFE-Q subscales after correction for multiple testing.</p><p><strong>Conclusion: </strong>This study suggests that symptom-based selection for fifth metatarsal osteotomy provides satisfactory outcomes while avoiding unnecessary procedures in asymptomatic cases with radiographic bunionette deformity.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026662","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}