Foot & ankle specialist最新文献

{"title":"Impact of Non-Tobacco Nicotine Dependence on Fusion Success and Complications in Midfoot Arthrodesis.","authors":"Joydeep Baidya, Kush Mody, Anish Ponna, Micah Kranzel, Nana Amponsah, Grant Thomas, Kaushal Upadhyay, David Pedowitz, Joseph Daniel, Selene G Parekh","doi":"10.1177/19386400261465094","DOIUrl":"https://doi.org/10.1177/19386400261465094","url":null,"abstract":"<p><p>BackgroundNon-tobacco nicotine dependence (NTND) products, such as vaping, nicotine patches/pouches, gum, and lozenges, have become increasingly prevalent. While the negative effects of cigarette smoking on bone healing are well established, the impact of NTND on surgical outcomes remain unclear, particularly in foot and ankle surgery. This study aimed to evaluate the effect of NTND on short- and long-term postoperative complications following midfoot arthrodesis, a procedure commonly performed for arthritis, trauma, and congenital deformities.MethodsThis retrospective cohort study was conducted utilizing the TriNetX database. Patients undergoing midfoot arthrodesis were identified and stratified into NTND (ICD-10: F17, excluding tobacco-specific codes) and nonsmoker cohorts. 1:1 propensity score matching was performed based on demographic and comorbid variables. Postoperative complications were assessed at both 90 days and 2 years utilizing risk ratios (RRs) and 95% confidence intervals (CIs).ResultsAfter matching, 1235 patients were included in each cohort. At 90 days, NTND patients had significantly higher rates of opioid prescriptions (RR 1.18, 95% CI: 1.11-1.26), emergency department visits (RR 1.52, 95% CI: 1.20-1.93), hospitalizations (RR 1.59, 95% CI: 1.28-1.99), postoperative infections (RR 1.95, 95% CI: 1.13-3.37), and wound complications (RR 1.72, 95% CI: 1.14-2.58) (all P < .05). At 2 years, NTND was associated with increased rates of pseudoarthrosis (RR 1.27, 95% CI: 1.06-1.51) and mechanical implant failure (RR 1.39, 95% CI: 1.11-1.75) (both P < .05).ConclusionNon-tobacco nicotine dependence is associated with significantly increased risk of both early and late postoperative complications following midfoot arthrodesis. These findings suggest that vaping may adversely affect bone healing and implant integrity. Surgeons should incorporate NTND screenings and cessation counseling into preoperative planning to optimize patient outcomes.Level of Evidence:<i>III-Retrospective Comparative Study</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261465094"},"PeriodicalIF":2.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Staged Distraction Osteogenesis of the Fourth Metatarsal With Biplanar First Metatarsal Osteotomies in an Adolescent Athletic Patient: A Case Report.","authors":"Grady Edens, Cameron Merryman, Joel P White, Travis Winston","doi":"10.1177/19386400261469907","DOIUrl":"https://doi.org/10.1177/19386400261469907","url":null,"abstract":"<p><p>IntroductionCongenital fourth-ray brachymetatarsia and juvenile hallux valgus are rare forefoot deformities that, when coexisting, may amplify biomechanical dysfunction, pain, and footwear intolerance, particularly in adolescent athletic patients. No reports describe a combined surgical approach to correct both conditions in adolescents.MethodsA 15-year-old female with bilateral symptomatic juvenile hallux valgus and congenital fourth-ray brachymetatarsia was treated with staged unilateral biplanar first metatarsal chevron osteotomies and fourth metatarsal distraction osteogenesis with the use of an external fixator. Distraction was performed at approximately 0.5 mm per day to a planned length of approximately 13.5 mm, followed by consolidation and device removal. The contralateral side was treated after functional recovery of the first foot.ResultsBoth feet achieved successful correction of hallux valgus and restoration of fourth-ray length with radiographic confirmation. The patient had maintained alignment, resolution of forefoot pain, tolerance of standard footwear, and return to baseline athletic activity without complications or recurrence. Conclusion.ConclusionThis case demonstrates that staged biplanar first metatarsal osteotomy combined with fourth metatarsal distraction osteogenesis can safely and effectively restore forefoot alignment and function in adolescents with coexisting hallux valgus and brachymetatarsia. This combined strategy offers a viable treatment pathway for complex bilateral forefoot deformities in young active patients.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261469907"},"PeriodicalIF":2.1,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Intervention for Moderate-To-Large lesions (1-2.9 cm²): Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle.","authors":"Jared Rubin, Alexander Tham, James J Butler, Paloma Gauthier, John G Kennedy, Samuel B Adams, Carol L Andrews, Chayanin Angthong, Jorge P Batista, Stephen Bayer, Christoph Becher, Gregory C Berlet, Lorraine A T Boakye, Alexandra J Brown, Roberto Buda, James D F Calder, Gian Luigi Canata, Dominic S Carreira, Thomas O Clanton, Jari Dahmen, Pieter D'Hooghe, Christopher W DiGiovanni, Malcolm E Dombrowski, Mallory Ehlers, Eric Ferkel, Richard D Ferkel, Paulo N F Ferrao, Mark Glazebrook, Arianna L Gianakos, Eric Giza, Mohamed Gomaa, Simon Görtz, Amgad M Haleem, Kamran S Hamid, Laszlo Hangody, Charles P Hannon, Daniel Haverkamp, Jay Hertel, Beat Hintermann, MaCalus V Hogan, Kenneth J Hunt, Eoghan T Hurley, Jón Karlsson, Stephen R Kearns, Gino M M J Kerkhoffs, Hak Jun Kim, Siu Wah Kong, Sebastian Krebsbach, Sameh A Labib, Kaj T A Lambers, Jin Woo Lee, Keun Bae Lee, Jeffrey S Ling, Umile Giuseppe Longo, Alberto Marangon, Graham McCollum, Kirk McCullough, Adam W Mitchell, Peter N Mittwede, Christopher D Murawski, Stefan Nehrer, Raluca Nicolescu, Philipp Niemeyer, James A Nunley, Martin J O'Malley, Cristian Ortiz, David O Osei-Hwedieh, Jochen Paul, Christopher J Pearce, Helder Pereira, Rohan Phadke, Adam Popchak, Marcelo P Prado, Steven M Raikin, Mikel L Reilingh, Guillaume Robert, Benjamin B Rothrauff, Lew C Schon, Helene Simpson, Niall A Smyth, Carolyn M Sofka, Pietro Spennacchio, James W Stone, Martin Sullivan, Masato Takao, Yasuhito Tanaka, Hajo Thermann, David B Thordarson, Rocky Tuan, Victor Valderrabano, Christian J A van Bergen, C Niek van Dijk, Pim A D van Dijk, Francesca Vannini, Tanawat Vaseenon, Monika Volesky, Cian Walls, Markus Walther, Martin Wiewiorski, Xiangyang Xu, Youichi Yasui, Hua Yinghui, Ichiro Yoshimura, Alastair S E Younger, Urszala Zdanowicz, Zijun Zhang","doi":"10.1177/19386400261456897","DOIUrl":"https://doi.org/10.1177/19386400261456897","url":null,"abstract":"<p><p>BackgroundManagement of moderate-to-large (1-2.9 cm²) osteochondral lesions of the talus (OLT) remains challenging due to the transition from reparative to replacement surgical strategies and the absence of high-level comparative evidence guiding treatment selection.MethodsAn international panel of experts participated in a modified Delphi consensus process during the International Congress on Cartilage Repair of the Ankle (ICCRA) meetings held in 2017 and 2025. Survey rounds and structured discussions were used to generate and refine consensus statements. Consensus strength was categorized as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%), and levels of evidence were graded according to established criteria.ResultsConsensus statements were developed for autologous osteochondral transplantation (AOT), osteochondral allograft transplantation (OCA), scaffold-based cartilage restoration techniques, and emerging extracellular matrix and juvenile cartilage allograft strategies. Autologous osteochondral transplantation was supported as a primary treatment option for cystic, uncontained, and revision lesions, with emphasis on graft continuity and appropriate depth. Osteochondral allograft transplantation was recommended for larger or uncontained lesions and in cases where autograft is contraindicated, with preference for fresh, size-matched grafts used within 28 days. Scaffold-based techniques were identified as viable alternatives in select primary and revision settings, although not superior to AOT for larger lesions. Extracellular matrix cartilage allograft (ECMA) and particulate juvenile cartilage allograft transplantation (PJCAT) potentially enhance cartilage restoration.ConclusionThe ICCRA consensus provides a structured, evidence-informed framework for the surgical management of moderate-to-large OLT. Although multiple treatment strategies demonstrate clinical utility, the current literature remains heterogeneous with limited high-level evidence. Further prospective and comparative studies are warranted to better define optimal indications and long-term outcomes for each approach.Level of Evidence:<i>V, Expert consensus</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261456897"},"PeriodicalIF":2.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcome of Isolated Endoscopic Flexor Hallucis Longus Transfer for Chronic Achilles Tendon Ruptures of Demanding Patients.","authors":"António Serrano, Sara Rodrigues, João Caetano, Marta Gomes, Hélder Pereira, Nuno Côrte-Real","doi":"10.1177/19386400261465108","DOIUrl":"https://doi.org/10.1177/19386400261465108","url":null,"abstract":"<p><strong>Background: </strong>Chronic rupture of the Achilles tendon, including neglected primary lesions and re-ruptures, remains a demanding clinical condition, particularly in active individuals. Endoscopic-assisted procedures with flexor hallucis longus tendon transfer have gained increasing popularity. This study aims to evaluate the clinical and functional outcomes of isolated endoscopic-assisted flexor hallucis longus tendon transfer in patients with high functional demands over an 11-year period.</p><p><strong>Methods: </strong>This retrospective study included 35 patients (29 males, 6 females; mean age 48.3 ± 11.6 years) who underwent isolated endoscopic-assisted flexor hallucis longus tendon transfer for treatment of chronic rupture of the Achilles tendon between 2014 and 2024. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, the Achilles Tendon Total Rupture Score, and the single-leg heel-rise test. The mean follow-up was 20.0 ± 11.3 months. Rates of return to sports, running and work were evaluated. The Wilcoxon signed-rank test was used to compare pre and postoperative scores. The Spearman correlation coefficient was used to analyze the association between functional outcomes and both patient age and time from injury to surgery.</p><p><strong>Results: </strong>Significant improvement was observed in functional scores: the American Orthopaedic Foot and Ankle Society score increased from a median of 49 to 97, and the Achilles Tendon Total Rupture Score from 18 to 95 (both P < .001). The heel-rise test was completed by 97.1% of patients. All previously active patients returned to sport, and 96.9% resumed work. Weak, nonsignificant negative correlations were observed between functional outcomes and both age and time to surgery. Three postoperative complications (8.6%) were observed.</p><p><strong>Conclusions: </strong>Endoscopic-assisted flexor hallucis longus tendon transfer is an effective treatment option for chronic Achilles tendon ruptures in demanding patients. It provides excellent functional outcomes, a high rate of return to previous activity levels, and a low rate of complications.<b>Level of Evidence:</b> <i>Level IV</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261465108"},"PeriodicalIF":2.1,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Conservative Management With Injectable Orthobiologic Therapies: Proceedings of the International Consensus Meetings on Cartilage Repair of the Ankle.","authors":"Alexander Tham, Jared Rubin, James J Butler, Paloma Gauthier, John G Kennedy, Samuel B Adams, Carol L Andrews, Chayanin Angthong, Jorge P Batista, Onno L Baur, Stephen Bayer, Christoph Becher, Gregory C Berlet, Lorraine A T Boakye, Roberto Buda, James D F Calder, Gian Luigi Canata, Dominic S Carreira, Thomas O Clanton, Jari Dahmen, Pieter D'Hooghe, Christopher W DiGiovanni, Malcolm E Dombrowski, Mallory Ehlers, Richard D Ferkel, Eric Ferkel, Paulo N F Ferrao, Eric Giza, Arianna L Gianakos, Mark Glazebrook, Mohamed Gomaa, Simon Görtz, Amgad M Haleem, Kamran S Hamid, Laszlo Hangody, Charles P Hannon, Daniel Haverkamp, Jay Hertel, Beat Hintermann, MaCalus V Hogan, Kenneth J Hunt, Eoghan T Hurley, Jon Karlsson, Stephen R Kearns, Gino M M J Kerkhoffs, Hak Jun Kim, Siu Wah Kong, Sebastian Krebsbach, Sameh A Labib, Kaj T A Lambers, Jin Woo Lee, Keun Bae Lee, Jeffrey S Ling, Umile Giuseppe Longo, Alberto Marangon, Graham McCollum, Kirk McCullough, Adam W Mitchell, Peter N Mittwede, Christopher D Murawski, Stefan Nehrer, Raluca Nicolescu, Philipp Niemeyer, James A Nunley, Martin O'Malley, Cristian Ortiz, David O Osei-Hwedieh, Jochen Paul, Christopher J Pearce, Helder Pereira, Rohan Phadke, Adam Popchak, Marcelo P Prado, Steven M Raikin, Mikel L Reilingh, Guillaume Robert, Benjamin B Rothrauff, Lew C Schon, Helene Simpson, Niall A Smyth, Carolyn M Sofka, Pietro Spennacchio, James W Stone, Martin Sullivan, Masato Takao, Yasuhito Tanaka, Hajo Thermann, David B Thordarson, Rocky S Tuan, Victor Valderrabano, Christian J A van Bergen, Pim A D van Dijk, Niek van Dijk, Francesca Vannini, Tanawat Vaseenon, Monika Volesky, Raymond C Walls, Markus Walther, Martin Wiewiorski, Xiangyang Xu, Youichi Yasui, Hua Yinghui, Ichiro Yoshimura, Alastair S E Younger, Urszala Zdanowicz, Zijun Zhang","doi":"10.1177/19386400261456925","DOIUrl":"https://doi.org/10.1177/19386400261456925","url":null,"abstract":"<p><p>BackgroundThe management of osteochondral lesions of the talus (OLT) is challenging, with 2 main options being conservative and surgical management. Orthobiologic therapies come to bridge the gap between these 2 options; however, inconsistencies in indication, composition, and heterogeneous evidence limit clinical decision-making. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the role of conservative management and injectable orthobiologic strategies in the treatment of OLT.MethodsSeventy-five multidisciplinary experts from over 25 countries and 1 territory participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1-E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%)ResultsIn total, 29 consensus statements were achieved across the 3 meetings. Strong agreement was reached regarding indications and expected outcomes of conservative management, including the role of immobilization and appropriate timing for surgical intervention. Orthobiologic injections, including platelet-rich plasma, concentrated bone marrow aspirate, and hyaluronic acid, were considered appropriate in select patients with persistent symptoms, although no superiority was demonstrated among formulations, preparation methods, or injection strategies. When used as adjuncts to surgical procedures, orthobiologics may improve radiological outcomes, with limited evidence for improvement in clinical outcomes. Technical considerations, including preferred harvest sites and a lack of standardized preparation protocols, were identified, along with key principles for patient counselingConclusionThese international consensus statements establish a standardized framework for the conservative management and use of injectable orthobiologic therapies in OLT. By clarifying indications, technical considerations, and current limitations, this work aims to improve consistency in clinical practice, guide treatment decision-making, and inform future research.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261456925"},"PeriodicalIF":2.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weightbearing CT Evaluation of Contact and Distance Mapping of the First Tarsometatarsal and Metatarsophalangeal Joints Following MIS Hallux Valgus Correction.","authors":"Sudheer C Reddy, Daniel J Cuttica, Steven K Neufeld, Khue Tran, Xiaoxu Li, Cunjian Chen, Qiuhong Ke","doi":"10.1177/19386400261465100","DOIUrl":"https://doi.org/10.1177/19386400261465100","url":null,"abstract":"<p><p>BackgroundThree-dimensional distance and coverage mapping (DM and CM) generated through weightbearing CT (WBCT) can aid in understanding the complex articular relationship in hallux valgus (HV). Minimally invasive (MIS) hallux valgus correction has become popular in correcting this deformity. Prior biomechanical studies have demonstrated that alterations occur at the first metatarsophalangeal (MTP) and tarsometatarsal (TMT) articulations following correction. The purpose of this study is to evaluate DM and CM characteristics at the first MTP and TMT joint as well as the medial metatarsosesamoid joint in a cohort of hallux valgus patients following MIS hallux valgus correction.MethodsTwelve patients (10 female, 2 male; mean age 56.42 ± 13.15 years) were enrolled, undergoing preoperative and 6-month postoperative WBCT scans following MIS hallux valgus correction. Foot Ankle Ability Measure (FAAM) scores were also collected at both visits. Automated segmentation was performed using a deep learning-based approach to generate accurate bone masks from volumetric imaging data. Coverage (contact) and distance maps were created based on established protocols for the medial metatarsosesamoid, first MTP, and first TMT joints. Statistical analysis was conducted using paired t-tests and Wilcoxon signed-rank test as appropriate.ResultsRegarding distance maps, at the metatarsosesamoid articulation, there was a significant increase in distance between the metatarsal and medial sesamoid along all quadrants of the joint postoperatively when compared with preoperative (P < .05). At the MTP and TMT joints, there was no significant change in joint distance postoperatively. Regarding coverage maps, at the MTP joint, increases in joint contact for dorsomedial (17.9 ± 11.1% vs 38.5 ± 15.1%, P < .001) and plantarmedial (21.7 ± 16.0% vs 54.1 ± 24.7%, P < .001) quadrants when compared with pre-op were observed. There was no significant change along its dorsolateral (80.3 ± 10.1% vs 68.7 ± 16.2%, P = .05) or plantarlateral (87.5 ± 6.5% vs 86.8 ± 10.6% P = .85) aspects. At the TMT joint, there was a significant increase at the dorsolateral (83.5 ± 11.8% vs 89.7 ± 10.2%, P = .02) and plantarlateral (57.6 ± 4.7% vs 65.4 ± 5.6%, P < .001) quadrants when compared with pre-op. There was a significant decrease in contact along the dorsomedial (89.2 ± 13.1% vs 71.1 ± 20.6%, P = .002) and plantarmedial (86.7 ± 10.6% vs 70.2 ± 14.3%, P < .001) quadrants. There was no difference between pre-op and post-op FAAM scores.DiscussionNotable differences were observed with respect to contact maps at the MTP and TMT joints indicating improved coverage of the MTP joint postoperatively. Relative decrease in coverage was observed at the medial TMT joint, reflecting medial displacement of the proximal metatarsal segment. Distance mapping at the medial metatarsosesamoid articulation demonstrated improved sesamoid alignment postoperatively.Levels of EvidenceLevel 2.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261465100"},"PeriodicalIF":2.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-Rich Plasma in the Management of Foot and Ankle Pathologies.","authors":"Jared Rubin, Alexander Tham, Ryan Rutherford, James J Butler, Samuel R Montgomery, Nathaniel P Mercer, Bradley A Lezak, Megan Donnelly, John G Kennedy","doi":"10.1177/19386400261465086","DOIUrl":"https://doi.org/10.1177/19386400261465086","url":null,"abstract":"<p><p>Platelet-rich plasma (PRP) has emerged as a regenerative treatment option for various foot and ankle pathologies, containing growth factors and anti-inflammatory proteins to promote tissue healing. The most consistent clinical evidence supports PRP use for plantar fasciitis and osteochondral lesions of the talus, with significant improvements in pain and function observed. In contrast, outcomes for Achilles tendon pathologies and ankle osteoarthritis are mixed, demonstrating heterogeneity in PRP preparation and implementation. Future high-quality, standardized studies are necessary to determine the efficacy, optimal protocols, and long-term outcomes of PRP in foot and ankle pathologies.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261465086"},"PeriodicalIF":2.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Multifocal Noninfectious Wound Dehiscence After Cavovarus Reconstruction in TRPV4-Associated Charcot-Marie-Tooth Disease Type 2C: A Case Report.","authors":"Moamen Elhaddad, Jacob Stibelman, Alexander Carrillo-Kashani, Glenn Pfeffer","doi":"10.1177/19386400261465090","DOIUrl":"10.1177/19386400261465090","url":null,"abstract":"<p><p>BackgroundCharcot-Marie-Tooth disease (CMT) commonly produces progressive cavovarus/equinovarus deformity, and severe pediatric deformity may require complex reconstruction when bracing and therapy fail. Postoperative wound complications can occur after extensive hindfoot/midfoot surgery, but genotype-specific factors influencing wound healing remain poorly defined. Charcot-Marie-Tooth disease type 2C (CMT2C) is associated with transient receptor potential vanilloid 4 (TRPV4) variants, and experimental data suggest that TRPV4 signaling may influence fibroblast behavior and extracellular matrix depositionCaseA 10-year-old girl with genetically confirmed CMT2C due to TRPV4 c.806G>A (p.Arg269His) presented with progressive ambulatory difficulty, severe bilateral stiff equinovarus (left worse), and a left knee flexion contracture (~25°). Weightbearing cone-beam computed tomography confirmed severe left cavovarus deformity. She underwent left anterior distal femoral hemiepiphysiodesis followed by complex left foot/ankle reconstruction, including Achilles Z-lengthening with posterior capsulotomy, multiple soft-tissue releases, posterior tibial tendon transfer to the lateral cuneiform, talonavicular release, peroneus longus-to-brevis transfer, and calcaneocuboid fusion. Within weeks, she developed severe multifocal wound dehiscence across multiple incision sites without clinical or microbiologic evidence of infection. She required readmission, serial debridements, and negative-pressure wound therapy. Adjunct dermal punch-biopsy-derived fibroblast explant culture showed delayed early outgrowth and reduced adherence/spread versus control, with preserved proliferation after passage. Plastic surgery performed operative debridement; perfusion imaging confirmed viable tissue, and biodegradable temporizing matrix was applied to key wounds with bridged vacuum-assisted closure, resulting in wound healing with long-term follow-up.ConclusionThis case highlights unusually severe, noninfectious, multifocal wound dehiscence following technically appropriate, consensus-guided reconstruction in a child with TRPV4-associated CMT2C. Although causality cannot be established, the complication pattern raises the possibility of genotype-associated wound-healing vulnerability and supports heightened postoperative surveillance, early multidisciplinary involvement, and consideration of staged reconstruction in similarly high-risk patients.Level of EvidenceTherapeutic, Level V (Case Report).</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261465090"},"PeriodicalIF":2.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Effectiveness of Ultrasound-Guided Popliteal Nerve Block for Foot Surgery: A Retrospective Study.","authors":"Yang S Kang, Tommy Chan, Antony Wilkinson","doi":"10.1177/19386400261465087","DOIUrl":"https://doi.org/10.1177/19386400261465087","url":null,"abstract":"<p><p>BackgroundRegional anesthesia is central to elective foot and ankle surgery. The popliteal nerve block (PNB) provides extended coverage for midfoot and hindfoot procedures, and ultrasound guidance is postulated to improve block accuracy, safety, and patient comfort.PurposeTo evaluate the clinical effectiveness of ultrasound-guided PNBs in elective foot surgery, focusing on anesthetic success, onset and duration of action, patient tolerance, and postoperative analgesic use.MethodsA retrospective review was conducted of 101 consecutive patients who received ultrasound-guided PNBs in a UK podiatric surgery department between March 2018 and August 2020. Blocks were performed by podiatric surgeons or advanced podiatrists. Outcome measures included onset time of anesthesia (minutes), injection pain assessed using a visual analogue scale (VAS), anesthetic success (adequate anesthesia without top-up), anesthetic failure (complete, tibial, or common peroneal), duration of anesthesia (hours until return of normal sensation), and postoperative analgesic use (days). Descriptive analysis was performed.ResultsThe mean onset time of anesthesia was 21.8 ± 12.2 minutes, and the mean duration was 24.9 ± 11.9 hours. Anesthetic success was achieved in 94 of 101 cases (93.1%), with 7 failures (6.9%) managed using supplementary ankle blocks. The mean VAS pain score during injection was 2.4 ± 1.9 out of 10. Patients required oral analgesia for an average of 4.1 days postoperatively (range: 0-56). No serious complications were reported.ConclusionsUltrasound-guided PNBs provided high success rates, prolonged postoperative analgesia, and good patient tolerance, with no major adverse events. These findings suggest that ultrasound-guided PNBs are a safe and effective regional anesthetic option for elective foot surgery, supporting their role in improving perioperative care and recovery. Prospective comparative studies are recommended to further evaluate their performance against other regional anesthetic techniques.Study DesignRetrospective case series.Level of Evidence4.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261465087"},"PeriodicalIF":2.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demineralized Bone Matrix in Foot and Ankle Surgery: Products, Mechanisms, and Clinical Outcomes.","authors":"Alexander Tham, Jared Rubin, James J Butler, Samuel R Montgomery, Nathaniel P Mercer, Bradley A Lezak, Osama Alzobi, Edward Mojica, Lefko Charalambous, John G Kennedy","doi":"10.1177/19386400261465088","DOIUrl":"https://doi.org/10.1177/19386400261465088","url":null,"abstract":"<p><p>BackgroundBone grafting is a commonly used adjunct in foot and ankle surgery to enhance osseous healing in fracture fixation and arthrodesis. Although autologous corticocancellous bone is commonly used, donor site morbidity and limited graft availability have driven the development of allogenic alternatives such as demineralized bone matrix (DBM).FormulationsDemineralized bone matrix is produced through decalcification of donor bone, preserving a collagen-rich scaffold and biologically active proteins that support osteoconduction and osteoinduction. Commercial formulations vary in carrier systems, structural properties, and quality control processes. Products such as DBX (DePuy Synthes/MTF Biologics) and AlloSync (Arthrex) incorporate lot-specific osteoinductivity testing, whereas others including AlloMatrix (Stryker), OrthoBlast II (SeaSpine/Orthofix), and Grafton (Medtronic) use carriers to improve handling. Carrier-free and structural grafts, as well as injectable systems, further expand available options.Clinical ApplicationsThe strongest clinical evidence for DBM exists in fracture fixation, where high union rates have been consistently reported. In arthrodesis procedures, DBM demonstrates union rates comparable to autograft, though without evidence of superiority. Applications in osteochondral lesions of the talus and hallux valgus correction remain less clearly defined, with variable outcomes reported in predominantly small case series. Limited evidence also suggests a potential role in calcaneal bone cysts.ConclusionDemineralized bone matrix is a safe and versatile adjunct that avoids donor site morbidity and provides favorable handling characteristics. However, the current literature is dominated by level III-IV evidence, with no high-quality comparative studies demonstrating superiority over autograft. Demineralized bone matrix is best used in fracture fixation and selective arthrodesis, while further studies are required to define its role in cartilage-related and forefoot procedures.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400261465088"},"PeriodicalIF":2.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}