Foot & ankle surgery (New York, N.Y.)最新文献

{"title":"Utilizing the spare parts technique to aid in complex wound reconstruction for a necrotizing soft tissue infection: A case report","authors":"Zoe Dolcimascolo DPM ,&nbsp;Suhail Masadeh DPM ,&nbsp;Michael Liette DPM","doi":"10.1016/j.fastrc.2025.100582","DOIUrl":"10.1016/j.fastrc.2025.100582","url":null,"abstract":"<div><div>Necrotizing fasciitis is a life threatening, rapidly progressive infection requiring emergent surgical debridement. As a result of the extensive debridement patients are often left with large soft tissue defects, which may have considerable implications on morbidity. As a means to reduce patient morbidity and more rapidly cover large defects, the “spare parts” technique may serve as a viable option for reconstruction. The goal of this surgical technique is to utilize repurposed tissue from non-salvageable areas as a tool to cover critical structures expeditiously. Presented here is a case of utilizing the spare parts technique for a patient after debridement due to necrotizing fasciitis. A hallux digital fillet flap was harvested as a full thickness skin graft and inset over a soft tissue defect of the anterior ankle. This was done in an attempt to decrease the amount of wound contracture across the joint and provide rapid soft tissue coverage of a critical area.</div></div><div><h3>Level of Clinical Evidence</h3><div>Level 4 Case Study</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100582"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415799","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":"Ipsilateral achilles tendon rupture and medial malleolar fracture in an elderly patient: A rare case report and review","authors":"Emanoil Shafik DPM, MPH, MS,&nbsp;Stephen Trimnell DPM, MS,&nbsp;Joseph D. Cuomo DPM, MS,&nbsp;Max Sanginario DPM,&nbsp;Abdelhafid El Akri MD, DPM,&nbsp;Sagar Shah DPM,&nbsp;Michael Piccarelli DPM, AACFAS","doi":"10.1016/j.fastrc.2025.100561","DOIUrl":"10.1016/j.fastrc.2025.100561","url":null,"abstract":"<div><div>A 77-year-old male presented with a left Achilles tendon rupture and an ipsilateral medial malleolus fracture sustained after a misstep. This combination of injuries is rare, with only eight cases previously reported in the literature. Magnetic resonance imaging (MRI) confirmed a complete rupture of the Achilles tendon approximately 7 cm proximal to its calcaneal insertion. Intraoperative evaluation using an Arthroscopy procedure demonstrated no intra-articular step-off of the medial malleolus fracture. A positive Thompson test further confirmed the tendon rupture. The medial malleolus was stabilized with two 4 × 40 mm Arthrex cannulated screws, and the Achilles tendon was repaired using the Percutaneous Achilles Repair System.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100561"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926567","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":"Closed reduction of subtalar and talonavicular dislocation: Novel technique description","authors":"William Stallings ,&nbsp;Fernando Pinero","doi":"10.1016/j.fastrc.2025.100584","DOIUrl":"10.1016/j.fastrc.2025.100584","url":null,"abstract":"<div><h3>Background</h3><div>Subtalar dislocations are uncommon, high-energy injuries that frequently occur with associated fractures and significant soft tissue compromise. Prompt closed reduction is essential to prevent avascular necrosis of the talus, neurovascular injury, and post-traumatic arthritis.</div></div><div><h3>Purpose</h3><div>Traditional reduction methods are technically demanding, dependent on operator strength, and may endanger already compromised soft tissues. The Quigley method, which applies traction through the toes, can exacerbate deformity and doesn’t provide sufficient force to achieve reduction safely, increasing the risk of injury to the toes and forefoot. Similarly, Charnley’s technique requires exaggeration of the deformity, which raises the risk of neurovascular damage and conversion of closed to open dislocation, while also relying on operator grip strength that may not always be feasible.</div></div><div><h3>Method</h3><div>We present the case with displaced comminuted fractures of the lesser metatarsals and combined subtalar and talonavicular dislocation to support the use of novel technique conceptualized by the authors. This method uses a padded ankle distraction strap secured with kerlix gauze to the surgeon’s hips, allowing body weight to generate steady, high force in line traction. With traction maintained, the surgeon’s hands are free to correct deformity and apply splinting without loss of distraction.</div></div><div><h3>Result</h3><div>Reduction was achieved on the first attempt, achieving reduction on the first attempt reduces the risk of further soft tissue injury, limits the need for repeat sedation and radiation, and decreases the likelihood of requiring urgent operative intervention.</div></div><div><h3>Conclusion</h3><div>This Method represents a safe, reproducible, and cost-effective option for closed reduction in both emergency and operative settings.</div></div><div><h3>Level of Clinical Evidence</h3><div>IV</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100584"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465677","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":"Managing complex foot deformities in paraplegia: Outcomes of intramedullary hindfoot arthrodesis for spastic pes cavovarus; A case series review","authors":"Gil Genuth ,&nbsp;Martin Keith Ulrich ,&nbsp;Markus Damrau ,&nbsp;Lukas D Iselin","doi":"10.1016/j.fastrc.2025.100572","DOIUrl":"10.1016/j.fastrc.2025.100572","url":null,"abstract":"<div><h3>Background</h3><div>Patients with spinal cord injury (SCI), particularly those with paraplegia, often develop rigid foot deformities such as spastic pes cavovarus due to unopposed muscle activity and chronic spasticity. These deformities compromise seating alignment, hinder passive standing programs, and significantly increase the risk of pressure ulcers (PUs), especially at the heel, lateral border, first metatarsal head, and lateral malleolus. Conservative treatments often fail in severe, fixed deformities, necessitating surgical intervention.</div><div>This study aimed to evaluate the clinical and radiographic outcomes of hindfoot arthrodesis using intramedullary nail (IMN) fixation in paraplegic patients with spastic foot deformities, focusing on fusion rates, PU recurrence, and improvements in wheelchair positioning.</div></div><div><h3>Methods</h3><div>This retrospective case series included eight paraplegic patients (mean age: 34 years) with fixed pes cavovarus deformities treated between 2015 and 2019. All underwent percutaneous soft tissue release and open hindfoot joint preparation, followed by IMN fixation using a hindfoot nail. Radiographic fusion was assessed at 3, 6, and 9 months via standard radiographs and selected CT scans. Clinical follow-up lasted at least 12 months.</div></div><div><h3>Results</h3><div>Radiographic fusion was achieved in 75 % of cases. All patients showed clinical improvement in seating alignment and tolerance to gravity-loading protocols. Two patients had asymptomatic non-union. Postoperative complications included two superficial infections, one new PU, and two cases of symptomatic screw protrusion requiring hardware removal.</div></div><div><h3>Conclusion</h3><div>Hindfoot arthrodesis using IMN offers a promising surgical option for SCI patients with rigid foot deformities. It enables plantigrade alignment, supports pressure redistribution, and improves functional seating. Despite a small sample size, the outcomes justify further prospective studies to confirm its role in this complex, underserved population.</div></div><div><h3>Level of evidence</h3><div>4</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100572"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220586","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":"Letter to the editor regarding “Clinical and biomechanical analysis of a dynamic compression intramedullary nail for hindfoot and ankle arthrodesis\"","authors":"Kenneth M Dupont PhD CCRP ,&nbsp;James W Johnson PhD ,&nbsp;Chance H McClure BS ,&nbsp;David L Safranski PhD","doi":"10.1016/j.fastrc.2025.100585","DOIUrl":"10.1016/j.fastrc.2025.100585","url":null,"abstract":"","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100585"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519668","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":"Titanium implants and type IV hypersensitivity reactions: A systematic literature review","authors":"Susanna Oppong B.S. PMS-3,&nbsp;Amber del Rosario B.S. PMS-3,&nbsp;Steffi Casimir B.S. M.S. PMS-3,&nbsp;Jasmine Atri B.S. PMS-3,&nbsp;Dr. Mark Razzante DPM","doi":"10.1016/j.fastrc.2025.100578","DOIUrl":"10.1016/j.fastrc.2025.100578","url":null,"abstract":"<div><div>This study investigates titanium (Ti) hypersensitivity in surgical implants, which can cause complications like implant failure and inflammation. The goal is to evaluate diagnostic methods, particularly skin patch testing versus the Memory Lymphocyte Immunostimulation Assay (MELISA), to improve outcomes for patients with metal sensitivities. A literature search using databases such as Google Scholar and PubMed identified 18 peer-reviewed studies from 2006 to 2024, focusing on titanium implant reactions. Inclusion criteria involved studies with clinical or experimental data on Ti hypersensitivity, excluding non-metallic implant failures and unrelated hypersensitivity reactions. Titanium hypersensitivity, though rare, can result in chronic inflammation and implant failure in foot and ankle surgeries. Patch testing often fails to detect deep tissue reactions, while MELISA testing shows greater accuracy. Alternative materials, such as ceramic or niobium, may be better for patients with metal allergies. MELISA testing is a more reliable tool for diagnosing metal hypersensitivity than patch testing. Surgeons should consider preoperative MELISA testing and alternative implants to reduce hypersensitivity risks, improving patient outcomes. Preoperative MELISA testing should be standard for titanium implant patients to minimize allergic reactions.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100578"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324754","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":"Acute simultaneous correction of 4th and 5th brachymetatarsia: A case report","authors":"Taimur Hasan DPM,&nbsp;Kasandra Trott DPM,&nbsp;Meghan Susek DPM","doi":"10.1016/j.fastrc.2025.100538","DOIUrl":"10.1016/j.fastrc.2025.100538","url":null,"abstract":"<div><div>Brachymetatarsia results from the premature closure of growth plates, leading to the development of an abnormally short metatarsal. This is typically congenital. The incidence is estimated to be between 0.02 % to 0.05 %. When evaluating cases involving more than one metatarsal, the combination of the first and fourth metatarsals is more common. The presentation of fourth and fifth brachymetatarsia is extremely rare. This case report serves as the first to discuss the acute correction of the fourth and fifth brachymetatarsia simultaneously.</div><div>A 15-year-old male patient presented with bilateral pain in the fourth sub-metatarsal region, accompanied by shortening and dorsal lateral aspect involvement of bilateral fourth digits. Sport activities worsened his symptoms, especially to the right fifth digit. Clinical, biomechanical, and radiographic evaluations were conducted. A plantar crease was observed bilaterally at the fourth sub-metatarsal region, along with varus deformity of the fifth digit and an elevated fourth digit.</div><div>Radiographically, a notable shortening of the fourth and fifth rays was observed in the metatarsal parabola, measuring 16.5 mm and 18.5 mm, respectively. The joint space appeared congruent, and a moderate plantar bowing of the fifth metatarsal was evident on lateral view. The patient underwent acute correction of the fourth and fifth metatarsals. Additionally, the patient underwent tendon lengthening and capsulotomies utilizing two separate incisions.</div><div>The patient experienced a successful recovery without complications, achieving complete relief of symptoms within a year. Two commonly utilized correction techniques include gradual lengthening with an external fixator and single-stage lengthening using a graft. In this case, the patient underwent single-stage lengthening, and post-operative serial radiographs demonstrated the full incorporation of the grafts.</div><div>Level of clinical evidence: IV</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100538"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049164","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":"Adjuvant hydrolyzed collagen powder in high-risk patients with large soft tissue defects undergoing orthoplastic limb preservation surgery","authors":"Christopher Bibbo ,&nbsp;Sara Mateen ,&nbsp;Suhail Masadeh","doi":"10.1016/j.fastrc.2025.100567","DOIUrl":"10.1016/j.fastrc.2025.100567","url":null,"abstract":"<div><div>Limb preservation in the multi-morbid patient remains a significant challenge. The combination of orthopedic and plastic reconstructive techniques (“Orthoplastics”) is well known to result in limb preservation (“limb salvage”) even in extremely high-risk patients. Despite advances, adjunctive healing techniques remain desirable.</div><div>In this case series, we examined the use of hydrolyzed collagen powder in limb salvage in multi-morbid patients undergoing limb preservation surgery. The medical records of ten high-risk patients with multiple co-morbidities undergoing limb preservation reconstruction, who would otherwise have required a major level amputation, were reviewed retrospectively. Of these patients, there was an average of nine varying risk factors, including the presence of infection, diabetes mellitus, renal impairment, vascular disease, smoking, illicit drug or alcohol abuse, or nicotine use. The case review data included patient demographics, risk factors, specific pathophysiology, Orthoplastic procedure, and the volume of adjunctive hydrolyzed collagen during the reconstructive procedures.</div><div>All patients achieved limb preservation or the prevention of an anticipated higher-level amputation. On average, two hydrolyzed collagen applications were used per patient with a mean volume of 1.8 g (range 2-4 g). Notably, the presence of an actively treated infection did not appear to diminish the efficacy of hydrolyzed collagen. Additionally, no adverse reactions were identified with the use of hydrolyzed collagen. These findings suggest that use of hydrolyzed collagen is a safe, valuable adjunct in Orthoplastic limb preservation surgery for patients at extreme risk for limb loss.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100567"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220587","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":"Gunshot wounds in the lower extremities: Treatment review","authors":"Michael A. Coyer DPM FACFAS ,&nbsp;James C. Connors DPM FACFAS ,&nbsp;Mark A. Hardy DPM FACFAS ,&nbsp;Victoria Suggs BS ,&nbsp;Kasra Karamlou DPM","doi":"10.1016/j.fastrc.2025.100571","DOIUrl":"10.1016/j.fastrc.2025.100571","url":null,"abstract":"<div><div>A high number of gunshot injuries occur in the lower extremities, making it likely that foot and ankle surgeons will encounter these wounds when involved in lower extremity trauma care. Understanding current thought processes and standards of care regarding high and low velocity wounds is imperative for surgeons to appropriately manage these unique and challenging traumatic injuries. Additionally, it is crucial to consider legal ramifications related to evidence collection, interaction with law enforcement, and witness testimony. This article discusses treatment guidelines that are crucial for patient care as well as preservation of evidence and appropriate documentation for law enforcement.</div></div><div><h3>Level of Evidence</h3><div>5</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100571"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220585","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":"Limb salvage with transverse tibial bone transport in a high-risk patient with a Chronic Achilles Tendon Ulcer: a case report","authors":"Lucian M. Feraru DPM, FACFAS ,&nbsp;Mikhail Samchukov MD","doi":"10.1016/j.fastrc.2025.100575","DOIUrl":"10.1016/j.fastrc.2025.100575","url":null,"abstract":"<div><div>Diabetic foot ulcers (DFUs), particularly in the Achilles region, pose significant challenges for limb salvage due to poor perfusion and high infection risk. Transverse tibial bone transport (TTBT), utilizing distraction osteogenesis, enhances local blood flow and promotes tissue regeneration(1, 2). This case report describes a high-risk 60- year-old female patient with a chronic Achilles tendon ulcer refractory to standard treatments who underwent TTBT. The procedure successfully resulted in complete wound healing and limb salvage, avoiding major amputation. This report discusses the clinical details and implications of TTBT as an effective intervention in managing recalcitrant diabetic foot ulcers.</div><div>Background: Diabetic foot ulcers at the posterior heel/Achilles are difficult to heal due to limited soft tissue, high stress, and microvascular disease, often ending in major amputation.</div><div>Purpose: To describe limb salvage using transverse tibial bone transport (TTBT) for a recalcitrant Achilles‑region ulcer in a high‑risk patient.</div><div>Study Design: Single‑patient case report.</div><div>Methods: A 60‑year‑old woman with type 2 diabetes, peripheral arterial disease, renal disease, and calcaneal osteomyelitis had a chronic 16 × 8 cm posterior heel/Achilles ulcer refractory to revascularization, antibiotics, and advanced wound care. After radical debridement, a circular external fixator was applied with a tibial corticotomy and TTBT module. Following a 7‑day latency, distraction was performed at 0.25 mm twice daily for 28 days, then compression 0.25 mm four times daily for 14 days until redocking. External fixation continued for consolidation.</div><div>Results: Granulation developed during distraction; ulcer dimensions decreased ∼50 % by frame removal. Complete epithelialization occurred by 20 weeks with infection control and limb preservation. Postoperative CT angiography showed a patent anterior tibial artery with collateral reconstitution of the peroneal and posterior tibial arteries, consistent with improved microcirculation. A superficial plantar heel ulcer related to calcaneal‑gait biomechanics after Achilles resection healed with offloading and local care. At 12‑month follow‑up the limb remained salvaged with functional recovery.</div><div>Conclusion: TTBT may augment local perfusion and support healing of intractable Achilles‑region diabetic ulcers in selected patients. When macro‑revascularization is insufficient or contraindicated, TTBT offers a driven limb‑salvage option that targets distal microcirculatory failure while avoiding free‑tissue transfer in compromised hosts.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"5 4","pages":"Article 100575"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324753","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}