Foot & ankle international最新文献

{"title":"General Anesthesia vs Monitored Anesthesia Care With Local Anesthetic Infiltration (MAC-VL) for Ankle Fracture Open Reduction and Internal Fixation: Impact on Recovery Metrics and Safety.","authors":"Tyson J Kauffman, Rajesh Rangarajan, Steven Liss, Alex Burton, Glenn Shi, Jonathan Kraus","doi":"10.1177/10711007261486017","DOIUrl":"10.1177/10711007261486017","url":null,"abstract":"<p><strong>Background: </strong>Monitored anesthesia care (MAC) combined with regional anesthetic techniques is commonly used for open reduction and internal fixation (ORIF) of unstable ankle fractures. When compared to general anesthesia (GA), MAC with regional anesthesia has been associated with reduced systemic adverse effects and shorter recovery times, although regional anesthesia carries additional costs and potential complications of its own. A new technique involving the infiltration of high-volume, low-concentration (VL) local anesthetic was therefore developed. When used in conjunction with MAC, we refer to this technique as MAC-VL. This study evaluates outcomes and recovery metrics following outpatient ankle ORIF performed under GA vs MAC-VL without regional anesthesia.</p><p><strong>Methods: </strong>An IRB-approved retrospective cohort study was conducted including 159 adults who underwent outpatient ankle ORIF between February 1, 2023, and January 31, 2026. Patients were identified using standardized diagnostic and procedural codes and grouped according to anesthesia type. All patients received a standardized injection of local anesthetic around the proposed operative sites before the procedure; anesthesia type was MAC (n = 48) or GA (n = 111). The primary outcome was time to discharge, defined as the interval from incision closed to hospital discharge. Secondary outcomes were considered exploratory and included tourniquet, operative, anesthesia time, time in room, Post Anesthesia Care Unit length of stay, conversion from MAC to GA, reported postoperative nausea and vomiting, admissions, and postoperative emergency department visits.</p><p><strong>Results: </strong>Among 160 procedures for which no significant difference in case mix could be detected with the numbers available, MAC-VL was associated with a significantly shorter time to discharge-reducing discharge time by 55.2 minutes (<i>P</i> < .001) following adjustment for demographic, clinical, and operative covariates-and shortened total anesthesia and operating room time compared with GA. With the numbers available, no significant difference was detected for the remaining secondary outcomes.</p><p><strong>Conclusion: </strong>The MAC-VL protocol was associated with shorter operating room and recovery times and may improve health care resource use.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261486017"},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140017","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":"Letting the Patient Lead: Weightbearing to Tolerance and the Evolving Science of Recovery After First Metatarsophalangeal Joint Fusion.","authors":"Judith F Baumhauer","doi":"10.1177/10711007261491747","DOIUrl":"https://doi.org/10.1177/10711007261491747","url":null,"abstract":"","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261491747"},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139985","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":"To Walk or Not? A Prospective, Randomised Controlled Trial to Evaluate the Effect of Weightbearing on Patient Outcomes Following First Metatarsophalangeal Joint Fusion.","authors":"Scott D Purdie, Haley M Glazebrook, Ruchith Dissanayake, Bernard N Burgesson, Joel G Morash, Mark A Glazebrook","doi":"10.1177/10711007261481828","DOIUrl":"https://doi.org/10.1177/10711007261481828","url":null,"abstract":"<p><strong>Background: </strong>First metatarsophalangeal (MTP) joint arthrodesis is the gold standard surgical treatment of hallux rigidus and severe hallux valgus with osteoarthritis after failed nonoperative management. Despite its common use, postoperative weightbearing protocols vary considerably. To date, no prospective randomised controlled trials have directly compared outcomes between immediate weightbearing as tolerated (WBAT) and non-weightbearing (NWB) using modern fixation techniques. This study aimed to evaluate whether immediate WBAT following first metatarsophalangeal joint arthrodesis leads to differences in patient outcomes compared with traditional non-weightbearing protocols.</p><p><strong>Methods: </strong>A prospective randomised controlled trial was conducted including 68 patients undergoing isolated first-MTP fusion. Patients were randomly allocated either WBAT or NWB protocols. Standardised surgical technique and fixation (crossed screws or plate) were performed by 2 fellowship-trained foot and ankle surgeons. Primary outcomes were the visual analogue scale (VAS) pain scores and the Foot and Ankle Ability Measure (FAAM-activities of daily living [ADL] subscale) functional scores, at 12 months. Secondary outcomes included non-union, complications including infection, wound issues, and patient satisfaction. Statistical analysis used <i>t</i> tests and χ² or Fisher exact tests, with significance at <i>P</i> < .05.</p><p><strong>Results: </strong>Sixty-eight patients (33 WBAT, 35 NWB) completed follow-up. Both groups demonstrated significant improvements in pain and function at 12 months (<i>P</i> < .001 for both). No statistically significant differences were found between WBAT and NWB groups in VAS pain scores (2.97 ± 2.215 vs 2.54 ± 2.147; <i>P</i> = .423), FAAM scores (81.31 ± 16.028 vs 85.02 ± 18.863; <i>P</i> = .387), or patient satisfaction (8.00 ± 2.76 vs 8.34 ± 2.52; <i>P</i> = .594). Complication rates were comparable, with 1 case of hardware irritation in each group (<i>P</i> = .739).</p><p><strong>Conclusion: </strong>Following first-MTP joint fusion, immediate weightbearing is safe and results in similar pain relief, patient satisfaction, and complication rates compared with traditional NWB protocols, although a clinically meaningful functional advantage for NWB could not be excluded. These findings support more permissive postoperative strategies, which may offer benefits for patient mobility, independence, recovery time, and health care resource use that were not directly measured in this trial.</p><p><strong>Level of evidence: </strong>Level I, randomised controlled trial.</p><p><strong>Clinicaltrials: </strong>gov ID:NCT04473196.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261481828"},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140019","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":"Which Anesthetic Is Better? The Devil Is in the Details.","authors":"Jeffrey D Swenson","doi":"10.1177/10711007261491753","DOIUrl":"https://doi.org/10.1177/10711007261491753","url":null,"abstract":"","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007261491753"},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140023","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":"Preoperative Computer Simulation and 3D-Printed Guide Plate of Autologous Transplantation Achieved Favorable Outcomes in Patients With Large Cystic Osteochondral Lesion of the Talus.","authors":"Bingyao Cai, Xiangyun Cheng, Tong Su, Yuelin Hu, Qinwei Guo, Chen Jiao, Dong Jiang","doi":"10.1177/10711007261471540","DOIUrl":"10.1177/10711007261471540","url":null,"abstract":"<p><strong>Background: </strong>Autologous osteoperiosteal transplantation (AOPT) with osteotomy is an effective surgical treatment to large cystic osteochondral lesion of the talus (OLT), wherein osteoperiosteal grafts harvested from iliac crest are transplanted to osteochondral defects. However, operative complexity and high postoperative complication rate have emerged as key concerns. This study aims to design a customized AOPT preoperative planning and intraoperative navigation protocol to improve accuracy and efficiency.</p><p><strong>Methods: </strong>Medial cystic OLT patients with lesion area >100 mm² and/or depth >8 mm who underwent customized or conventional AOPT were identified from our database between May 2019 and June 2021. Surgical procedures were simulated and optimized on 3D reconstructed ankle models, and customized guide plates (cutting jigs) were designed to navigate osteotomy and bone socket creation intraoperatively. The MOCART, FAAM and VAS scores were recorded and compared. Postoperative complications were recorded.</p><p><strong>Results: </strong>19 patients undergoing conventional and 13 patients receiving individualized AOPT were included. No significant difference was observed in OLT area (89.96 ± 28.23 mm² vs 87.85 ± 23.74 mm², <i>P</i> = .821). Postoperatively, the customized AOPT group had significantly lower VAS (2.00 [2.00-2.00] vs 3.00 [2.00-4.50], <i>P</i> = .004), significantly higher FAAM-ADL scores (mean difference, 5.75; 95% CI, 2.60-8.91, <i>P</i> < .001) and required significantly shorter surgery time (mean difference, -0.74 hours; 95% CI, -0.98 to -0.50, <i>P</i> < .001). Cyst recurrence was significantly reduced in the customized AOPT group (1/13 [7.69%] vs 9/19 [47.37%]; mean difference, -39.68%; 95% CI, -66.40% to -12.96%; <i>P</i> = .024). Osteotomy-site morbidity was lower but did not reach statistical significance (1/13 [7.69%] vs 8/19 [42.11%]; mean difference, -34.41%; 95% CI, -60.92% to -7.90%; <i>P</i> = .050). With the numbers available, no significant difference could be detected in FAAM-Sports or MOCART scores.</p><p><strong>Conclusion: </strong>In this retrospective comparative study, AOPT assisted by computer simulation and 3D printing was associated with improved clinical outcomes, shorter operative time, and fewer postoperative complications. These findings suggest that preoperative planning and patient-specific guidance may help standardize the execution of AOPT for complex medial large cystic OLTs. Given the limited sample size and non-randomized design, these results should be interpreted cautiously and warrant further validation in larger studies.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1275-1284"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984323","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 Regarding: Does Platelet-Rich Plasma Speed Recovery After Acute Lateral Ankle Sprain? A Prospective Comparative Study Among Athletes.","authors":"Yu Tong","doi":"10.1177/10711007261484153","DOIUrl":"https://doi.org/10.1177/10711007261484153","url":null,"abstract":"","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":"47 10","pages":"1362"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169283","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":"Outcomes of Iliac Crest Bone-Block Arthrodesis After Failed First MTP Joint Surgery With Bone Loss.","authors":"Nurettin Mantı, Melih Atalay, Nuri Koray Ülgen, Mehmet Orçun Akkurt, Sadık Emre Erginoğlu, Ali Öznur","doi":"10.1177/10711007261471136","DOIUrl":"10.1177/10711007261471136","url":null,"abstract":"<p><strong>Background: </strong>Failed first metatarsophalangeal (MTP) joint surgery with bone loss is a challenging revision problem. This study aimed to evaluate the radiographic and clinical outcomes of iliac crest bone-block arthrodesis in this setting.</p><p><strong>Methods: </strong>This retrospective cohort included 72 patients who underwent revision first MTP arthrodesis with tricortical iliac crest autograft between 2018 and 2022. All patients had at least 2 years of clinical and radiographic follow-up, and 83.3% had at least 3 years of follow-up. Fusion rates, complications, and changes in visual analog scale (VAS) and 36-Item Short Form Health Survey (SF-36) scores were recorded; the influence of age, comorbidities, and graft length was explored.</p><p><strong>Results: </strong>The median time from the index procedure to revision was 24 months, and the median graft length 11 mm. Primary radiographic union was achieved in 67 of 72 patients (93.1%); after secondary grafting in 3 additional patients, final radiographic union was 70 of 72 (97.2%), with persistent nonunion in 2 patients (2.8%); 44.4% had at least 1 complication and 6.9% required further surgery. Median VAS improved from 8 (7.8-9.0) preoperatively to 0 (0-1.0) at 24 months, and SF-36 improved from 55 (50-62) to 88 (82-90). Exploratory analyses suggested that systemic comorbidities and longer graft length were associated with less favorable pain and functional outcomes.</p><p><strong>Conclusion: </strong>Iliac crest bone-block arthrodesis may be an acceptable salvage option after failed first MTP joint surgery with bone loss, achieving a high radiographic union rate and meaningful clinical improvement; however, postoperative complications were frequent, and outcomes were less favorable in patients with systemic comorbidities or larger structural defects.</p><p><strong>Level of evidence: </strong>Level IV, non-comparative retrospective cohort.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1285-1293"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858000","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":"Hallux Valgus, Not Hallux Abductus Valgus: A Short Report on Historical and Anatomical Terminology.","authors":"Miki Dalmau-Pastor, Carmelo Errichiello, Christopher P Miller, Marco Marcarelli, Margherita Germano, Jorge Javier Del Vecchio","doi":"10.1177/10711007261471835","DOIUrl":"10.1177/10711007261471835","url":null,"abstract":"<p><strong>Background: </strong>This short report argues that the term \"hallux abductus valgus\" is anatomically inconsistent and should be replaced by \"hallux valgus.\" Hallux valgus describes a lateral deviation of the great toe with a medial deviation of the first metatarsal. Although the deformity has historically been called \"hallux abductus valgus,\" this creates confusion because the muscle contributing to the lateral deviation is the adductor hallucis, not the abductor hallucis.</p><p><strong>Methods: </strong>The authors trace this inconsistency back to Carl Hueter's original description in the 19th century. Hueter defined the deviation of the great toe as abduction when referenced to the median plane of the whole body but as adduction when referenced to the median plane of the foot, and he preferred the former terminology. The authors argue that this was a conceptual error because movements of the toes should be described relative to the foot axis, classically defined through the second toe, rather than the body's midline.</p><p><strong>Results: </strong>This terminology problem has persisted in the literature, leading some authors to misidentify the muscle released during lateral soft tissue procedures as the abductor hallucis, or to incorrectly describe the abductor hallucis as having transverse and oblique heads.</p><p><strong>Conclusion: </strong>Based on anatomical principles and historical analysis, the authors conclude that \"Hallux Abductus Valgus\" is misleading and suggest that the deformity should be called either \"hallux adductus valgus\" or, preferably, simply \"hallux valgus.\"</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1272-1274"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857987","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":"Corrigendum to \"Plantar Pressure Analysis and the Ankle Instability Index: Quantifying 'Giving Way' in Functional Ankle Instability\".","authors":"","doi":"10.1177/10711007251350162","DOIUrl":"10.1177/10711007251350162","url":null,"abstract":"","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"NP3"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487495","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":"The Superior Fascicle of the Anterior Talofibular Ligament Functions as a Restraint Against Internal Rotation: A Cadaveric Biomechanical Study.","authors":"Tomoki Koyama, Atsushi Teramoto, Yuta Mori, Yasutaka Murahashi, Katsunori Takahashi, Nanami Ueda, Kota Watanabe, Toshimi Aizawa","doi":"10.1177/10711007261472466","DOIUrl":"10.1177/10711007261472466","url":null,"abstract":"<p><strong>Background: </strong>Lateral ankle sprains frequently result in anterior talofibular ligament (ATFL) dysfunction, leading to chronic lateral ankle instability. The ATFL consists of superior and inferior fascicles; however, the stabilizing role of the superior fascicle remains unclear. We biomechanically evaluated its function using cadaveric models.</p><p><strong>Methods: </strong>Nine frozen cadaveric ankles were tested using a robotic system (FRS2015). The superior fascicle was sequentially transected arthroscopically to simulate cumulative 3 injury types: type 1, partial detachment at the medial margin of the fibular attachment; type 2, proximal detachment; and type 3, complete detachment. Anterior talar translation, internal rotation, and inversion angles relative to the tibia were measured as displacements under the anterior drawer, internal rotation, and inversion loads, respectively, at 15° dorsiflexion and 15° and 30° plantarflexion. In situ forces and ankle kinematics were also measured.</p><p><strong>Results: </strong>Internal rotation displacement at 30° plantarflexion was significantly greater in type 3 than in the intact (mean difference, 2.9°; 95% CI, 0.6°-5.0°; <i>P</i> = .01), type 1 (mean difference, 2.6°; 95% CI, 0.5°-4.8°; <i>P</i> = .02), and type 2 (cumulative with type 1; mean difference, 2.5°; 95% CI, 0.4°-4.5°; <i>P</i> = .02). With the numbers available, no significant differences were found among intact, type 1, and type 2, nor in anterior or inversion displacement across any conditions. The in situ force was greater in type 3 than in type 1 during anterior drawer and internal rotation loading, and ankle kinematics did not differ.</p><p><strong>Conclusion: </strong>Partial injury to the superior fascicle of the ATFL was not associated with a statistically significant difference in ankle instability under the tested conditions, whereas complete injury was associated with significantly greater internal rotational displacement.</p><p><strong>Clinical relevance: </strong>Injury to the superior fascicle of the ATFL is associated with increased internal rotational laxity, supporting the use of internal rotation testing, such as the anterolateral drawer test, when evaluating suspected ATFL injury.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1338-1347"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}