Foot & ankle international最新文献

{"title":"Kinematic and Kinetic Effects of 10-Degree Coronal Wedge Floors on Lower Limb Joints During Static Standing: An Upright Multidetector-Row CT Study.","authors":"Hiroyuki Seki, Naomichi Ogihara, Akimasa Ito, Asahi Sujino, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki","doi":"10.1177/10711007251361132","DOIUrl":"https://doi.org/10.1177/10711007251361132","url":null,"abstract":"<p><strong>Background: </strong>Coronal wedge insoles are commonly prescribed to mitigate musculoskeletal disorders, yet their static-standing kinematic and kinetic effects on lower extremity joints remain insufficiently understood.</p><p><strong>Methods: </strong>This cross-sectional experimental study included 15 healthy older adults (mean 64.9 ± 6.0 y; 11 females, 4 males) who underwent CT imaging of the entire lower limbs during static standing. Ground reaction forces (GRFs) were simultaneously recorded using right and left force plates, with their sum equal in magnitude and opposite in direction to the body weight vector. Three floor conditions were tested: a 10-degree medial wedge, a flat surface, and a 10-degree lateral wedge. Lower limb alignment, GRF vector inclinations, projected GRF location at the height of the joint center, and external joint moments were assessed under 3 floor conditions.</p><p><strong>Results: </strong>Coronal wedges altered hip and subtalar joint angles, with medial wedges inducing hindfoot supination and hip abduction, whereas lateral wedges promoted hindfoot pronation and hip internal rotation. The GRF vector was found to generally pass lateral to the tibiotalar and subtalar joints and medial to the hip joint, generating eversion and adduction moments, respectively. Notably, these moments increased on the lateral wedge but were reduced on the medial wedge. In contrast, projected GRF location at joint height remained near the knee joint center across all conditions, resulting in minimal varus/valgus knee moments.</p><p><strong>Conclusion: </strong>This study provides the first quantifications of the 3-dimensional GRF vector concerning joint centers during static standing; these exploratory findings warrant confirmation during gait and in symptomatic cohorts. Our study suggests that lateral wedges tend to increase external joint moments at the hip and tibiotalar. Although further investigation is needed, these mechanical effects at the hip may have potential relevance and should be considered with caution when prescribing lateral wedge insoles.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251361132"},"PeriodicalIF":2.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014867","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":"Long-term Functional Outcomes After Modern Surgical Treatment of Talus Fractures: A 10-Year Single Center Cohort Study.","authors":"Erika Roddy, William Hannay, Bilal Khilfeh, Kira Newell, David Dalstrom, Bruce Sangeorzan, Stephen Benirschke, Reza Firoozabadi","doi":"10.1177/10711007251355611","DOIUrl":"https://doi.org/10.1177/10711007251355611","url":null,"abstract":"<p><strong>Background: </strong>Talus fractures are rare injuries. To date, there is limited literature on outcomes after modern operative treatment of talus fractures. Many prior studies are limited by a small number of patients, limited follow-up, and include radiographic outcomes only. The purpose of this study was to report long-term patient-reported outcomes after operative treatment of talus fractures.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients with a talus fracture treated surgically at a level 1 trauma center between 2008 and 2018, with a minimum of 5 years of follow-up.Detailed demographic, injury, and radiographic data were collected. Attempts were made to contact all patients for long-term follow-up to collect the Foot and Ankle Ability Measure (FAAM) patient-reported outcome score.</p><p><strong>Results: </strong>One hundred twenty-eight patients met inclusion criteria and were successfully contacted for follow-up. The average length of follow-up was 10.4 years. There was a 47% rate of posttraumatic arthritis. Thirty-eight patients (30%) underwent unplanned reoperation, of which 12 (9%) were a salvage procedure (fusion, arthroplasty, or amputation). Median FAAM score at a mean of 10 years was 83 (interquartile range [IQR] 58-96). For patients who did not require a salvage procedure (fusion, arthroplasty, or amputation), the median FAAM score was 85 (IQR 63-96). In contrast, those who underwent a salvage procedure had a median FAAM score of 52 (IQR 36-65), representing significantly poorer function. In univariate analysis, factors associated with lower FAAM score included open injuries, higher Injury Severity Score (ISS), and elevated body mass index (BMI). Additional negative predictors included increased time to definitive surgery, presence of a subtalar dislocation, development of subtalar arthritis, undergoing any reoperation, and salvage procedures. Fracture location, Hawkins classification, development of avascular necrosis, age, reoperations excluding salvage procedures, presence of ipsilateral foot/ankle fractures, and duration of follow-up were not independently associated with FAAM score. In multivariate analysis, only undergoing a salvage procedure and increasing BMI and ISS remained associated with poorer FAAM scores.</p><p><strong>Conclusion: </strong>In a large cohort of surgically treated talus fractures, long-term functional outcomes were better than anticipated, with a median FAAM score of 83 despite a 47% rate of posttraumatic arthritis and 30% reoperation rate. These results suggest that modern dual-approach surgical techniques may substantially improve patient prognosis compared with historical expectations.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251355611"},"PeriodicalIF":2.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024927","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":"Trends in Relative Value Units in the Surgical Management of Ankle Arthritis: A Contemporary Review.","authors":"Alexandra N Krez, Allison L Lewis, Emily Arciero, Janice Havasy, Terence Ng, Adam D Bitterman","doi":"10.1177/10711007251363237","DOIUrl":"https://doi.org/10.1177/10711007251363237","url":null,"abstract":"","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"10711007251363237"},"PeriodicalIF":2.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024975","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":"Minimally Invasive Achilles Tendon Repair: Dresden vs PARS/Knotless Techniques in a Retrospective Comparative Study.","authors":"Mauro Andrés Goveo, Juan Ignacio Crosa, Juan Ignacio Peralta, Corali Colombo, Fernando Vago Anaya, Emiliano Loncharich","doi":"10.1177/10711007251341896","DOIUrl":"10.1177/10711007251341896","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive techniques have emerged as promising options for the surgical treatment of acute Achilles tendon ruptures, aiming to reduce complication rates associated with open procedures. However, comparative data between different minimally invasive methods are limited.</p><p><strong>Methods: </strong>In this retrospective case series, we evaluated 102 patients treated with either the Dresden or PARS/Knotless technique between January 2017 and June 2021. Clinical outcomes included time to return to sports, ankle range of motion, Achilles Tendon Total Rupture Score (ATRS), and postoperative complications. Postoperative complications were also documented.</p><p><strong>Results: </strong>Both groups demonstrated similar rates of return to sports (91.48% PARS/Knotless vs 92.70% Dresden) and comparable ATRS scores (91.1 ± 6.7 vs 92.3 ± 8.9, <i>P</i> = .47). Surgical time was significantly shorter with the Dresden technique (38.3 ± 8.5 vs 43.5 ± 8.9 minutes, <i>P</i> = .005). The overall complication rate was significantly lower in the Dresden group (10.90% vs 29.78%, <i>P</i> = .024), primarily because of lower rates of calcaneodynia.</p><p><strong>Conclusion: </strong>Although both techniques demonstrated similar functional outcomes, the Dresden procedure was associated with a lower complication rate.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"951-957"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487496","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":"Long-Term Outcomes Following EHL Jones Tenosuspension With or Without Peroneus Longus to Brevis Transfer for First Metatarsal Head Ulcers in Patients With Diabetes.","authors":"S Raja Sabapathy, Madhu Periasamy, Vamseedharan Muthukumar, S J Karthikeyan, Sriram Khanna","doi":"10.1177/10711007251346442","DOIUrl":"10.1177/10711007251346442","url":null,"abstract":"<p><strong>Background: </strong>Forefoot ulcers, particularly those beneath the first metatarsal head (MTH), are a common and serious complication in patients with diabetes. These ulcers typically result from elevated plantar pressures and loss of protective sensation due to peripheral neuropathy. We conducted this study to evaluate long-term outcomes following EHL Jones tenosuspension, with or without peroneus longus to brevis tendon transfer, in promoting healing of first metatarsal head ulcers in patients with diabetes.</p><p><strong>Methods: </strong>The retrospective study of 45 patients with diabetes and a plantar first metatarsal head ulcer who underwent extensor hallucis longus (EHL) Jones tenosuspension with or without a concomitant peroneus longus to brevis tendon transfer during the study period. They were divided into 2 groups: group 1 included those who had undergone a modified EHL Jones transfer with peroneus longus to brevis tendon transfer; and group 2, who had undergone a modified EHL Jones transfer only. We studied the long-term wound healing rates from patient records and then did a prospective survey of the post-review period.</p><p><strong>Results: </strong>In group 1, the mean time for the ulcers to heal was 5.3 weeks, and in group 2, it was 6.2 weeks. One ulcer failed to heal in group 1, and 2 in group 2. In group 1, 1 patient had a recurrence of the first metatarsal head ulcer, while 3 had transfer lesions under the lesser metatarsal heads. In group 2, 1 patient reported a recurrence at the first metatarsal head region and subsequently underwent a peroneus longus to brevis transfer.</p><p><strong>Conclusion: </strong>We observed high recurrence-free healing rates (approaching 95% at 30 months) following EHL Jones tenosuspension with or without peroneus longus to brevis transfer in patients with diabetes and plantar first metatarsal head ulcers. Although findings are encouraging, the absence of a formal comparator group and the small number of patients treated with the single procedure limit definitive conclusions regarding comparative effectiveness.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"960-967"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499923","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":"Risk Factors for Postoperative Infection and Associated Outcomes After Pilon Fracture Fixation: A Propensity-Matched Cohort Study.","authors":"Crystal Jing, Julia E Ralph, Kathleen Chang, Joshua Helmkamp, Alexandra Krez, Albert T Anastasio, Kevin A Wu, Jackson Cathey, Anna Bryniarski, Jacob Torrey, Samuel B Adams","doi":"10.1177/10711007251344250","DOIUrl":"10.1177/10711007251344250","url":null,"abstract":"<p><strong>Background: </strong>Pilon fractures are complex, often involving severe comminution and soft tissue compromise. Risk factors for infection after ankle fracture definitive fixation have been associated with open and/or comminuted fractures and poorly managed diabetes. However, infection risk following pilon fractures have not been well studied, and the effect of infection on other postoperative outcomes have not been widely discussed. This study aims to identify risk factors for developing infection following pilon fracture and assess the effect of infection on postoperative outcomes.</p><p><strong>Methods: </strong>This study was a retrospective review of patients who presented with a pilon fracture and underwent surgical fixation between January 1, 2013, and June 1, 2023. Only patients with at least 6-month follow-up were included. Demographic data and clinical data were collected. A 2:1 propensity score matching was completed to identify infection and no-infection cohorts.</p><p><strong>Results: </strong>There were 146 patients included in this study. Following propensity score matching, 2 cohorts were identified, including 24 patients with no infection and 14 patients with infection, following pilon fracture. Gustilo-Anderson classification and AO-Orthopaedic Trauma Association (AO-OTA) Classification did not differ significantly between groups (<i>P</i> > .05). Perioperative characteristics were similar between the 2 cohorts. Mean time to partial weightbearing in weeks was 12.51 (SD 7.6) for the no-infection cohort and 29.61 (SD 28.3) for infection cohort (<i>P</i> = .0198). Mean time to full weightbearing in weeks was 21.06 (SD 9.7) for the no-infection cohort and 35.90 (SD 31.7) for the infection cohort (<i>P</i> = .142). In the infection cohort 50.0% (n = 7) of patients experienced nonunion compared with 4.2% (n = 1) in the no-infection cohort (<i>P</i> < .01).</p><p><strong>Conclusion: </strong>Although fracture severity classification was not significantly different between groups, infection significantly negatively affected time to partial weightbearing, time to full weightbearing, and nonunion rates.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"1049-1058"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531951","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":"Immediate Postoperative Weightbearing Following Arthroscopic Bone Marrow Stimulation for Talar Osteochondral Lesions: A Matched Cohort Study.","authors":"Tristan M F Buck, Jari Dahmen, Quinten G H Rikken, Julian J Hollander, Sjoerd A S Stufkens, Gino M M J Kerkhoffs","doi":"10.1177/10711007251348196","DOIUrl":"10.1177/10711007251348196","url":null,"abstract":"<p><strong>Background: </strong>Bone marrow stimulation (BMS) is the most frequently performed surgical procedure for osteochondral lesions of the talus (OLTs). After the surgical intervention, one of the first goals of rehabilitation is to resume weightbearing. This study aims to compare clinical and radiologic outcomes between immediate weightbearing and delayed weightbearing, which represent unrestricted weightbearing and weightbearing starting at 6 weeks postoperatively.</p><p><strong>Methods: </strong>All patients who underwent BMS for their OLT between July 2019 and September 2022 in our clinic were screened for eligibility. Patients were retrospectively included with prospective collected data and were matched into 2 groups, the immediate weightbearing group or the delayed weightbearing group. The following variables were used for matching: age, gender, side, lesion size (volume and surface measured on CT scans), primary or nonprimary lesion, body mass index (BMI) and the numeric rating scale (NRS) of pain during walking. The primary outcome of this study is the comparison of the change in NRS of pain during walking between baseline and 12 months postoperatively, between both groups. Secondary outcomes consist of change in the NRS of pain during running, NRS pain during stairclimbing, NRS pain during rest, 36-Item Short Form Health Survey, Foot and Ankle Outcome Score, return to work, return to sport, and radiologic outcomes between both groups at 12 months.</p><p><strong>Results: </strong>After matching, 13 patients per group were included. Both groups showed improvement in NRS pain during walking from baseline to 12 months postoperatively. The difference in change scores between immediate and delayed weightbearing was not statistically significant (<i>P</i> = .57, 95% CI -3.25 to 1.86). A higher proportion of patients in the immediate weightbearing group exceeded the minimal clinically important difference threshold of 2 points compared with the delayed group (OR = 1.9, 95% CI 0.30-11.7), although this was not statistically significant. No significant between-group differences were observed in secondary clinical or radiologic outcomes, nor in return-to-work or return-to-sport rates.</p><p><strong>Conclusion: </strong>This matched cohort study found no statistically significant difference in clinical or radiologic outcomes at 12 months between immediate and delayed weightbearing following arthroscopic BMS for talar osteochondral lesions. Although early weightbearing may be feasible and well tolerated, the small sample size and wide CIs limit the strength of conclusions. These findings should be considered hypothesis-generating and underscore the need for larger, prospective trials.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"943-950"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602613","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}

{"title":"Early Functional Outcomes After Single-Stage Achilles Tendon Reconstruction Using Free Anterolateral Thigh Flap With Tubularized Fascia Lata.","authors":"Sami Ferdousian, Isabel A Snee, Rachel N Rohrich, Ryan P Lin, Karen R Li, Meghan E Currin, Jess Lee, Christopher E Attinger, Richard C Youn, Karen K Evans","doi":"10.1177/10711007251343556","DOIUrl":"10.1177/10711007251343556","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendon injury with extensive soft tissue loss presents challenges to lower extremity (LE) reconstruction with functionally favorable results. The use of a free anterolateral thigh (ALT) flap incorporating a tubularized fascia lata (FL) segment offers a reconstructive option for these complex cases. This study evaluates the early outcomes of microsurgical reconstruction for Achilles tendon and soft tissue defects.</p><p><strong>Methods: </strong>A retrospective review of patients requiring LE free tissue transfer (FTT) between 2012 and 2023 was performed. All patients included had Achilles tendon defects and underwent reconstruction using an ALT flap with tubularized FL. Demographics, comorbid conditions, baseline functionality, reconstructive details, and wound characteristics were collected. Primary outcomes were flap success, return to functional ambulation, and complication rate.</p><p><strong>Results: </strong>Twenty-two patients underwent single-stage FTT for both soft tissue coverage and Achilles tendon reconstruction. The average age was 46.9 ± 16.1 years, with a median Charlson Comorbidity Index of 0 (IQR: 2). Average wound size was 80.6 ± 40.1 cm². All patients (n = 22, 100.0%) were ambulatory preoperatively. Flap success rate was 95.5% (n = 21). Twelve patients (55%) had long-term physical therapy follow-up. At a median of 7.6 months (IQR: 5.2), median ankle active range of motion (AROM) was 15 degrees (IQR: 7) for dorsiflexion (DF) and 43.5 degrees (IQR: 10) for plantarflexion (PF). Eleven (50%) patients had normal DF AROM (91.7%), and 9 (81.8%) patients had normal PF AROM. At a median of 2.3 months (IQR: 2.8), all 22 patients (100.0%) returned to full weightbearing and ambulation. Median follow-up time was 6.9 months (IQR: 16.5). These findings reflect early functional outcomes, with a median follow-up period of less than 1 year.</p><p><strong>Conclusion: </strong>The ALT free flap with an attached FL is a functional reconstructive technique for Achilles tendon injury in the setting of large soft tissue defects. The composite free flap provides consistent operative success with robust early patient return to ambulation and weightbearing. Further evaluation into patient-reported outcomes can provide additional understanding of functionality.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"977-986"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639065","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":"Comparative Effectiveness of Platelet-Rich Plasma and Steroid Injections in Chronic Plantar Fasciitis: Evaluating Pain Relief and Functional Recovery.","authors":"Ömer Faruk Bucak, Eser Kalaoglu, Mucahit Atasoy, Evrim Coskun","doi":"10.1177/10711007251346784","DOIUrl":"10.1177/10711007251346784","url":null,"abstract":"<p><strong>Background: </strong>Chronic plantar fasciitis (CPF) is a prevalent cause of heel pain, often refractory to conservative treatments. Corticosteroid injections (CSIs) are frequently used for symptom relief but may provide only transient benefits and are associated with potential adverse effects. Platelet-rich plasma (PRP) has gained attention as an alternative because of its regenerative properties. This study compares the effectiveness of PRP injections (n = 75) and CSI (n = 77) in reducing pain and improving function over six months in patients with CPF.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 152 patients diagnosed with CPF who received ultrasound-guided injection therapy at a tertiary university hospital between September 2021 and September 2024. Patients were divided into CSI (n = 77) and PRP injection (n = 75). Pain intensity was measured using the visual analog scale (VAS), and functional status was assessed with the Foot Function Index (FFI). Evaluations were performed at baseline and 1, 3, and 6 months postinjection.</p><p><strong>Results: </strong>At baseline, VAS (<i>P</i> = .449) and FFI (<i>P</i> = .462) scores were comparable between groups. At 1 month, no significant differences were found for VAS (<i>P</i> = .368) and FFI (<i>P</i> = .392). At 3 months, VAS (<i>P</i> = .586) and FFI (<i>P</i> = .578) scores remained similar. At 6 months, PRP showed significantly lower VAS scores (1.98 ± 0.35) compared with corticosteroids (2.79 ± 1.13; <i>P</i> < .001); however, the difference did not exceed the MCID threshold (0.9 cm), suggesting limited clinical significance. Conversely, FFI scores improved more in the PRP group (22.3 ± 4.1) than in the corticosteroid group (29.8 ± 5.5; <i>P</i> < .001), exceeding the MCID threshold (7 points), confirming clinical relevance.</p><p><strong>Conclusion: </strong>PRP injections were associated with superior 6-month functional improvement over corticosteroids in CPF, with statistically significant gains that met the MCID threshold. Although both treatments were effective in the short term, only functional improvements reached clinical significance. These findings support PRP's role in providing a modest functional advantage and highlight the need for future trials to optimize injection protocols and assess long-term outcomes.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"987-995"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531949","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":"Flexor Tendon Injury Risk With Percutaneous Intramedullary Screw Fixation for Lesser Metatarsal Fractures: A Cadaveric Study.","authors":"James D Baker, Joseph S Burke, Jantz Arbon, Arsh Patel, Kelly Hynes, Jeannie Huh","doi":"10.1177/10711007251351300","DOIUrl":"10.1177/10711007251351300","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous intramedullary screws have recently become a fixation option for the surgical management of lesser metatarsal fractures. Their advantages over Kirschner (K)-wire fixation include avoidance of pin site complications, fixation stability, and need for removal. To date, there has been limited literature published on their use and safety profile. The purpose of this study is to determine the frequency and extent of flexor tendon disruption associated with percutaneous intramedullary screw fixation for lesser metatarsal fractures.</p><p><strong>Methods: </strong>Seven left and right lower extremity cadaver specimens were procured. A cannulated 3.6-mm screw was placed percutaneously in the second through fifth metatarsals (MTs) in a retrograde fashion. The plantar surface of each specimen was then exposed to visualize the flexor tendons. The tendon location relative to the drill hole, incidence of tendon disruption, percentage of tendon disruption, and the distance between the tendon and the drill hole were measured.</p><p><strong>Results: </strong>Overall, 21 of 56 (37.5%) flexor tendons were damaged, 5 (35.7%) in the second MT, 7 (50%) in the third MT, 9 (64.3%) in the fourth MT, and 0 (0%) in the fifth MT. The percentage of tendon disruption for each metatarsal was 15%, 11%, 11%, and 0%, respectively. The mean distance from uninjured tendons to the drill hole was 1.07 mm, 0.94 mm, 0.9 mm, and 2.03 mm, respectively. Across all metatarsals, the majority of flexor tendons were located medial to the drill hole, with the greatest clearance seen in the fifth metatarsal.</p><p><strong>Conclusion: </strong>Percutaneous insertion of intramedullary screws for lesser metatarsal fixation resulted in a 37.5% rate of flexor tendon injury, primarily affecting the fourth metatarsal. Although these disruptions involved 10% to 20% of tendon width, their clinical impact remains uncertain. Adjusting the starting point to a slightly more lateral position, if possible, may minimize the risk of flexor tendon injury. Future studies should assess functional outcomes, plantar plate involvement, and biomechanical consequences of partial tendon injury.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"996-1002"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602612","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}