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Foot and Ankle Surgery: Current Advances and Prospects

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 July 2026 | Viewed by 8568

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Prof. Dr. Jaeho Cho

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Guest Editor

Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon 24253, Republic of Korea
Interests: foot and ankle surgery; foot pathologies; ankle disease, trauma; diabetic foot; epidemiology; clinical anatomy; foot orthoses; weight-bearing CT
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Special Issue Information

Dear Colleagues,

Foot and ankle surgery is a cornerstone of modern orthopedic and podiatric practice, addressing a wide spectrum of conditions ranging from trauma to chronic diseases. The complex anatomy and biomechanics of the foot and ankle, coupled with their critical role in mobility and weight bearing, make this field both challenging and essential. Over recent decades, there has been a remarkable evolution in our understanding of foot pathologies, ankle diseases, and their underlying clinical anatomy, driving significant advancements in treatment strategies.

This Special Issue, “Foot and Ankle Surgery: Current Advances and Prospects,” seeks to highlight the latest research and innovations shaping the field. It emphasizes not only the surgical management of trauma and deformities but also emerging non-invasive approaches, such as foot orthoses and advanced imaging techniques like weight-bearing CT. Special attention is given to multidisciplinary efforts targeting complex issues such as diabetic foot, where surgical precision, preventive strategies, and public health initiatives converge to improve patient outcomes.

The scope of this Special Issue includes the following:

Surgical and non-surgical interventions for foot and ankle trauma and pathologies.
Advances in imaging modalities, including weight-bearing CT, to refine diagnosis and treatment planning.
Epidemiological studies exploring the prevalence, risk factors, and prevention of foot and ankle diseases.
The role of foot orthoses and rehabilitation in managing biomechanical dysfunctions.
Innovations in the treatment of diabetic foot complications and associated infections.
Clinical anatomy insights driving improved surgical techniques and outcomes.

Through original research and reviews, this Special Issue aims to provide a comprehensive perspective on the evolving field of foot and ankle surgery. By integrating epidemiology, clinical anatomy, and technological advancements, this collection of articles will serve as a valuable resource for clinicians, researchers, and public health experts.

We invite contributions that explore these topics, with the shared goal of advancing the field and improving care for patients with foot and ankle disorders worldwide.

Prof. Dr. Jaeho Cho
Guest Editor

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Keywords

foot and ankle surgery
foot pathologies
ankle disease and trauma
diabetic foot
epidemiology
clinical anatomy
foot orthoses
weight-bearing CT

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Published Papers (7 papers)

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Research

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13 pages, 470 KB

Open AccessArticle

Biomechanical and Viscoelastic Properties of the Ankle Muscles in Relation to Muscle Force in Patients with Operated Tibial Pilon Fractures

by Andrei-Daniel Bolovan, Roxana-Ramona Onofrei, Gheorghe-Bogdan Hogea, Ahmed Abu-Awwad, Jenel-Marian Patrascu, Jr., Alexandra-Roxana Tapardea, Alexandru-Florian Crisan and Elena-Constanta Amaricai

J. Clin. Med. 2026, 15(8), 2934; https://doi.org/10.3390/jcm15082934 - 12 Apr 2026

Viewed by 279

Abstract

Background: Tibial pilon fractures are complex injuries frequently associated with persistent functional impairment, even after successful surgical fixation. While previous studies have reported deficits in muscle strength and balance, little is known about the side-to-side variations in intrinsic biomechanical and viscoelastic muscle properties following surgery. Objectives: This study aimed to compare the biomechanical and viscoelastic properties of ankle periarticular muscles between the affected and non-affected limbs in patients with surgically treated unilateral tibial pilon fractures. A secondary objective was to evaluate the relationship between intrinsic muscle properties and isometric muscle force. Methods: A total of 39 subjects with unilateral surgically treated tibial pilon fractures were evaluated after fracture healing. Myotonometric assessment was performed to evaluate muscle mechanical parameters, including tone (frequency), stiffness, and elasticity (decrement), as well as viscoelastic properties, including relaxation time and creep, in the tibialis anterior, peroneus longus, medial gastrocnemius, and lateral gastrocnemius muscles. Isometric muscle force of ankle dorsiflexors and plantar flexors was measured using a handheld dynamometer. Side-to-side comparisons and Pearson correlation analyses were performed. Results: The affected limb showed significantly reduced ankle range of motion in all planes and significantly lower isometric muscle force in both the dorsiflexors (p = 0.0002) and the plantar flexors (p = 0.0066). Stiffness was significantly higher in the medial (p = 0.038) and lateral gastrocnemius (p = 0.045) muscles on the affected side. Decrement was significantly increased (indicating reduced elasticity) in the peroneus longus (p = 0.021). No significant differences were observed for tone, relaxation time, or creep. Conclusions: Myotonometry revealed increased stiffness in the gastrocnemius muscles and reduced elasticity in the peroneus longus on the operated side compared with the non-affected limb. Tone and viscoelastic properties did not differ significantly between sides. However, tone, stiffness, and elasticity were significantly correlated with muscle force, indicating a relationship between intrinsic muscle mechanical properties and force production after tibial pilon fracture surgery. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Current Advances and Prospects)

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15 pages, 1806 KB

Open AccessArticle

Radiographic and Demographic Factors Associated with Syndesmotic Screw Breakage in Ankle Fractures

by Emre Kocazeybek, Mehmet Ekinci, Salih Magi, Murat Altunsoy, Kubilay Yolaçan, Murat Yılmaz and Mehmet Ersin

J. Clin. Med. 2026, 15(7), 2647; https://doi.org/10.3390/jcm15072647 - 31 Mar 2026

Viewed by 309

Abstract

Background: Syndesmotic screw breakage is a well-recognized mechanical complication following ankle fracture fixation. Although several studies have investigated patient-related and technical factors associated with screw breakage, the temporal pattern of screw failure and implant survival remains less clearly defined. Therefore, this study aimed to evaluate one-year syndesmotic screw survival using time-to-event analysis and to identify factors associated with screw breakage. Materials and Methods: A total of 132 patients with unstable AO-Weber 44-B/C ankle fractures treated with syndesmotic screw fixation were retrospectively analyzed. Patients were followed for a minimum of 12 months or until screw breakage occurred. Screw survival was evaluated using Kaplan–Meier analysis and Cox proportional hazards regression was performed to identify factors associated with screw breakage. Demographic variables, fracture type, and screw-related parameters were analyzed. Receiver operating characteristic (ROC) analysis was used to assess the discriminative ability of age. Results: Screw breakage occurred in 31 patients (23.5%) during follow-up. Kaplan–Meier analysis demonstrated significantly lower screw survival in Weber C fractures compared with Weber B fractures (log-rank p < 0.001). Cox regression analysis identified younger age (HR: 0.965, 95% CI: 0.937–0.993, p = 0.016) and Weber C fracture type (HR: 1.811, 95% CI: 1.260–2.602, p = 0.001) as independent predictors of screw breakage. ROC analysis showed that age had moderate discriminative ability (AUC: 0.719, 95% CI: 0.612–0.816), with a cut-off value of 35.5 years. Conclusions: Younger age and Weber C fracture type are associated with an increased risk of syndesmotic screw breakage and Weber C fractures also demonstrating reduced screw survival. These findings may assist in patient counseling; however, the clinical implications of screw breakage remain uncertain. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Current Advances and Prospects)

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10 pages, 1536 KB

Open AccessArticle

Effect of Surgical Procedures for Rheumatoid Forefoot Deformities on Radiographic Foot Length and Width Variations

by Masahiro Horita, Yohei Kiso, Yoshihisa Nasu, Ryuichi Nakahara, Kenta Saiga, Toshifumi Ozaki and Keiichiro Nishida

J. Clin. Med. 2026, 15(5), 1877; https://doi.org/10.3390/jcm15051877 - 28 Feb 2026

Viewed by 309

Abstract

Background: The number of patients with rheumatoid arthritis (RA) undergoing forefoot arthroplasty has increased to better control the disease. Despite patients frequently expressing concerns regarding postoperative foot appearance and footwear-related expectations, no study has investigated postoperative changes in foot length and width in patients with RA. The aim of this study was to evaluate the effect of surgical procedures for rheumatoid forefoot deformities on variations in radiologically determined foot length and width. Methods: In total, 72 feet of 50 women and 3 men (average age: 66.7 years) underwent joint-preserving arthroplasty (n = 33) and arthrodesis of the first metatarsophalangeal joint with shortening osteotomy of the lesser metatarsals or resection arthroplasty of the lesser metatarsal heads (n = 39); procedures were carried out in our institute from August 2013 to February 2020. The mean disease duration was 23.5 years, and the average follow-up period was 17.5 months. Pre- and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA) of the first and second metatarsals (M1M2A), and IMA of the first and fifth metatarsals (M1M5A) were measured on weightbearing radiographs as well as foot length and width. We also evaluated the correlation between changes in radiographic parameters and variations in radiologically determined foot length and width. Results: Radiologically determined foot width changed significantly from 10.1 cm to 9.7 cm (p < 0.01), while no significant difference was found between pre- and postoperative radiologically determined foot length. HVA, M1M2A, and M1M5A were significantly improved after the surgery (p < 0.01, p < 0.01, and p < 0.01, respectively). A significant negative correlation was found between the variation in radiologically determined foot length and changes in HVA (r = −0.29, p = 0.02) and M1M5A (r = −0.23, p < 0.05), while a significant positive correlation was found between the variation in the foot width and changes in HVA (r = 0.34, p < 0.01), M1M2A (r = 0.55, p < 0.01), and M1M5A (r = 0.45, p < 0.01). There were no significant differences between operative procedures regarding variation in radiologically determined foot length and width. Conclusions: Surgical procedure for rheumatoid forefoot deformity improved radiographic parameters and reduced radiographic foot width while maintaining foot length. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Current Advances and Prospects)

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22 pages, 46566 KB

Open AccessFeature PaperArticle

The Impact of Spring Ligament Injuries on Flatfoot Deformity: An Exploratory Study of Morphological and Radiographic Changes in 198 Patients

by Roxa Ruiz, Roman Susdorf and Beat Hintermann

J. Clin. Med. 2025, 14(14), 5109; https://doi.org/10.3390/jcm14145109 - 18 Jul 2025

Cited by 2 | Viewed by 1406

Abstract

Background: Spring ligament (SL) injuries are primarily associated with progressive collapsing flatfoot deformity, but can also occur due to trauma. It remains unclear whether the morphological changes following trauma differ from those caused by chronic overload. The aim of this study was (1) to analyze whether a relationship exists between the injury pattern and foot deformity and (2) to evaluate whether there is a distinction between trauma-related and non-trauma-related injuries. Method: We prospectively enrolled 198 patients with a median age of 57 years (range, 13 to 86 years; female, 127 (64%); male, 71 (36%)) who had a clinically diagnosed, surgically confirmed, and classified SL injury. We used weight-bearing standard X-rays to assess foot deformity. The control group consisted of 30 patients (median age 51 years, range, 44–66; female, 21 (70.0%); male, 9 (30.0%)) with no foot deformities or prior foot surgeries. Results: A 41.9% incidence of trauma was identified as the cause of these injuries, accounting for 16 (20.8%) of isolated injuries to the SL, 30 (42.9%) of SL injury accompanied by a posterior tibial (PT) tendon avulsion, and 37 (72.5%) of SL injury alongside a bony avulsion at the navicular injuries. The odds of being post-traumatic decreased with each year of age by a factor of 0.97 (95% CI: 0.95–0.99). Conclusions: While all radiographic measurements for flatfoot deformity became pathological after an injury to the SL, they did not accurately predict the injury patterns of the SL and distal PT tendon. Generally, post-traumatic cases exhibited lower severity of foot deformity, suggesting that other structures beyond the SL may contribute to the development of flatfoot deformity. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Current Advances and Prospects)

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14 pages, 3733 KB

Open AccessArticle

Weightbearing Computed Tomography (WBCT) Analysis of Subtalar Joint Dynamics in Hindfoot Valgus Malalignment

by Otgonsaikhan Nomkhondorj, Dong-Il Chun, Kwang-Rak Park and Jaeho Cho

J. Clin. Med. 2025, 14(8), 2587; https://doi.org/10.3390/jcm14082587 - 9 Apr 2025

Cited by 1 | Viewed by 1624

Abstract

Background/Objectives: Hindfoot valgus malalignment, characterized by the lateral deviation of the calcaneus and medial tilting of the talus, disrupts hindfoot biomechanics and increases strain on subtalar joint. This study evaluates weightbearing and non-weightbearing imaging modalities to identify dynamic alignment changes and their diagnostic implications. This study aims to (1) quantify changes in subtalar joint parameters between non-weightbearing computed tomography (NWBCT) and weightbearing computed tomography (WBCT) in patients with hindfoot valgus; (2) evaluate correlations between WBCT and standard radiographic parameters; and (3) identify radiographic predictors of subtalar joint status during weightbearing. Methods: We reviewed 70 patients with confirmed hindfoot valgus malalignment (hindfoot valgus angle >5°), identified through radiographic measurements. Of these, 32 underwent both NWBCT and WBCT, while 38 underwent WBCT alone. Hindfoot alignment angle (HAA) and hindfoot alignment ratio (HAR) were measured on hindfoot alignment radiographs, while heel valgus angle (HVA), talocalcaneal distance (TCD), subtalar joint subluxation (SL) and calcaneofibular distance (CF) were assessed on CT. Results: WBCT revealed significant increases in HVA and SL (both, p < 0.001) and decreases in TCD and CF (p < 0.001 and p = 0.002, respectively) compared to NWBCT, reflecting dynamic subtalar joint changes under weightbearing conditions. Receiver operating characteristic (ROC) analysis identified hindfoot alignment angle (HAA) as the most reliable predictor of talocalcaneal osseous contact, with a cutoff value of >9.25° based on Youden’s index, yielding a sensitivity of 73% and specificity of 81.8%. Inter- and intra-observer reliabilities for all parameters were excellent (ICC > 0.81). Conclusions: WBCT provides critical insights into subtalar joint dynamics under physiological loads, surpassing NWBCT in assessing weightbearing-induced alignment changes. Although standard radiographic parameters, particularly HAA, can serve as reliable, cost-effective predictors of subtalar joint pathology in resource-limited settings, WBCT should still be preferred when available, especially in patients with significant malalignment or when detailed dynamic evaluation is needed to guide clinical decision-making. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Current Advances and Prospects)

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Review

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15 pages, 21531 KB

Open AccessReview

Avoiding Hallux Sesamoidectomy: A Narrative Review

by Kenichiro Nakajima

J. Clin. Med. 2025, 14(21), 7687; https://doi.org/10.3390/jcm14217687 - 29 Oct 2025

Viewed by 2079

Abstract

Hallux sesamoid pain arises from various pathological conditions, such as fracture nonunion, painful plantar keratosis, sesamoiditis, and avascular necrosis. Traditionally, sesamoidectomy is the primary surgical approach for these conditions, but its outcomes are inconsistent. In recent years, extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP) have gained popularity as effective conservative treatments in orthopedic practice. This review explored treatment approaches that avoid sesamoidectomy. First, we examined studies on ESWT and PRP for hallux sesamoid pathologies. We also reviewed research on ESWT and PRP for other foot conditions with similar characteristics to evaluate whether these treatments could be applicable to different types of sesamoid pathologies. Finally, we discussed surgical alternatives to sesamoidectomy and introduced several novel techniques. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Current Advances and Prospects)

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Other

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13 pages, 1490 KB

Open AccessSystematic Review

Prevalence of the Os Supranaviculare: A Systematic Review with Meta-Analysis

by Maksymilian Osiowski, Aleksander Osiowski, Maciej Preinl, Grzegorz Fibiger, Katarzyna Majka, Barbara Jasiewicz and Dominik Taterra

J. Clin. Med. 2025, 14(17), 5934; https://doi.org/10.3390/jcm14175934 - 22 Aug 2025

Viewed by 1696

Abstract

Background/Objectives: The os supranaviculare (OSSN), also known as os talonaviculare dorsale, astragalo-scaphoid ossicle, or Pirie’s bone, is a small extra bone that was first described in 1921 by A.H. Pirie and is located at the top front part of the navicular bone or talonavicular joint. The knowledge regarding the epidemiology of the OSSN is scarcely established, as its prevalence remains unknown and varies significantly among multiple studies. This meta-analysis aims to clarify and systematically summarize all available data on the characteristics and prevalence of the OSSN. Methods: Four major databases (PubMed/Medline, Embase, ScienceDirect, Scopus) were thoroughly searched for studies reporting original data regarding the OSSN up until May 2025. The protocol of this study was pre-registered on PROSPERO (ID: CRD42025638111) and adhered to PRISMA guidelines. To evaluate the between-study heterogeneity, the 95% prediction intervals (95%PI) were calculated; I² statistic and Chi² test were also used. The AQUA-tool was used to assess the quality of included studies. Results: In total, 13 studies (18,745 feet) qualified for inclusion in the quantitative analysis. The pooled prevalence estimate (PPE) of the OSSN in the general population was found to be 0.88% (95%CI: 0.62–1.24%). The PPE of the OSSN was higher in males (0.87%, 95%CI: 0.58–1.32%) than in females (0.48%, 95%CI: 0.14–1.64%). The os supranaviculare was similarly prevalent in both European (1.04%, 95%CI: 0.55–1.96%) and Asian (0.87%, 95%CI: 0.66–1.13%) populations. Conclusions: the os supranaviculare is a very rare anatomical variation that is present in less than one in a hundred feet. Moreover, although usually asymptomatic, it can occasionally be associated with dorsal foot pain or navicular stress fractures. Accurate differentiation from avulsion fractures is essential to avoid unnecessary invasive treatment. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Current Advances and Prospects)

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