Search Results (313)

Background/Objectives: Foot and ankle presentations during Hajj occur in a dense mass-gathering environment where prolonged walking, heat exposure, crowding, variable footwear, and limited self-care can interact with chronic disease and wound vulnerability. Previous Hajj studies have described foot injuries and diabetes-related complications, but less is known about whether simple high-risk foot documentation flags identify presentation records with higher care-pathway intensity. The primary objective was to estimate the presentation-level burden of core high-risk foot profiles among pilgrims presenting with foot and ankle conditions during Hajj 2025. Secondary objectives were to evaluate associations with a surgery-coded care-intensity indicator, hospital referral, and component heterogeneity. Methods: This observational presentation-level analysis included 3957 foot and ankle presentation records. The unit of analysis was the presentation/case record, not a unique individual pilgrim. A core high-risk foot profile was defined as diabetes, neuropathy, diabetic foot ulcer, foot ulcer, complications of open wound, or osteomyelitis. The primary outcome was a surgery-coded care-intensity indicator, defined solely from treatment documentation containing “Surgery” and interpreted as a care-pathway proxy rather than confirmed operating-room surgery. Logistic regression estimated crude and adjusted odds ratios (ORs); exploratory risk-category analyses assessed heterogeneity within the composite profile. Results: Core high-risk foot profiles were identified in 1793/3957 presentations (45.3%). The primary outcome occurred in 239/1793 high-risk presentations (13.3%) and 201/2164 non-high-risk presentations (9.3%), an absolute difference of 4.0 percentage points. The crude OR was 1.50 (95% CI 1.23–1.83; p < 0.001). The association persisted in the primary adjusted model (adjusted OR 1.47; 95% CI 1.20–1.79; p < 0.001) and in the extended clinical sensitivity model (adjusted OR 1.47; 95% CI 1.20–1.80; p < 0.001). Care pathways and secondary outcomes are summarized was also more frequent in high-risk presentations (12.2% vs. 9.8%; crude OR 1.28; 95% CI 1.05–1.57; p = 0.017). Exploratory category analysis showed that chronic-risk-only presentations had a primary outcome rate similar to non-high-risk presentations (9.0% vs. 9.3%), whereas ulcer/wound/deep-infection presentations had a higher rate (17.3%; crude OR 2.04; 95% CI 1.63–2.55; p < 0.001). Model discrimination was modest (C-statistics 0.55–0.64). Conclusions: Core high-risk foot flags were common among Hajj foot and ankle presentation records and were associated with surgery-coded care-intensity and referral documentation. However, the composite was clinically heterogeneous, the outcome was not a validated surgery endpoint, and the models were not prediction tools. These findings support cautious use of high-risk foot flags as operational prompts for assessment and pathway planning rather than as standalone clinical risk estimates. Full article

Introduction: Plantar fasciitis is a common cause of heel pain in adults, with a significant impact on quality of life and athletic performance. While conservative treatments are effective in most cases, a subset of patients remains symptomatic and may require surgical intervention. Minimally invasive techniques, such as bipolar radiofrequency (RF) coblation using the TOPAZ system, have emerged as promising alternatives to traditional open or endoscopic procedures. Methods: This retrospective study evaluated the clinical outcomes of 49 consecutive patients (20 males and 29 females; mean age 54.3 ± 11.4 years; mean BMI 25.3 ± 3.2, range 21.5–34.7) with chronic plantar fasciitis unresponsive to at least six months of conservative treatment. The affected side was left in 24 patients and right in 25, and 35 patients were regularly engaged in sports prior to symptom onset. All patients underwent percutaneous bipolar RF coblation using the TOPAZ device between July 2019 and November 2024. Patient-reported outcome measures—including the Visual Analog Scale (VAS), AOFAS Ankle–Hindfoot Score, SF-36, and Tegner Activity Scale—were collected at the final follow-up (mean 41.7 ± 18.3 months, range 6–71). Results: Statistically significant improvements were observed in pain and function: mean VAS decreased from 8.5 to 3.1 (p < 0.001), and American Orthopaedic Foot and Ankle Society (AOFAS) pain and function scores improved from 2.5 and 12.75 to 28.75 and 38.75, respectively (p < 0.001). The mean Tegner score increased from 1.3 to 4.1 (p < 0.001), with 100% of previously active patients returning to sport. No major complications or reoperations were reported. Conclusions: Percutaneous bipolar RF coblation appears to be a safe and effective treatment for recalcitrant plantar fasciitis, offering significant pain relief, functional improvement, and a high return-to-sport rate with minimal morbidity. This technique may represent a valuable intermediate option between conservative care and open surgery. Full article

Background/Objectives: Postgraduate training is an essential component for the development of professional skills in health sciences. Our research question was: How does the implementation of structured residency and fellowship programs in podiatry and foot and ankle surgery impact the acquisition of clinical and surgical skills, academic productivity, interprofessional integration, leadership development, and resident well-being compared to less structured or traditional programs? Methods: We conducted a systematic review of published research, between September and November 2025, selecting observational studies that evaluated structured training programs compared to traditional approaches. The studies included reported residency or fellowship programs in podiatry and foot and ankle surgery that described clinical, surgical or academic experiences, together with the factors that influence learning variability. Results: Eleven cross-sectional studies were included. Program structure, mentorship, clinical exposure, availability of educational resources, and individual motivation are determining factors in the variability of skills acquisition. Structured programs were associated with better academic and clinical performance, greater technical confidence, and professional leadership development. However, substantial heterogeneity was observed among programs, particularly regarding access to resources, which contributed to differences in the ultimate preparation of residents and fellows. The Newcastle–Ottawa Scale adapted assessed methodological quality, showing a low-to-moderate risk of bias. Conclusions: The literature suggests that although the programs generally achieve basic training objectives, the standardization and implementation of structured educational strategies could optimize skills acquisition and reduce variability across programs. Furthermore, multicenter research incorporating objective outcome measures would facilitate the development of internationally applicable standards for evaluation in health education. Full article

Background/Objectives: The increasing prevalence of foot and ankle procedures in the United States has coincided with rising costs of care, exposing socioeconomic disparities within this area of orthopedics. Insurance payor status is one such factor that can affect the quality and accessibility of medical care and has been implicated in orthopaedic patient outcomes. While previous studies in other fields of orthopaedics have demonstrated an association between insurance status and access to treatment, length of hospital stay, post-operative outcomes and complication rates, no comprehensive review has yet explored this relationship in foot and ankle surgery. Thus, the goal of this study is to examine the association between insurance payor status and outcomes in foot and ankle procedures. Methods: A systematic review of five databases was conducted, focusing on the interplay between insurance coverage and foot/ankle procedures. Included studies reported on insurance payor status and patient outcomes following foot and ankle surgery. Extracted outcomes included time to be seen by a provider, complication and revision rates, post-operative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to work/activity, and follow-up. Meta-analyses were performed using the Revman 5.3 software. Studies that did not qualify for meta-analyses were described qualitatively. Results: Of 1401 studies identified, 24 texts met inclusion and exclusion criteria. Across the 24 studies, there were a total of 20,950 patients. Noninsured patients had a 59% higher risk of ED/urgent care utilization within 30 days of surgery compared to insured patients [Risk Ratio (RR) = 1.59, 95% Confidence Interval (CI) = 1.18 to 2.12, p < 0.05]. Privately insured patients were seen 3.65 days earlier than patients with government insurance [95% CI = 2.02 to 5.27, p < 0.0001]. Worker’s Compensation patients had statistically significant findings for poorer outcomes, higher pain scores, and lower functional scores. Similarly, Medicaid patients also fared worse on functional scores and had delayed access to appointments and treatments. Conclusions: Patients without private insurance have worse pain and functional outcomes, delayed access to care, and increased utilization of emergency resources following foot and ankle procedures. It is crucial for providers to be cognizant of these discrepancies when caring for patients. Further research is needed to better understand the nuances of these insurance-related disparities within foot and ankle subspecialties. Full article

Background: Calcaneal fractures are complex injuries frequently associated with significant soft tissue damage and a high risk of post-operative complications, particularly infection. Despite advances in surgical techniques, infectious complications remain a major cause of morbidity and can severely compromise functional outcomes. The aim of this systematic review was to analyze the incidence, management strategies, and clinical impact of infectious complications following surgical treatment of calcaneal fractures. Methods: A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science in accordance with PRISMA guidelines, including studies published up to May 2025. Randomized controlled trials and prospective and retrospective cohort studies involving adult patients surgically treated for calcaneal fractures and reporting post-operative infectious outcomes were included. Data extraction focused on patient demographics, fracture characteristics, surgical techniques, infection rates, microbiological findings, management strategies, complications, and functional outcomes. Methodological quality and risk of bias were assessed using the MINORS score. Due to substantial heterogeneity, results were synthesized descriptively. Results: Forty studies met the inclusion criteria, encompassing 5343 patients and 4638 surgically treated calcaneal fractures. Displaced intra-articular fractures predominated, with Sanders type II and III accounting for 79.8% of classified fractures, while Sanders type IV fractures represented 20.2% and were associated with higher complication rates. The overall post-operative infection rate was 9.4%, including 6.3% superficial surgical site infections and 3.0% deep infections. Open fractures accounted for 7.5% of reported cases and demonstrated markedly higher infection rates than closed injuries. Deep infections frequently required implant removal (62%), prolonged intravenous antibiotic therapy (100%), and additional surgical procedures (71%). Staphylococcus aureus, including methicillin-resistant strains, was the most commonly isolated pathogen. Functional outcomes were consistently worse in patients who developed infections. Conclusions: Infectious complications remain a clinically significant problem following surgical treatment of calcaneal fractures, particularly in severe fracture patterns, open injuries, and patients with relevant comorbidities. Deep infections are associated with substantial morbidity and inferior functional outcomes. Optimization of patient-related risk factors, careful surgical planning, and the selective use of minimally invasive approaches may help reduce infection risk. Further high-quality prospective studies with standardized outcome measures are needed to define optimal management strategies. Full article

Effective management of acute, complex, and chronic wounds requires constructs that simultaneously support tissue repair and provide sustained infection control. Biologic-derived materials, despite their regenerative potential, are limited by insufficient long-term antibacterial activity and susceptibility to enzymatic degradation. To overcome these limitations, a fully absorbable synthetic matrix composed of electrospun composite fibers functionalized with polyhexamethylene biguanide (PHMB) (hereafter, PHMB Matrix) was developed to mimic extracellular matrix architecture while enabling durable antibacterial performance. Quantitative assessment per AATCC 100 demonstrated robust broad-spectrum efficacy (>99.99% reduction) against six clinically relevant Gram-positive and Gram-negative pathogens, with potency retained after 15 months of real-time aging. The matrix’s interconnected fibrous architecture enables a controlled, biphasic PHMB release coordinated with biodegradation, sustaining antibacterial protection throughout a 28-day healing period. In porcine full-thickness wound models, the PHMB Matrix achieved 63.53% ± 12.0% wound area reduction by Day 22, demonstrating accelerated mid-phase healing compared to an antibacterial collagen control (p < 0.05 on Day 22), with both treatments achieving comparable near-complete closure by Day 28. Pharmacokinetic analysis confirmed localized drug enrichment with negligible systemic exposure. These findings establish the PHMB-functionalized synthetic matrix as a safe, effective, fully absorbable alternative to biologic-derived materials for soft tissue repair, offering sustained antibacterial efficacy and a favorable safety profile. Full article

Venothromboembolic (VTE) events are considered rare complications following foot and ankle surgery. Most instances of VTE following surgical procedures occur in particularly high-risk patient populations; therefore, VTE prophylactic anticoagulation is initiated based on risk/benefit stratification for each individual patient undergoing foot and ankle surgery. We present a case report on a 40-year-old male who underwent isolated Lisfranc ligament repair and subsequently developed an acute saddle pulmonary embolism and deep vein thrombosis 1 month postoperatively. The patient was on prophylactic Lovenox, yet still developed a life-threatening complication. The patient was found to be on a selective estrogen receptor modulator for the off-label treatment of male infertility. This medication, surgical intervention, and a period of non-weight bearing are believed to be contributory to the patient’s relatively increased hypercoagulable state. This case depicts a rare complication of foot and ankle surgery and highlights the importance of VTE prophylaxis during the postoperative period. Full article

Background/Objectives: Rigid interfragmentary compression is essential for primary bone healing following fractures, osteotomies, and arthrodeses of the foot and ankle. Evidence on the clinical performance of the MAX Variable Pitch Compression (VPC) Screw System (Zimmer Biomet, Warsaw, IN, USA) remains limited. This post-market, retrospective cohort study evaluated its safety, performance, and patient-reported outcomes. Methods: A single-center, consecutive series of patients treated with the MAX VPC Screw System for foot or ankle fractures, osteotomies, or arthrodeses between March 2018 and October 2023 was analyzed. The primary endpoint was radiographic and clinical bone union or joint fusion at 6–8 weeks and ≥18 months. Secondary endpoints included adverse events and functional outcomes using the Foot and Ankle Ability Measure (FAAM). Results: A total of 214 procedures were included (27 fractures, 80 osteotomies, 107 arthrodeses). Union was assessed in 209 procedures (97.7%) at 6–8 weeks and in 82 procedures (38.3%) at ≥18 months. Union rates were 86.1% at 6–8 weeks and 98.8% at ≥18 months. Early union was higher in arthrodeses (91.5%) than in fractures/osteotomies (80.6%). Adverse events occurred in 13.1% of procedures, 67.9% of which were device-related; no recurrent mechanical failures were observed. Mean FAAM scores were 92.3 (ADL) and 78.8 (Sports) for arthrodeses and 94.3 and 85.8, respectively, for fractures/osteotomies, at a mean FAAM follow-up of 2.9 years. Conclusions: The MAX VPC Screw System demonstrated high bone-union rates, favorable functional outcomes, and a moderate number of device-related complications. These results support its clinical use in foot and ankle surgery. However, the retrospective, single-center design limits generalizability, and prospective multicenter trials are warranted to confirm these findings. Full article

Diabetes mellitus (DM) is highly prevalent among patients undergoing foot and ankle surgery and is associated with substantially increased perioperative and postoperative risk. This narrative review synthesizes the current literature on optimization of DM patients undergoing foot and ankle surgery. Complications of chronic hyperglycemia, including neuropathy and peripheral vascular disease, make the foot and ankle particularly vulnerable to ulceration, infection, and deformity, contributing to high rates of both operations and postoperative complications such as surgical site infection and readmission. Glycemic control and obesity are modifiable predictors of surgical outcomes and represent key targets for preoperative optimization. Lifestyle modification and pharmacologic therapy play central roles in DM optimization. Traditional agents such as metformin, sulfonylureas, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors remain foundational therapies, while newer therapies such as sodium–glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 (GLP-1) agonists offer meaningful improvements to glycemic control and weight loss. Pharmacologic regimens must be individualized, and many agents require careful perioperative management. Despite advances in medical therapy, high-quality evidence specific to foot and ankle surgery remains limited. Future research should focus on developing procedure- and agent-specific guidelines to reduce the substantial clinical and economic burden of DM in foot and ankle surgical patients. Full article

Offloading remains the cornerstone of diabetic foot ulcer (DFU) management. This review traces the evolution of mechanical offloading from early plaster casting in South Asian leprosy clinics to modern removable walkers and emerging “SmartBoot” technologies. We examine the historical progression from total contact casting (TCC) through the era of randomized trials and instant TCC (iTCC), up to the current integration of wearable sensors and digital adherence tools. Contemporary evidence—including meta-analyses—is discussed to compare the effectiveness of offloading modalities (non-removable vs. removable devices, knee-high vs. ankle-high boots, therapeutic footwear, and adjunctive surgeries). Current challenges, such as patient adherence, frailty, and balance, are linked to technological responses like smart insoles, remote monitoring, and gamification strategies. Through this historical and evidence-based lens, we highlight how decades-old biomechanical principles are being reimagined with 21st-century innovations, aiming to improve healing rates and patient engagement in DFU care. Full article

Background: Discogenic low back pain (LBP) is a significant therapeutic and social problem. Discopathy is associated with neurological symptoms that severely disrupt the patient’s functional status. Regardless of the choice of neurosurgical procedure for discopathy, its effectiveness highly varies. Aims: This study aimed to assess the effectiveness of neurosurgical treatment and neurorehabilitation procedures based on a comprehensive analysis of a number of neurological symptoms and the functional status of patients with chronic discogenic LBP. Material and Methods: This study involved 110 patients (56 women and 54 men) who underwent first-ever lumbar spine surgery. Before the surgery and 3 months after the hospital discharge, all patients were subjected to neurological examination and comprehensive assessment of neurological symptoms. Results: After the procedure, improvement was shown in sensory disturbance (p < 0.0001), pain (p < 0.0001), and sexual dysfunction (p < 0.0001). The results of lower limb paresis, monoplegia, and sphincter complications remained non-significant. A reduction in scoliosis (p = 0.0040) and lumbar pain (p < 0.0001) was observed. There was a reduction in pain in the lower leg (p = 0.0136) and foot (p = 0.0122) during movements. Improvement in passive and active mobility as well as pain reduction in the lumbar spine area were demonstrated (p < 0.0001). There was significant improvement in the knee and ankle reflexes (p < 0.0001). There were no significant changes in the superficial sensation. In the functional assessment, an improvement in the toe-to-floor test of 13.3 cm was confirmed (p < 0.0001), while there was no difference in the Lasègue’s test. Conclusions: The general and neurological condition of patients with LBP significantly improved after the spine surgery. The improvement included mainly a reduction in pain and sensory disturbances, return of deep reflexes, and increased mobility of the lower limbs and spine. Full article

Introduction: Medial compartment knee osteoarthritis (OA) is characterized by varus deformity. A medial open-wedge high tibial osteotomy (MOWHTO), frequently invoked in the treatment of this deformity, affects the knee as well as the ankle joints. This study aims to evaluate the radiological and clinical effects of a MOWHTO on the ankle joint. Materials and Methods: A retrospective analysis was conducted with data from 110 patients (mean age: 52 years; 74.5% female) who underwent a MOWHTO between 2020 and 2023. Radiographic assessments were conducted both preoperatively and one year after surgery using full-length weight-bearing radiographs. The measurements included several alignment parameters such as the hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral distal tibial angle (LDTA), and talar tilt. Clinical outcomes were assessed using the Lysholm knee score and the American Orthopedic Foot and Ankle Society (AOFAS) ankle score. Results: While changes in the LDTA demonstrated a small effect size (d = 0.225), moderate-to-large effect sizes were observed in key alignment parameters (MPTA (d = 0.838), the JLCA (d = 0.798), and talar tilt (d = 0.752)), all of which showed statistically significant differences indicative of a correction in the joint alignment of potential clinical significance. Median Lysholm and AOFAS scores at one year were 90 and 100, respectively, indicating favorable clinical outcomes. No significant difference in outcomes was observed based on the amount of correction. Conclusions: An MOWHTO not only restores knee alignment but also significantly improves ankle alignment in the coronal plane. These findings suggest that an MOWHTO is associated with the restoration of knee alignment and with improvements in ankle alignment in the coronal plane. Full article

Background/Objectives: Heel reconstruction is a complex procedure that requires soft tissue reconstruction resistant to weight, pressure, and shear stress. Various flap reconstruction methods have been reported; among them, free fasciocutaneous flaps have advantages in terms of function and aesthetics, but also have challenges due to the longer operation time required and the possibility of failure. The primary aim of this study was to examine the functional outcomes of heel reconstruction using free lateral arm fasciocutaneous flaps after wide excision of heel skin cancer. Methods: Between January 2014 and December 2020, eight patients underwent wide excision of skin cancer and reconstruction of the heel with a lateral arm free flap. Perioperative clinical data and postoperative outcomes, including flap survival, complications, Lower Extremity Functional Scale (LEFS) score, and American Orthopaedic Foot and Ankle Society scale (AOFAS) score, were analyzed from clinical records. Functional assessments were performed at a minimum of 12 months postoperatively (mean 18.3 months, range 12–24 months) by a single blinded examiner who was not involved in the surgical procedures. Both preoperative and postoperative LEFS and AOFAS scores were recorded for comparison. Results: The mean size of the skin and soft tissue defect was 32 cm², the mean duration of surgery was 179 (range: 160–215) minutes, and the mean duration of hospital stay after surgery was 17 (range: 14–19) days, with a mean follow-up period of 48 (range: 33–59) months. Among the eight patients, two had diabetes mellitus (25%), one had peripheral neuropathy (12.5%), and none had clinically significant peripheral vasculopathy. All flaps survived, with one congestive episode. Satisfactory aesthetic and functional results were observed in all patients. The mean preoperative LEFS score was 28 (SD ± 6.1), which improved significantly to a postoperative mean of 57 (SD ± 8.3). Similarly, the mean preoperative AOFAS score was 45 (SD ± 5.8), improving to a postoperative mean of 61 (SD ± 6.2). Minor donor site complications included hypertrophic scarring in two patients (25%) and transient sensory changes in the lateral arm region in three patients (38%), all of which resolved with conservative management. Conclusions: This research suggests that the lateral arm free flap can be considered a reliable option in heel reconstruction, resulting in acceptable functional and aesthetic outcomes. It provides excellent durability, with solid bony union and good contour in small to moderate-sized heel defect cases. Full article

Background/Objectives: Triple arthrodesis (TA) involves fusion of subtalar, talonavicular and calcaneocuboid joints. In the paediatric population, this procedure is used to correct foot deformities, augment stability and decrease pain, often in neuromuscular conditions. There is limited research into long-term outcomes of paediatric TA in regards to patient quality of life (QOL). This study aims to retrospectively evaluate the long-term patient-reported outcomes of the paediatric TA at a single centre. Methods: All paediatric patients who underwent TA at the Women’s and Children’s Hospital between 1998 and 2012 were identified from operative records and the patient and/or their carer were given the opportunity to be interviewed. Patient-reported outcomes were measured over the phone using the Foot and Ankle Ability Measure (FAAM) and Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) tools. Results: Eighteen patients were included in the study, with a total of 23 feet, with five patients having bilateral surgery in the one sitting. Follow-up was at a mean time of 17 years post-surgery, with a mode of 20 years. There were recurring themes of continued pain plus impaired function and mobility, especially in children who could not walk prior to surgery. Derived from the FAAM, the average Activities of Daily Living Scale was 39.81%, with four patients at 0%. The MOXFQ outcomes for walking, pain and social interaction domains were converted from the Likert scale into an average total score of 34.99/64. Over half of the patients continued to have pain after the surgery in adult life. Conclusions: This study highlights variable results post-paediatric triple arthrodesis, with concerning rates of limited improvement in functional outcomes, ongoing pain and negative psychosocial impact in adulthood, as reported by the patient or their carer. Full article