Search Results (69)

Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed long-term clinical and radiographic outcomes. Methods: This retrospective cohort study included 47 feet from children aged 8–13 years who underwent STA with adjunctive soft tissue procedures between 2014 and 2018, following ≥6 months of failed conservative treatment, with a minimum follow-up of 5 years. Exclusion criteria included neuromuscular or rigid flatfoot. Weight-bearing radiographs assessed anteroposterior (AP) and lateral Meary’s angles, reflecting forefoot-to-hindfoot alignment, and calcaneal pitch, indicative of longitudinal arch height. Implant migration was recorded and clinical outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) score. Measurements were recorded preoperatively, immediately postoperatively, and at 1 month, 3 months, 6 months, 1 year, and 5 years. Results: Radiographic correction was significant and sustained at 5 years. The AP Meary’s angle improved from 13.09° to 5.26° at 1 month and 6.69° at 5 years (p < 0.001); lateral Meary’s angle from 9.77° to 4.06° and 4.88° (p < 0.001); and calcaneal pitch from 14.52° to 16.87° and 16.89° (p < 0.001), respectively. AOFAS scores increased from 67.52 to 90.86 at 1 month and 96.33 at 5 years (p < 0.001). Implant migration peaked within the first postoperative month (mean: 3.2 mm on ankle AP view; 3.0 mm on foot AP view) and stabilized thereafter. Four cases of complications included implant dislodgement, subsidence, and persistent sinus tarsi tenderness, which were successfully resolved after appropriate management. No recurrence of deformity was observed. Conclusions: STA implant migration is most pronounced during the first month, likely due to physiological settling as the foot adapts to altered biomechanics. With appropriate implant selection, technique, and follow-up, migration does not compromise long-term correction or outcomes. In general, symptomatic cases can often be managed conservatively prior to implant removal. Full article

Background: Hallux rigidus is a painful and degenerative pathology of the first metatarsophalangeal (MTP1) joint. In severe cases it is usually appropriate to consider arthrodesis or arthroplasty of the joint. Arthrodesis represents the gold standard, but arthroplasty allows patients to recover mobility. Although arthroplasty has slightly inferior functional results to arthrodesis, it has shown very good results in terms of joint mobility, patient satisfaction and pain reduction. The goal of the present study was to evaluate short-term outcomes of patients that received a third-generation double-stemmed MTP1 implant manufactured from high-performance silicon. Methods: In this retrospective study the authors analyzed data of 37 patients who underwent MPT1 joint arthroplasty with Silktoe^TM double-stemmed implant using the R 4.2.2 software (R Foundation for Statistical Computing, Vienna, Austria). The indications were hallux rigidus of grade III and grade IV (81.1%), hallux rigidus plus valgus (10.8%), painful or unstable joint following previous surgery (5.4%) and hallux rigidus due to gout (2.7%). Data were collected during routine visits at 1 and 6 months and 1 and 2 years. Results: There were no intraoperative and postoperative complications. There were no revisions or reoperations at a follow-up of two years. The American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS-HMI) score was 94.6 ± 7.6 (median, 100; range, 70–100) and the Visual Analogue Scale (VAS) score was 0.4 ± 0.80 (median, 0; range, 0–3.5) at the final follow-up. Conclusions: The data from this study presented excellent short-term results for patients who received an arthroplasty of the MTP1 joint using a third-generation double-stemmed spacer made of high-performance silicone. For all patients who received the Silktoe^TM implant, AOFAS-HMI scores of 94.6 and VAS scores of 0.4 were obtained at a two-year follow-up. These values were in line with results reported in the literature for similar devices. Full article

Background: Continuous Compression Implants (CCIs) are low-profile implants made of nitinol and titanium. They offer multiple benefits in comparison to plate and screw fixation for foot and ankle indications, and they are designed in such a way that they continuously and dynamically compress the opposed bony surfaces throughout the entire healing process. Methods: In this study, we present our experience on the use of those nitinol implants for midfoot and hindfoot surgery. Furthermore, we elaborate on the advantages and downsides of using this internal fixation method and highlight common pitfalls which could lead to undesirable clinical outcomes. We also demonstrate our proposed surgical technique on how to use CCIs in a reproducible and reliable way and present surgical tips which could help reduce surgical time when utilising these implants. We also make surgical recommendations on their use and present the underlying biomechanics, which could provide a better understanding of the rationale behind using them in the field of foot and ankle surgery. Last but not least, we presented the early clinical and radiological results of a series of patients who underwent primary midfoot fusion for Lisfranc injury between 2020 and 2023. Results: With a minimum follow-up of 9 months, satisfactory clinical and radiological union was noted in all those patients. The mean difference between pre- and post-operative MOxFQ scores was −37.7 (95% CI was 16.9 to 58.5; p = 0.03). The mean post-operative VAS pain at rest was 3.2 (SD = 2.3). No major complications were noted. Conclusions: CCI internal fixation is a safe, reproducible, and reliable method when it comes to foot and ankle conditions, but it requires appropriate pre-operative planning, surgical training, and careful implantation. Full article

Background: Defects of the foot and ankle area pose a significant challenge for both patients and surgeons. While the primary objective of microvascular free flap reconstructions of lower leg defects is limb preservation, there should be an effort to obtain the best functional and aesthetic results possible and to restore the patient’s quality of life. The aim of this study was to investigate the long-term post-operative functional outcome, health-related quality of life, scar quality, and aesthetic satisfaction in patients following microsurgical reconstructions of defects of the foot and ankle area. Methods: We conducted a monocentric, controlled cohort study of adult patients who underwent microsurgical reconstructions for defects of the foot and ankle area between 2006 and August 2022 at our department. As a control, we recruited healthy individuals. Patient-Reported Outcome Measures questionnaires were used to assess long-term results regarding functionality (LEFS: Lower Extremity Functional Scale), health-related quality of life (SF-36: Short-Form 36 Health Survey Questionnaire), scar quality (PSAS: Patient Scar Assessment Scale), aesthetic satisfaction (Aesthetic Likert Scale), pain at rest and activity (10-point Numeric Rating Scale) and usage of footwear. Results: Of the 55 potential patients who had received microvascular free flaps for reconstructions of ankle and foot defects and were eligible for study inclusion, 13 (23.6%) agreed to participate in this study. The study cohort consisted of 84.6% male subjects and the mean follow-up period was 8.6 years (±5.2). Significant moderate limitations were observed with regard to physical function of the lower extremity (LEFS: 42.5 ± 20.5, p = 0.002). Significant limitations were found in the SF-36 subscales of pain (55.8 ± 34.5, p = 0.019), physical functioning (55.0 ± 29.7, p = 0.013), and physical role functioning (38.5 ± 44.0, p = 0.006). The study yielded favorable outcomes with regard to aesthetic satisfaction (14.3 ± 4.4) and scar quality (23.5 ± 13.5). Out of all the patients, 61% were required to wear orthopedic shoes or insoles. Conclusions: Patients undergoing microsurgical reconstructions for ankle and foot defects experience moderate long-term physical limitations and persistent pain during activity. Furthermore, we observed a significant long-term impact on specific physical domains of health-related quality of life, whereas mental health seems less affected. Full article

Background: Tibiotalocalcaneal (TTC) arthrodesis using talar allografts has emerged as a viable surgical option for managing complex hindfoot pathologies, including post-traumatic avascular necrosis (AVN), infection-related complications, and failed total ankle replacement (TAR). These conditions present significant therapeutic challenges due to extensive bone loss and joint instability. Previous reports have focused on TTC arthrodesis using talar allografts, highlighting its potential to provide enhanced structural support. This study aims to further evaluate the efficacy and safety of this surgical approach by assessing union, clinical outcomes, and complications in a diverse patient population. Methods: This retrospective study reviewed 11 patients who underwent TTC arthrodesis with talar allograft between January 2020 and November 2022. The study cohort included patients with post-traumatic AVN, infection-related complications, and failed TAR. Preoperative and postoperative evaluations included X-rays, computed tomography scans, and functional outcome scores such as the Visual Analog Scale (VAS) and the Foot and Ankle Outcome Score (FAOS). Results: This study included 11 patients who underwent surgical treatment between January 2020 and November 2022, with a minimum follow-up of 24 months and a mean follow-up of 33.45 months (range, 24–50 months). Successful arthrodesis was observed in nine patients, yielding a success rate of 82%. Significant improvements in functional outcomes were noted, including marked reductions in pain and enhanced activity levels, as evaluated by VAS and FAOS scores. Two patients demonstrated radiographic nonunion (one tibiotalar, one subtalar), but both remained asymptomatic and did not require revision surgery. No other complications such as infection, wound issues, or thromboembolism were observed. Immediate postoperative radiographs confirmed appropriate allograft alignment and placement. Conclusions: TTC arthrodesis using structural talar allografts may be a viable and safe option for managing severe hindfoot pathology, potentially resulting in satisfactory fusion rates and clinical outcomes. Full article

Background: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is revolutionizing surgery by providing a bloodless field without tourniquet use, reducing risks, costs, and enhancing patient comfort. While extensively used in hand surgery, its application in foot and ankle procedures, particularly for high-risk patients with diabetic neuropathy and peripheral artery disease (PAD), remains underexplored. This study evaluates the safety, efficacy, and outcomes of WALANT for tarsal tunnel decompression in such patients. Methods: Between March 2022 and April 2024, 32 patients with diabetic neuropathy and PAD underwent Dellon decompression of the tarsal tunnel. Five received spinal anesthesia with a tourniquet, while 27 underwent WALANT. Outcomes assessed included operative time, Visual Analogue Scale (VAS) pain scores, posterior tibial artery blood flow (via Doppler ultrasonography), and complications. Data were collected preoperatively, immediately postoperatively, and at six and nine months. Results: WALANT reduced operative time (40 ± 8 min vs. 65 ± 10 min) and required fewer personnel (four vs. six). VAS scores improved significantly in the WALANT group (from 8.65 ± 0.84 preoperatively to 1.21 ± 0.24 at nine months). Posterior tibial artery blood flow also showed superior improvements with WALANT (5.30 ± 0.65 cm³/s vs. 2.50 ± 0.45 cm³/s). Minor wound healing delays were noted in two WALANT cases; no major complications occurred. Conclusion: WALANT offers a safe, efficient alternative to spinal anesthesia for tarsal tunnel decompression in high-risk patients, minimizing ischemic risks, enhancing vascular outcomes, and reducing postoperative pain. Full article

Treating ankle fractures in athletes, commonly resulting from training injuries, remains a significant challenge. Current approaches to managing both non-surgical and postoperative foot and ankle disorders have focused on integrating sensory systems into orthotic devices. Recent analyses have identified several gaps in rehabilitation strategies, especially regarding gait pattern reformation during recovery. This work aims to enhance rehabilitation effectiveness for patients with ankle injuries by controlling load distribution and monitoring joint flexion/extension angles, as well as the reactive forces during therapeutic exercises and walking. We developed an exoskeleton device model using SolidWorks 2024 software, based on data from two patients: one healthy and one with an ankle fracture. Pressure measurements in the posterior limb region were taken using the F-Socket system and a custom electromechanical sensor designed by the authors. The collected data were analyzed using the butterfly parameterization method. This research led to the development of an adaptive exoskeleton device that provided pressure distribution data, gait cycle graphs, and a diagram correlating foot angles with the duration of exoskeleton use. The device demonstrated improvement in the patients’ conditions, facilitating a more normalized gait pattern. A reduction in the load applied to the ankle joint was also observed, with the butterfly parameter confirming the device’s correct operation. Full article

Objective: This study aimed to examine the impact of early postoperative physical therapy combined with an educational program on wound recurrence and quality of life in patients with foot ulcers. Methods: Forty-eight postoperative patients with diabetic foot ulcers were randomly assigned to either an intervention group, which received both physical therapy and an educational program (n = 25), or a control group, which received physical therapy only (n = 23). Each intervention was initiated on the day after surgery in both groups. The intervention group participated in physical therapy sessions, followed by a 15 min disease education program conducted five times per week. The primary endpoint was the rate of wound recurrence six months after hospital discharge. Secondary endpoints included ankle dorsiflexion range of motion, knee extension strength, gait functional independence measure scores, problem areas in diabetes scores, and EuroQol-5 dimensions-5 levels scores. Results: The intervention group demonstrated a significantly lower rate of wound recurrence within six months after discharge (10.5%) compared with the control group (27.7%). Conclusions: The combined use of early postoperative physical therapy and educational programs was an effective intervention strategy, contributing to reduced wound recurrence rates in patients with diabetic foot ulcers. Full article

Objectives: To compare the safety and efficacy of open surgery (OS) and minimally invasive surgery (MIS) techniques in the correction of symptomatic hallux valgus (HV). Methods: A systematic review of studies up to January 2024 was conducted, identifying all the relevant literature comparing OS and MIS for symptomatic HV. Searches were performed across major databases including MEDLINE, Cochrane and EMBASE. A total of 32 studies were included, comprising randomised control trials, prospective and retrospective cohort studies as well as grey literature. Key outcomes assessed included radiographic measures such as the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), with preoperative and postoperative angles analysed to calculate the power of correction. Secondary outcomes included American Orthopaedic Foot and Ankle Society (AOFAS) scores, operative time, hospital stay duration, radiation exposure and complication rates. Both fixed-effect and random-effects models were applied based on the observed heterogeneity in the data. Results: Thirty-two studies with 2423 patients contributed to the summative outcome. Postoperative HVA and IMA were comparable between OS and MIS groups. However, MIS showed a significantly lower DMAA angle (MD = −0.90, CI: −1.55 to −0.25, p = 0.01). In radiographic correction analysis, MIS demonstrated significantly greater DMAA correction (MD = 1.09, CI: 0.43 to 1.75, p = 0.001). The odds of hardware removal were significantly higher with MIS (OR = 2.37, CI: 1.41 to 4.00, p = 0.001). Functional analysis showed that MIS achieved significantly higher postoperative AOFAS scores (MD = 2.52, CI: 0.92 to 4.13, p = 0.002). MIS was associated with a shorter operative (MD = −12.07 min, CI: −17.02 to −7.11, p < 0.00001) and a significantly shorter hospital stay (MD = −0.76, CI: −1.30 to −0.21, p = 0.007). MIS was linked to higher radiation exposure (MD = 51.18, CI: 28.71 to 73.65, p < 0.00001). Conclusions: There is no definitive superiority between MIS and OS for hallux valgus correction. While MIS offers benefits such as improved DMAA correction, higher functional AOFAS scores, shorter operative times and reduced hospital stays, it also carries risks like increased radiation exposure and a higher rate of hardware removal. The decision between MIS and OS should be personalised, taking into account the specific needs and circumstances of each patient. Larger studies are warranted to validate these findings as newer MIS techniques continue to emerge and evolve. Full article

Controlling pain after major orthopedic surgery may be challenging, and it is related to delayed recovery, the development of chronic pain, and analgesic dependence. It is well known that effective postoperative pain control can reduce hospital stays by ensuring a more rapid rehabilitation,
thereby decreasing the overall costs. Despite the development of analgesics, the use of opioids and their derivates remains the cornerstone of treatment for patients with acute moderate-to-severe pain in association with general or regional anesthesia. To reduce the risk of side effects and opioid addiction, considering the alarming epidemiological reports in relation to opioid abuse, combined analgesic methods are used, in addition to lower dosages or different forms of administration, such as transdermal administration. Fentanyl transdermal patches appear to be effective in controlling postoperative pain as part of multimodal analgesic regimens in knee and hip surgery, shoulder arthroplasty, traumatic fractures, and one-day surgery; this treatment has fewer associated side effects and can be safely used even in patients with renal impairment. It is also recommended for postoperative pain management in combination with a femoral–sciatic nerve block during foot and ankle surgery. Full article

Soft tissue reconstruction in the lower limbs presents a significant challenge, particularly when addressing defects in the distal third of the leg, ankle, and foot. The reverse sural flap reliant on the perforating branches of the peroneal artery has emerged as a versatile option, offering a solution for patients for whom microsurgical techniques are not feasible. Despite its advantages, the procedure carries inherent risks, especially in populations with underlying conditions, such as venous insufficiency, cardiovascular disease, and diabetes, as well as in elderly patients, where the likelihood of flap necrosis is elevated. This report details a case of reverse sural flap necrosis in a patient with lupus-like syndrome, a complex scenario that underscores the need for meticulous preoperative assessment and planning. The case illustrates not only the technical considerations and challenges associated with the reverse sural flap but also the broader implications of systemic autoimmune disorders on postoperative outcomes. Through a comprehensive review of the literature, we explore the relationship between vascularization, autoimmune profiles, and the success of reverse sural flap procedures. We highlight the critical need for surgeons to adopt a holistic approach to patient evaluation, considering both local and systemic factors that may influence the viability of the flap and the overall reconstructive success. Full article

Background: Ankle arthritis is a common degenerative disease that progresses as cartilage damage in the lower tibia and upper talus progresses, resulting in loss of joint function. In addition to typical arthritis, there is also structural bone loss in the talus due to diseases such as talar avascular necrosis. Total talus replacement surgery is the procedure of choice in end-stage ankle arthritis and consists of a tibial, talar component and an insert. However, in cases of severe cartilage and bone damage to the talar bone with less damage to the tibial cartilage, a talar component hemiarthroplasty may be considered. Although the application of total talus replacement surgery using ceramics has been studied, reports on the application of metal 3D printing technology are limited. We aimed to investigate the feasibility of partial talar components using ceramic and titanium 3D printing technology in terms of biocompatibility and stability through animal experiments. Methods: Preoperative 3D CT was acquired and converted to STL files to fabricate a partial talus component for ankle hemiarthroplasty using ceramic and titanium. Six minipigs with an average age of 17 months were implanted with three ceramic (C-group) and three titanium talar components (T-group) in the hind limb ankle joint. The surgery was performed under anesthesia in a sterile operating room and was performed by two experienced foot and ankle specialist orthopedic surgeons. Blood analysis and CT were performed before surgery and every month for 3 months after surgery to assess the extent of inflammatory response and physical stability, sacrifices were performed 3 months after surgery, and H&E staining and micro-CT analysis were performed to compare histological biocompatibility. A grading score was calculated to semi-quantitative assess and compare the two groups. Results: In the postsurgical evaluation, blood analysis revealed that both groups had increased white blood cell counts on the postoperative day after surgery. The white blood cell count increased more in the titanium group (1.85-fold) than in the ceramic group (1.45-fold). After 3 months, all values normalized. During the study, CT analysis confirmed that all artificial samples were displaced from their initial positions. In micro-CT analysis, the adhesive tissue score of the ceramic artificial sample was better than that of the titanium sample (average threshold = 3027.18 ± 405.92). In histologic and grading scores for the inflammatory reactions, the average inflammation indices of the ceramic and titanium groups were 2.0 and 1.21, respectively. Also, the average grade score confirmed based on the results of fibrous tissue proliferation and new blood vessels was 18.4 in the ceramic application group and 12.3 in the titanium application group. Conclusions: In conclusion, both titanium and ceramics have excellent biocompatibility for artificial joints, and ceramic materials can be used as novel artificial joints. Further research on the strength and availability of these ceramics is required. Full article

Background/Objectives: The interest in performing total ankle arthroplasty (TAA) to address end-stage ankle osteoarthritis (OA) is continuously growing. Sports activity plays an important role in our world. The literature is sparse regarding return-to-sports activity following TAA. The levels and types of sports in TAA are rarely reported. The purpose of this prospective case series study is to investigate sports activity in ankle osteoarthritis (OA) and TAA in terms of rate, frequency, type, and clinical outcomes with a minimum 2 years of follow-up after surgery. Methods: A total of 103 patients (105 implants, 52 female, and 51 male), mean age 60.5 years (range, 23–84 years) with end-stage ankle OA were treated using a three-component, uncemented, mobile-bearing VANTAGE Total Ankle System. The mean follow-up was 2.9 years (range, 2–5 years). Visual Analogic Scale Pain Score (VAS, 0–10 points), Ankle Dorsiflexion/Plantarflexion (DF/PF) range of motion (ROM; degrees), functional American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0–100 points), Subjective Patients’ Satisfaction Score (0–10 points), Sports Activity Rate, Sports Frequency Score, and sports type were assessed. Results: The mean preoperative VAS Pain Score was 6.7 points (range, 3–10 points) and 0.2 points for postoperative (range, 0–3 points) (p < 0.001). The mean DF/PF ROM was 24.9° preoperative (range, 0–60°) and 52.9° postoperative (range, 15–85°) (p < 0.001). The mean preoperative functional AOFAS Ankle/Hindfoot Score was 39.5 points (range, 4–57 points) and 97.8 points for postoperative (range, 75–100 points) (p < 0.001). The mean postoperative Subjective Patients’ Satisfaction Score was 9.7 points (range, 7–10 points). The preoperative Sports Activity Rate was 31.1%, with 85.4% for postoperative (p < 0.001). All the groups exhibited substantial Sports Frequency Score increases (p < 0.001). The most practised sports were hiking, biking, fitness, and swimming. Conclusions: total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle OA. TAA facilitates a noteworthy increase in sports activity. This research offers important sports insights to patients with ankle OA and TAA. Full article

Background/Objectives: Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon’s arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Methods: Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. Results: A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. Conclusions: The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology. Full article

Background: Evidence on return to sport (RTS) criteria and timelines for pediatric patients with osteochondral (OCD) lesions of the foot and ankle is limited. Methods: This systematic review evaluated RTS criteria and outcomes in this population by querying PubMed, Embase, Web of Science, CINAHL, and SPORTDiscus up to 30 May 2024. Inclusion criteria were retrospective or prospective studies that examined pediatric patients with osteochondral lesions of the foot and ankle and gave outcomes or criteria regarding RTS. Results: Five observational studies (n = 168 patients; n = 180 OCD lesions; mean age: 14.19 ± 0.47 years; mean follow-up: 42 ± 174 months) were included. Two studies (40%) used time-based criteria for RTS, two studies (40%) used mixed criteria, and the final study (20%) used milestone-based criteria. Across the mixed and milestone criteria, physical therapy (n = 3) and minimal partial weight-bearing prior to RTS (n = 4) were most frequently seen as the milestones used for assessing RTS readiness. RTS from the postoperative period ranged from 3 months to 6 months. At the final follow-up, 61.45% of patients (n = 110) were available to provide information regarding their ability to RTS. Of these patients, 80% (n = 88) achieved RTS. Conclusions: Results showed variability in RTS criteria, ranging from three to six months, with no clear patterns. Most patients returned to sport, suggesting that such individualized criteria may be effective to an extent. Future research should focus on larger, high-quality studies to develop consistent RTS protocols. Full article