Early Tibiotalar Joint Changes Following Subtalar Arthrodesis for Progressive Collapsing Foot Deformity: A 3D Distance Mapping Short Scientific Report.

Background: Subtalar joint (SJ) fusion may be required to treat subtalar osteoarthritis in progressive collapsing foot deformity (PCFD). Our goal was to understand how anterolateral arthroscopic subtalar arthrodesis (ALAPSTA) may alter joint congruency at the tibiotalar level.

Methods: We retrospectively assessed pre- and postoperative weightbearing computed tomography images of patients diagnosed with PCFD 2A (arthritic SJ) and/or 2D (peritalar subluxation) which underwent isolated ALAPSTA.

Valgus Deviation of the Intersesamoid Crista in Hallux Valgus and Its Association With the Distal Metatarsal Articular Angle: A Pilot Study.

Background: In hallux valgus (HV), the sesamoid bones embedded in the distal tendon of the flexor hallucis brevis and surrounding the tendon of the flexor hallucis longus are partially guided beneath the head of the first metatarsal (M1) by the intersesamoid crista. The distal metatarsal articular angle (DMAA) assesses the valgus deviation of M1 distal articular surface but is influenced by the pronation of the M1 head relative to the ground. Currently, it is unknown whether the intersesamoid crista itself deviates in valgus in association with the articular surface, and understanding this relationship may have clinical relevance for both the pathogenesis of hallux valgus and its surgical correction.

From Asymptomatic Flatfoot to Progressive Collapsing Foot Deformity: Peritalar Subluxation Is the Main Driver of Symptoms.

Background: Flatfoot, or pes planus, is a common anatomical variation marked by a reduced or absent longitudinal arch. Although it is often considered benign, the condition can progress to progressive collapsing foot deformity (PCFD), a debilitating pathology. This study aimed to identify imaging biomarkers that distinguish asymptomatic flatfoot from PCFD by comparing 3D measurements among normally aligned feet, asymptomatic flatfeet, and feet with PCFD.

Bacterial profile and antimicrobial resistance in diabetic foot ulcer infections: a 10-year retrospective cohort study.

Introduction: Diabetic Foot Infections (DFI) are severe complications of diabetes, often resulting in poor clinical outcomes, including amputations. The objective of this study is to identify the main pathogens causing infections in the diabetic foot ulcers, as well as the antibiotic resistance profile.

Methods: This study included all patients treated for diabetic foot infections at a private tertiary hospital between 2013 and 2022.

Fifth Metatarsal Stress Fractures Are Associated With Increased Bone Density and Altered Alignment on Weightbearing CT.

Background: Stress fractures of the fifth metatarsal (M5) are common among individuals engaging in repetitive impact activities or patients with preexisting deformities. Compared with patients who have traumatic fractures, those with stress fractures often develop delayed union, nonunions, or recurrence. Risk factors such as hindfoot varus and foot adduction have been implicated.

Reconstruction of the interosseus talocalcaneal ligament in progressive collapsing foot deformity: A review of the literature and description of a novel surgical technique.

Background: The Interosseous Talo-Calcaneal Ligament (ITCL) is a key stabilizer of the subtalar joint, essential in preventing talo-calcaneal divergence. Its attenuation significantly contributes to the pathogenesis of Progressive Collapsing Foot Deformity (PCFD). Thus, anatomical reconstruction of the ITCL could offer promise in treating flexible (Stage 1) PCFD, aiming to restore subtalar joint stability and prevent deformity progression.

Mid-to-Long-term Clinical Outcomes of Ankle Arthroscopy on the Treatment of Chronic Ankle Conditions: Systematic Review and Meta-analysis.

BackgroundThe effectiveness of arthroscopic ankle surgery for chronic ankle conditions, including pain intensity, functionality, and success rates, remains uncertain.MethodsPubMed, Scopus, and Web of Science databases were searched until October 2023. Mean differences (MDs) were calculated for pain reduction and functional improvements, and arthroscopy success rates were determined using a random-effects model.

Correction of syndesmotic malreduction following fixation flexibilization.

Prior studies showed the potential of a rigid fixation, such as a trans-syndesmotic screw, to produce tibiofibular malreduction. Flexible implants, although capable of allowing forgiveness, may not provide sufficient stability for all injury patterns. To assess the malreduction forgiveness of a two-phase syndesmotic device that is designed to transition from a rigid screw construct to a flexible suture-type.

First Metatarsal Pronation Correction After Fourth-Generation Percutaneous Transverse Osteotomy for Hallux Valgus.

Background: There is increasing interest in the role of pronation as part of the deformity correction in hallux valgus (HV) especially with the advent of weightbearing computed tomography (WBCT) and percutaneous surgical techniques. This study aimed to assess the coronal rotation of the first metatarsal before and after percutaneous distal transverse osteotomy (Metaphyseal Extra-Articular Transverse and Akin Osteotomy [META]) using WBCT and to correlate these findings with clinical outcome scores.

Methods: A retrospective analysis of prospectively collected data from a single center of patients who underwent WBCT both before and after percutaneous distal transverse osteotomy for hallux valgus correction.

Advanced Three-Dimensional Assessment and Planning for Hallux Valgus.

The article discusses advanced three-dimensional evaluation of hallux valgus deformity using weightbearing computed tomography. Conventional two-dimensional radiographs fall short in assessing the complexity of hallux valgus deformities, whereas weightbearing computed tomography provides detailed insights into bone alignment and joint stability in a weightbearing state. Recent studies have highlighted the significance of first ray hypermobility and intrinsic metatarsal rotation in hallux valgus, influencing surgical planning and outcomes.

Semi-automated Segmentation and Distance Mapping of Weight Bearing CT Data to Estimate Select Midfoot Joint Volumes.

Background: Injury to the Lisfranc complex can prove difficult to diagnose, particularly injuries that are purely ligamentous. Missed Lisfranc injuries can cause long-lasting consequences including accelerated midfoot arthritis and collapse. Previous studies have investigated the volume and area of the space between the medial cuneiform and the second metatarsal, but the Lisfranc complex involves additional joints whose articulations have yet to be described.

A Hallux Valgus Surgical Planning Survey Using WBCT-based 3D Printing.

Background: Recent literature highlights the importance of treating hallux valgus (HV) as a 3-dimensional (3D) deformity. Although 3D printing may enhance visualization of the multiplanar aspects of HV, its influence on surgical planning remains unclear. This study assessed changes in surgical plans when surgeons sequentially reviewed 2D radiographs, 3D weightbearing computed tomography (WBCT), and 3D-printed models, hypothesizing that 3D printing would have the greatest impact.

Complications and Early-Term Radiographic Analysis of a Novel Active Compression Tibiotalocalcaneal Arthrodesis Nail With a Proximal Flexible Coil.

Background: Tibiotalocalcaneal (TTC) arthrodesis is used among other methods as a salvage procedure for complex foot/ankle deformity. Fixation is usually achieved through plate/screw constructs or intramedullary (IM) nailing. Although IM nailing uses smaller incisions, fusion rates are variable and complications rates ranging from 25% to 55.

Foot Malalignment and Proximal Fifth Metatarsal Fractures.

Background: Proximal fifth metatarsal fractures are common injuries that are classified into 3 zones according to their anatomical localization. While zone 1 and 2 fractures typically are traumatic, zone 3 fractures may be linked to foot alignment abnormalities, such as hindfoot varus and metatarsus adductus. The aim of the study was to explore the association between hindfoot alignment and different fracture zones, as well as the relationship between traumatic and atraumatic fracture origin and foot alignment.

Talar Morphology of Charcot-Marie-Tooth Patients With Cavovarus Feet.

Background: Charcot-Marie-Tooth disease (CMT), a common inherited neurologic disorder, significantly impacts the morphology of foot bones, particularly the talus. The disease has been classified into types based on specific mutations, with the most common being CMT type 1 (CMT1; demyelinating) and CMT type 2 (CMT2; axonal). However, the specific osseous morphologic variations in CMT patients and their major genetic subgroups remain insufficiently understood, posing challenges in clinical management and surgical intervention.

Standardizing 3 Dimensional Measurements in Foot and Ankle Imaging: A Contemporary Review and Methodological Proposal.

Increasing utilization of weight-bearing computed tomography and fluoroscopy has driven the need for standardization of 3 dimensional (3D) measurements in the foot and ankle. These emerging imaging modalities are currently used to evaluate foot and ankle conditions including ankle osteoarthritis, progressive collapsing foot deformity, midfoot instability, and hallux valgus. This study aims first to provide a comprehensive review of clinical studies that have utilized these 3D methodologies.

A Comprehensive Weightbearing Computed Tomography Study on Patients With Hallux Valgus: Exploring Multiplanar Deformity Interrelationships.

Background: Hallux valgus (HV) is a complex, multiplanar deformity. In this study, we examined the interrelationships between various components of this deformity using weightbearing computed tomography (WBCT). We hypothesized that the severity of traditional axial plane deformities would correlate with malpositioning of the metatarsosesamoid complex, first-ray coronal rotational deformity, and malalignment of the hindfoot and midfoot.

Coronal Plane Alignment of the Medial Column in Isolated Hallux Valgus, Isolated Flatfoot, and Combined Hallux Valgus-Flatfoot.

Background: To provide improved treatment for hallux valgus (HV), we sought to understand more about the pathophysiologic connection between flatfoot deformity and HV by comparing coronal plane alignment of the medial column of the foot for patients with isolated HV, isolated flatfoot, and combined HV-flatfoot vs controls.

Methods: This study retrospectively assessed a consecutive series of 33 patients with combined symptomatic and radiographic HV and flatfoot, 33 isolated symptomatic HV, 33 isolated symptomatic flatfoot, and 33 controls. The medial column alignment was assessed in the coronal plane using 3-dimensional weightbearing computed tomography (WBCT); rotation was measured for the navicular, medial cuneiform, and first metatarsal (M1).

Acquired : Current Concepts - "From Adult Acquired to Progressive Collapsing Foot Deformity".

The clinical disorder traditionally known as or has been the subject of several publications over the past two decades. Now, it is understood that the problem does not lie in the posterior tibial tendon per se and may even occur without tendon injury. Studies have brought new concepts and understanding that question the views on this subject, culminating in the replacement of existing classifications with one that is more assertive and discriminative of the potential presentation patterns of the deformity.

Cadaveric Diagnostic Study of Subtle Syndesmotic Instability Using a 3-Dimensional Weight-Bearing CT Distance Mapping Algorithm.

Background: The diagnosis of syndesmotic instability is challenging, and chronically unstable injuries can potentially lead to ankle arthritic degeneration. The objective of this cadaveric study was to utilize a 3-dimensional (3D) weight-bearing computed tomography (WBCT) distance mapping algorithm for the detection of subtle syndesmotic instability, induced by complete syndesmotic ligament sectioning and stressed by isolated axial load. We hypothesized that this algorithm would accurately detect subtle syndesmotic instability.

Survey of Utilization of Weightbearing Computed Tomography Within AOFAS Membership.

Background: Weightbearing computed tomography (WBCT) has been increasingly employed to evaluate and treat patients with varied pathologies such as progressive collapsing foot deformity (PCFD), posttraumatic deformity, hallux valgus, ankle arthritis, Charcot arthropathy, lisfranc, and syndesmosis injuries. However, little is known regarding its overall availability to foot and ankle providers and how it is being used in clinical practice. The goal of this study is to assess the utilization of WBCT among AOFAS members, identify the indications for use in clinical practice and potential barriers for implementation.

Anatomical and Micro-CT Assessment of the First Metatarsal Head Vascularization and Soft Tissue Envelope Following Minimally Invasive Chevron Osteotomy for Hallux Valgus Deformity.

Background: Minimally invasive surgical (MIS) chevron-type osteotomy for hallux valgus (HV) treatment offers a surgical alternative to open surgery with minimal surgical dissection and a hypothetical decreased risk for soft tissue complications. The objectives of this study were to assess the incidence of injuries to the soft tissue envelope and to the blood supply of the first metatarsal head through gross dissection and, using micro-computed tomography (micro-CT), to identify the safe position to perform the MIS chevron-type osteotomy of the first metatarsal head based on the anatomical data.

Methods: Twenty cadaveric specimens with HV were used for the study.