Explore the vast range of titles available.

Background Patients with ankle arthritis often present with concomitant hindfoot deformity, which may involve the tibiotalar and subtalar joints. However, the possible compensatory mechanisms of these two mechanically linked joints are not well known. Questions/purposes In this study we sought to (1) compare ankle and hindfoot alignment of our study cohort with end-stage ankle arthritis with that of a control group; (2) explore the frequency of compensated malalignment between the tibiotalar and subtalar joints in our study cohort; and (3) assess the intraobserver and interobserver reliability of classification methods of hindfoot alignment used in this study. Methods Between March 2006 and September 2013, we performed 419 ankle arthrodesis and ankle replacements (380 patients). In this study, we evaluated radiographs for 233 (56%) ankles (226 patients) which met the following inclusion criteria: (1) no prior subtalar arthrodesis; (2) no previously failed total ankle replacement or ankle arthrodesis; (3) with complete conventional radiographs (all three ankle views were required: mortise, lateral, and hindfoot alignment view). Ankle and hindfoot alignment was assessed by measurement of the medial distal tibial angle, tibial talar surface angle, talar tilting angle, tibiocalcaneal axis angle, and moment arm of calcaneus. The obtained values were compared with those observed in the control group of 60 ankles from 60 people. Only those without obvious degenerative changes of the tibiotalar and subtalar joints and without previous surgeries of the ankle or hindfoot were included in the control group. Demographic data for the patients with arthritis and the control group were comparable (sex, p = 0.321; age, p = 0.087). The frequency of compensated malalignment between the tibiotalar and subtalar joints, defined as tibiocalcaneal angle or moment arm of the calcaneus being greater or smaller than the same 95% CI statistical cutoffs from the control group, was tallied. All ankle radiographs were independently measured by two observers to determine the interobserver reliability. One of the observers evaluated all images twice to determine the intraobserver reliability. Results There were differences in medial distal tibial surface angle (86.6° ± 7.3° [95% CI, 66.3°–123.7°) versus 89.1° ± 2.9° [95% CI, 83.0°–96.3°], p < 0.001), tibiotalar surface angle (84.9° ± 14.4° [95% CI, 45.3°–122.7°] versus 89.1° ± 2.9° [95% CI, 83.0°–96.3°], p < 0.001), talar tilting angle (−1.7° ± 12.5° [95% CI, −41.3°–30.3°) versus 0.0° ± 0.0° [95% CI, 0.0°–0.0°], p = 0.003), and tibiocalcaneal axis angle (−7.2° ± 13.1° [95% CI, −57°–33°) versus −2.7° ± 5.2° [95% CI, −13.3°–9.0°], p < 0.001) between patients with ankle arthritis and the control group. Using the classification system based on the tibiocalcaneal angle, there were 62 (53%) and 22 (39%) compensated ankles in the varus and valgus groups, respectively. Using the classification system based on the moment arm of the calcaneus, there were 68 (58%) and 20 (35%) compensated ankles in the varus and valgus groups, respectively. For all conditions or methods of measurement, patients with no or mild degenerative change of the subtalar joint have a greater likelihood of compensating coronal plane deformity of the ankle with arthritis (p < 0.001–p = 0.032). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent (the correlation coefficients range from 0.820 to 0.943). Conclusions Substantial ankle malalignment, mostly varus deformity, is common in ankles with end-stage osteoarthritis. The subtalar joint often compensates for the malaligned ankle in static weightbearing. Level of Evidence Level III, diagnostic study.

Introduction Progressive collapsing foot deformity (PCFD), formally known as “adult-acquired flatfoot deformity” (AAFFD), is a complex foot deformity consisting of multiple components. If surgery is required, joint-preserving procedures, such as a medial displacement calcaneal osteotomy (MDCO), are frequently performed. The aim of this systematic review is to provide a summary of the evidence on the impact of MDCO on foot biomechanics. Materials and methods A systematic literature search across two major sources (PubMed and Scopus) without time limitation was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria. Only original research studies reporting on biomechanical changes following a MDCO were included. Exclusion criteria consisted of review articles, case studies, and studies not written in English. 27 studies were included and the methodologic quality graded according to the QUACS scale and the modified Coleman score. Results The 27 included studies consisted of 18 cadaveric, 7 studies based on biomechanical models, and 2 clinical studies. The impact of MDCO on the following five major parameters were assessed: plantar fascia ( n  = 6), medial longitudinal arch ( n  = 9), hind- and midfoot joint pressures ( n  = 10), Achilles tendon ( n  = 5), and gait pattern parameters ( n  = 3). The quality of the studies was moderate to good with a pooled mean QUACS score of 65% (range 46–92%) for in-vitro and a pooled mean Coleman score of 58 (range 56–65) points for clinical studies. Conclusion A thorough knowledge of how MDCO impacts foot function is key in properly understanding the postoperative effects of this commonly performed procedure. According to the evidence, MDCO impacts the function of the plantar fascia and Achilles tendon, the integrity of the medial longitudinal arch, hind- and midfoot joint pressures, and consequently specific gait pattern parameters.

The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review.

After a lower extremity injury, patients often return to sport (RTS) when the injured limb's performance on unilateral hopping tests is similar to that of the uninjured limb. However, the exact target symmetry value patients must reach before the RTS is unclear. To identify variables that predict limb symmetry index (LSI) values on 6 unilateral hopping tests in healthy, physically active adults. Cross-sectional study. Research laboratory. In total, 275 healthy, physically active adults, consisting of recreational athletes (n = 198), National Collegiate Athletic Association Division I student-athletes (n = 56), and Army Reserve Officer Training Corps cadets (n = 21), volunteered to participate (143 men, 132 women, age = 20.16 ± 2.19 years, height = 172.66 ± 10.22 cm, weight = 72.64 ± 14.29 kg). Each participant completed 3 speed (6-m crossover-hop, side-hop, figure-8 hop) and 3 distance (triple-crossover-hop, lateral-hop, medial-hop) functional performance tests on both limbs. Mean performance of the dominant and nondominant limbs and LSI values. Two multiple regression models were used to find variables that might help to predict a participant's LSI for each functional performance test. The models helped to predict limb symmetry for 10 of the 12 multiple regressions. Unilateral limb performance was the best predictor of LSI values, as it was statistically significant in 11 of the 12 regression models. Sex and body mass index were significant predictor variables for the side hop and figure-8 hop, respectively. We found significant predictor variables that clinicians can use in the absence of baseline testing to determine patient-specific LSI values. Individualizing RTS decisions in this way may help to minimize subjectivity in the decision-making process and ensure a safe and timely return to competition.

Background and Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disease that frequently causes foot deformities, decreasing mobility and quality of life. Although surgical interventions seek to alleviate these alterations, the long-term experiences of patients have not been deeply explored. The aim of this study was to describe the experiences of patients with RA undergoing osteoarticular surgery to correct acquired foot deformities. Materials and Method: A qualitative study design was used with structured interviews including 19 patients with RA treated in a specialised rheumatology service. The thematic analysis was carried out using the Braun and Clarke thematic analysis, ensuring compliance with ethical standards and the anonymity of the participants. Results: Five main themes were identified: experience with pain before and after surgery; impact on functional capacity; complications and need for additional surgeries; emotional impact and quality of life; overall satisfaction with the surgery. While many patients reported significant pain reduction and functional improvements, others faced recurrences of the deformities, persistent pain, and post-surgical complications. Emotional responses ranged from well-being to frustration, depending on surgical outcomes. The five-year follow-up period allowed for a comprehensive assessment of the long-term impact of surgery. The recurrence rate of deformities was notable, and the emotional impact of these recurrences was significant, with patients expressing frustration and distress in some cases. Conclusions: The patients’ experiences were heterogeneous, with both positive and negative outcomes. These findings underscore the importance of individualized management and comprehensive follow-up that consider the clinical outcomes, expectations, and emotional well-being of RA patients undergoing foot surgery.

Introduction Rheumatoid arthritis (RA) is a systemic autoimmune disease that primarily affects the synovial membrane, leading to progressive joint destruction. Among RA-related deformities, forefoot deformities are particularly common, causing severe pain, gait disturbances, and a significant decline in patient quality of life. Typical forefoot deformities observed in patients with RA include hallux valgus (HV), hammer toe deformities, and plantar callosities, all of which require appropriate therapeutic intervention. We aimed to evaluate the clinical outcomes of modified Mitchell’s osteotomy with shortening oblique osteotomy (SOO) for forefoot deformities in patients with RA. Methods Twenty-four patients (31 feet) underwent surgery between 2005 and 2023. The cohort included 22 women (29 feet) and two men (2 feet) with a mean age of 59 ± 12 years and disease duration of 20.3 ± 8.7 years. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) RA Foot and Ankle Scale and radiographic evaluations. Results At a mean follow-up of 10.1 years, the JSSF scale score improved significantly from 57.9 to 77.1 points; HV angle (HVA) significantly improved from 31.7° to 17.1°; and the 1st to 5th intermetatarsal angles (M1M5A) significantly improved from 29.3° to 20.6°. The 28 joint-Disease activity score with erythrocyte sedimentation rate significantly improved from 2.75 to 2.20. Complications included recurrence of callosities in six feet (16.1%), metatarsal phalangeal joint subluxation in 13 feet (8.4%), appearance of HV deformity in 10 feet (32.3%), and infections in two feet (6.5%). No non-union was observed. Conclusions Modified Mitchell’s osteotomy with SOO significantly reduced pain and improved walking ability in patients with RA. The procedure also achieved a remarkable degree of radiographic correction, particularly a reduction in HVA and M1M5A, contributing to improved forefoot alignment. These findings suggest that the procedure provides clear benefits. Careful attention should be paid to potential postoperative complications such as the appearance of HV deformity and infection.

Charcot neuroosteoarthropathy of the feet can induce severe instability and deformity with subsequent plantar ulceration leading to substantial disability or even amputation. Traditionally, nonoperative treatment is regarded as the primary option of treatment while surgery is restricted to treating complications or failure of nonoperative treatment. Failed nonoperative treatment essentially prolongs treatment period. We retrospectively reviewed 22 patients (26 feet) with midfoot (n = 9) or hindfoot (n = 17) neuropathy who underwent primary surgical reconstruction and reorientation arthrodesis due to manifest instability, nonplantigrade foot position, and deformity with overt (n = 8) or what we judged was impending ulceration (n = 9). The minimum followup was 0.5 years (mean, 2.7 years; range 0.5–7 years). All eight ulcers healed without recurrence of ulceration or manifestation of new ulcers during the followup period. We observed complications leading to further surgery in nine patients: five with perioperative hematoma and four with instability. AOFAS scores rose from a preoperative mean of 39 to 70 points (hindfoot cases) and from 51 points to 84 (midfoot cases). Early surgical reconstruction in high-risk patients can provide timely restoration of a plantigrade and stable foot and improved quality of life of the patient at complication rates comparable to those after secondary surgery following failed nonoperative treatment; however we emphasize we had no control group in this small case series for which we could compare nonoperative treatment. Level of Evidence: Level IV, therapeutic study (case series). See Guidelines for Authors for a complete description of levels of evidence.

Purpose Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA). Methods A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6–17). Mean follow-up was 7 ± 2.9 years (5–10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P  < 0.01. Results Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P  < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing. Conclusions SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications. Level of Evidence IV

Background Calcaneal lengthening has been used to correct planovalgus foot deformities in patients with cerebral palsy (CP). Questions/purposes This study was performed to investigate the amount of correction that can be achieved after calcaneal lengthening for the treatment of a planovalgus deformity in patients with CP and to provide cutoff values based on the preoperative radiographic measurements that suggest additional procedures to achieve satisfactory correction. Methods Seventy-five consecutive patients with CP who underwent calcaneal lengthening for planovalgus deformity were included. Radiographic indices were measured on preoperative and latest followup weightbearing foot radiographs. The cutoff values of the preoperative radiographic measurements between the corrected and undercorrected groups were analyzed. The cutoff values are the reference values that can judge the possibilities of sufficient correction of a planovalgus deformity by calcaneal lengthening. Results The mean age of the patients at the time of surgery was 11.0 ± 5.2 years and the minimum followup was 1.0 years (mean, 3.1 ± 2.2 years; range, 1.0–8.4 years). AP talus-first metatarsal angle, calcaneal pitch angle, talocalcaneal angle, lateral talus-first metatarsal angle, and naviculocuboid overlap showed major improvements after calcaneal lengthening. The cutoff values of preoperative measurements between the corrected and undercorrected groups were 23° AP talus-first metatarsal angle, 36° lateral talus-first metatarsal angle, and 72% naviculocuboid overlap. Conclusions Calcaneal lengthening with concomitant peroneus brevis lengthening is an effective procedure for correcting a planovalgus foot deformity in patients with CP. However, for patients with greater than 23° AP talus-first metatarsal angle, 36° lateral talus-first metatarsal angle, and 72% naviculocuboid overlap, additional procedures for medial stabilization, such as tibialis posterior tendon reefing and talonavicular arthrodesis, should be considered as a result of the possibility of undercorrection with calcaneal lengthening alone. Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Objective: To explore patients’ experiences of foot problems associated with rheumatoid arthritis, from onset of symptoms to being provided with foot health interventions. Design: A qualitative design was used with an interpretive phenomenological approach to the data collection and analysis. Setting: University of Salford, School of Health Science. Subjects: Sixteen female and six male adults with rheumatoid arthritis-related foot problems and experience of receiving foot health interventions. Method: Data were collected through digital recordings of three focus groups which were conducted by an experienced researcher. An observer made field notes. Transcribed data were analysed using a thematic framework. Data were verified with randomly selected participants and agreement achieved with the participants, researcher and observer. Results: The results were organized into five themes: the significance of foot symptoms in relation to diagnosis of rheumatoid arthritis; knowledge of and explanation about foot symptoms; accessing foot health interventions; the effectiveness of foot health interventions; and improvements to foot health interventions. Despite foot problems being of concern to the participants, they were often ignored by practitioners from before diagnosis through to foot management. Conclusions: This study has highlighted a polarity between what these participants need in relation to their foot symptoms and the management of them. That foot problems are often ignored is of concern at multiple levels. These range from the implications of ignoring foot symptoms that may aid diagnosis of rheumatoid arthritis, to ignoring the need for effective foot health interventions.