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Background The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs. Methods Ultimately, 80 patients with a DIACFs were randomly allocated to receive either PR+CSC ( N  = 42) or MISTA ( N  = 38). Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded. Results The average time from initial injury to operation and the average operation time in the PR+CSC group were both significantly shorter than those in the MISTA group ( p  < 0.05). There were significantly fewer complications in the PR+CSC group than those in the MISTA group (7.1 % vs 28.9 %, p  < 0.001). The calcaneal width immediate postoperatively and at the final follow-up in the MISTA group were obviously improved compared to those in the PR+CSC group ( p  < 0.001). The variables of sagittal motion and hindfoot motion of the AOFAS scoring system in the PR+CSC group were significantly higher than those in the MISTA group ( p  < 0.05). The good and excellent results in the two groups were comparable for Sanders Type-II calcaneal fractures, but the good to excellent rate in the MISTA group was significantly higher for Sanders Type-III fractures ( p  < 0.05). Conclusion The clinical outcomes are comparable between the two minimally invasive techniques in the treatment of Sanders Type-II DIACFs. The PR+CSC grafting is superior to the MISTA in terms of the average time between initial injury and operation, operation time, wound-related complications and subtalar joint activity. However, the MISTA has its own advantages in improving the calcaneal width, providing a more clear visualization and accurate reduction of the articular surface, especially for Sanders Type-III DIACFs. Trial registration ChiCTRIOR16008512 . 21 May 2016.

This study proposes a novel concept for the automated and computerised segmentation of ultrasound images of bone based on motion information. Force is applied on the heel region using the ultrasound probe and then removed while recording the video of the bone using ultrasound. The interface between the bone and surrounding tissues is the region that moves with maximum speed. This concept is utilised to determine a map of movement, where speed is the criterion used for the bone segmentation from the surrounding tissues. To achieve that, the image is subdivided into regions of uniform sizes, followed by tracking individual regions in the successive frames of the video using an optical flow algorithm. The average movement speed is calculated for the regions. Then, the regions with the higher speed are identified as bone surfaces. It is given as the initial contour for the Chan–Vese algorithm to achieve smoother bone surfaces. Then, the final output from the Chan–Vese is post-processed using a boundary tracing algorithm to get the last automated bone segmented output. The segmented outcomes are compared against the manually segmented images from the experts to determine the accuracy. Bhattacharyya distances are used to calculate the accuracy of the algorithmic and manual output. The quantitative results from Bhattacharyya distances indicated an excellent overlap between algorithmic and manual works (average ± STDEV Bhattacharyya distance: 0.06285 ± 0.002051). The bone-segmented output from the optical flow algorithm is compared with the model output and the texture-based segmentation method’s output. The work from the motion estimation methods has better segmentation accuracy than the model and texture segmentation methods. The results of this study suggest that this method is the first attempt to segment the heel bone from the ultrasound image using motion information.

Background The aim of this retrospective monocentric study was to investigate the clinical efficacy of percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III displaced intra-articular calcaneal fractures (DIACFs). Methods The medical records of calcaneal fractures patients who were admitted to our department from January 2018 to January 2020 were retrospectively reviewed, and those meeting the inclusion criteria were fnally included for analysis. All patients were treated with percutaneous reduction and screw fixation, and no patients received bone grafting. The radiologic parameters evaluated included the BÖhler angle and the calcaneal height. In addition, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, Maryland Foot Score (MFS), and visual analog scale (VAS) score were determined. Results Thirty-eight patients with Sanders Type-II and Type-III DIACFs were finally included, including 30 males and 8 females aged 21 to 61 years [(42.6 ± 9.6) years]. According to the Essex-Lopresti classification, 27 of the fractures were the tongue type, and 11 were the joint compression type. According to the Sanders classification, 27 of the fractures were type II, and 11 were type III. Immediately postoperatively, the calcaneal height had recovered to 39.8 ± 2.1 mm, the BÖhler angle had recovered from 4.2° ± 13.6° preoperatively to 27.2° ± 3.4° ( P  = 0.000). All patients were followed up for 18–42 months [(25.2 ± 9.5) months]. All fractures healed. No differences were found in the outcome measures six-months postoperatively (BÖhler angle, p  = 0.24; calcaneal height, p  = 0.82) or at final follow-up (BÖhler angle, p  = 0.33; calcaneal height, p  = 0.28) compared to the immediately postoperative values. At the final follow-up, the AOFAS score was 91.7 ± 7.4 points, with an excellent and good rate of 92.1%; the MFS was 90.3 ± 7.8 points, with an excellent and good rate of 92.1%; and the VAS score was 2.2 ± 1.5 points. None of the patients had incision complications, and one patient developed traumatic arthritis. Conclusion Percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III DIACFs can achieve good recovery and maintenance of the BÖhler angle and calcaneal height. Moreover, it has the advantage of a low complication rate.

Purpose The aim of this study is to investigate the preoperative and postoperative psychological health status of patients with calcaneal fractures, and to explore the impact of preoperative psychological health status on the prognosis of surgical treatment for calcaneal fracture patients. Methods This study included 67 patients with calcaneal fractures who underwent surgical treatment in the Foot and Ankle Surgery Department of Honghui Hospital in Xi’an from November 2019 to September 2022. Patients were divided into two groups based on the presence of preoperative anxiety/depression symptoms, with patients exhibiting preoperative anxiety/depression symptoms assigned to Group A and those without such symptoms assigned to Group B. Preoperative and final follow-up assessments were conducted using the Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Score to evaluate patients. Results Among the 67 patients with complete follow-up for calcaneal fractures, 33 patients exhibited preoperative anxiety/depression symptoms (49.25%). Both Group A and Group B patients showed significant improvements in various evaluation indicators after calcaneal fracture surgery compared to preoperative assessments, but the overall prognosis of Group A was worse than that of Group B. Conclusions The preoperative psychological health status of patients is related to postoperative clinical outcomes, and patients with poorer psychological health have a worse prognosis.

Objective. To assess the potential relationship of demographic (age, gender, body mass index, height, weight), clinical (affected side, duration of symptoms, health-related quality of life), psychological (depressive levels), or neurophysiological (pressure pain sensitivity and number of trigger points) variables with foot function and pain intensity in patients with unilateral plantar heel pain (PHP). Methods. Fifty-four patients with PHP (48% females) were recruited. Data on demographics, months with pain, time in standing position, depression, pressure pain thresholds (PPTs), number of trigger points, health-related quality of life, function, and pain intensity were collected. A multivariable correlation analysis was performed to determine the associations among the variables, and a regression analysis was conducted to explain the variance in function and pain intensity. Results. Pain intensity was negatively correlated with symptom duration and calcaneus bone PPT and positively associated with gender, time in standing position, and number of trigger points. Function was negatively correlated with PPTs on the calcaneus bone, the flexor digitorum brevis muscle, and the abductor hallucis muscle and with quality of life and was positively correlated with age, gender, and depressive levels. Stepwise regression analyses revealed that 60.8% of pain intensity was explained by female gender, calcaneus PPTs, time in a standing position, and function. Furthermore, gender, quality of life, age, depressive levels, and calcaneus bone PPTs explained 52.4% of function variance. Conclusions. This study found that demographic, clinical, psychological, and neurophysiological variables can mutually interact to affect function and pain intensity in patients with unilateral PHP. These findings could guide clinicians in the identification, prevention, and treatment of PHP risk factors. Key Words: Plantar Heel Pain; Pain; Depression; Function; Foot; Pressure Pain

Objective To investigate the imaging characteristics and clinically assess heel enthesitis in spondyloarthritis (SpA) by applying in a post hoc analysis the Heel Enthesitis Magnetic Resonance Imaging Scoring system (HEMRIS) in blinded and centrally-read MRI data from the ACHILLES trial (NCT02771210). Methods ACHILLES included patients (≥18 years) with active psoriatic arthritis or axial SpA with clinical and MRI-positive heel enthesitis refractory to standard treatment. Patients were randomized to receive subcutaneous secukinumab 150/300 mg or placebo. At week 24, patients on placebo were switched to secukinumab treatment. MRI-positive heel enthesitis was confirmed in all patients by local investigators. MRIs were performed at 3 timepoints: screening and weeks 24 and 52. In the present analysis, all MRIs were re-evaluated by 2 blinded central readers in a consensus read fashion for a priori defined MRI parameters based on HEMRIS. Results At screening, 171/204 (83.8%) of patients presented with entheseal inflammation and/or structural damage, considering both the Achilles tendon and plantar fascia. Pathologies were more evident in the Achilles tendon area compared to the plantar aponeurosis. The most frequent pathologies were intra-tendon hypersignal and retrocalcaneal bursitis. The mean total entheseal inflammation score at screening in the Achilles tendon area was 2.99 ( N =204) and the mean change (standard deviation [SD]) from screening to weeks 24 and 52 was − 0.91 (1.99) and − 0.83 (2.12) in the secukinumab group vs − 0.48 (1.86) and − 0.80 (1.98) in the placebo-secukinumab group, respectively. The mean total structural damage score at screening was 1.36 ( N =204) and the mean change (SD) from screening to weeks 24 and 52 was 0.00 (0.65) and − 0.06 (0.56) in the secukinumab group vs 0.08 (0.48) and 0.04 (0.75) in the placebo-secukinumab group, respectively. Conclusions Based on the newly developed HEMRIS, entheseal inflammation and/or structural damage was confirmed in 83.3% of ACHILLES patients. Pathologies were more evident in the Achilles tendon area compared to plantar fascia, with the inflammatory parameters being more responsive with secukinumab treatment compared to placebo. The present analysis, with detailed information on individual MRI parameters, contributes to the scientific debate on heel enthesitis. Trial registration ClinicalTrials.gov NCT02771210 .

Aims Which is the best extensile lateral (ELA) or sinus tarsi (STA) approach for osteosynthesis displaced intraarticular calcaneal fracture (DIACF) is still debatable. The current RCT’s primary objective was to compare the complications incidence after open reduction and internal fixation of DIACFs through STA vs. ELA. The secondary objectives were the differences in intraoperative radiation exposure, time to fracture union, functional and radiological outcomes. Methods Between August 2020 and February 2023, 157 patients with Sanders type II and III fractures were randomly assigned to either ELA (81 patients with 95 fractures) or STA (76 patients with 91 fractures). The primary outcome was the incidence of complications. The secondary outcomes were Böhler’s and Gissane angles angle, fracture union, and American Orthopaedic Foot and Ankle Society (AOFAS) score. Results No statistical differences between both groups regarding basic demographic data, injury characteristics, and fracture classification; however, patients in the STA group were operated upon significantly earlier (4.43 ± 7.37 vs. 7 ± 6.42 days, p  = 0.001). STA’s operative time was significantly shorter (55.83 ± 7.35 vs. 89.66 ± 7.12 min, p  < 0.05), and no statistical difference regarding intraoperative radiation exposure. The time to fracture union was significantly shorter in STA (6.33 ± 0.8 vs. 7.13 ± 0.7 weeks, p  = 0.000). Skin complications (superficial or deep infection) and Subtalar osteoarthritis were significantly higher in ELA (18.9% vs. 3.3%, p  = 0.001) and (32.6% vs. 9.9%, p  = 0.001), respectively. The radiological parameters were significantly better in STA postoperatively and at the last follow up. The AOFAS scores were significantly better in STA (83.49 ± 7.71 vs. 68.62 ± 7.05, respectively, p  = 0.000). Conclusion During osteosynthesis of Sanders type II and III DIACFs, STA is superior to ELA in terms of operating earlier, shorter operative time, fewer complications, and better radiological and functional outcomes.

Objective Calcaneal fracture fixation remains a challenging procedure in orthopedics, with computational tools increasingly aiding in the optimization of preoperative planning. To compare the biomechanical stability of intramedullary fixation and locking plate fixation for Sanders II and III calcaneal fractures by three-dimensional (3D) finite element analysis and to provide a theoretical basis for clinical application. Methods The Computed Tomography (CT) images were segmented using Mimics software (Materialise NV, Belgium) to identify the region of interest based on threshold segmentation. The 3D morphology was reconstructed using Mimics 10.01 software. Subsequently, Geomagic2012 software (3D Systems, USA) was employed to remove noise points, sharp corners, and scattered points, achieving a smooth surface map. This map was saved in Initial Graphics Exchange Specification (IGES) format and imported into Solidworks (Dassault Systèmes, France) for model assembly and volume model construction. A three-dimensional finite element model of Sanders II/III, calcaneal fractures with intramedullary fixation and locking plate fixation, was established and analyzed by linear finite element analysis. The forced displacement, stiffness, and stress distribution of the two fixation methods were calculated. In addition, the three-dimensional model was tested using a compression mechanical experiment. Results Comparing fixation methods for Sander II and III fractures, the force-displacement curve of the intramedullary nail group aligned more closely with standards. Under axial compression, bone stress was highest with the Sanders II locking plate and lowest with the intramedullary nail. Across models, the intramedullary nail consistently exhibited slightly higher stress than the locking plate. The intramedullary nailing group model of the overall stiffness was slightly greater than the locking plate. By comparing the compressive mechanical test performance of the two fixation methods, it was found that the plate fixation group had an abnormal load until 7092.895 N, which was 1.5 times more than the load of the intramedullary nail. Conclusion Both intramedullary fixation and locking plate fixation for Sanders II and III calcaneal fractures have certain biomechanical stability, and locking plate fixation has potential application value in clinical practice.

Objective: Calcaneus is the most commonly fractured tarsal bone. This type of fracture may result from high-energy trauma or axial loading. The ideal treatment method for calcaneal fractures remains controversial in terms of surgical approach and the material that will be used for fracture fixation. This study aims to evaluate the outcomes of screw-only fixation in intra-articular calcaneal fractures using the sinus tarsi approach. Methods: Patients who were treated between 2014 and 2021 for calcaneal fractures were retrospectively investigated. Functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot-ankle score, and Gissane and Böhler angles were measured and compared. Results: The study included 32 patients (23 male, 9 female) who underwent screw fixation through the sinus tarsi approach for intra-articular calcaneal fractures. The mean age of the patients was 45.2 years. The fractures were classified according to the Sanders Classification, with 15 patients having type 2 fractures, 12 with type 3 fractures, and five with type 4 fractures. AOFAS hindfoot-ankle score revealed nine patients achieving excellent results, 14 patients achieving good results, and nine patients achieving fair results. AOFAS scores were lower in patients with Sanders type 4 fractures when compared to type 3 and type 2 fractures (p=0.005 and p<0.001 respectively). Conclusion: This study provides evidence supporting the favorable results of the sinus tarsi approach using screw-only fixation for treating intra-articularcalcaneal fractures. Keywords: Sinus tarsi, screw-only fixation, mini incision, calcaneus, Sanders type 4 Amaç: Kalkaneus, yüksek enerjili travma veya aksiyel yükleme sonucunda en sik kirilan tarsal kemiktir. Kalkaneal kiriklarin ideal tedavi yöntemi, cerrahi yaklasim ve kirik fiksasyonunda kullanilacak malzeme açisindan hala tartismalidir. Bu çalisma, sinüs tarsi yaklasimi kullanilarak intraartiküler kalkaneal kiriklarda sadece vida fiksasyonunun sonuçlarini degerlendirmeyi amaçlamaktadir. Yöntemler: 2014-2021 yillari arasinda kalkaneal kirik tanisiyla tedavi edilen hastalar geriye dönük olarak incelendi. Fonksiyonel sonuçlar Amerikan Ortopedik Ayak ve Ayak Bilegi Dernegi (AOFAS) ayak bilegi-ard ayak skoru kullanilarak degerlendirildi ve Gissane ve Böhler açilari ölçüldü ve karsilastirildi. Bulgular: Çalismaya, intraartiküler kalkaneal kiriklar için sinüs tarsi yaklasimiyla vida ile tespit yapilan 32 hasta (23 erkek, 9 kadin) dahil edildi. Hastalarin yas ortalamasi 45,2 yildi. Kiriklar, Sanders Siniflandirmasi'na göre siniflandirildi ve 15 hastada tip 2 kirik, 12 hastada tip 3 kirik ve bes hastada tip 4 kirik saptandi. AOFAS ayak bilegi-ard ayak skoru sonuçlarina göre, dokuz hastada mükemmel, 14 hastada iyi ve dokuz hastada orta sonuç elde edildi. AOFAS skorlari, Sanders tip 4 kiriklari olan hastalarda tip 3 ve tip 2'ye göre daha düsük bulundu (sirasiyla p=0,005, p<0,001). Sonuç: Bu çalisma, intraartiküler kalkaneal kiriklarin tedavisinde sinüs tarsi yaklasimi kullanilarak sadece vida ile tespitin olumlu sonuçlarini destekleyen kanitlar sunmaktadir. Anahtar kelimeler: Sinüs tarsi, sadece vidalar ile tespit, mini insizyon, kalkaneus, Sanders tip 4

Background Ankle sprain is one of the common traumatic injuries in daily life, and PRICE (protection, rest, ice, compression pressure bandaging, elevation of the affected limb) principle is routinely recommended at its early stage. In traditional Chinese medicine (TCM), bone-setting technique (BST) can quickly relieve ankle pain and improve walking function, but physicians require high skills and physical strength. In this study, we designed an exercise—heel kicking exercise (HKE) based on the principles and methods of BST. This study aims to observe its true efficacy and safety. Methods 68 patients (18–45 years old) with grade I and II lateral ankle sprain within 48 h were recruited from TCM hospital affiliated to Guangzhou medical university and 60 cases meeting the criteria were enrolled and randomized into control group and intervention group (30 cases separately). The patients in both groups were treated with the PRICE and ankle pump exercise, and the ones in intervention group added heel kicking exercise (HKE). The visual analogue scale (VAS) for pain, swelling degree, and American orthopedic foot & ankle society ankle-hindfoot scale (AOFAS) score before and after the intervention (within 4 W), and Karlsson score (the 26th week follow-up) were measured. Results Before treatment, there were no significant differences in VAS scores, swelling degrees and AOFAS scores between two groups. During the treatment for 4 weeks, VAS scores and swelling degrees of the patients in both groups gradually decreased, and the AOFAS score gradually increased ( p  < 0.01). In addition, patients in the intervention group were observed to get a quicker pain reliever, swelling subsiding, and ankle function restore than those in control group at most of time points of observation (1st d, 3rd d, 1st w, 2nd w, 4th w) ( p  < 0.05, p  < 0.01). But there was no significant difference in Karlsson scores between two groups at the 26th week follow-up. Conclusions HKE is a method designed to provide rapid movement rehabilitation for patients with ankle sprains, which can be used as one of its basic treatments. Trial registration This study was registered in China Clinical Trial Center (NO. ChiCTR2300073709). Trial registration date: August 16th 2022.