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Purpose To evaluate the surgical outcomes of arthroscopic removal of intraosseous deposits in patients with intraosseous calcific tendinitis of the rotator cuff. Methods This study involved a retrospective review of 96 patients operated on from 2004 to 2019. Patients were divided into two groups according to the location of calcific deposits. Group I had pure tendinous involvement ( n  = 71), and Group II had tendinous and intraosseous involvement ( n  = 25). The mean follow-up time was 6.4 ± 3.9 years. There were 71 patients (46 women, 25 men) in Group I, and the mean age was 49.3 ± 8.2 years (range 30–65 years). In group II, there were 25 patients (18 women, 7 men); the mean age was 47.3 ± 11.2 years (range 28–70 years). Results The mean preoperative VAS pain score was 8.8 ± 1.4 in Group I compared to 9.5 ± 0.5 in group II ( p  = 0.017). The median preoperative Constant and Oxford scores were 42 (20–65) and 22 (8–34) in Group I and 25.5 (22–46) and 10 (8–16) in group II, respectively ( p  < 0.001). There was no difference in postoperative pain scores (Group I: 0.7 ± 1.6 and group II: 0.5 ± 0.6, p  = 0.926), Constant scores [Group I: 100 (80–100) and group II: 100 (90–100), (n.s).] and Oxford scores [Group I: 48 (28–48) and group II: 46.5 (4–48), (n.s.)] between the two groups. The number of preoperative injections was higher in Group II ( p  = 0.05). There was no correlation between the size of the soft tissue calcific deposit and the preoperative pain, Constant, and Oxford scores (n.s.). Conclusion Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement. Level of evidence III.

Das Krankheitsbild des Tennisellenbogens beschreibt eine schmerzhafte Tendinose der Handgelenkextensoren mit Schmerzprojektion am lateralen Ellenbogen. Der Tennisellenbogen wird klinisch diagnostiziert und initial nahezu immer konservativ therapiert. Neben Physiotherapie und Infiltrationen können verschiedene physikalische Therapieformen wie Stoßwellen‑, Radio‑, Ultraschalltherapie etc. zur Beschwerdebesserung beitragen. Die Erfolgsaussichten unter konservativer Therapie sind mit ca. 89 % Ausheilung bzw. Besserung im Laufe eines Jahres hoch. Bei therapierefraktären Beschwerden bietet sich die operative Versorgung an, wobei sich die Operationstechnik nach der Präferenz des Chirurgen richtet, aber unabhängig vom Vorgehen insgesamt sehr gute Ergebnisse liefert. Im vorliegenden Beitrag werden Entstehung, Untersuchung sowie konservative und operative Therapiemöglichkeiten des Tennisellenbogens erläutert.

Category: Hindfoot; Other Introduction/Purpose: Zadek dorsal closing wedge calcaneal osteotomy (DCWCO) has been increasingly investigated as an effective technique for the treatment of Insertional Achilles Tendinopathy and Haglund’s deformity. More recently, this strategy has been modified using minimally invasive techniques. A percutaneous approach, in comparison to the standard open DCWCO, allows for reduced postoperative complication, improved clinical function, and decreased pain. This retrospective chart review aims to evaluate the postoperative outcomes of patients undergoing Zadek osteotomy via a minimally invasive percutaneous approach to assess early functional outcomes, complication rates, and revision rates. Methods: Two fellowship-trained foot and ankle orthopaedic surgeons at one academic institution performed minimally invasive percutaneous Zadek osteotomies on 21 patients. All cases were completed between March 2021 and February 2023. Patient charts were reviewed for outcome data including complication rate, union rate, revision rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Results: Average age of patients was 54 years. Average BMI was 39.4. Average follow up was 111.6 days. Complications included 1/21 (4.7%) superficial infection that resolved with oral antibiotics, 1/21 (4.7%) tibial neuritis that resolved 3 months after surgery, and 1/21 (4.7%) postoperative plantar fasciitis that resolved with home stretching by 6 months. There were no revisions to open procedures or hardware removal. All participants achieved union. 20/21 (95%) were very satisfied with their surgery. Average preoperative PROMIS scores regarding physical function, pain interference, and mobility were 38.3 (27-51), 65.1 (55-75), and 35.0 (25-46), respectively. Average postoperative PROMIS scores in these same domains were 38.5 (19-54), 58.8 (39-72), and 36.8 (22- 51). There was an average improvement in PROMIS scores in all domains (0.23, -6.35, and 1.76). Conclusion: Minimally invasive percutaneous Zadek osteotomy appears to be an efficacious and safe treatment option for insertional Achilles tendinitis and Haglund’s deformity with low complication profile, high union rate of the osteotomy and high patient satisfaction. Early functional outcome data shows trends in improvements in PROMIS scores. However, longer term data will be needed to assess long term functional outcomes and revision rates.

Category: Midfoot/Forefoot; Basic Sciences/Biologics; Sports; Trauma Introduction/Purpose: Flexor tendon injuries of the hallux are uncommon overall but when they happen, the flexor hallucis longus (FHL) tendon is the most frequent one affected. The rupture of FHL usually results from open injuries and deep cuts in the sole at the base of the toe;4 complete subcutaneous ruptures are extremely rare.5 There are around 36 cases reported of complete or partial closed ruptures of the FHL tendon along its entire course6 and the majority of the partial ruptures correspond to dancers and athletes.7 As far as FHB, we found a few reports of calcific tendinitis of the medial bundle and cases of calcifying tendinitis.8 To the best of our knowledge, this is the only case report of isolated closed rupture of the FHB tendon. Methods: A 33-year-old man, amateur soccer player, presented with mild swelling, ecchymosis, and increasing pain in the left hallux triggered by movement and palpation, relieved by rest. He sustained a direct axial blow and blunt force trauma with a soccer ball plus hyperextension. Standard bilateral weightbearing feet radiographs were normal. Physical exam revealed the left hallux normally aligned but with limited painful motion of 20° each way and no obvious instability. Palpation of the left first metatarsophalangeal joint was tender but not particularly over the sesamoids. MRI revealed an avulsion of the flexor Hallucis Brevis tendon off the proximal aspect of the medial sesamoid accompanied by fluid and edema, effusion in the first MTP joint and bone contusions in the first metatarsal head and dorsal base of the first proximal phalanx. Treatment with a toe spacer and postop sandal with the toe straight with an extension block was decided. Results: Tendon's blood flow around the sesamoids is limited making it susceptible to degenerative rupture. The most common mechanism of complete tendon rupture is direct open injury. Closed rupture is very rare and complete rupture in closed injury is even more. We did not find reports on third degree type of injuries, neither for any kind of isolated rupture of FHB. In our patient's case, dorsiflexion stretched all plantar soft tissue around the first MTP but he was able to do active movement of the great toe probably due to the FHL and lateral FHB insertion integrity. We found few reports of second-degree strain injury of FHL and FHB in a chronic setting, all treated conservatively with partial immobilization and strapping of the hallux to prevent extension. After conservative treatment at 3 months follow-up, our patient presented with no subjective complains, normal motion, stability and alignment of the hallux. Conclusion: Despite an extensive literature search, we did not find a similar injury, and this is probably the first time it is described. As found in our research, the most common injury related to the flexor tendons of the hallux are in soccer players and involve the FHL or both.23 These findings made us conclude that these injuries are either under-diagnosed or exceptional.

Acute calcific tendinitis of the longus colli muscle (CTLCM) is a rare reason of neck pain and symptoms can bear odynophagia, mild fever, and restricted cervical motion. Computed tomography is the most important radiologic examination for diagnosis, and magnetic resonance imaging or plain radiographs can also be used for diagnosis. We present two cases of acute CTLCM with specific imaging findings, prevertebral edema and calcium accumulation.

To compare the clinical outcomes of information and communications technology (ICT)-based home exercise programs using the exercise therapy platform (ETP™) with traditional handout-based programs for treating heel pain syndrome. Eighty-seven patients with heel pain syndrome (plantar fasciitis or Achilles tendinitis) were randomly assigned to either an ICT-based ETP™ (n = 44) or a traditional handout-based (n = 43) home exercise program. Both groups performed the same exercises for 12 weeks. Outcomes were assessed at baseline and at 4, 12, and 24 weeks using a visual analog scale (VAS) for first-step pain (primary outcome), pain at rest and during activity, foot function index (FFI), Short Form-36 (SF-36) score, and self-reported recovery. In the ETP™ group, mean improvement in VAS score for first-step pain exceeded the minimal clinically important difference (MCID) of 1.9 at all follow-up points, whereas the handout group did not achieve MCID at 4 weeks (1.4 ± 1.9). However, the mixed-effects model did not demonstrate a statistically significant between-group difference for first-step pain. For FFI, the ETP™ group showed greater improvement than the handout group at 4 weeks (between-group difference in change − 16.66, 95% confidence interval [CI] − 32.34 to − 0.99; p = 0.037; Hedges g = − 0.47) and 24 weeks (− 16.37, 95% CI − 32.04 to − 0.69; p = 0.041; g = − 0.39). For SF-36 PCS, improvement was significantly greater in the ETP™ group at 24 weeks than in the handout group (8.90, 95% CI 2.41 to 15.40; p = 0.007; g = 0.47). Self-reported recovery rates were higher in the ETP™ group at 12 and 24 weeks. In this study, both interventions improved symptoms of heel pain syndrome. Although the ETP™ group demonstrated clinically meaningful reductions in first-step pain and greater improvements in some secondary outcomes, no statistically significant between-group difference was observed for the primary outcome. These findings suggest potential benefits of ICT-based exercise therapy platforms, and further studies are needed to confirm their comparative effectiveness. Trial registration Retrospectively registered with the Clinical Research Information Services (identifier KCT0010211, registration date: 19/02/2025).

Category: Hindfoot; Other Introduction/Purpose: Insertional Achilles tendinitis (IAT) is a common orthopedic condition that can be treated conservatively or surgically. While non-operative treatment is thought to be beneficial in approximately 50-70% of cases, the precise success rate of non-operative treatment is not fully defined in the current literature. The purpose of this study is to define the success rate of modern non-operative treatment of IAT more precisely. Methods: A retrospective chart review was performed to identify patients who received either surgical or non-surgical treatment of IAT with a single fellowship-trained foot and ankle surgeon at an academic medical center between September 2015 and June 2019. A total of 133 patients (137 ankles) were identified. The success rate of non-operative treatment, defined as the lack of need for surgical treatment within two years of initial diagnosis of IAT, was recorded. Patients with IAT were treated with scheduled anti-inflammatory medications, physical therapy with a focus on eccentric strengthening and Achilles stretching and, when needed, controlled ankle motion (CAM) boot, short leg casting, or Platelet-Rich Plasma injections for refractory cases. A demographic and comorbidity comparison was performed between groups. Statistical analysis was performed using two-tailed Student t-test and Chi-squared test. Results: There was no difference in treatment method between those successfully treated conservatively and those who went on to fail conservative management and require surgery. At first encounter, patients who later received surgery were significantly more likely to have higher VAS pain scores (surgery=6.54, conservative=5.10; p=.045) and lower SF-12 physical scores (surgery=25.16, conservative=35.61; p<.001). The overall success rate of non-operative treatment was 78.57% and the average time from initial diagnosis to surgery was 198.83 days (range, 28-486). Conclusion: Based on the results of this study, the success rates of non-operative treatment for IAT may be higher than what is traditionally thought, at just under 80%. Further, patients with worse VAS and SF-12 physical scores were significantly more likely to fail conservative management. Orthopedic surgeons should use this information to provide more accurate counseling on the most appropriate treatment strategies for IAT.