Equinovarus is a prevalent and debilitating foot deformity requiring surgical intervention when conservative management fails. We performed triple arthrodesis using a modified Lambrinudi combined with X-shaped plate internal fixation to correct deformity, improve gait, and restore walking function, with the primary goal of enhancing the patient's quality of life. This retrospective consecutive case series of 14 patients (mean age, 41.9 ± 15.7 years) aimed to describe clinical/radiographic outcomes and the feasibility of X‑shaped plate fixation within a modified Lambrinudi triple arthrodesis. The patient cohort comprised 4 males and 10 females, with underlying etiologies including poliomyelitis, cerebral palsy, post-traumatic sequelae, and Charcot-Marie-Tooth disease. All patients underwent modified Lambrinudi triple arthrodesis combined with soft tissue procedures. Outcomes were assessed through radiographic evaluation (including the talar-calcaneal angle, talus-first metatarsal angle, and calcaneal-fifth metatarsal angle, all measured on anteroposterior radiographs, along with the lateral talus-first metatarsal angle) and clinical investigations: MOS 36-Item Short-Form Health Survey (SF-36) score, visual analog scale (VAS), and International Clubfoot Study Group (ICFSG) Outcome Evaluation Score. Mean follow-up time was 46.1 ± 14.8 months (range, 24-69). Radiographic assessment demonstrated bony union in all patients at 6 months following triple arthrodesis. Postsurgical improvements in foot morphology and function occurred at varying levels across the cohort. At last follow-up, marked increases in SF-36 scores were observed in both physical and mental domains, whereas the VAS score decreased from 6.7 to 1.4 (P < .001) and ICFSG score decreased from 37.7 to 8.1 (P < .001), with an excellent-to-good rate of 93%. Patients' quality of life improved. Satisfactory fusion rates, favorable clinical outcomes, simple internal fixation requirements were all associated with the modified Lambrinudi procedure with X-shaped plate fixation for triple arthrodesis. This internal fixation is reliable.

The availability of total ankle arthroplasty (TAA) systems with varying designs of talar condylar geometry has increased. However, it remains unclear how these features influence the motion of the ankle and hindfoot joints. This study assessed the ankle and hindfoot kinematics using a contemporary TAA system with a symmetric bicondylar talar component design. TAA was performed in eleven mid-tibia specimens. A 6-degree-of-freedom robot sequentially simulated the stance phase for the intact and post-TAA conditions. The kinematics and range of motion (ROM) of the ankle, subtalar, and talonavicular joints were calculated and compared between conditions. The ankle demonstrated decreased dorsiflexion by 4.0 degrees (P = .041) and increased inversion by 1.5 degrees (P = .04) during early stance. The talonavicular joint was significantly more everted by 3.5 degrees during a portion of late stance (P = .016). There were no significant differences between conditions in the subtalar joint. The ankle ROM in the transverse plane increased 1.9 degrees post-TAA (P = .025), but no significant changes were observed in the subtalar or talonavicular joints. In this cadaveric stance‑phase simulation, ankle and hindfoot kinematics and ROM were modestly altered after TAA. Therefore, a TAA system with a symmetric talar condylar design may closely replicate native ankle and hindfoot joint motion. Implant design may influence joint kinematics; in this cadaveric model, a symmetric bicondylar talar component showed smaller transverse‑plane ROM increases than those previously reported for one asymmetric design tested under similar conditions.

Patients with an osteochondral lesion of the talus (OLT) often present with deep ankle pain, but the direct relationship between structural damage and the perceived pain remains unclear. The aim of this study was therefore to determine whether pain is associated with demographic and radiologic (computed tomography [CT]-only) lesion characteristics. This cross-sectional study was conducted in patients with symptomatic OLTs at a tertiary referral academic hospital. The primary outcome was the Pain subscale of the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the Numeric Rating Scale (NRS) for pain at rest and during walking, as well as the other FAOS subscales. Associations with patient demographics, lesion size, morphology, and location were assessed using univariate linear regression, followed by multivariate linear regression with backward selection. A total of 310 patients were included. In the final multivariate model for the FAOS Pain subscale, higher age (β = -0.18, P = .04) and smoking (β = -8.70, P < .001) were significantly associated with worse pain scores. Lesion morphology characterized by the presence of an osteochondral fragment was associated with lower NRS pain scores during walking. For NRS pain at rest, worse scores were significantly associated with female sex, higher body mass index, smoking, non-primary lesion nature, and greater lesion depth. No association was found between CT-based radiologic lesion characteristics and patient-reported pain as measured by the FAOS Pain subscale. In secondary analyses, some lesion characteristics showed associations, but these were limited and directionally inconsistent. These findings suggest structural damage alone does not seem to fully explain the patient's pain. Given the CT‑only approach and other design constraints, further research is warranted.

Tarsometatarsal (TMT) joint arthrodesis is essential for managing surgical management of severe bunion deformities, complex midfoot trauma, and osteoarthritis. Various fixation methods and bone grafting types have been described, but the impact of the number of joints fused on union rates remains unclear. This study aimed to evaluate whether fusing multiple joints affects arthrodesis rates and to compare union outcomes among different fixation constructs and grafting techniques. We conducted a single-center retrospective cohort study of 582 TMT fusions, comparing single- vs multiple-joint fusions involving medial and central columns. The average follow-up was 15.5 months. Two fellowship-trained foot and ankle surgeons assessed radiographs and computed tomographic (CT) scans. Radiographic union was evaluated at 8 and 12 weeks as well as the specific fixation constructs and bone graft used across each joint. Single-TMT-joint surgeries had a significantly greater proportion of fusions occurring by 12 weeks than the multiple-TMT-joint surgeries, 74.9% vs 67.0%, respectively, P = .0002. Ultimate union rates were similar for single-joint fusions (80.3%) and multiple-joint fusions (82.6%. Many nonunions were asymptomatic; the combined asymptomatic nonunion and union rate was 95.4%. The revision rate for all nonunions was 25.5%. Staple fixation was associated with higher nonunion rates in the second (46.15%) and third (37.5%) TMT joints, whereas screw fixation showed the highest nonunion at the first TMT joint (54.6%). The lowest nonunion rates were observed with combined interfragmentary screw fixation and plating across all joints. Diabetic patients and current smokers experienced higher complication and nonunion rates. Although the radiographic nonunion rate (18.2%) exceeded prior reports, symptomatic nonunion was rare (4.6%). Multiple-TMT-joint surgeries required more time to confirm radiographic union than single joint surgeries. Among the modifiable factors, implant and graft choice were associated with differences in union rates.

Modern percutaneous hallux valgus surgery, including the minimally invasive chevron and Akin (MICA) technique, is considered to cause less pain than traditional methods because of reduced soft tissue morbidity. Nevertheless, opioids are often prescribed postoperatively. This study investigates whether mild to moderate analgesics (World Health Organization [WHO] level 1 and 2) are sufficient for pain control following modern percutaneous hallux valgus correction. This prospective single-surgeon case series includes 125 consecutive feet that underwent MICA surgery between May 2018 and May 2023; 95 feet (76%) were included with ≥12-month follow-up. Data on pre- and postoperative analgesic consumption and radiologic parameters were recorded. Patient-reported analgesic consumption was collected at prespecified visits via electronic questionnaires; no pill counts were performed. The primary endpoint was the proportion of patients using any opioid by the end of postoperative week 2. Secondary outcomes included radiologic parameters and complication rates. The mean follow-up period was 1.6 years (±0.5). Fourteen percent (95% CI 0.08-0.22) required any opioids within the first two postoperative weeks, with a mean of 23.3 morphine milligram equivalents (MME; 95% CI 9.7-37.0). Two percent (95% CI 0.01-0.07) required WHO level 3 opioids. Seventy-five percent of patients stopped taking analgesics within 3 weeks (95% CI 0.65-0.82). Significant improvements were observed in hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). In this prospective case series within a standardized care pathway, most patients did not require opioids, and high-potency opioids were rarely used. Routine prescription of high-potency opioids after third/fourth-generation percutaneous hallux valgus correction may be unnecessary for most patients in similar settings. Hardware-related findings should be interpreted cautiously because the screw design and osteotomy technique changed during the study period, which may have confounded comparisons.

Custom 3-dimensionally (3D)-printed titanium cages are increasingly used for managing critically sized bone defects (CSDs) of the foot and ankle. Little is known regarding the optimal bone graft (allograft, synthetic, or mixed) to enhance osseointegration. In this study, we compared radiographic osseointegration across synthetic, allograft, and mixed graft formulations in custom 3D‑printed cage reconstructions of foot/ankle CSDs. This was a single-institution retrospective cohort study of patients who underwent foot and ankle reconstruction for CSDs using a custom cage. Demographic and clinical variables included race/ethnicity, age, body mass index, number of prior ipsilateral foot/ankle surgeries, procedure type, cage type, and graft type. The primary outcome was evidence of radiographic osseointegration using a longitudinal mixed effects model at 6, 12, and 24 months. Secondary outcomes included reoperation rates, need for implant removal, and ipsilateral limb amputation, which are summarized descriptively. A total of 62 patients were included (20 synthetic graft only; 23 allograft only; 19 mixed). Osseointegration proportions were 74% (synthetic), 64% (allograft), and 89% (mixed) at 6 months; 82%, 75%, and 95% at 1 year; and 100%, 92%, and 100% at 2 years for the patients we were able to follow, with no statistically significant differences in the mixed effects model (unadjusted odds ratios). There were no statistically significant differences in baseline patient demographics, comorbidities, or procedural indications among the 3 graft cohorts. The longitudinal mixed effects model found no statistically significant differences in radiographic osseointegration among the graft groups through 6, 12, and 24 months. We found an overall reoperation rate of 40%, an average of 3.6 reoperations performed on this 25 patient subgroup, and an overall amputation rate of 8%. In this single-institution retrospective cohort, we did not detect statistically significant differences in radiographic osseointegration or major postoperative outcomes among synthetic, allograft, or mixed graft formulations; larger prospective studies are warranted.

Our aim in this study was to prospectively assess the patient-reported clinical outcomes of arthroscopic bone marrow stimulation (BMS) for non-primary osteochondral lesions of the talus (OLT) and to compare these with primary cases at 2-year follow-up. The secondary aims were to assess the association of baseline factors with outcomes and the occurrence of adverse events. Patients who underwent arthroscopic BMS were prospectively included and assessed up to 2-year follow-up and were grouped according to non-primary (ie, failed previous OLT surgery) or primary BMS. Patient-reported outcomes were collected at baseline and 2-year follow-up and included the numeric rating scale (NRS) for pain and the Foot and Ankle Outcome Score (FAOS) questionnaires. The primary outcome was the improvement in NRS pain during walking, with a minimal clinically important difference (MCID) of 2.0. Adverse events concerned reoperations and complications during the study period. Forty-four patients were included: 25 in the primary group and 19 in the non-primary group. Both groups showed a statistically significant improvement in pain and functional outcomes from preoperatively to 2-year follow-up. The improvement in the primary outcome was significantly higher in the primary group (median 3 [IQR: 1-5] out of 10) compared to the non-primary group (median 1 [IQR: 1-3] out of 10), P = .01. Moreover, 68% (95% CI 46%-85%) reached the MCID compared with 32% (95% CI 13%-57%) in the non-primary group, which was statistically significant (P = .03). Baseline variables showed no consistent association with the primary outcome, except for a moderate correlation with age and lower improvements for patients who received concomitant surgery in the primary group. None of the changes in the FAOS sub-scales showed a statistically significant difference between the two groups. Two revision procedures (non-primary group: 11% [95% CI 1%-33%] vs 0% primary group, P = .2) occurred in the non-primary group. During the study period, 1 case (non-primary group: 5% [1%-26%] vs primary group: 0%, P = .4) had a complication. The most important finding of this prospective study is that arthroscopic BMS for non-primary OLT yields a significant improvement in patient-reported outcomes compared with baseline, but an inferior improvement compared with primary OLT at 2-year follow-up. On average, approximately two-thirds of BMS-treated primary OLTs reached the MCID compared with one-third in the non-primary group. Level II, prospective comparative cohort study.

Total ankle arthroplasty (TAA) is increasingly used as a motion-preserving alternative to ankle arthrodesis for end-stage ankle disease. The Salto Talaris fixed-bearing prosthesis was designed to enhance joint kinematics while minimizing bone resection and reducing complications seen in earlier implant generations. This study reports midterm clinical outcomes, including survivorship, complications, reoperation and failure rates in a large, single-surgeon cohort. A retrospective review was conducted of 1121 primary TAAs performed in 1023 patients (98 bilateral) between May 2008 and December 2022. Patients with a minimum of 2-year clinical follow-up were included and any patients who failed or passed away before then were accounted for. Data included demographics, comorbidities, preoperative ankle diagnosis, ancillary procedures, intra- and postoperative complications, and patient-reported outcomes measures (PROMs). Complications were identified and then classified by the Glazebrook system (low-, medium-, high-grade). Reoperations and revisions were coded according to the Canadian Orthopaedic Foot and Ankle Society reoperations coding system. The mean age at the index TAA surgery was 65.5 (range, 28.7-94.4) years, with osteoarthritis being the most common diagnosis. The average follow-up was 5.5 (range, 2-17.2) years. Key PROMs showed statistically significant improvements from preoperative to latest follow‑up (Veterans RAND 12-Item Health Survey physical component summary, +10.1 [95% CI 8.83-10.77]; Ankle Osteoarthritis Scale [AOS] pain, -29.2 [95% CI 25.43-29.72]; AOS disability, -32.8 [95% CI 29.32-33.80]; visual analog scale for pain, -36.8 [95% CI 32.6-40.7]; all P < .001). Implant survivorship was 94.6% at the time of this report. A total of 240 ankles (21.4%) experienced at least 1 complication. Secondary reoperations occurred in 134 ankles (12.0%), with 61 ankles failing (5.4%) and leading to a revision TAA, conversion to arthrodesis, or an explant to antibiotic spacer. Most failures were due to high-grade complications including aseptic loosening (22/61) and deep infection (19/61). Among the failed ankles, 2 patients ultimately underwent a below-the-knee amputation. In this large cohort, the Salto Talaris TAA was associated with improvements in patient-reported quality of life, activity, and pain, and showed high survivorship with relatively low failure (5.4%) and reoperation (12.0%) rates at an average of 5.5 years after index surgery.

Middle facet subluxation (MFS) of the subtalar joint is a key indicator of peritalar subluxation in progressive collapsing foot deformity (PCFD). Although its assessment relies on weightbearing computed tomography (WBCT), it remains unclear which weightbearing radiographic (WBR) measurements correlate with MFS. We hypothesize that radiographic parameters assessing hindfoot alignment are correlated with MFS. Seventy-three feet diagnosed with PCFD were evaluated using WBR and WBCT. Five parameters were measured in both modalities: talonavicular coverage (TNC) angle, hindfoot moment arm (HMA), talo-first metatarsal angle, calcaneal pitch angle, and sinus tarsi impingement. MFS was then measured on WBCT. Multivariate and bivariate regression analyses were used to identify which WBR measurements predict or correlate with MFS. Partition analysis was used to identify cutoff values for WBR measurements linked with MFS. Multivariate regression identified TNC angle and HMA as combined MFS predictors (R² = 0.524, P < .0001). In the bivariate analysis, TNC angle demonstrated a moderate individual correlation with MFS (r = 0.68), whereas HMA showed a weak individual correlation (r = 0.39). Partition analysis identified practical radiographic thresholds (TNC angle ≥ 38 degrees, HMA ≥ 11.4 mm) for MFS ≥18% yet these thresholds explained only 27.3% of variability (R² = 0.273). TNC angle and HMA are the most useful WBR measurements for identifying MFS in PCFD. In settings without WBCT access, these offer a practical assessment tool, associated with MFS ≥18%; however, these cutoffs accounted for only 27.3% of variance (R² = 0.273), underscoring residual unexplained factors.