Ankle Region Research Articles

Imminent risk of the first and second recurrent osteoporotic fractures in South Korea

BackgroundA history of fractures increases the likelihood of experiencing subsequent and secondary fractures. To prevent further fractures, global guidelines recommend aggressive proactive treatment with medication for patients at an imminent risk of osteoporotic fracture (OF), which is defined as a high likelihood of experiencing subsequent fractures in the near future. However, there is a lack of research focusing on patients with imminent risk of OFs in South Korea. Hence, this study aimed to evaluate the imminent risk of the first and second recurrent OFs among patients with OF in South Korea. MethodsWe conducted a retrospective analysis using the comprehensive Health Insurance Review and Assessment database, which encompasses the entire population of Korea from 2012 to 2017. The study focused on eligible patients aged 55 years and older who experienced an OF in 2013, including fractures in the hip/femur, vertebral, humerus, radius, tibia/fibula, and ankle regions. The first OF occurring in 2013 was considered the index OF. To ensure that the index fracture was the index OFs, we excluded patients who had any OF within 1 year before their index OF. We assessed the incidence of the first recurrent OF within 2 years after the index OF, and the second recurrent OF within 2 years after the occurrence of the first recurrent OF. Additionally, we estimated the risks of experiencing the first and second recurrent OFs according to age and sex using multi-variable Cox proportional hazard regression analysis. ResultsApproximately 17 % of patients with an index OF had the first recurrent OF within 2 years after the index OF. Of those with a first recurrent OF, 28 % experienced a second recurrent OF within 2 years after the first recurrent OF. The two-year incidence rate of the first recurrent OF was 9.6 per 100 person-years (95 % confidence interval [CI], 9.6–9.7). The two-year incidence rate of the second recurrent OF was 22.0 per 100 person-years (95 % CI, 21.6–22.4), which is higher than that of the first recurrent OF. Females had a 31 % higher risk of the first recurrent OF (hazard ratio [HR] = 1.31; 95 % CI, 1.20–1.43) and a 43 % higher risk of the second recurrent OF than males (HR = 1.43; 95 % CI, 1.35–1.51). ConclusionsIn Korea, the imminent risk of a second recurrent OF was higher than that of a first recurrent OF. Consequently, given the elevated risk of subsequent fractures with the number of OFs experienced, a more targeted approach to treatment is recommended for patients with a first recurrent OF considering the risk of subsequent OF.

Comparison of accuracy and speed between plaster casting, high-cost and low-cost 3D scanners to capture foot, ankle and lower leg morphology of children requiring ankle-foot orthoses.

Traditional plaster-cast fabrication of an ankle-foot orthosis (AFO), although robust, is time-consuming and cumbersome. 3D scanning is quickly gaining attention as an alternative to plaster casting the foot and ankle region for AFO fabrication. The aim of this study was to assess the accuracy and speed of two high-performing 3D scanners compared with plaster casting in pediatric patients requiring an AFO. Ten participants (mean age 10.0±3.9years) prescribed AFOs for a movement disorder were 3D scanned with the high-cost Artec Eva (Eva) and low-cost Structure Sensor II (SSII) using one-person (1p) and two-person (2p) protocols. Accuracy and speed for both 3D scanners were compared with corresponding plaster cast measures (≤5% acceptable difference). Bland and Altman plots were generated to show mean bias and limits of agreement. Overall, Eva and SSII were accurate for foot, ankle, and lower leg key clinical landmarks (Eva-1p: 4.4±7.3%; Eva-2p: 3.2±7.5%; SSII-1p: 0.6±7.4%; SSII-2p: 0.7±8.2%). Bland and Altman plots for the SSII demonstrated lower biases for 1p (bias 0.5mm, LoA: -12.4-13.5mm) and 2p (0.4mm, LoA: -11.4-12.2mm) protocols compared with Eva for 1p (bias 2.3mm, LoA: -8.0-12.7mm) and 2p (1.8mm, LoA: -10.7-14.3mm) protocols. The SSII 2p protocol was the fastest 3D scanning method (26.4±11.1s). The high-cost Eva and low-cost SSII 3D scanners using the 1p and 2p protocols produced comparable accuracy and faster capture of key clinical landmarks compared with plaster cast measures for the fabrication of AFOs in pediatric patients.

Free vascularized medial femoral condyle periosteal flaps in the ankle and foot region: A narrative review.

The objective of this study was to determine the role and reliability of the free medial femoral condyle (MFC) flap (MFCF) in demanding foot and ankle reconstruction procedures. A search of the MEDLINE, PubMed, and Embase electronic databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines between January 2008 and September 2023. Articles concerning free MFC bone flaps for reconstruction of the foot and ankle regions were included. Outcomes of interest included flap failure, complications, union rate, time to union, and functional scores. Twenty studies involving 131 patients met the inclusion criteria. The most common clinical indications for the free MFCF were nonunion, avascular necrosis, and osteomyelitis. The most common sites of nonunion were tibiotalar arthrodesis (50%) and subtalar arthrodesis (33%). Overall, the bony union rate was 93.1%, with a mean time to union of 14.6±0.1 weeks. There were no flap failures reported. Postoperative complications were observed in 39 (29.7%) cases (e.g., delayed donor site wound healing, flap debulking, medial condyle osteonecrosis, and donor site numbness), with 21 (16%) patients requiring further operative intervention. No major donor or recipient site morbidity occurred, except for one case. Free MFCFs offer a versatile and dependable choice for cases of foot and ankle reconstruction, displaying favorable rates of bone fusion and acceptable complication rates. Existing literature indicates that MFC reconstruction in the foot and ankle is not associated with significant morbidity at the donor or recipient sites. The pooled data demonstrated a 93% success rate in achieving bone fusion in the foot and ankle region, supporting the view that it can be considered another option of treatment.

Posterior Tibial Artery Perforator Based Propeller Flap for Reconstruction of 143 Skin and Soft Tissue Defect Around Ankle Joint

Background: Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this needs facility of microsurgery, may lead to donor site morbidity and is time consuming. With the introduction of perforator flap, management of small and medium size defects of distal leg and ankle region is easier, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180-degree, donor site can be closed primarily and increases the distance crossed by flap, thus increasing versatility. Objectives: To observe the outcome of soft tissue coverage of defects around ankle joint by posterior tibial artery perforator based propeller flaps. Methods: This was a prospective type of observational study carried out on 20 patients with skin and soft tissue defects in and around ankle joint for a period of 14 months in the Department of Burn and Plastic Surgery, Dhaka Medical College and Hospital. Results: Among 20 cases 17 were male and 3 females; age ranged from 11 to 60 years. Post operative outcome of flap were excellent in 11 cases, good in 6 cases, poor in 3 cases as per defined criteria. Uneventful outcome was observed in 14 cases and minor complications were observed in 5 cases; and total flap loss occurred in 1 case which required revision surgery. Conclusions: Perforator flap provides adequate soft tissue coverage for small & medium size wound around ankle. It is an easy, reliable & effective procedure with reasonable outcome. J Dhaka Med Coll. 2022; 31(2) : 243-250

Soulful Rhythm, Dancing Bodies: Spirituality, Pain Tolerance, and the Risk of Lower Extremity Musculoskeletal Injuries Among Classical Kathak Dancers of India

Background: Dance and dancers reflect happiness, sadness, passion, anger, and all other emotions as every single dancing movement carries a significant signal that goes beyond words. Kathak, an Indian classical dance form, requires a divine balance between the soul and the physical body. This balance allows for a high pain tolerance of the dancers, but the spiritual nature of this dance form also generates ignorance and disinterest in their health seeking behavior towards injuries. Objectives: This comprehensive narrative review is aimed at exploring and examining the prevalence of lower extremity musculoskeletal injuries among Kathak dancers and proposes management strategies for their prevention and treatment. Methods: This review is based on a search of relevant articles, research papers, books and book chapters conducted across a wide array of online sources, utilizing the search engines like PubMed, Medline, CrossRef; etc. Considering the inclusion criterion, the review process included three stages: initial assessment of papers through title and abstract review, a detailed examination of relevant items, and systematic compilation of pertinent information into a categorized table under topical headings. Results: The review finds that the majority of injuries were reported in the foot and ankle region of dancers practicing Kathak. Conclusion: There is a need to develop supplementary exercise training programs and also spread awareness among dancers regarding their physical health and seeking medical care in time to delay/prevent lower extremity injuries.

Tuning the mechanical responses of 3D-printed ankle-foot orthoses: A numerical study

Ankle-foot orthoses (AFOs) are frequently prescribed for children with cerebral palsy (CP) to correct specific features of abnormal gait. However, traditional AFO manufacturing and design involve labor-intensive processes and rely on subjective evaluations of clinicians. Recent advances in three-dimensional (3D) printing allow the rapid prototyping of AFOs, but the expanded design options complicate decision-making. This study aims to evaluate how AFO design affects the mechanical responses of 3D-printed AFOs. The lower limb geometry is established by a 3D-scanning system, and a prototypical AFO is designed, 3D printed, and tested under compression. A parametric study on the effect of base materials, thickness, and trimline location is conducted based on a validated numerical model. The results reveal that AFOs exhibit distinct behaviors under plantarflexion and dorsiflexion motions, with AFO stiffness correlating to thickness through a power function. AFO stiffness is more sensitive to posterior trim depth than inferior, while both trim depths significantly influence stress concentration around the ankle region. This investigation demonstrates the potential of combining 3D printing and computational modeling to improve the design and fabrication process of AFOs, providing insights into the development and customization of 3D-printed AFOs.

Three-Dimensional MRI of Foot and Ankle: Current Perspectives and Advantages Over 2D MRI

The foot and ankle region, distinguished by its complex and intricate anatomy, is frequently susceptible to injuries, particularly in the context of sports-related activities and fall-related trauma. This article reviews the literature with respect to 3-Dimensional (3D) magnetic resonance imaging (MRI) of foot and ankle. Technical considerations and imaging and interpretation-related advantages and pitfalls will be discussed with relevant case examples. 3D MRI is advantageous over 2-Dimensional (2D) MRI in producing higher spatial resolution in a short duration of time with less partial volume artifacts and in creating structure-specific imaging using multiplanar and curved planar reconstructions. The reader will be able to apply such principles in their practice in obtaining higher-resolution volume imaging of ankle and foot with respect to ligaments, tendons, articular cartilage, plantar fascia, plantar plate, and peripheral nerves for the benefit of their patients and referring physicians.

Adaptation of the Oslo Sports Injury and Health Problems Questionnaire to the Bahasa Version and Its Application for Athletes Surveillance

The Oslo Sports Trauma Research Center (OSTRC) questionnaire on injuries and health problems is one of the recommended methods for monitoring athletes’ health problems, but until now it has not been available and validated in a Bahasa version. This study aims to develop the OSTRC Questionnaire into Bahasa and assess its application in adolescent athlete surveillance. The research process is divided into two stages; The adaptation and validity assessment according to ISPOR rules involving 42 adolescent athletes for 2 weeks and the second stage is 8 weeks of surveillance involving 46 adolescent athletes. Results of the analysis found that the Bahasa version of the OSLO Questionnaire for shoulder, knee, ankle, and health problems has good validity and reliability with Cronbach-α 0.905, 0.940, 0.933, and 0.840 respectively. The intraclass correlation coefficient for health problems was 0.905, the shoulder region was 0.94, the knee region was 0.933 and the ankle region was 0.840, with all p-values <0.001. The sensitivity of the health problems questionnaire reached 97.6% and specificity 99.4%, while the sensitivity of the injury questionnaire reached 100% and specificity reached 99.4%. The Bahasa version of OSLO Sports Trauma Research Center Injury and Health Problems is valid and reliable and shows high sensitivity and specificity to detect and separate athletes with injuries or health problems.

Use of Figueiredo’s technique for treating extensive infected skin lesions – a case report

Demonstrate that a low-complexity surgical technique can effectively solve problems of extensive skin lesions in cities where microsurgical techniques are not available. We present a 59-year-old male patient with diabetes mellitus and an extensive and infected lesion in his right ankle region, suggestive of a diabetic foot. Urgent surgical treatment was performed with debridement of the devitalized tissues, drainage of a large amount of purulent secretion, and exhaustive washing with 0.9% saline solution. After a new debridement, abundant washing with 0.9% saline solution and coverage of the extensive bloody area with a polypropylene prosthesis were performed. He remained under outpatient follow-up, and subsequently, twice, new cleanings were performed, and a small diameter mesh was applied due to the good evolution of healing. A good range of motion was maintained in the right ankle and foot, with the medial wound completely healed, leaving only a small area of the lateral wound to complete the healing process. Figueiredo’s technique, described in 2017 for fingertip lesions, uses a flexible thermoplastic polymer, which can be obtained from a small portion of silicone from a saline bag, to form a semi-occlusive dressing that allows the drainage of secretions and provides a favorable environment and temperature for healing. The exact limits of this technique are not yet well established, but the practice has shown excellent results in larger lesions. Figueiredo’s technique is a simple, low-cost, and effective option for treating extensive infected skin lesions. Level of Evidence IV; Therapeutic studies; Case Report.

Effects of trimline cut in ankle foot orthosis: An experimental and finite element analysis

An Ankle-foot orthosis (AFO) is a structure that spans from the lower leg to the foot and controls ankle joint movement. It prevents or assists the human body's lower leg and foot in replicating a normal human gait. The purpose of AFO is to achieve a stable gait by controlling the musculoskeletal system adequately. The mechanical features of AFO stiffness will play an essential role in helping gait, if this stiffness is not matching to the patient's conditions, gait will decrease and knee joint motion will be compromised. In general, trimline cut were introduced in the AFO medial and lateral side to control the stiffness of orthosis. However, this will result in stress concentration in the ankle region and lead to failure of AFO. In this study first evaluate the effects of trimline cut in AFOs using finite element analysis with three geometrical shapes like circle, elliptical and slot were introduced on the dorsal side. The stress concentration and stiffness of AFOs in the ankle region were computed. The stiffness of the basic model and trimline cut AFO model were compared and found elliptical trimline cut model is optimum one. The experimental analysis was performed using 3D Printed AFOs and calculated stiffness. It was observed that finite element analysis results, stress concentration of trimline cut models were reduced maximum of 2 % with basic model (without trimline cut)., whereas, in the experimental study of 3D-Printed AFO of trimline cut model, stiffness were reduced around 16 % compared with basic models. This study clearly indicates that, geometrical shapes trimline cut influencing on stiffness of AFOs. It will give the insight's for orthosis designers to make custom design of AFOs in particularly foot drop conditions to optimized the stiffness of orthosis.

Management of Dushtavrana (Non-Healing Ulcer) through Ayurveda - A Case Report

Shalyatantra is one among the Astang Ayurveda, the branch of Shalyatantra refers to surgical and parasurgical procedures in Ayurveda. Dusthavrana (non healing ulcer) are a frequently encountered problem in present era produced commonly as a complication of trauma or pathologic insult and it causes long term agony to the patient. The issue of non-healing ulcers management with Ayurvedic remedy is one of the major areas of the research and has come under increased study. This is a case report of 40-year-old female, who had an episode of Dushtavrana (non healing ulcer) and presented to the outpatient department with complaints of severe pain, itching and ulcer over right ankle region. The first line of management for Dushtavrana is Shodhana. Kalka is the specific treatment for Dusthavrana which is mentioned under Shodhana and Ropana Kriya of Saptopakrama. Yavadi Kalka is one of the formulations mentioned in Dwivraniya Chikitsa Adhyaya. Yavadi Kalka is simple, very cost-effective procedure. In the present case, Yavadi Kalka after Jaloukavacharana has shown assuring results in the management of Dushtavrana.

-A machine learning model to predict surgical site infection after surgery of lower extremity fractures.

This study aimed to develop machine learning algorithms for identifying predictive factors associated with the risk of postoperative surgical site infection in patients with lower extremity fractures. A machine learning analysis was conducted on a dataset comprising 1,579 patients who underwent surgical fixation for lower extremity fractures to create a predictive model for risk stratification of postoperative surgical site infection. We evaluated different clinical and demographic variables to train four machine learning models (neural networks, boosted generalised linear model, naïve bayes, and penalised discriminant analysis). Performance was measured by the area under the curve score, Youdon's index and Brier score. A multivariate adaptive regression splines (MARS) was used to optimise predictor selection. The final model consisted of five predictors. (1) Operating room time, (2) ankle region, (3) open injury, (4) body mass index, and (5) age. The best-performing machine learning algorithm demonstrated a promising predictive performance, with an area under the ROC curve, Youdon's index, and Brier score of 77.8%, 62.5%, and 5.1%-5.6%, respectively. The proposed predictive model not only assists surgeons in determining high-risk factors for surgical site infections but also empowers patients to closely monitor these factors and take proactive measures to prevent complications. Furthermore, by considering the identified predictors, this model can serve as a reference for implementing preventive measures and reducing postoperative complications, ultimately enhancing patient outcomes. However, further investigations involving larger datasets and external validations are required to confirm the reliability and applicability of our model.

Lower Third Leg Trauma Management Algorithm; Kasr Alainy Protocol.

Soft tissue defects in the lower third of the leg present significant challenges for surgeons. Despite various options available for soft tissue coverage, selecting the most suitable option is limited by potential complications. In response to this challenge, some surgeons have sought to develop algorithms to guide decision-making in the management of lower leg trauma. This prospective observational cross-sectional study included 53 patients with traumatic injuries to the lower third leg and ankle regions. Each patient underwent a management plan based on our proposed algorithm, which incorporated the utilization of negative pressure wound therapy and dermal substitutes. Outcomes were assessed in terms of the ability to achieve complete coverage, complication rates, duration of hospital stay, and return to normal daily activity. The proposed algorithm proved to be comprehensive and easily applicable, achieving complete coverage in 98.1% of cases. The mean duration for definitive coverage was 21.89 ± 12.84 days, and the majority of cases (81.1%) returned to normal daily activity within a mean duration of 60.69 ± 56.7 days. The use of dermal substitutes resulted in achieving coverage in wounds with exposed structures, with favorable outcomes in cases with a mean size of 11.39 ± 10.05 cm². Our algorithm provides a safe and effective approach to manage traumatic defects of the lower third leg and ankle, considering the patient's general condition and the complexity of the wound. Proper utilization of dermal substitutes and negative pressure wound therapy is emphasized in the algorithm.

Posterior Tibial Artery Perforator Flap for Reconstruction of Soft Tissue Defects in the Middle and Lower Thirds of Leg and Ankle Region: A Prospective Observational Study

Posterior Tibial Artery Perforator Flap for Reconstruction of Soft Tissue Defects in the Middle and Lower Thirds of Leg and Ankle Region: A Prospective Observational Study

Flexor hallucis longus tendon transfer for Tendo Achillis reconstruction

Background: Tendo Achilles injuries are common in orthopaedic practice. Degenerative, Chronic and failed repaires requires some form of soft tissue sleeve augmentation like Flexor Hallucis longs (FHL), Peroneus Brevis (PB), Plantaris etc.. are used along with proximal Tendo Achilles advancement procedures lie V-Y plasty, musculo tendinous Recession or Turn Down Procedures. These advancement procedure leads to weakening of already compromised Tendon. So, wanted to evaluate functional outcome of FHL tendon Trans Tendinous Transfer without any Advancement procedures. Methods: 20 patients satisfying inclusion criteria underwent FHL Trans tendinous Transfer to Tendo Achilles which is secured with Interference screw into the prepared bone bed of calcaneum. Initially anterior slab in planter flexion was applied later converted to cast in neutral position which is removed at the end of 6 weeks and joint mobilization started. Results: Out of 20 patients,11 were male patients and 9 were females. Average age ranged from 22 to 65 years. 9 were chronic Tears,9 were Degenerative Tears and 2 were failed Repairs. Wound healing complications were seen in 4 cases, 1 with chronic tear, 1 with Degenerative Tear and Both Filed repairs, all of them healed eventually. ALL patients were assessed for AOFAS at 6th and 12thmonth. The mean AOFAS of each subgroup improved significantly from months 3 to 12 (Table). At the one-year follow-up, all patients achieved good functional outcome in terms of the AOFAS scoring system. Conclusions: Tendo Achilles is the common tendon injured in ankle region due to repetitive stress and degeneration. Degenerative, Chronic and failed repair injuries of Tendo Achilles requires some form of soft tissue augmentation for healing. Trans-Tendinous FHL tendon transfer for Tendo Achilles Reconstruction shows good results with minimal complications in these scenarios in non-Athletic Population.

An evaluation of ankle and foot bolus in paediatric modulated arc total body irradiation (MATBI).

This retrospective planning study aimed to evaluate the role of bolus in achieving dose uniformity in the ankles and feet in paediatric patients undergoing Modulated Arc Total Body Irradiation (MATBI) treatment and to identify patient factors that may negate or warrant its use. The clinically treated plans of 20 paediatric patients who received MATBI treatment utilising ankle and foot bolus (Bolus plan) were compared with two retrospectively generated plans; a plan with bolus removed and no re-optimisation (No Bolus plan), and a re-optimised plan without bolus attempting to achieve equal dosimetry to the clinical plan via monitor unit adjustment (MU plan). Descriptive statistics were used to evaluate the dose uniformity criteria of ±10% coverage of the reference dose (RD) for each subregion of the ankle and foot for the three plans. The impact of patient height, weight, and age at the time of treatment was evaluated using Spearman's correlation. Variation in doses >10% RD was minimal across the three plans, with an average D1cc difference < 0.4Gy. For the ankle and foot regions in the Bolus plans, the volume receiving at least 90% of the RD (V90) was on average > 92%. In No Bolus and MU plans, there was an average reduction of 24.5% and 23.2% V90 coverage respectively in the toes. Spearman's correlation suggests height has the strongest relationship to D1cc. This study validated the continued use of ankle and foot bolus to achieve dosimetric goals for paediatric MATBI treatments, particularly V90 coverage across all heights.

The impact of a mid-season FIFA World Cup™ on injury occurrence and patterns in French professional soccer clubs

ABSTRACT This study retrospectively compared the effect of holding the 2022 FIFA World Cup™ (WC) mid-season (season 2022/23) on injury rates and patterns in French Ligue 1 soccer clubs. Epidemiological data in 17 clubs were prospectively recorded by their physicians. Time-loss injuries (injuries leading to a player being unable to fully participate in play over the following 72-hour period) were compared with those reported during a regular season (2021–22). In the WC season, an increase of approximately 23% (training + match-play) was observed for both the total number of injuries and knee, ankle and muscle injuries combined. Incidences for match-play injury overall and for the knee, ankle and muscle regions combined and the hamstrings and calf regions specifically also rose significantly (range: p < 0.05-p < 0.01). These results suggest that injury occurrence and patterns in French L1 soccer clubs were substantially affected during the 2022/23 season when a mid-season WC was held.

Descriptive analysis of injury types and incidence during futsal preseason across different competitive levels.

This study aimed to verify the typology and incidence of injury by comparing the different competitive levels of futsal during the preseason. The sample consisted of 68 senior male futsal players (24.26 ± 4.63 years). Data were collected using an injury recording grid that examined the affected body part, anatomical region, type of injury, mechanism, and severity. It was found that the elite group has the lowest incidence rate of injury (4.8 injuries per 1,000 h of exposure) compared to the sub-elite (11.8 injuries per 1,000 h of exposure) and amateur groups (13.9 injuries per 1,000 h of exposure). However, at this level, there is the highest percentage of injury occurrence (38.5%), the lower limb was the most affected part of the body (30.8%), and ligament (23.1%) and muscle (15.4%) injuries are the most prevalent. The most frequent mechanism of injury was non-traumatic (30.8%), and the majority were moderate injuries in the elite (23.1%) and sub-elite (17.9%) groups and severe injuries in the amateur group (12.5%). The amateur futsal players had the highest incidence of injury during the preseason period compared to the other competitive levels. Still, it was at the elite level where the highest percentage of injuries occurred, most of them non-traumatic and of ligament origin, primarily affecting the ankle region. The results highlight the importance of adopting specific injury prevention programs for ligament and muscle injuries during the preseason phase, regardless of the competitive level.

An investigation into the frequency and risk factors of low back pain following surgical treatment of isolated calcaneal fractures.

This study aimed to determine the frequency of low back pain after calcaneal fractures treated with open reduction internal fixation (ORIF) and the risk factors that cause this condition. Thirty-one patients (27 males and 4 females) who underwent surgery for a unilateral calcaneal fracture between 2016 and 2020 and had no complaints of low back pain before fracture surgery were included in the study. The patients were divided into 2 groups: those who developed low back pain after the operation and those who did not. Patients were evaluated with the Life Quality Short Form SF-36, the Oswestry Disability Index (ODI), and American Orthopedic Foot-Ankle Association Score (AOFAS). Sanders' fracture type, joint range of motion (ROM) measurements of injured and uninjured limbs, maximal isometric muscle strength measurements, balance on 1 leg with pedobarographic measurements, and walking time were evaluated. The obtained data were compared among the 2 groups. Low back pain was observed in 71% of the patients and was detected after an average of 6 months from the operation. In ODI, 59.1% of the patients reported that low back pain limited their lives slightly. Patients with low back pain have lower AOFAS scores and worse SF-36 physical functionality than those without low back pain (P < .001, P=.016). Balance time on 1 foot in pedobarographic measurements, foot in ROM, ankle in ankle active, passive plantar flexion, inversion, active hip, passive internal, external rotation, muscle is the foot eversion force. In these measurements, the values of the injured side are intact. It was statistically significantly lower than the other side (interaction P < .1). Low back pain may occur after unilateral calcaneal fractures treated by ORIF. This may be caused by decreased angles of ankle dorsi and plantar flexion, foot inversion, hip abduction, and internal and external rotation. In the rehabilitation program, not only the ankle region but also the hip joint of the affected side should be included, and the kinetic chain that describes the interaction mechanism of the human body should not be forgotten. Level IV, Prognostic Study.

Angioleiomyoma of the Foot: Clinical and Functional Outcomes of Surgical Treatment in a Case Series.

Angioleiomyoma is a benign soft-tissue tumor that arises from the smooth muscle cells in the tunica media of the blood vessels. Although the most common location for these neoplasms is the uterine wall, they can also originate from lower limbs. Altogether, these neoplasms account for 0.2% of all those located in the foot and ankle region. Signs and symptoms of foot angioleiomyoma can be a localized pain, swelling, and functional impairment. To date, only case reports and case series with small populations have been reported in the literature to describe the clinical picture of these neoplasms and the effectiveness of surgical treatment. In this study, we report our results of surgical treatment for angioleiomyomas of the foot. Thirteen cases suffering from angioleiomyoma of the foot underwent surgical resection in our institution between January of 2017 and January of 2022. For each case, we recorded preoperative and postoperative symptoms, and their preoperative and postoperative functional status according to both Musculoskeletal Tumor Society Score (MSTS) and American Orthopedic Foot and Ankle Society Score (AOFAS). Eventual complications and local recurrence were reported. Each patient had at least mild pain before surgical treatment. The mean preoperative MSTS and AOFAS were 22.1 and 76.8, respectively. The mean tumor size was 17.7mm. Preoperatively, each patient underwent resection with wide margins. None had local recurrences or major complications at their latest follow-up. After surgery, the mean postoperative MSTS and AOFAS increased to 29.5 and 98.8, respectively. Each case had a marked increment of their functionality and a reduction of their pain after surgery. Our results suggest that surgical approach with tumor resection should be considered a safe and reliable treatment for foot angioleiomyomas in light of the extremely low risk of local recurrence and because of the good postoperative pain relief and functional restoration that can be obtained after the treatment.