ABSTRACTDiabetes is a leading cause of morbidity and mortality, contributing to complications such as cardiovascular disease, kidney failure and lower‐limb amputations. Diabetic foot complications, such as structural deformities, ulceration and infection, present significant risks, necessitating early detection and intervention. This study explores the development and validation of artificial intelligence (AI) image analysis for diabetic foot screening, focusing on structural deformity identification which includes callus, hallux valgus and hammer toes, because they represent the earliest detectable visual risk markers for ulceration, preceding wound formation. Leveraging datasets comprising over 1000 healthy foot images and 215 diabetic foot deformity images, the model employed YOLOv5 for object detection, a convolutional autoencoder for anomaly detection, and DenseNet201 for anomaly classification. Initial internal validation yielded 91.1% anomaly detection accuracy, while anomaly classification accuracy improved to 88.57% following refinement. External validation using 27 participants achieved an overall accuracy of 85.2% and anomaly classification accuracy of 66.7%. Final evaluation on 35 unlabelled images demonstrated promising performance, with 88.57% accuracy, 90.47% precision and an F1 score of 86.11%. Integrated into the ‘Foot at Risk’ (FAR) mobile application, this AI‐driven solution offers a scalable tool for early diabetic foot deformity detection. With larger dataset input for training and development, it can be utilised as an early screening tool for diabetic foot and integrated into existing community diabetic care model, facilitating timely intervention and improving patient outcomes.

The February 2026 Foot & Ankle Roundup 360 looks at: Percutaneous distal metatarsal osteotomy with Akin offers better early soft-tissue recovery and equivalent one-year outcomes to open chevron Akin; Is autologous osteoperiosteal transplantation a good option for osteochondral lesions of the talus?; Os vesalianum pedis is uncommon and found in around 0.6% of feet, but important to recognize in lateral foot pain; Neuroma width an important factor in success of Morton’s treatment; Lateral metatarsosesamoid suspensory ligament release is unnecessary for moderate hallux valgus but adds correction in severe deformity; Unimalleolar fractures generally do well in the long term, but trimalleolar injuries carry a substantial risk of persistent impairment; Altered gait biomechanics after peroneus longus tendon harvest for anterior cruciate ligament reconstruction: truth or myth?; Early clinical benefit with the TARIC total ankle prosthesis but a high incidence of early radiological abnormalities warrants vigilance.

Pain and dysfunction are common indications for hallux valgus surgery, yet the factors that are associated with these baseline symptoms are not fully understood. This study aimed to investigate the associations of patient and disease specific factors with baseline patient-reported outcome measures (PROMs) in patients undergoing hallux valgus surgery. A prospective cohort of 221 hallux valgus surgeries were enrolled (January 2021 to November 2023). A total of 181 (82%) patients who had undergone surgery met inclusion criteria. Patients completed PROMs preoperatively assessing mental health (VR-12 Mental Component Summary [MCS]), pain (visual analog scale [VAS]), and function (Foot and Ankle Ability Measure-Activities of Daily Living [FAAM-ADL] and FAAM Single Assessment Numeric Evaluation [FAAM-SANE]). Better mental health was associated with higher preoperative function and lower pain: each 1-point higher VR-12 MCS corresponded to +0.62 FAAM-ADL points (95% CI 0.27-0.98; P = .001), +0.52 FAAM-SANE points (0.11-0.93; P = .013), and -0.06 VAS points (-0.09 to -0.02; P = .004). Education showed similar associations: per additional year, +1.85 FAAM-ADL (0.68-3.03; P = .002), +1.74 FAAM-SANE (0.39-3.09; P = .012), and -0.16 VAS (-0.28 to -0.03; P = .013). Male sex was linked to better function on FAAM-SANE (+13.64; 1.93-25.34; P = .023) and lower pain (-1.14 VAS; -2.22 to -0.06; P = .038); the FAAM-ADL difference was not significant (P = .513). Higher BMI was associated with worse FAAM-SANE function (-0.89; -1.56 to -0.22; P = .010) but not FAAM-ADL (P = .510) or VAS pain (P = .916). Greater socioeconomic deprivation (Area Deprivation Index [ADI]) was associated with higher pain (+0.02 VAS per ADI point; 0.00-0.04; P = .041). Diabetes and prior surgery were associated with lower VAS pain in the adjusted table (diabetes: -1.87; -3.66 to -0.08; P = .041; prior surgery: -2.37; -4.29 to -0.44; P = .017), which differs from the narrative; this should be reconciled. Other covariates were not significantly associated with outcomes. Better preoperative mental health and higher education were associated with higher function and lower pain; male sex with higher function (FAAM-SANE) and lower pain; higher BMI with worse FAAM-SANE only; greater deprivation with higher pain; diabetes and prior surgery with slightly lower pain; other covariates showed no consistent associations. Level III, Prospective cohort study.

Background:Metal implants, the gold standard for osteotomy fixation in foot surgery, do have inherent problems. A relatively high percentage of patients undergoing hallux valgus correction require secondary surgery for metal implant removal. Although available since the 1980s, bioabsorbable implant use in foot surgery has been limited because of concerns of osteolysis and inferior strength. Magnesium screws are bioabsorbable implants without the inherent risks associated with other bioabsorbable implants. We prospectively compared outcomes of MAGNESIX to metal implants in hallux valgus deformity correction.Methods:A prospective, randomized study comparing radiographic and clinical outcomes between hallux valgus corrections fixated with magnesium (24 feet) or titanium (25 feet) screws, with an average follow-up of 44 and 35 months, respectively. Clinical outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score and radiographic parameters measured on weightbearing radiographs pre-operatively and at final follow-up. All complications were documented.Results:Both magnesium and titanium cohorts showed statistically significant improvements in radiographic parameters (P < .05) and AOFAS scores (P < .05), with no statistically significant difference between cohorts.All post-operative radiographs in the magnesium cohort had visible gas formation at 6 weeks, resolving by 12 weeks, and all screws fully resorbed on final radiographs with no evidence of osteolysis (more than 1 year). Four recurrences occurred in the magnesium cohort vs 3 in the titanium cohort. A single case of hallux varus was noted in the magnesium group and 1 incidence of screw removal for symptomatic hardware in the titanium group.Conclusion:We found no difference between bioabsorbable magnesium screws and titanium screws for fixation in hallux valgus surgery, although small between-group differences may not have been detectable given the relatively small sample size. Magnesium screws appeared safe with no allergic reactions or wound complications and may offer added benefits of not interfering with advanced imaging, decreasing the need for hardware removal and likely easier revision surgery.Level of Evidence:Level II, randomized controlled trial.

This retrospective observational study aimed to evaluate the outcomes of subcapital osteotomy using an intramedullary locking plate for the treatment of hallux valgus (HV) deformity. We hypothesized that plate fixation would provide superior angular correction and lower recurrence compared to screw fixation. Between January 2018 and July 2023, a total of 49 feet underwent corrective osteotomy for HV. Of these, 36 feet were treated with headless screws and 13 with intramedullary locking plates. All cases had a minimum follow-up duration of 12 months. Radiographic outcomes were assessed using weight-bearing radiographs obtained preoperatively and at 1, 6, and 12 months postoperatively. The mean follow-up duration was 24.64 ± 14.34 months in the screw group and 18.23 ± 8.47 months in the plate group. HV recurrence was observed in 9 feet – 7 (77.78%) in the screw group and 2 (22.22%) in the plate group (P = 1.000). The findings demonstrate that subcapital osteotomy with an intramedullary locking plate is effective in correcting the intermetatarsal angle, particularly when compared to the use of headless screws in modified Mitchell osteotomy. Furthermore, precise adjustment of the plate tip position allowed for effective correction of significant deviations in the distal metatarsal articular angle. Three cases of loss of reduction were observed in the screw group, while the plate group experienced minimal complications. Longer-term follow-up data are required to provide a more accurate and comprehensive assessment of clinical outcomes.

Childhood interstitial lung diseases (chILDs) are rare respiratory conditions with significant mortality rates in neonates. They can be misdiagnosed as the symptoms overlap with other, more common neonatal diseases. Since chILD can be a manifestation of the underlying syndrome, suggestive physical findings, genetic testing, and practitioners' notion can contribute to better recognition, as in our patient with confirmed Chitayat syndrome. A male preterm infant born at 34 weeks of gestation showed signs of progressive respiratory distress from birth with lung hyperinflation and ground glass opacities on chest X-ray, requiring progressive respiratory support: initially non-invasive, then invasive ventilation and surfactant administration within the first hour of life. Physical examination revealed craniofacial disproportion, low-set ears, brachydactyly of the index fingers with ulnar deviation, hallux valgus, hypotonia, and hyporeflexia. Congenital heart defects, cystic fibrosis, and primary ciliary dyskinesia were excluded. Open lung biopsy demonstrated focally dilated alveoli and thickened septa. Sanger sequencing revealed a recurrent missense variant c.266A>G p.(Tyr89Cys) in the ERF gene. A tracheotomy was performed and despite gradual improvement with occasional respiratory support, he died at the age of 1 year and 5 months of a Pseudomonas aeruginosa respiratory infection.

Hallux valgus (HV), characterized by triplanar deviation of the first metatarsophalangeal joint, significantly alters foot biomechanics and provokes adaptations along the kinetic chain. While its static effects are well-documented, its dynamic impact during high-velocity, multiplanar maneuvers remains unclear. This study investigated the dose-dependent relationship between HV severity and lower limb stability during side-cutting using a novel multimodal validation framework. Sixty-six male participants (n = 22 per group: normal, mild, and moderate HV) underwent biomechanical evaluation through three-dimensional motion capture, inverse dynamics-driven finite element (FE) modeling, and dynamic fluoroscopy. Real-time bone displacement was quantified using shape-matching algorithms to validate FE simulations. Results indicated compensatory adaptations in HV groups, such as reduced first metatarsal dorsiflexion and external rotation of the first metatarsophalangeal joint. Dynamic fluoroscopic data revealed progressive displacement in the tibiotalar and subtalar joints, with significantly increased posterior glide (p &lt; 0.001). Kinematic correlations showed a decline in ankle plantarflexion (p &lt; 0.001) and hip flexion (p &lt; 0.001) with advancing HV severity, while moderate HV was associated with significantly greater knee valgus angles (R² = 0.47, p &lt; 0.001). FE simulations demonstrated a non-linear increase in contact pressures at the first MTPJ and lateral metatarsal overload. These findings reveal that HV induces a compensatory kinematic cascade through load redistribution and altered joint dynamics, destabilizing three-dimensional lower limb alignment. By linking pathological tissue loads to vector field shifts, this multiscale framework enhances our understanding of injury mechanisms and offers insights into kinematic chain optimization for injury prevention.

Hallux valgus (HV) is a prevalent three-dimensional foot deformity, yet it is primarily assessed in the anteroposterior plane radiographs. The role of the sagittal plane and specifically the plantar fat pad remains poorly understood. This study aimed to quantitatively explore the relationship between plantar fat-pad geometry and HV progression. In this retrospective study, we analysed 274 feet from 144 patients who underwent HV corrective surgery at Hasharon Hospital, Israel (2014-2024). Using custom Python-based software, we annotated 22 anatomical landmarks on preoperative, weight-bearing lateral radiographs (3 plantar fat pads and 19 plantar bony points). For each fat pad, 19 Distance features were generated (total 57), comprising 19 pairwise standardised distances. Associations between these distances and standard HV angles (HVA, IMA, DMAA, HIA) were assessed using Pearson and Spearman correlations, A subgroup analysis was carried out to compare patients aged below and above 40 years, as well as between male and female patients. In the full cohort, no distance feature correlated with standard HV angles at the prespecified threshold ([Formula: see text] or [Formula: see text], two-sided [Formula: see text]). Stratified analyses revealed subgroup-specific patterns: females showed three significant relationships (mainly involving the calcaneal fat pad), whereas males showed 29 predominantly negative forefoot-hindfoot correlations (e.g., base of 5th metatarsal fat pad [Formula: see text] calcaneal fat pad vs. HIA: [Formula: see text], [Formula: see text], both [Formula: see text]). The [Formula: see text] y group exhibited six significant features (including sesamoid-based positives), while the [Formula: see text] y group showed two first-ray-focused associations. Several effects were stronger on Spearman than Pearson, consistent with nonlinearity, and many between-group differences were significant by Fisher's [Formula: see text]-to-[Formula: see text] ([Formula: see text]). Progressive Distance Mapping (PDM) summarized these effects into composite, radiograph-overlaid maps. Progressive Distance Mapping (PDM) may suggest subgroup-dependent, progressive associations between plantar fat-pad-anchored distance geometry and hallux valgus (HV) severity. Despite no universal cohort-level correlations, PDM identifies four distinct morphologic subtypes within each subgroup (stratified by age and sex), this may suggest differing pathogenesis and patterns of plantar fat-pad involvement. These subtype-specific signatures are often nonlinear.

Mayo versus ankle block in minimally invasive hallux valgus surgery: A comparative study.

Percutaneous Hammertoe Correction Using Extra-Articular Osteotomies: A Retrospective Study of Patient-Reported Outcomes and Complications.

Metatarsus Adductus Osteotomy.

The aim of this study was to investigate the effect of hallux valgus deformity on dynamic knee movement pattern and lower extremity injuries in athletes. This was a cross-sectional observational study. The study was included 92 athletes (male: 62, female: 30). Athletes without acute injuries that could affect performance tests were included. Demographic data were collected, and the hallux valgus angle was measured using a goniometer. A standard warm-up protocol was then applied. A drop jump test from a 30 cm platform was conducted, and images captured during the test were analyzed in 2D using Kistler+Noraxon Measurement Device cameras to determine the dynamic knee movement pattern based on the knee-foot ratio. The dynamic knee movement pattern was determined that values greater than 1 were determined dynamic knee varus and values less than 1 were considered dynamic knee valgus. Dynamic knee movement pattern did not show a significant relationship with hallux valgus angle (p&gt;0.05). However, a greater hallux valgus angle was observed in female athletes with a history of injury (p

Objective:This study aimed to investigate the potential association between transfer metatarsalgia, a complication that may arise postoperatively following hallux valgus surgery, and the preoperative relative second metatarsal length measured on weight-bearing radiographs. Additionally, it was sought to evaluate the predictive value of this radiographic parameter.Methods:A total of 126 patients who underwent primary hallux valgus surgery between January 2022 and December 2023 and had a minimum follow-up of 12 months were retrospectively reviewed. Patients were categorized into 2 groups based on the presence or absence of transfer metatarsalgia during the postoperative follow-up. Relative second metatarsal length was measured as the primary radiographic variable using preoperative weight-bearing anteroposterior foot radiographs. In addition, the hallux valgus angle (HVA) and the intermetatarsal angle (IMA) were evaluated preoperatively. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal–Interphalangeal (AOFAS Hallux MTP-IP) score at the 12-month follow-up. Demographic and surgical variables, such as age, sex, surgical technique, and implant type, were also recorded. Group comparisons were performed, and multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to identify variables predictive of transfer metatarsalgia.Results:Patients who developed transfer metatarsalgia had significantly higher preoperative relative second metatarsal length values (P < .001). Among the variables included in the multivariate logistic regression model, only relative second metatarsal length was found to be a statistically significant predictor of transfer metatarsalgia (odds ratio: 5.176; 95% CI: 2.813-9.493). Receiver operating characteristic curve analysis identified a threshold value of 2.15 mm, which was adopted as 2 mm for clinical applicability, with an area under the curve of 0.832, sensitivity of 79.4%, and specificity of 78.2%. In contrast, other parameters such as age, sex, surgical technique, implant type, preoperative HVA, IMA, and postoperative AOFAS Hallux MTP-IP scores were not significantly associated with the development of transfer metatarsalgia.Conclusion:Relative second metatarsal length was found to be significantly associated with the development of postoperative transfer metatarsalgia, and ROC analysis identified 2 mm as a clinically applicable cutoff value. Preoperative measurement of relative second metatarsal length can help identify patients at higher risk of this complication, allowing for improved patient counseling and more informed surgical planning.Level of Evidence:Level III, Prognostic study.

Foot and ankle biomechanics play a central role in soccer performance, influencing stability, movement efficiency, and injury susceptibility. Although numerous structural and functional assessment tools exist, the literature lacks an integrated synthesis that evaluates these tests collectively in relation to injury mechanisms and sport-specific demands. This narrative review aims to critically examine commonly used biomechanical assessments—including FPI-6, Navicular Drop Test, Hallux Valgus Angle, plantar pressure analysis, CAIT, FAAM, weighted dorsiflexion ROM, and tibial torsion measurements—and to highlight their relevance for identifying risk factors in soccer players. Evidence indicates that structural abnormalities such as pes planus, subtalar overpronation, and hallux valgus alter plantar pressure distribution and increase the likelihood of overuse injuries, ankle sprains, and chronic instability. Functional measures including CAIT and FAAM provide complementary insight into ankle instability and sport-related performance limitations. By synthesizing current findings, this review underscores the need for comprehensive, multi-dimensional assessment strategies that support individualized training and injury-prevention programs in soccer.Keywords: Choronic Ankle Instability, CAIT, FAAM, FPI-6, Plantar Pressure, Soccer Biomechanics.

Objective:This study aimed to investigate the relationship between spinopelvic parameters and radiographic foot axes and to examine whether these associations differ across age groups.Methods:This retrospective radiographic study analyzed imaging from patients treated at a university medical center for degenerative or traumatic conditions. Cases with weight-bearing, 2-view foot radiographs and standing lumbar spine radiographs, including the femoral heads, were included. Spinopelvic parameters (lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence) and radiographic foot axes (including hallux valgus angle, tibiotalar angle, and metatarsal declination angle) were measured, and correlation analyses were performed with age-based subgroup comparisons.Results:A total of 46 Caucasian patients (33 females, 13 males) were included (mean age 55.6 ± 18.5 years). Lumbar lordosis showed a significant negative correlation with hallux valgus angle (r = −0.29, P = .015). Sacral slope was negatively correlated with the hallux valgus angle (r = −0.42, P < .001). Pelvic tilt correlated positively with tibiotalar angle (r = 0.34, P = .004) and metatarsal declination angle (r = 0.25, P = .042). Age-stratified analyses demonstrated age-related differences in correlation patterns.Conclusion:Spinopelvic alignment demonstrates measurable associations with radiographic foot alignment, supporting the concept of the spine–pelvis–lower-limb unit as a biomechanically integrated system. Clinically, these findings suggest that integrated, chain-oriented assessment and management strategies (considering both spinal and foot alignment, particularly with aging) may be relevant when evaluating patients with coexisting spine and foot disorders.Levels of Evidence:Level IV, Prognostic Study.

Foot-related factors such as plantar foot muscle weakness, hallux valgus, hammer toe, excessive pronation, and foot pain are known causes of falls in older adults (ages > 65). Minimally cushioned footwear may naturally strengthen and provide enhanced sensory awareness to the feet, leading to reduced fall risk. The purpose of this study was to analyze the effects of long-term minimal footwear use on fall risk and fall incidence in older adults with established fall risk. Adult volunteers ages > 65 were screened for fall risk and randomized into minimal footwear (n=33) and control (sham intervention, n=32) groups. Participants performed intervention or control activities 5x/week for 16 weeks and then at least 2x/week for the remainder of the 1-year study. They were measured for fall risk using the Mini Balance Evaluation Systems Test (Mini-BESTest) at baseline, 16 weeks, and 1 year. Participants kept written journals of intervention adherence and falls, and were contacted bimonthly to collect details on falls. A mixed-effects linear model analysis was used to measure change in fall risk. The minimimal detectable change (MDC) of > 3.5 points defined "meaningful change". Fall incidence was analyzed with number of falls per participant, proportion of fallers in each group, and fall rates per person-year. Time-to-first-fall analyses using Kaplan-Meier survival curves were used to visualize the cumulative probability of remaining fall-free over the 1-year period. The log-rank test was used to evaluate differences between groups. Minimal footwear group made significant improvements in Mini-BESTest scores at both follow-up time points (16 weeks: 2.24 points, p < 0.001; 1 year: 2.62 points, p < 0.001) compared to no improvements made by control group (16 weeks: 0.108 points, p=0.794; 1 year: 0.119 points, p=0.797). At 16 weeks, 28.6% of minimal footwear group and 3.3% of control group achieved the MDC (p =0.005). At 1 year, 23.1% of minimal footwear group and 7.4% of control group achieved the MDC (p=0.111). Fall incidence was not significantly different between groups at 1 year; however, minimal footwear group had fewer falls, a smaller proportion of fallers, and longer time to first fall. For the 1-year study duration, 76.9% of minimal footwear group and 51.9% of control group remained fall-free. Long-term minimal footwear use resulted in meaningful improvements in balance and reduced fall risk in older adults. This type of footwear can be gradually incorporated into daily activities using our progressive schedule, or could be included in existing fall-prevention programs. This study was underpowered to detect fall incidence, and we did not see a difference in falls incidence between groups.

Introduction: Hallux valgus surgery is common, with variable recurrence rates of 4 – 78% reported in multiple case series. Any further surgery for forefoot pathology is costly both to individuals and healthcare systems. The aim of this study was to understand the rate of revision surgery, further forefoot surgery and 90-day risks of bunion surgery in England. Method: An England population cohort study of 152,061 operations was performed using the Hospital Episode Statistics database, linked to ONS mortality data (1998-2023). The primary outcome was Kaplan-Meier curve analysis of revision surgery free survival of bunion surgery. Secondary outcomes included the risk of 90-day complications and any further re-operation to the same 1st MTP joint or forefoot. Cox proportional hazard modelling was used to identify those at highest risk of further surgery. Results: The overall revision-free survival was 93.1% at 20 years. Revision rates were significantly higher among females (HR 1.12, 95%CI: 1.05-1.21), white patients (HR 1.65 95%CI: 1.39 – 1.97), patients aged 40-59 years (HR 2.2, 95%CI: 1.62 – 3.01), and those from the most deprived socioeconomic group (HR 1.52, 95%CI: 1.41– 1.64). Within 20 years, 4.6% of patients underwent revision hallux valgus surgery, whereas only 2.6% proceeded to 1st MTPJ fusion. Females were more likely to get a revision surgery, whereas males were more likely to undergo revision to fusion. The 90-day mortality rate following hallux valgus surgery was 0.053%. Conclusion: This study shows that hallux valgus correction in England is safe and has a low risk of further intervention. This is the largest retrospective cohort to date and illustrates that for the vast majority of cases, traditional hallux valgus surgery represents a monotherapy with a low revision rate and few complications.

Background:In orthopaedic foot and ankle procedures, bone debris generated during osteotomies is typically discarded. However, this autograft bone debris has good handling properties and can be amenable for use as a stimulus to bone healing at the site of the osteotomy.Methods:In the present study, discarded bone debris was harvested intraoperatively during minimally invasive chevron Akin (MICA) hallux valgus corrections, isolated Akin osteotomies of the proximal phalanx of the great toe, cheilectomies, and calcaneal osteotomies from 9 participants.Results:Multiplex protein arrays of 40 cytokines and 41 growth factors identified 76 immunomodulatory and reparative proteins within the bone debris. Fifteen key growth factors and cytokines (VEGF, PDGF-BB, M-CSF, EGF-R, HGF, ICAM1, GCSF, TIMP-2, sTNFRII, MCP-1, GM-CSF, IL-6sR, IL-10, MCP-2, RANTES) were prominent, suggesting that bone debris proteins may have potential effects on immunomodulation and bone regeneration including cytokine-cytokine receptor interaction, interleukins, MAPK, PI3K-Akt, Wnt, BMP, and TGFβ signaling pathways.Mesenchymal stem/stromal cells (MSCs) were isolated from bone debris of the osteotomies. MSCs expressed genes involved in bone and cartilage formation, homeostasis, angiogenesis, and immunomodulation. Fourteen genes were associated with maintaining cell stemness, whereas seventeen genes were linked to osteochondral development and spatial organization. Additionally, the study identified eight genes promoting angiogenesis and ten genes regulating immune responses in the mesenchymal stem cell environment.Conclusion:This repurposed surgical waste contains a concentrated array of growth factors, antiinflammatory mediators, and viable MSC that might enhance bone healing when reintroduced to surgical sites.Clinical Relevance:The results could serve as a foundation for repurposing previously discarded bone debris as autologous bone grafts for reimplantation in minimally invasive orthopaedic procedures to potentially enhance bone tissue healing. To confirm clinical relevance, further well-controlled trials are required to establish whether these findings improve bone healing rates and related patient-reported outcomes.

Introduction: First Metatarsophalangeal (MTP) joint arthrodesis is a common procedure for the treatment of hallux rigidus and severe hallux valgus with osteoarthritis. Despite its commonality, post-operative weight bearing protocols vary widely. To date, no prospective randomised controlled trials have directly compared outcomes between immediate weight bearing as tolerated (WBAT) and non-weight bearing (NWB) following 1st MTP fusion. Method: A prospective randomised controlled trial was conducted with 68 patients undergoing isolated 1st MTP fusion, allocated to WBAT or NWB. Standardised surgical technique and fixation methods (screws or plate) were performed by two fellowship-trained foot and ankle surgeons. Primary outcomes were pain measured by the Visual Analogue Scale (VAS) and function measured by the Foot &amp; Ankle Ability Measure, (FAAM–ADL subscale) at 12 months. Secondary outcomes included non-union, complication, and patient satisfaction. Statistical analysis used t-tests and chi-squared or Fisher's exact tests, with significance at p&lt;0.05. Results: Sixty-eight patients (33 WBAT, 35 NWB) completed the study. At a minimum 12 months follow-up, both groups demonstrated significant improvements in pain and function. No statistically significant differences were found between WBAT and NWB groups in VAS pain scores (2.97+/-2.215 vs 2.54+/-2.147; p=0.423), FAAM scores (81.31+/-16.028 vs 85.02+/-18.863; p=0.387), or patient satisfaction (8.00+/-2.76 vs 8.34+/-2.52; p=0.594). Complication rates were comparable, with one case of hardware irritation in each group (p=0.739). Plate fixation was more common in the NWB group (p=0.028), this is unlikely to affect outcomes. Conclusion: Immediate weight bearing following 1st MTP fusion is safe and results in equivalent pain relief, function, satisfaction, and complication rates, compared to traditional NWB protocols. These findings support a shift toward more permissive postoperative strategies, with potential benefits for patient mobility, independence, recovery time, and healthcare resource use.

ObjectiveTo analyze the biomechanical consequences on the lesser metatarsals using different screw configurations for fixation of the minimally-invasive Chevron-Akin (MICA) osteotomy, through the finite element method (FEM).MethodsA FEM model was developed from a computed tomography scan of a moderate hallux valgus (HV) deformity. Five different screw configurations were tested. We measured the maximal tension in the lesser metatarsals for each screw configurations, in physiological and supraphysiological loads.ResultsThe lesser metatarsals received the lowest loads when the first metatarsal osteotomy was fixed with one intramedullary and one bicortical screw, with tensile load values varying between 30 and 70 MPa in physiological loads, and 50 to 350 MPa in supraphysiological loads. In all fixing techniques, the 2nd and 4th metatarsals received the highest loads, especially in groups 3 (two bicortical screws) and 5 (only one bicortical screw), with values reaching up to 230 and 600 MPa in physiological and supraphysiological loads, respectively. Regardless of the fixation technique, the region of the lesser metatarsals that received the most load was the diaphysis.ConclusionAfter MICA surgery to correct HV, there is an increase in tension forces on the lesser metatarsals, especially the second and fourth. The technique of fixing the first metatarsal with one bicortical and one intramedullary screw showed the lowest values on the lesser metatarsals load. Furthermore, for physiological and supraphysiological loads, independently of the technique, the forces were concentrated mainly on the metatarsal shaft.