Midfoot Joints Research Articles

The Effects of Midfoot/Hindfoot Fusions on the Behaviour of Peroneus Longus Tendon in Adult-Acquired Flatfoot Deformity: A Biomechanical and Finite Element Analysis

Adult-acquired flatfoot has been considered to arise from tibialis posterior tendon deficiency. Recent evidence shows that arch stability is mainly maintained by structures such as plantar fascia and spring ligament. The dysfunction of these ’passive’ stabilizers results in loss of arch integrity that causes forefoot pronation and reactive tendon overload, especially in the tibialis posterior tendon and peroneus longus tendon. The peroneus longus tendon (PLT) spans several midfoot joints and overloads with arch lengthening. The biomechanical stress/changes that occurs in this tendon are not well recognized. This study evaluates the biomechanical consequences that fusions have on peroneus longus tendon stresses in soft-tissue deficiencies associated with flatfoot deformity. A complete computational human foot model was used to simulate different scenarios related to the flatfoot deformity and associated common midfoot/hindfoot fusions, to quantify the biomechanical changes in the peroneus longus tendon. The results showed that the stress of the peroneus longus tendon is especially affected by the fusion of hindfoot joints and depends on the soft tissue types that fail, causal in generating the flatfoot. These results could be useful to surgeons when evaluating the causes of flatfoot and the secondary effects of surgical treatments on tissues such as the peroneus longus tendon.

Cone-beam computed tomography imaging and three-dimensional analysis of midfoot joints during non-weightbearing and weightbearing in 11 healthy feet.

Studies report that Lisfranc injury is more common than thought. Several imaging methods for assessing the stability of Lisfranc injury have been described but many are impossible to standardize and not accurate enough. To present a three-dimensional (3D) method for analyzing the changes in the joint space width of the midfoot joint and the joints of the medial part of the Lisfranc complex in healthy individuals. Non-weightbearing and weightbearing cone-beam computed tomography (CBCT) images of 11 healthy feet were acquired and analyzed with 3D software. The mean range of joint space width changes of each joint was computed from the changes in individual image pairs. 3D analysis software was used to analyze the medial part of the Lisfranc complex. In this sample of healthy feet, the changes in the joint spaces in the medial part of Lisfranc complex, calculated with 3D analysis software, was less than 0.6 mm. The distance between bones increased or decreased, depending on which part of the joint surface the measurements were taken. In this study, we present a 3D analysis method to evaluate midfoot joint space width changes. Our analysis revealed that in healthy feet there are only minimal changes in the joint space width between weightbearing and non-weightbearing indicating minimal movement of the midtarsal joints. The 3D analysis of weightbearing CBCT data provides a promising tool for analyzing the small midfoot joints in a variety of conditions.

Clinical and Radiographic Outcomes of Nitinol Compression Staples for Midfoot and Chopart Arthrodesis

Nitinol staple use in orthopedic surgery has increased in recent years. Biomechanical studies provide useful data for use in foot/ankle; however, clinical data is limited. This study's purpose is to determine the efficacy of nitinol staples to achieve stable, bony arthrodesis in midfoot and Chopart joints, and examine their clinical outcomes and pain scores. A retrospective chart review was performed on 127 midfoot/Chopart joint arthrodeses (71 patients) using nitinol staples in isolation. The primary outcome variable was radiographic evidence of healing. Radiographs were blinded, randomized, and independently reviewed by three board certified foot and ankle surgeons. Complete/partial union was seen in 89% of all joints (113/127), increasing to 93% when including only midfoot joints (98/106). Chopart joints had significantly lower healing rates (15/21; 71%) compared to all midfoot joints (p = 0.01) and isolated tarsometatarsal joints (86/91; 95%) (p = 0.006). Neuropathy and smoking did not affect arthrodesis, but diabetes did (p = 0.004). Joints requiring bone grafting had worse rates of arthrodesis (38/49; 76%) (p = 0.002). For all joints, post-operative visual analog scale scores were significantly lower than pre-operative (p < 0.001). Pre-operative midfoot and Chopart pain scores were similar (p= 0.30). Midfoot joints had significantly lower pain scores post-operatively than pre-operatively (p < 0.001). No such significance existed in Chopart joints (p = 0.07). Isolated nitinol staples are a viable option for midfoot arthrodesis, especially tarsometatarsal joints, and offer significant pain improvement. Chopart joints may require more rigid fixation than nitinol staples, given the lower healing rate. Level of Clinical EvidenceIV

Effects of different step lengths at a preferred walking speed on forefoot, midfoot, and hindfoot motion in healthy young adults

Hindfoot, midfoot, and forefoot motion during the stance phase of walking provide insights into the forward progression of the body over the feet via the rocker mechanisms. These segmental motions are affected by walking speed. Increases in walking speed are accomplished by increasing step length and cadence. It is unknown if taking short, medium, and long steps at the same speed would increase hindfoot, midfoot, and forefoot motion similarly to walking speed. We examined effects of different step lengths at the same preferred walking speed on peak forefoot, midfoot, and hindfoot motions related to the foot rockers. Twelve young healthy adults completed five walking trials under three step length conditions in a random order as feet and lower extremity motion were measured via marker positions for the combined Oxford foot and conventional gait models. Peak hindfoot, midfoot, and forefoot joint angles indicating heel, ankle, and forefoot rockers were identified. When walking at the same preferred speed with increase in step length, there were increases in peak hindfoot-tibia plantarflexion angle (p < 0.001; ηp2 = 0.76) in early stance associated with the heel rocker and peak hindfoot-tibia dorsiflexion angle (p = 0.016; ηp2 = 0.39) in midstance associated with ankle rocker. In late stance, the peak hindfoot-tibia plantarflexion angle, forefoot-hindfoot angle, and forefoot-hallux dorsiflexion angle indicating forefoot rocker motion also increased with step length (p < 0.01). When foot kinematics are compared across different individuals or the same individual across different sessions, researchers and clinicians should consider the influence of step length as a contributor to differences in foot kinematics observed.

Hallux valgus in children. Biomechanical aspect: A literature review

BACKGROUND: The study comprehensively describes the issues of the normal biomechanics of the first toe, first metatarsophalangeal joint, and first ray when walking. Understanding the fundamental processes of the functioning of these structures is a leading aspect in the study of the etiopathogenesis of hallux valgus and is important in treatment planning.&#x0D; AIM: To analyze the literature concerning the kinematic and kinetic indicators of the first toe, first metatarsophalangeal joint, and first ray of the foot when walking in the final support phase.&#x0D; MATERIALS AND METHODS: The characteristics of periods, gait phases, kinetic and kinematic movements were analyzed.&#x0D; RESULTS: To perform a “push-off” when walking, sufficient extension of the first toe in the first metatarsophalangeal joint is necessary, which is fully accomplished only in combination with flexion and eversion of the first ray of the foot. Muscular control of the position of the first toe in the first metatarsophalangeal joint is carried out by the short and long flexors of the first toe with the sesamoid apparatus of the first metatarsal bone, whereas functions of the first ray and midfoot joints are stabilized by the peroneus longus muscle.&#x0D; CONCLUSIONS: The influence of kinematic and kinetic indicators of movements in the lower-limb joints in the horizontal plane on the flexion of the first ray and extension of the first toe in the metatarsophalangeal joint and the determination of the nature and volume of movements in midfoot joints in various phases of the gait cycle remains a pressing issue.

Multi-segment foot kinematics during gait in children with spastic cerebral palsy

BackgroundFoot deformities (e.g. planovalgus and cavovarus) are very common in children with spastic cerebral palsy (CP), with the midfoot often being involved. Dynamic foot function can be assessed with 3D gait analysis including a multi-segment foot model. Incorporating a midfoot segment in such a model, allows quantification of separate Chopart and Lisfranc joint kinematics. Yet, midfoot kinematics have not previously been reported in CP. Research questionsWhat is the difference in multi-segment kinematics including midfoot joints between common foot deformities in CP and typically-developing feet? Methods103 feet of 57 children with spastic CP and related conditions were retrospectively included and compared with 15 typically-developing children. All children underwent clinical gait analysis with the Amsterdam Foot Model marker set. Multi-segment foot kinematics were calculated for three strides per foot and averaged. A k-means cluster analysis was performed to identify foot deformity groups that were present within CP data. The deformity type represented by each cluster was based on the foot posture index. Kinematic output of the clusters was compared to typically-developing data for a static standing trial and for the range of motion and kinematic waveforms during walking, using regular and SPM independent t-tests respectively. ResultsA neutral, planovalgus and varus cluster were identified. Neutral feet showed mostly similar kinematics as typically-developing data. Planovalgus feet showed increased ankle valgus and Chopart dorsiflexion, eversion and abduction. Varus feet showed increased ankle varus and Chopart inversion and adduction. SignificanceThis study is the first to describe Chopart and Lisfranc joint kinematics in different foot deformities of children with CP. It shows that adding a midfoot segment can provide additional clinical and kinematic information. It highlights joint angles that are more distinctive between deformities, which could be helpful to optimize the use of multi-segment foot kinematics in the clinical decision making process.

Running intralimb coordination patterns after a foot core exercise program in recreational runners.

This study investigated the effects of a foot core intervention on the coordination of foot joints in recreational runners. This was a secondary analysis from a randomized controlled trial conducted with 87 recreational runners allocated to the control group (CG), which followed a placebo lower limb stretching protocol, or the intervention group (IG), which underwent an 8-week (3 times/week) foot core training. The participants ran on a force-instrumented treadmill at a self-selected speed (9.5-10.5 km/h) while the foot segment motion was captured. The vector coding technique was used to assess inter-joint coordination for four selected coupled segment and joint angles. The coordination patterns of the calcaneus and midfoot (CalMid) and midfoot and metatarsus (MidMet) joint pairs were affected. In the frontal plane, IG showed an in-phase with proximal dominancy coordination at heel strike, with a decrease in its frequency after the training (P=0.018), suggesting a longer foot supination. Additionally, IG showed an anti-phase with distal dominancy pattern at early stance compared to CG due to a smaller but earlier inversion of the CalMid-MidMet pair (P=0.020). The intervention also had an effect on the transverse plane of the CalMid-MidMet pair, with IG showing a significantly greater frequency of anti-phase coordination with proximal dominancy during propulsion than CG (P=0.013), probably due to a reduction in the CalMid abduction. Overall, the results suggested that the foot core intervention reduces the occurrence of running-related injuries by increasing the resistance to calcaneus pronation and building a more rigid and efficient lever during push-off.

The Midfoot Joint Complex (Foot Arch) Contributes to the Upper Body Position in Bipedal Walking and Coordinates With the Lower Limb Joints.

This study estimated the contribution of the midfoot joint complex (MJC) kinematics to the pelvis anterior-posterior positions during the stance phase of walking and investigated whether the MJC is functionally coordinated with the lower limb joints to maintain similar pelvic positions across steps. Hip, knee, ankle, and MJC sagittal angles were measured in 11 nondisabled participants during walking. The joints' contributions to pelvic positions were computed through equations derived from a link-segment model. Functional coordination across steps was identified when the MJC contribution to pelvic position varied and the summed contributions of other joints varied in the opposite direction (strong negative covariations [r ≤ -.7] in stance phase instants). We observed that the MJC plantarflexion (arch raising) during the midstance and late stance leads the pelvis backward, avoiding excessive forward displacement. The MJC was the second joint that contributed most to the pelvis positions (around 18% of all joints' contributions), after the ankle joint. The MJC and ankle were the joints that were most frequently coordinated with the other joints (≅70% of the stance phase duration). The findings suggest that the MJC is part of the kinematic chain that determines pelvis positions during walking and is functionally coordinated with the lower limb joints.

Plantar pressures in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot

BackgroundMidfoot osteoarthritis (OA) is a common condition, however its aetiology is not well understood. Understanding how plantar pressures differ between people with and without midfoot OA may provide insight into the aetiology and how best to manage this condition. Research questionTo compare plantar pressures between people with and without symptomatic radiographic midfoot OA. MethodsThis was a cross-sectional study of adults aged ≥ 50 years registered with four UK general practices who reported foot pain in the past year. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last four weeks, combined with radiographic OA in one or more midfoot joints. Cases were matched 1:1 for sex and age ( ± 5 years) to controls. Peak plantar pressure and maximum force in 10 regions of the foot were determined using a pressure platform (RSscan International, Olen, Belgium) and compared between the groups using independent samples t-tests and effect sizes (Cohen’s d). ResultsWe included 61 midfoot OA cases (mean age 67.0, SD 8.1, 31 males, 30 females) and matched these to 61 controls (mean age 66.0, SD 7.9). Midfoot OA cases displayed greater force (d=0.79, medium effect size, p = <0.001) and pressure at the midfoot (d=0.70, medium effect size, p = <0.001), greater force at the fourth metatarsophalangeal (MTP) joint (d=0.28, small effect size, p = 0.13), and fifth MTP joint (d=0.37, small effect size, p = 0.10) and greater pressure at the fifth MTP joint (d=0.34, small effect size, p = 0.13). They also displayed lower force (d=0.40, small effect size, p = 0.02) and pressure at the hallux (d=0.50, medium effect size, p = <0.001) and lower force (d=0.54, medium effect size, p = <0.001) and pressure at the lesser toes (d=0.48, small effect size, p = <0.001) compared with controls. SignificanceMidfoot OA appears to be associated with lowering of the medial longitudinal arch, greater lateral push off and less propulsion at toe off. Longitudinal studies are needed to establish causal relationships.

The Efficiency of Highly Porous β-Tricalcium Phosphate With Bone Marrow Aspirate Concentrate in Midfoot Joint Arthrodesis.

Nonunion is one of the most common and devastating complications following midfoot joint arthrodesis. Many different types of bone grafts and bone substitutes have been used to promote osseous fusion. However, there is no consensus on the gold standard bone grafting material and whether biologic materials should be used alone or in combination. The purpose of this study is to investigate the efficiency of highly porous β-tricalcium phosphate (β-TCP) with bone marrow aspirate concentrate (BMAC) in midfoot joint arthrodesis. This retrospective comparative study included patients who underwent midfoot joint arthrodesis using compression screws. Patients were classified into 2 groups: arthrodesis with highly porous β-TCP and BMAC (group A) and arthrodesis without them (group B). The osseous union rate was compared between the 2 groups. A total of 44 patients (46 feet) including 89 joints were included in this study. There was a significant difference in the union rate between the 2 groups: 91.5% (43/47 joints) in arthrodesis with highly porous β-TCP and BMAC (group A) and 76.2% (32/42 joints) in arthrodesis without highly porous β-TCP and BMAC (group B; P = .048). This study investigated the efficiency of highly porous β-TCP and BMAC to promote bony healing in midfoot joint arthrodesis. A significantly higher union rate was shown when arthrodesis was performed with highly porous β-TCP and BMAC, compared with arthrodesis performed without them. We suggest that highly porous β-TCP and BMAC can be a viable and effective adjunct to the fixation in midfoot joint arthrodesis. Level III: Retrospective comparative analysis.

Structural Foot Characteristics in People With Midfoot Osteoarthritis: Cross-Sectional Findings From the Clinical Assessment Study of the Foot.

This study compared radiographic measures of foot structure between people with and without symptomatic radiographic midfoot osteoarthritis (OA). This was a cross-sectional study of adults aged 50 years and older registered with four UK general practices who reported foot pain in the past year. Bilateral weightbearing dorsoplantar and lateral radiographs were obtained. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last 4 weeks, combined with radiographic OA in one or more midfoot joints (first cuneometatarsal, second cuneometatarsal, navicular-first cuneiform, and talonavicular). Midfoot OA cases were matched 1:1 for sex and age to controls with a 5-year age tolerance. Eleven radiographic measures were extracted and compared between the groups using independent sample t-tests and effect sizes (Cohen's d). We identified 63 midfoot OA cases (mean ± SD age was 66.8 ± 8.0 years, with 32 male and 31 female participants) and matched these to 63 controls (mean ± SD age was 65.9 ± 7.8 years). There were no differences in metatarsal lengths between the groups. However, those with midfoot OA had a higher calcaneal-first metatarsal angle (d = 0.43, small effect size, P = 0.018) and lower calcaneal inclination angle (d = 0.46, small effect size, P = 0.011) compared with controls. People with midfoot OA have a flatter foot posture compared with controls. Although caution is required when inferring causation from cross-sectional data, these findings are consistent with a pathomechanical pathway linking foot structure to the development of midfoot OA. Prospective studies are required to determine the temporal relationships between foot structure, function, and the development of this common and disabling condition.

Clinical and Radiographic Outcomes of Nitinol Compression Staples for Midfoot and Chopart Arthrodesis

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Continuous compression implant (nitinol staples) use in orthopaedic surgery has increased in recent years. There are several advantages of nitinol staples, including a lower profile when compared to traditional fixation methods. They are easy to apply and take up a smaller footprint than most plating techniques, thus decreasing surgical time and dissection. Additionally, continuous compression across the fusion site is maintained during the resorptive phase of bone healing. Biomechanical studies provide useful data supporting the use of nitinol staples in the foot and ankle; however, clinical data is limited. This study’s purpose is to determine the efficacy of nitinol staples to achieve stable, bony healing in midfoot and Chopart joint arthrodesis, and examine their clinical outcomes, complications, and pain scores. Methods: A retrospective chart review was performed on 127 midfoot/Chopart joints (71 patients) that underwent arthrodesis using nitinol staples in isolation over a five-year period (January 2017 – February 2022). The primary outcome variable was radiographic evidence of healing. Radiographs were blinded, randomized, and independently reviewed by three board certified foot and ankle surgeons. Each investigator reviewed digital radiographs independently and recorded their radiographic finding responses. Fusions were deemed healed if greater than 50% of the arthrodesis site contained bridging bone. A partially healed arthrodesis was defined as some bridging bone, but less than 50% of the overall arthrodesis site, and a nonunion was defined as no healing seen radiographically or loss of reduction. There were no cases of complete inter-surgeon radiographic disagreement in this study. Pain scores and clinical outcomes were also collected. Smokers and diabetics represented 27% (n = 19) and 13% (n=9) of the patient population, respectively. Results: Complete/partial union was seen in 89% of all joints (113/127) and 93% of midfoot joints (98/106). Chopart joints had a significantly lower healing rate (15/21; 71%) compared to midfoot joints (p = 0.013) and TMT joints in isolation (86/91; 95%) (p = 0.006). Neuropathy and smoking had no effect on healing but diabetes did (p = 0.004). Joints requiring bone grafting had a worse healing rate (38/49; 76%) (p = 0.002). For all joints, post-operative VAS scores were significantly lower than pre-operative (p &lt; 0.00001). Midfoot and Chopart pre-operative pain scores did not differ (p= 0.30), but differed post-operatively (p = 0.003). Midfoot joints had significantly lower pain scores post-operatively than pre-operatively (p &lt; 0.00001). No such significance existed in Chopart joints (p = 0.070). Conclusion: Isolated nitinol staples are a viable option for midfoot arthrodesis, especially TMT joints, and offer significant pain improvement. Staples are lower profile, decreasing hardware irritation and potential secondary surgeries, and ease of use makes insertion efficient and reproducible. They offer the benefit of continuous compression of the fusion site, and are rigid enough to maintain reduction. Chopart joints, however, may require a more rigid fixation than nitinol staples can provide, given the lower healing rate. Caution should be exercised in diabetics and joints that may require bone grafting.

Non-operative Success of Treating Midfoot and Transverse Tarsal Joint Osteoarthritis

Category: Midfoot/Forefoot; Other Introduction/Purpose: Midfoot osteoarthritis affects over 16% of adults over the age of 50, interfering with activities of daily living and leisure. One form of non-operative management is cortico-steroid injections, which are often done under fluoroscopic guidance to improve accuracy. Operative intervention is sometimes performed, although non-union rates and continued pain after surgery can be challenging. This study aims to quantify how well midfoot and transverse tarsal joint arthritis can be treated non- operatively with fluoroscopic-guided injections. Methods: We reviewed the records of 132 patients (155 feet), who were newly diagnosed with midfoot arthritis between 2015 and 2019. Conservative management included periodic fluoroscopic-guided steroid injections at an academic medical center by a single fellowship-trained foot and ankle surgeon. These joints were identified by computed tomography prior. Mean age was 62.7 years and mean BMI was 30.9 kg/m2. Twenty-five feet (16.1%) eventually underwent surgical treatment, and one of those (4.0%) underwent reoperation. Results: On average, each foot received 3.1 (range, 1-21) injections, this did not differ between the surgical and conservative cohorts (operative=3.9, non-operative=3.0; p=.147). Of the 95 feet (61.3%) that received more than one injection, mean duration was 21.6 (range, 0.9-67.4) months. Injection duration did not differ between cohorts (operative=21.8 months, non-operative=21.6 months; p=.952). Cases treated surgically did not receive any injections postoperatively. Patients with higher pre-treatment Pain Catastrophizing Scale (PCS) scores in all subsection5-depression=2.9, p=.046) over a greater injection duration (depression=22.2 months, non-depression=11.4 months, p=.046). Conclusion: Overall, fluoroscopic-guided injections are sufficient for the non-operative treatment of midfoot and transverse tarsal joint arthritis, as only 16.1% of our cohort failed conservative treatment and required surgery. Therefore, although not always successful, non-operative treatment with fluoroscopic guidance injections is able to provide patients relief for an extended period.

A Bio-Inspired Arched Foot with Individual Toe Joints and Plantar Fascia.

This paper presents the design and testing of an arched foot with several biomimetic features, including five individual MTP (toe) joints, four individual midfoot joints, and plantar fascia. The creation of a triple-arched foot represents a step further in bio-inspired design compared to other published designs. The arched structure creates flexibility that is similar to human feet with a vertical deflection of up to 12 mm. The individual toe joints enable abduction-adduction in the forefoot and therefore a natural pronation motion. Adult female bone data was obtained and converted into a CAD model to accurately identify the location of bones, joints, and arches. An analytical model is presented that gives the relationship between the vertical stiffness and horizontal stiffness of the longitudinal arches and therefore allows the optimization of stiffness elements. Experimental tests have demonstrated a vertical arch stiffness of 76 N/mm which is similar to adult human feet. The range of movement of the foot is similar to human feet with the following values: dorsi-plantarflexion (28°/37°), inversion-eversion (30°/15°), and abduction-adduction (30°/39°). Tests have also demonstrated a three-point contact with the ground that is similar to human feet.

The signed helical angle: A technique for characterizing midfoot motion during gait

Quantifying motion in the midfoot during gait and other movements is important for a variety of applications, but challenging due to the complexity of the multiple small articulations involved. The most common motion capture based techniques are limited in their ability to characterize the non-planar nature of the midfoot joint axes. In this study we developed a novel Signed Helical Angle (SHA) to quantify midfoot angular displacement. Motion capture data from 40 healthy subjects walking at a controlled speed were used to calculate finite helical axes and angles from a two-segment foot model. Axes were classified as either pronation or supination based on their orientation, and given a sign, thus either adding to or subtracting from the angular displacement. Analysis focused on insights from axis orientation and comparisons to other techniques. Results showed that when transitions were excluded, pronation and supination axes were fairly well clustered in the transverse plane. The resulting SHA midfoot angle waveform was comparable to sagittal plane Euler and helical component waveforms, but with 39% (approximately 3°) greater range of motion in pronation and 25% (approximately 4°) greater in supination, due to the direct measurement of the motion path and the influence of the other planes. The proposed SHA method may provide an intuitive and useful method to analyze midfoot motion for a variety of applications, particularly when interventions cause subtle changes that may be diluted in planar analyses.

The ultrasound assessment of osteoarthritis: the current status.

Traditionally, osteoarthritis (OA) is diagnosed with the clinical examination supplemented by the conventional radiography (CR). In the research literature, the role of ultrasound (US) imaging in the diagnostics of OA has risen steadily during the last two decades. US imaging is cheap and globally widely available often already in primary healthcare. Here, we reviewed the most essential US literature focusing on OA diagnostics and progression prediction using the various search engines. Starting from the year 2000, our search provided 1 445 journal articles. After reviewing the abstracts, 89 articles were finally included. Most of the reviewed articles focused on the imaging of knee and hand OA, whereas only a minority dealt with the imaging of hip, ankle, midfoot, acromioclavicular, and temporomandibular joints. Overall, during the last 20years, the use of US imaging for OA assessment has increased in the scientific literature. In knee and hand joints, US imaging has been reported to be a promising tool to evaluate OA changes. Furthermore, the reproducibility of US as well as its association to MRI findings are excellent. Importantly, US seems to even outperform CR in certain aspects, such as detection of osteophytes, joint inflammation, meniscus protrusion, and localized cartilage damage (especially at the medial femoral condyle and sulcus area). Based on the reviewed literature, US can be truly considered as a complementary tool to CR in the clinical setup for OA diagnostics. New technical developments may even enhance the diagnostic value of the US in the future.

Preservation Surgery of Septic Osteoarthritis and Osteomyelitis in the Diabetic Foot Using S53P4 Bioactive Glass—A Case Series

(1) Background: Preservation surgery of the diabetic foot aims at tissue sparing to avoid further pathological changes from developing, while ultimately preserving the limb. For this purpose, osteoregenerative, antimicrobial, and osteostimulative materials are now available. The aim of this case series is to demonstrate several clinical situations in which the use of bioactive glass, a third-generation biomaterial, can potentially be of benefit. (2) Methods: In this retrospective case series, we present patients with a diabetic foot complication with septic osteoarthritis, treated at the University Medical Centre Ljubljana, in the years 2020–2022. Patients received surgical care with resection of the affected joint and bone and placement of bioactive glass material. We observed patient characteristics, recurrence of septic osteoarthritis or osteomyelitis, and the need for amputation in the follow-up period. (3) Results: Of the 16 included patients, 8 received treatment of the metatarsophalangeal joints, 4 of the midfoot joints, and 4 of the ankle joints. Ten suffered from Charcot neuroarthropathy. None required readmission within 30 days or suffered early complications. One complication with recidivant septic osteoarthritis and osteomyelitis was observed. (4) Conclusions: Our case series presents possible applications for treatment with bioactive glass in various joints and bones affected by septic osteoarthritis of the diabetic foot.

Comparison of foot kinematics of planovalgus feet using calculations of midfoot joint center based on anatomical landmarks, regression equations and functional calibration algorithms

Comparison of foot kinematics of planovalgus feet using calculations of midfoot joint center based on anatomical landmarks, regression equations and functional calibration algorithms

Assessment of foot kinematics in patients with equinus foot using different midfoot joint center locations

Assessment of foot kinematics in patients with equinus foot using different midfoot joint center locations

Patient Satisfaction and Pain Relief After Deep Peroneal Nerve Neurectomy for Midfoot Arthritis: A Preliminary Short Report.

The deep peroneal nerve (DPN) plays a role in afferent nociceptive dorsal midfoot joint pain perception. DPN neurectomy for treatment of symptomatic dorsal midfoot osteoarthritis allows early mobilization and weightbearing. The purpose of our study was to evaluate the patient satisfaction and pain relief after DPN neurectomy for treatment of chronic dorsal midfoot pain due to osteoarthritis. In this retrospective, IRB-approved, questionnaire-based study, we evaluated 48 patients (55 feet) with an average follow-up of 35.1 (range, 16-51) months who underwent DPN neurectomy at our institution between September 2017 and February 2021. There were 38 women and 10 men, 41 unilateral (22 right, 19 left) and 7 bilateral procedures, with an average age of 67.8 (range, 35-88) years at the time of surgery. A questionnaire that included questions regarding postsurgical dorsal midfoot pain relief, surgical result satisfaction, and current functional limitations was administered via telephone. Demographic information, patient responses, and complications were recorded. Of the 48 patients, 80.8% were satisfied with the result of the surgery in relieving their dorsal midfoot pain, 84.6% would repeat the surgery under the same circumstances, 83.8% would recommend the surgery to a friend, 10.4% reported they wish they had undergone arthrodesis, 91.7% reported pain relief in the first 6 months, and 55.6% reported current activity limitations. Six feet (10.9%) underwent a second procedure with an average postoperative time of 20.5 (range, 1-36) months. Complications included 1 hematoma and deep wound infection, 1 DPN neuroma and superficial peroneal nerve entrapment, and 4 patients with inadequate pain relief. In this cohort, DPN neurectomy appeared to be a reasonable surgical alternative to arthrodesis for the management of chronic dorsal midfoot pain due to midfoot osteoarthritis after failed nonoperative management. Level IV, retrospective case series.