Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR. A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method. A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%). This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms. Level IV.

Toddler's fractures (TF) are commonly treated with casts and fracture-clinic follow-up. A prefabricated boot that can be removed at the parent's discretion might be sufficient and eliminate further follow-up. We aim to determine whether children with TF treated with such boot are as comfortable at 4-weeks post injury as those managed with a circumferential cast. A pragmatic, multi-centered, assessor-blinded, non-inferiority randomized, controlled clinical trial was conducted between October 15, 2019 and February 5, 2024 at four urban, tertiary care, pediatric university-affiliated Canadian emergency departments. All children between nine months and four years of age with a radiograph-visible TF were eligible for participation. Enrolled children were randomized to a removable walking boot versus circumferential cast and no scheduled physician follow up in both groups. The main outcome measure was the child's pain score during ambulation at four weeks post injury measured with the EValuation ENfant DOuLeur (EVENDOL) scale (minimal important difference of 2 points, maximum of 15). Additional outcomes included complications, return to weight-bearing, parental care burden and satisfaction. In the 129 enrolled children, the mean age was 2.2 (SD 0.8) years and 118 (91.5%) completed the four-week follow-up. The boot (n=64) vs. cast (n=54) groups demonstrated mean EVENDOL pain scores of 1.2 and 1.8, respectively (diff −0.55; 95%CI −1.2, 0.1). In the boot group, 61/64 (95.3%) were weight-bearing “most/all of the time” versus 44/54 (81.5%) in the cast group (diff 13.8%; 95%CI 2.2%, 26.5%). Secondary skin complications were more frequent in the boot than cast group (diff 21.9%; 95%CI 5.1, 37.1). There was no difference in the percent of parents who reported they were “satisfied/very satisfied” (diff 9.3%; 95%CI −6.2, 24.8). Fewer parents reported bathing care burden (diff −31.6%; 95%CI −46.7%, −13.7%) and challenges with carrying the child (diff −20.8%; 95%CI −37.0%, −2.8%) in the boot than in the cast group. In the management of children with TF, a removable boot without physician follow-up was non-inferior to circumferential casting with respect to recovery. While there was a higher frequency of skin complications in the boot group, there was no difference in was no difference in parental satisfaction between the groups, and the boot strategy demonstrated reduced parent care-related challenges.

Abstract Unpowered ankle exoskeletons are advantageous over powered ankle exoskeletons owing to their low weight. However, passive ankle exoskeletons without force transmission control can cause discomfort in certain situations. In this study, we designed a bistable inertial clutch that controls spring force transmission using phase-specific inertial forces generated by foot movement during walking. It features a ratchet–pawl mechanism, dual passive springs, and an inertial weight to switch between engaged and disengaged states. The design facilitated the timely storage and release of elastic energy at a certain walking speed and ensured that interruptions to the slow movement of exoskeleton wearers were minimal. We determined the optimal mass of an inertial weight of the clutch using an optimization method that synchronizes the clutch motion with changes in the walking phase. Eight subjects walked on a treadmill at five speeds (0.8–1.6 m/s), and foot angle, heel acceleration, and foot pressure were measured using a custom-made walking boot. Optimal inertial weights for each speed were obtained via a nonlinear optimization algorithm that minimized the least-squares error between foot pressure data and simulated clutch switching. Pilot testing showed that the clutch with the optimal weight for 1.2 m/s began switching between engagement and disengagement once the treadmill speed exceeded 1.2 m/s, as predicted. Thus, the clutch operated in sync with the stance and swing phases at sufficient speeds and remained stationary during low-acceleration leg movements.

A recent systematic review reveals that a significant percentage of patients have residual symptoms 12 months after a first ankle sprain (such as persistent instability and chronic pain). Since this injury often occurred in sports activities and is more frequent in an adolescent population, it is important to understand if those numbers also apply to the pediatric patients. The objective of this study was to evaluate the outcome of a pediatric population at least 12 months after a first ankle sprain.The hypothesis is that the pediatric population, after following a systematic protocol for ankle sprain, will have a low percentage of persistent symptoms at 12 months post ankle sprain. A prospective cohort study was conducted which included patients ranging from 12 to 18 years of age who presented with a first ankle sprain at the emergency room. During the initial visit, sociodemographic data and injury history were collected through a basic questionnaire. A systematic physical examination and a quality-of-life questionnaire, the Foot and Ankle Measure (FAAM) were administered up to six times between the first visit and the last, at least one year after the injury. Routine radiographs were done at first visit for all patients to rule out fracture and a systematic rehabilitation protocol was started with a walking boot, protected weight bearing with crutches and physical therapy. The second visit was within 2 weeks of the injury and completed by an orthopedic surgeon. At this visit, the clinician determined the severity of the sprain by the level of residual swelling, painful palpation of the syndesmosis, a positive squeeze test or external rotation test, painful weight-bearing, in short, the level of clinical suspicion was set at the lowest possible level to classify patients in the complex sprain group. Descriptive statistics on the cohort were performed, and a comparison of FAAM scores at the last visit between the simple and complex sprain groups was made with t-tests. A total of 68 patients were recruited (28 male, 40 female). Forty-four were assign to the simple ankle sprain and 24 in the complex ankle sprain at their second visit. The mean follow-up time was 18 ± 5 months and the mean FAAM at this last visit was 96 ± 7. There was a statistical difference between the simple sprain (99 ± 2) and complex sprain (97 ± 7) for the functional component (p= 0.018) and for the sport activity component (simple (97 ± 5) vs complex (94 ± 12) p=0.016) but there was no significant difference for the overall score. In conclusion, in the paediatric population presenting to the emergency department for a first episode of ankle sprain, the outcome at over 12 months follow-up is excellent, with very little functional impairment overall. Systematic management of all sprains with a walking boot and physiotherapy program certainly helped to achieve these results.

Subtalar dislocation is a rare but severe condition that usually requires emergency attention and could be associated with secondary injuries. Most of the research about this injury is case reports focused on the medical management, so there are no guidelines for rehabilitation and return to sport(RTS). This case report describes the rehabilitation and RTS in an amateur basketball player with an isolated medial subtalar dislocation on his right foot. A 20-year-old amateur basketball player suffered a forced foot inversion after landing on an opponent's foot. The patient was taken to the emergency department for a closed reduction under anesthesia, followed by 2 weeks in a cast and 3 weeks in a walker boot. Rehabilitation started after the immobilization period with the main objective of returning to the same level of competition. It was organized through a 4 phase continuum with a stepwise approach. After 16weeks since injury, the patient returned to team training. To our knowledge, this is the first report to inform on rehabilitation and RTS of medial subtalar dislocation. The 4 phases continuum model could be useful for clinicians for safe progression in this rare condition.

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Treatment of Achilles tendinopathy remains a therapeutic challenge for orthopaedic surgeons due to lack of consensus regarding optimal patient-centered treatment protocol. Available treatment options include physical therapy, analgesics, immobilization, and surgery. However, not every patient is an optimal candidate for surgery, thus making the need for a sustainable and effective alternative necessary. Common non-operative management includes immobilization via tall CAM walker boot (walking boot) and less commonly, use of custom molded ankle-foot orthoses (mAFO). However, little objective evidence exists to evaluate the efficacy of the mAFO compared to the walking boot. This study aims to identify the level of patient satisfaction and treatment efficacy in using the mAFO and the walking boot for Achilles tendinopathy. Methods: Patients with Achilles tendinopathy were identified in this retrospective study by ICD-10 codes and prescription for a mAFO or walking boot by an Orthopaedic foot and ankle provider between 2016 and 2024. Patients were excluded if they had prior Achilles rupture or subsequent surgery, neurological foot/ankle disorders, and ankle injury or corticosteroid injection within 3 months of enrollment. After collection of patient contact information, surveys regarding satisfaction, functionality, and treatment course were sent to patients prescribed a mAFO or a walking boot for Achilles tendinopathy. The initial round of surveys was sent as a link to patients via email and text message. Non-responders were sent a reminder text each day for the following three days, which was then repeated two weeks later if no response was received. Patients were declared official non-respondents after receiving and not responding to a phone call from team members after the first two attempts. Results: Seventy-nine of 305 mAFO patients (26%) and 27 of 78 walking boot patients (35%) completed the survey. Fifty (63%) mAFO and 16 (59%) walking boot patients reported treatment interventions prior to immobilization. Fifty-three (67%) mAFO and 24 (89%) walking boot patients were “satisfied” with their treatment. Twenty-five (32%) mAFO and 13 (48%) walking boot patients underwent additional treatment after completion of the immobilization course. The mean Achilles tendon function rating score was 72 in the mAFO group and 75 in the walking boot group on a scale of 1 (nonfunctional) to 100 (completely functional), with the TOST procedure confirming equivalence within an equivalence margin of 1 (lower t = 0.2944, upper t = 0.6395, t-critical = 1.660, df = 101, α = 0.05). Conclusion: Both the mAFO and the walking boot are acceptable non-operative treatment options for Achilles tendinopathy as both demonstrate a high level of patient satisfaction, restoration of acceptable functional status, and reduction in the need of additional treatment after completing their prescribed immobilization course. The TOST procedure demonstrated that Achilles function scores in both the mAFO and walking boot groups are equivalent, indicating that both treatment options are viable non-operative alternatives to surgical intervention. These non-surgical options can be valuable for patients with Achilles tendinopathy who either prefer to defer surgery or are not suitable surgical candidates.

Functional outcome and correlation with ultrasound gap size of Achilles tendon rupture treated non-operatively with boot and wedges.

Background:A controlled ankle movement (CAM) walking boot introduces an artificial leg length discrepancy (LLD), which alters gait mechanics and may increase pain. Using a contralateral shoe lift in conjunction with the CAM boot is a common strategy to address this discrepancy; however, the extent to which the shoe lift restores gait biomechanics remains understudied. This study investigates the effects of the combination of CAM boot and contralateral shoe lift on gait parameters compared to normal (shod) conditions.Methods:Thirty healthy adults (mean age 24.6 ± 7.9 years), including 15 men and 15 women, walked overground under 3 conditions: normal shod walking, unilateral CAM boot, and CAM boot with a contralateral shoe lift. A Vicon motion capture system tracked 16 markers to calculate spatiotemporal gait parameters as well as hip and knee kinematics and kinetics using the Plug-in-Gait model. A 1-way analysis of variance followed by Tukey pairwise comparisons identified significant effects of walking condition on various gait characteristics.Results:The CAM boot with shoe lift restored kinematic parameters, including hip flexion (P = .036), knee flexion (P = .023), and hip abduction (P = .038), as well as kinetic parameters including knee axial compression force (P = .014) and hip medial-lateral force (P = .007), to normal walking levels on the booted limb. The reported P values reflect differences observed with the CAM boot alone, which were eliminated by the shoe lift.Conclusion:A corrective contralateral shoe lift used with a CAM boot can restore some of the knee and hip kinematic and kinetic alterations introduced by the CAM boot. However, it has limited effect on other gait parameters and does not fully replicate the mechanics of normal shod walking.Level of Evidence:Level IV, case series.

BACKGROUND: Individuals with type 1 diabetes mellitus (T1DM) have lower bone mineral density and increased fracture risk. Female distance runners are particularly prone to bone stress injury. CASE PRESENTATION: A 29-year-old female runner with T1DM experienced left shin pain and was diagnosed with a medial tibial stress fracture. After conservative therapy and 8 weeks of physical therapist (PT) treatment, a return-to-run program (RTRP) for those at high-risk of refracture was initiated. Increased shin pain after beginning the RTRP led to follow-up imaging. A magnetic resonance imaging scan revealed periosteal edema without a fracture line, and a dual-energy x-ray absorptiometry scan showed decreased bone mineral density. The patient was prescribed a bone stimulator and a walking boot, and received integrated multidisciplinary care provided by a PT, a physical medicine and rehabilitation physician, and an endocrinologist. OUTCOME AND FOLLOW-UP: The patient resumed PT treatment after 8 weeks of using the bone stimulator and walking boot as prescribed. After 8 weeks of PT treatment, the patient was pain-free while walking and resumed the RTRP. Three months after resuming PT treatment and improving her Lower Extremity Functional Scale score from 64% to 94%, she was discharged with an RTRP and strength training program. She resumed marathon training without pain. DISCUSSION: This case highlights bone stress injury management in a young female with T1DM, emphasizing the need for careful monitoring due to altered bone metabolism. JOSPT Cases 2025;5(4):1-8. Epub 29 September 2025. doi:10.2519/josptcases.2025.0112

Falls in the geriatric population lead to increased risk of injury and health-care costs. Orthotics are commonly prescribed because of this risk or after injury. This study aimed to evaluate center of pressure (COP) sway and velocity, functional testing, and participant preferences in different braces. In this laboratory-based crossover study, four conditions were evaluated: the participant's own shoe, own shoe plus TayCo brace, own shoe plus Moore balance brace, and walking boot. A total of 18 ambulatory adults over the age of 65 completed three bilateral stance balance trials in which COP excursion and velocity were measured on a Bertec instrumented force plate followed by a Timed Up and Go test for each condition. Participants rated each condition for overall perceived stability and comfort on a visual analog scale, ranking them from 1 to 4. There was significantly less anteroposterior COP excursion (P = .001; effect size [ES] = 1.03) in the TayCo brace versus the walking boot, and there was significantly less mediolateral COP excursion (P = .02; ES = 0.60) in the TayCo brace versus the Moore brace. There was significantly less overall COP velocity (P = .02; ES = 0.94) in the TayCo brace versus the Moore brace or walking boot. There were no significant differences (P > .05) between the rest of the conditions. Timed Up and Go times were found to be significantly higher (P < .05) for the walking boot compared with the other bracing conditions. There were no significant differences (P > .05) between the other orthotic conditions. The walking boot was perceived to be significantly (P < .05) less stable than the other conditions. Participants' shoes were perceived to be significantly (P = .03; ES = 1.44) more comfortable than the TayCo brace, but the TayCo brace was perceived to be significantly more comfortable (P < .01) than the Moore balance brace (ES = 0.74) and walking boot (ES = 2.37). The TayCo brace demonstrated decreased COP excursion compared with other conditions and performed similarly to the participants' own shoes. Further study should investigate the effects of this brace for clinical implementation.

This study aimed to evaluate the stability of bimalleolar ankle fracture fixation techniques (bicortical and unicortical lag screw) in simulated progressive rehabilitation with a walking boot. Five matched pairs of lower extremities underwent simulated bimalleolar ankle fracture and were randomly assigned into these 2 repair groups. Each specimen was tested under an axial compression cyclic load test for 10000 cycles at a rate of 1 Hz while the ankle was held in 30° inclination. Radiographic assessments (screw attached lengths [length from screw head to far cortex], fracture gap, and joint clear space [medial, superior, and lateral]) by 3 examiners were performed at 0th, 5000th, and 10000th cycles. Three repeated measurements by each examiner. The overall level of intra-rater reliability for all 3 raters and all measurements were found to be within "moderate" to "excellent" agreement. For radiographic screw loosening and fracture displacement, evaluation found that at no time point did either the bicortical group or the unicortical group meet the minimal threshold of clinical failure which defined as 2-mm of screw displacement or 2-mm of fracture displacement. Both bicortical and traditional unicortical lag screw fixation techniques provide equivalent stability for medial malleolar fractures in a bimalleolar ankle fracture during simulated progressive rehabilitation with a walking boot. This could potentially have clinical benefits in patient care with earlier return to function, prevention of stiffness and loss of range of motion, and decreased muscle atrophy during the postoperative rehabilitation period.Level of Evidence: Level V: bench top testing.

What is the best: Functional rehabilitation or traditional immobilization after double-row suture anchor repair for insertional Achilles tendinopathy?

Broström-Gould surgery is the gold standard operative treatment of chronic lateral ankle instability. In cases of failed nonoperative treatment, the Broström-Gould repair aims to improve lateral ankle stability via anatomic repair and the overlapping of the anterior talofibular ligament (ATFL) and calcaneofibular ligament, with reinforcement of the ATFL by the extensor retinaculum1-3. Lateral ankle ligament injuries typically present with additional pathologies, including hindfoot varus, peroneal tendon lesions, and tarsal coalition4,9. Previous studies have hypothesized that treatment of ligamentous injuries with concurrent osteotomy of the calcaneus can correct altered stress loading, aiding in the prevention of future injuries and complications4,9,10. The presently described technique is a modification of the Broström-Gould technique that allows the addition of a calcaneal osteotomy without additional incisions. Patients are positioned supine with a foam bump under the torso on the ipsilateral side and bone foam to elevate and pronate the operative foot. The incision begins 4 cm proximal to the tip of the lateral malleolus, posterior to the peroneal tendons, and ends 1 cm proximal to the base of the fifth metatarsal. Subcutaneous tissues are bluntly dissected, and neurovasculature is protected. Tenosynovectomy of the peroneus longus and brevis is performed. During the tenosynovectomy, care must be taken to avoid damaging the sural nerve, which is posterior to the tendon sheath. Hohmann retractors are utilized to better visualize the lateral calcaneus. Calcaneal osteotomy is performed with use of a micro saw for the lateral two-thirds and with use of an osteotome for the medial third. In the example case, a single 7.0-mm cancellous screw was utilized for fixation; however, 2 screws can be utilized to provide greater rotational stability. The ATFL is elevated from the talus and lateral malleolus. The lateral malleolus is freed of periosteum with use of a rongeur. Two 3.5-mm suture anchors (each with 4 needles) with number-0 FiberWire (Arthrex) are inserted through the tip of the lateral malleolus. The suture material is passed through the ATFL and calcaneofibular ligament to tighten the ligaments. The superior extensor retinaculum is advanced over, and sutured to, the ATFL. The incision is closed in layers, and a short leg splint is applied with the foot in slight eversion and dorsiflexion. Patients are transitioned from the splint to a short leg non-weight-bearing cast or boot for 6 weeks. At 6 weeks postoperatively, the patient is transitioned to a walking boot for progressive weight-bearing per a physical therapy protocol. Nonoperative treatment of chronic ankle instability involves rest and physical therapy with bracing or the use of orthotics. Operative treatments are performed when nonoperative treatment has failed. Alternatives include isolated open Broström-Gould repair, arthroscopic Broström repair, Broström repair augmented with a suture internal brace, a Chrisman-Snook procedure, and allograft repair of the ATFL1-3,11. Recent focus has been placed on the use of minimally invasive surgical techniques, including those for calcaneal osteotomies. The proposed technique offers advantages compared to minimally invasive calcaneal osteotomies by allowing for debridement of the peroneal tendons. A previous study on single-incision Broström-Gould surgery with calcaneal osteotomy has shown this technique to be safe and effective, without increased risk of postoperative complications5,6. This approach offers a useful modification to the Broström-Gould procedure by allowing for a simultaneous calcaneal osteotomy without the need for additional incisions. Advantages include decreased risk of incision-site complications and improved cosmesis. The Broström-Gould procedure has been shown to provide excellent patient satisfaction7. The goal of this surgery is to stabilize the ankle joint, allowing for improved mobility and decreased pain. On the basis of clinical evidence, modified versions of the Broström-Gould procedure, including a single-incision procedure with calcaneal osteotomy, have no proven clinical inferiority or increased risk of complications6-8. The addition of a calcaneal osteotomy with a single-incision technique allows for the correction of varus deformities, lowering the risk of future ligamentous injury and slowing the progression of osteoarthritis4. Common surgical complications include superficial wound healing complications, sensory abnormalities, persistent ankle pain, and prolonged swelling5. Most patients can tolerate weight-bearing beginning at 6 weeks postoperatively, and patients have a high rate of return to activity1. Avoid overtightening of the ATFL in order to prevent increased postoperative stiffness.Avoid over medialization of the micro saw blade in order to prevent potential overpenetration.Insufficiency of the calcaneofibular ligament can be identified by checking for opening of the posterior facet of the subtalar joint on an oblique view of the ankle as a guide to include calcaneofibular ligament tissue in the repair. CLAI = chronic lateral ankle instabilitySLCO = sliding lateralizing calcaneal osteotomyAP = anteroposteriorMRI = magnetic resonance imagingATFL = anterior talofibular ligamentCFL = calcaneofibular ligament.

Knee kinetics and kinematics of experienced skiers with and without ACL reconstruction performing landings in walking boots

There has been weak consensus and a paucity of robust literature with regard to the best postoperative weight-bearing and immobilization regime for operatively treated ankle fractures. This trial compared immediate protected weight-bearing (IWB) with non-weight-bearing (NWB) with cast immobilization following ankle fracture fixation (open reduction and internal fixation [ORIF]), with a particular focus on functional outcomes, complication rates, and cost utility. This INWN (Is postoperative Non-Weight-bearing Necessary?) study was a prospective, pragmatic, randomized controlled trial (RCT), with participants allocated in a 1:1 ratio to 1 of 2 parallel groups. IWB from postoperative day 1 in a walking boot was compared with NWB and immobilization in a cast for 6 weeks, following ORIF of all standard types of unstable ankle fractures. Skeletally immature patients and patients with tibial plafond fractures were excluded. The type of surgical fixation was at the surgeon's discretion. Patients were randomized postoperatively by an operating room nurse using computerized block randomization (20 patients per block). Surgeons were blinded until after the operation. The study was multicenter and included 2 major orthopaedic centers in Ireland. Analysis was performed on an intention-to-treat basis. The primary outcome was the functional outcome assessed by the Olerud-Molander Ankle Score (OMAS) at 6 weeks. A cost-utility analysis via decision tree modeling was performed to derive an incremental cost-effectiveness ratio (ICER). We recruited 160 patients between January 1, 2019, and June 30, 2020, with 80 patients per arm, who were 15 to 94 years of age (mean age, 45.5 years), and 54% of patients were female. The IWB group demonstrated a higher mean OMAS at 6 weeks (43 ± 24 for the IWB group and 35 ± 20 for the NWB group, with a mean difference of 10.4; p = 0.005). The complication rates were similar in both groups, including surgical site infection, wound dehiscence, implant removal, and further operations. Over a 1-year horizon, IWB was associated with a lower expected cost (€1,027.68) than NWB (€1,825.70) as well as a higher health benefit (0.741 quality-adjusted life-year [QALY]) than NWB (0.704 QALY). IWB dominated NWB, yielding cost savings of €798.02 and a QALY gain of 0.04. IWB in a walking boot following ankle fracture fixation demonstrated superior functional outcomes, greater cost savings, earlier return to work, and similar complication rates compared with NWB in a cast for 6 weeks. These findings support the implementation of IWB as the routine mobilization protocol following ankle fracture fixation. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Toddler's fractures (TF) of the tibia are commonly treated with casts and fracture clinic follow-up. However, a prefabricated removable boot might be sufficient and reduce unnecessary follow-up. To determine whether pain in children with TF treated with a removable boot is not worse than those managed with a circumferential cast at 4 weeks postinjury. This pragmatic, multicenter, assessor-blinded, noninferiority randomized clinical trial was conducted between October 2019 and February 2024 at 4 urban, tertiary care, pediatric Canadian emergency departments. Children aged between 9 months and 4 years with a radiograph-visible TF were eligible for inclusion. Prefabricated walking boot for up to 3 weeks (removable at caregivers' discretion) vs circumferential cast immobilization (site standard of care) for 3 weeks. The primary outcome was pain score, measured with the Evaluation Enfant Douleur (EVENDOL) scale (maximum score: 15). Additional outcomes included return to baseline activities, complications, parental satisfaction and care burden. In 129 enrolled children, the mean (SD) age was 2.2 (0.8) years, and 56 children (43%) were female. Of these, 118 children (92%) completed the 4-week follow-up, and the boot (n = 64) vs cast (n = 54) groups demonstrated mean (SD) EVENDOL pain scores of 1.21 (1.54) and 1.76 (2.13), respectively (difference, -0.55; 95% CI, -1.23 to 0.13). The percentage of participants who returned to baseline activities "almost all of the time" was 49 of 64 children (77%) in the boot group and 22 of 54 (41%) in the cast group (difference, 36%; 95% CI, 9%-63%). Skin complications occurred in both groups (boot: 46 total complications [72%], with 5 stage 1 pressure sores; cast: 27 total complications (50%), with 1 pressure sore]; difference, 22%; 95% CI, -6% to 50%). There was no statistically significant difference in the percentage of caregivers who were satisfied or very satisfied with the treatment (difference, 9%; 95% CI, -24% to 43%). Fewer caregivers reported bathing care burden (difference, -32%; 95% CI, -47% to -18%) and challenges with carrying the child (difference, -21%; 95% CI, -27% to -15%) in the boot vs cast group. In this multicenter randomized clinical trial examining the management of children with TF, a removable boot without physician follow-up was noninferior to circumferential casting with respect to pain recovery. While there was a clinically relevant but not statistically significant trend toward more skin complications in the boot group, there was no difference in caregiver satisfaction, and the boot strategy demonstrated reduced childcare-related challenges. ClinicalTrials.gov Identifier: NCT03971448.

In this study, we designed a wearable multi-sensor walking boot to measure foot angular momentum and introduced a novel method to quantify forefoot rocker motion as a function of walking speed. A treadmill walking experiment was conducted with eight healthy subjects wearing the multi-sensor walking boot. Using the collected data, we calculated foot angular momentum and the average rate of change in angular momentum during the double support phase. In addition, we used linear regression analysis to quantify foot rotation patterns across increasing walking speeds, assessing the potential of this method as a walking indicator. The results demonstrated that the foot rotation pattern in the healthy group was characterized by a gradual scaling of angular momentum and its average rate of change, with strong correlations to walking speed. Based on these findings, we conclude that the proposed method for quantifying forefoot rocker motion relative to walking speed can serve as an effective indicator of normal walking.

We present a case report of revision talonavicular joint arthrodesis following painful nonunion. Following the removal of the previously united subtalar joint arthrodesis hardware, the posterior screw tunnel was used to access the internal aspect of the calcaneus for bone and marrow harvesting avoiding a second graft site incision. A suction curettage system was then used to acquire adequate autologous cancellous bone graft and nondiluted bone marrow. The talonavicular joint was then prepared for revision arthrodesis, followed by augmentation with the autologous cancellous bone graft and rigid internal fixation placed across the joint for compression. There were no complications noted at the donor site or the arthrodesis site immediately following surgery or during follow-up. Radiographs obtained 4 months postoperatively demonstrate osseous union at the talonavicular joint and near complete consolidation at the calcaneal donor site. The patient is currently walking pain-free in a walking boot and will be continually followed to allow for long-term outcome measures.

IntroductionAs per national guidelines for Ankle fractures in the United Kingdom, fractures considered stable can be treated with analgesia, splinting and allowed to weight bear as tolerated. The guidelines also suggest further follow-up not mandatory. This study was aimed at evaluating the current clinical practice of managing stable ankle fractures at a university hospital against national guidelines.MethodThe study was undertaken using retrospectively collected data, the inclusion criteria being all adults with stable ankle fracture pattern treated non-operatively between December 2022 and April 2023. Collected data included age of patient, date of injury, type of immobilization, number of clinical visits and any complications.Results41 cases were identified and analyzed. The mean age of the cohort was 49.8 years (Standard deviation 20.01). Twelve percent (n = 5) were reviewed in clinic, treated and discharged as stable Weber B type fracture pattern as per national guidelines after the first visit. About 52% (n = 21) were seen in clinic twice before discharge, first visit between 1-2 weeks and the last clinic visit between 5-7 weeks. About a third of patients (30%, n = 12) were seen in clinic on more than two occasions. At the first clinic visit 87% (n = 36) were given a boot and allowed to weight bear as tolerated. Two patients were diagnosed with deep vein thrombosis/pulmonary embolism during the treatment duration. Three patients had extended duration of follow up for ongoing symptoms. None discharged after first or second visit needed surgery for displaced or malunited fracture.ConclusionPatients discharged from clinic after first or second visit did not need any further surgery. As per national guidelines, patients deemed stable weber B lateral malleolus fracture pattern after weight bearing radiograph can be treated safely with a weight bearing walking boot with no further follow up.

Realignment of the hindfoot by talonavicular arthrodesis. Idiopathic and posttraumatic arthritis of the talonavicular joint with or without malalignment. Optional in flatfoot reconstruction. General medical contraindications to surgical interventions. Medial, dorsomedial, or dorsal skin incision. Exposure of the talonavicular joint and cartilage removal. Decortication. Reposition of the joint if malaligned. Optional transplantation of corticocancellous bone. Temporary stabilization with Kirschner wires and stabilization with screws, optional with cramps or plates. Sixweeks nonweightbearing in along walker boot. Afterwards 2weeks of progressively weight bearing in along walker boot. Then full weightbearing in walking shoes with stiff soles. Physiotherapy. Atotal of 18feet in 18patients with isolated talonavicular arthritis were treated with isolated talonavicular fusion and corticocancellous bone thorough amidline incision. For postoperative management, patients had nonweightbearing for 6weeks in along walker boot. Mean follow-up was 14.5months (range 8-35months). Mean age was 63.2years (range 54-72years). Preoperative Manchester-Oxford Foot Questionnaire (MOXFQ) score was 65.3 (± 5.2); postoperative MOXFQ score was 28.5 (± 7.0). One revision surgery performed due to pseudarthrosis.