BackgroundFoot and ankle training has evolved with the development of the fellowship curriculum. Increased specialization has enhanced management of foot and ankle pathology. Despite this, physician marketing schemes have clouded this definition.PurposeThe purpose of this study was to review and compare current foot and ankle fellowship programs (podiatric and orthopaedic) to better define what a surgical foot and ankle fellowship is, thereby more appropriately delineating between that of a preceptorship.Study Design/ MethodsA digital search was performed through online published American Orthopedic Foot and Ankle Society (AOFAS) and American College of Foot and Ankle Surgeons (ACFAS) fellowship programs. Number of programs, case volume, faculty demographics, and duration (years) were all recorded.ResultsWe identified 51 total orthopaedic programs compared with 62 podiatric programs. Both societies defined a fellowship as a year-long experience. Each had a large attending faculty-to-fellow ratio [median of 3-1 orthopaedics and 6-1 podiatric, respectively]. Average case volume digitally published per year was on average 680 (±128) cases for orthopaedics and 481 (±123) for podiatric programs. However, publishable data are scarce and hard to prove.ConclusionThe foot and ankle community should continue to vet and differentiate what constitutes "fellowship training." Improved publicly available data would allow better transparency of different types of extended training. Further studies are warranted to provide a clearer definition of "fellowship" training, thereby maintaining quality control and preventing false advertising.Level of Evidence:Level IV.
BACKGROUND Gastrocnemius recession is a popular procedure utilized to treat chronic conditions related to isolated gastrocnemius contracture (IGC). Recent anatomical research detailing variable gastrocsoleus tendon morphology has raised important questions regarding the safety of some traditional recession procedures. Alternative gastrocnemius recession strategies may produce comparable dorsiflexion improvement results while avoiding the surgical risk related to conjoint tendon anatomical variability. METHODS Ten matched cadaver pairs were randomized to receive either a medial gastrocnemius recession (MGR) procedure or a gastrocnemius intramuscular recession "Baumann" procedure. Postoperative dorsiflexion improvement was measured and then compared between groups. Detailed postoperative surgical dissections were performed to assess structures at risk, conjoint tendon morphology, and anatomical symmetry. RESULTS Medial gastrocnemius recession and Baumann procedures were equally effective at producing significant increases in passive ankle dorsiflexion. No sural nerve injuries were observed. Thirty-five percent of specimens showed direct muscular fusion of at least a portion of the distal gastrocnemius muscular tissue to the adjacent soleus. CONCLUSION The MGR procedure produced comparable dorsiflexion improvement results to the Baumann procedure in our cadaver model. Surgeons must account for certain conjoint tendon anatomical variants when surgically treating IGC as traditional recession methods risk tendo-Achilles overlengthening. LEVELS OF EVIDENCE Level V: Cadaver Study.
Progressive collapsing flatfoot deformities (PCFD) are commonly the result of the impairment of medial hindfoot soft tissue structures including the posterior tibial tendon, deltoid, and spring ligament. These deformities have been treated surgically via calcaneal osteotomies and tendon transfers; only recently has soft tissue reconstruction gained momentum. Advancements have now made available graft materials to help augment and stabilize ligament repairs to further improve results. Medial hindfoot ligament reconstruction procedures require surgeon familiarity with soft tissue and osseocartilaginous structures. We assessed 20 cadaveric specimens after a simulated medial hindfoot ligament reconstruction procedure focusing on the sustentaculum bone tunnel. Post-procedure anatomic and radiographic observations carefully detailed any damage to anatomic structures. The sustentaculum tunnel guidewire at the lateral calcaneal cortex was documented, including angular position in relation to the subtalar joint. We determined that the posterior-inferior aspect of the lateral calcaneal surface serves as the ideal target region for the placement of the guidewire and subsequent tunnel drilling. Complications increased when drilling tunnels at 7 mm in diameter. The results provide insight for medial-to-lateral drilling of the calcaneus when performing tunneling techniques and can be used to help optimize surgical results when for deltoid/spring ligament repair augmented with graft materials.Level of Evidence: Level V.
Orthopedic screws are widely used to achieve bone reduction, compression, and construct stability. However, the relationship between insertion torque, interfragmentary compression, and fixation strength, especially when comparing standard screws with NiTiNOL/sustained dynamic compression (SDC), has not been thoroughly investigated. This study measured insertion torque, interfragmentary compression, and fixation strength for two types of headed orthopedic devices—standard and SDC—using solid foam bone replicates and cadaver validation. The study also assessed the interfragmentary compression produced by these devices in the context of simulated bone resorption.Results showed that compression force increased with insertion torque until thread stripping occurred, resulting in a 91.9 % loss of compression in the standard screw group. In contrast, the SDC device maintained significantly higher compression, even beyond the point of stripping. These findings suggest that SDC devices offer increased safety by continuing to apply interfragmentary compression after stripping. The SDC device's ability to generate internal compression allows it to re-engage threads into undamaged bone, potentially compensating for compression loss due to stripping. Clinically, these results indicate that surgeons might benefit from deliberately undershooting peak insertion torque, regardless of the device type, and may prefer NiTiNOL-based SDC devices for their resilience to stripping and bone resorption, ultimately optimizing patient outcomes in foot and ankle surgery.
