BACKGROUND:Ankle contracture/arthrofibrosis is addressed with physical therapy or low-intensity stretch assist splints, requiring prolonged treatment and if clinician-set goals remain unmet, surgical intervention is considered. Mechanical therapy using a hydraulic stretch assist device with a high-intensity stretch protocol offers a potential non-operative alternative. This study evaluated the effectiveness of a hydraulic stretch-assist device in improving ankle dorsiflexion range of motion (ROM). METHODS:This retrospective study reviewed patients from an internal database prescribed the Ermi Ankle Flexionater + device between October 2021 and May 2023 after plateauing in dorsiflexion recovery despite at least four weeks of standard treatment Dorsiflexion ROM was measured using the ErmiMotion application in straight- and bent-leg positions at baseline and follow-up. Changes between initial and final measurements were assessed using paired t-tests, with significance set at α< 0.05. RESULTS:Seventy-four patients had complete data available. Treatment began 214 days after injury/surgery. The final dorsiflexion ROM significantly improved in straight (from 4.0°±10.8° to 12.5°±10.2°; p < 0.001) and bent leg positions (from 8.1°±11.7° to 15.0°±10.8°; p < 0.001). Effect sizes were large (Cohen's d=0.86 and 0.80, respectively). Patients with severe motion loss showed marked improvement (straight: -7.7°±6.5° to 7.3°±11.4°; p < 0.001; bent: -9.1°±10.7° to 9.6°±10.3°; p = 0.001), with very large effect sizes (Cohen's d=1.52 and 3.06, respectively). CONCLUSIONS:Treatment with a hydraulic stretch assist device was associated with improved dorsiflexion ROM in patients with ankle contracture, including those with severe limitations. These findings support consideration of using a hydraulic stretch assist device for individuals who do not respond adequately to standard treatments. LEVEL OF EVIDENCE:Level III.
INTRODUCTION:Sagittal- and axial-plane lesser-toe deformities may be associated with plantar-plate attenuation, scarring, or rupture - limiting the feasibility of direct repair. Conventional options include osseous decompression, plantar-plate repair and flexor-to-extensor transfer. This technical tip describes a suture-based flexor digitorum longus (FDL) tenodesis to the proximal phalanx as an alternative for selected deformities. TECHNIQUE:Two operative approaches are presented. For deformity centred at the metatarsophalangeal (MTP) joint with preserved interphalangeal joints, the FDL is accessed through a dorsal approach following a Weil osteotomy and sutured to the proximal phalanx via a tunnel drilled through the base of the phalanx. Tendon position and suture tension are adjusted to provide dorsiflexion restraint and axial correction. Where concomitant proximal interphalangeal (PIP) joint fusion is required in a primarily sagittal plane deformity, the FDL may be accessed through the PIP joint, and sutures passed along either side of the proximal phalanx and tensioned after fusion. RESULTS:We have used this technique to provide dynamic stabilisation of the MTPJ. Asymmetric tendon positioning or tensioning can also generate an axial corrective moment. Established procedures remain appropriate, but this technique may have a role in selected patients. CONCLUSION:FDL tenodesis offers a suture-based option for multiplanar lesser-toe deformities as an alternative to plantar-plate repair. Its role may be considered within an individualised reconstructive strategy, with further clinical studies warranted to clarify its long-term comparative performance.
BACKGROUND:Hallux valgus is the most prevalent forefoot condition and is associated with substantial pain, functional impairment and reduced health-related quality of life. Despite established clinical effectiveness, since 2021 an increasing number of Integrated Care Boards in the UK have classified surgical correction as a procedure of limited clinical benefit, citing a perceived absence of population-level cost-effectiveness data. National-scale evidence is required to inform commissioning decisions and ensure equitable access to care. METHODS:A cost-utility analysis was performed from the perspective of the UK National Health Service (NHS) using British Orthopaedic Foot and Ankle Society (BOFAS) Registry data for adults undergoing primary hallux valgus correction by osteotomy (open or minimally invasive surgery, MIS). Fusion procedures were excluded. EuroQol-5 Dimension five-level (EQ-5D-5L) utility scores at baseline and 12 months were used to estimate quality-adjusted life year (QALY) gains. A six-state Markov model simulated lifetime costs and outcomes over 40 annual cycles from the UK NHS perspective, with costs and benefits discounted at 3.5% per annum. Incremental cost-effectiveness ratios (ICERs) were calculated against conservative management and deterministic sensitivity analysis was performed across procedural cost, utility gain and benefit duration. A pre-specified subgroup analysis compared open and MIS techniques. RESULTS:From 1111 registry pathways, 306 patients had complete EQ-5D-5L datasets for cost-utility modelling, comprising 129 open and 177 MIS procedures. EQ-5D-5L utility improved from 0.69 (95% CI 0.65-0.72) at baseline to 0.84 (95% CI 0.81-0.88) at 12 months in the open group, and from 0.69 (95% CI 0.66-0.72) to 0.82 (95% CI 0.79-0.84) in the MIS group (both p < 0.001). The base-case lifetime Markov model produced an ICER of £ 8737 per QALY for open correction and £ 11,969 per QALY for MIS correction, both well below the NICE willingness-to-pay threshold. In sensitivity analysis using incremental costs against conservative management, the ICER ranged from cost-saving (-£374 per QALY) to £ 3219 per QALY across all tested scenarios. Open correction was the dominant strategy in the pre-specified subgroup analysis, primarily driven by lower implant costs and higher removal rates in current literature. CONCLUSION:Hallux valgus correction surgery is highly cost-effective from the UK NHS perspective, with cost per QALY values substantially below those reported for total hip and total knee arthroplasty. The current restriction of access in some UK regions is not supported by national health-economic evidence. LEVEL OF EVIDENCE:III (economic and decision analysis based on prospective registry data).
Background Restricted ankle dorsiflexion from gastrocnemius tightness contributes to multiple foot and ankle disorders. Proximal medial gastrocnemius release (PMGR), originally developed for spasticity, is increasingly used for adult pathologies, yet its indications and outcomes remain debated. Methods We performed a contemporary review of PubMed, EMBASE, and CENTRAL up to January 2025, including clinical and biomechanical studies on PMGR in adults. Non-English, pediatric, distal gastrocnemius releases, and non-original articles were excluded. Results The Silfverskiöld and lunge tests remain the main diagnostic tools, though no standardized protocol exists. PMGR appears safe, with rare minor complications, and generally preserves calf strength. Evidence supports its role in plantar fasciitis with durable pain and function improvements. For Achilles tendinopathy, metatarsalgia, and progressive collapsing foot deformity, only small case series exist. Data for neuropathic ulcers and hallux deformities are sparse and inconclusive. Conclusions PMGR is effective for plantar fasciitis, but current evidence is limited and heterogeneous for other conditions. High-quality trials are required to define its broader role. Level of evidence Level IV, therapeutic review.
INTRODUCTION:Displaced intra-articular calcaneal fractures (DIACFs) managed with open reduction internal fixation through extensile lateral or sinus tarsi approaches are associated with a high rate of soft tissue complications. We present the technique of minimally invasive percutaneous fixation of DIACFs and the early outcomes from a major trauma centre. METHODS:This was a retrospective case series from a single major trauma centre between 2021 and 2024. Seventeen DIACFs in 13 patients were followed up for a mean of 14 months (range, 12-16 months). The mean age was 41 years (range, 18-60 years). Two out of 17 fractures were open injuries. There were seven Sanders type 2 and ten Sanders type 3 fractures. Simple tongue-type fractures were excluded. Fracture reduction was performed using a Schanz pin, combined with the 'Essex-Lopresti manoeuvre' and manual correction of varus and shortening. Fixation was with at least three 6.5 mm partially-threaded cancellous screws. Patients were immobilised in a below knee backslab for 6-weeks post-operatively. Radiological parameters (Böhler's angle, calcaneal height and width), the Kerr-Atkins score, VAS pain score, and any re-operations or complications were recorded. RESULTS:At final follow-up, the mean Kerr-Atkins score was 67 and the mean VAS pain score was 3.4. The average time from injury to surgery was 6.9 days (range, 3-21). All patients were mobilising unaided, and only 2 patients required orthotic footwear. One patient had a re-operation due to a late-declaring necrotic eschar. Mean Böhler's angle increased from 14.9° to 26.8° (p < 0.0001). The mean calcaneal height increased from 38.7 mm to 45.4 mm (p < 0.0001). No patients had developed clinical or radiological subtalar arthritis during the study period. CONCLUSION:In our case series, we have demonstrated that minimally invasive percutaneous fixation of DIACFs is a safe procedure, with a very low complication rate. Early functional and radiological outcomes are excellent, with all patients mobilising unaided, and most were able to wear normal footwear with a plantigrade, shoeable foot.
Background Lisfranc injuries are frequently overlooked or underestimated. Treatment of neglected injuries is challenging, and the optimal surgical strategy in delayed presentations remains unclear. Methods A PRISMA-compliant systematic review and meta-analysis were performed. Observational studies reporting surgical outcomes of corrective surgery for neglected Lisfranc injuries were included. Random-effects meta-analyses were conducted for AOFAS scores, complication rates, and return-to-work proportions. Meta-regression evaluated the influence of injury energy, surgical procedure, and treatment delay. Results Ten studies with 262 cases were included. Surgery was associated with a significant improvement in AOFAS scores. Patients with high-energy injuries demonstrated lower preoperative scores but greater absolute postoperative improvement, while postoperative scores remained comparable. The choice of surgical procedure and delay were not associated with functional improvement. The pooled complication rate was 34%, with higher rates observed in high-energy injuries and with longer delays. Conclusions In neglected Lisfranc injuries, functional recovery reflects baseline severity rather than timing alone. Surgical decision-making should prioritize joint viability and reducibility over delay.
BACKGROUND:The literature for a first metatarsocuneiform joint (MCJ) arthrodesis procedure and an early weight bearing post-operative regime (<2 weeks) has been systematically reviewed [1,2]. The concern regarding an increased risk of non-union with early weight bearing has largely been anecdotal. This is a single surgeon retrospective review assessing the union rates achieved following a Lapidus (1st tarsometatarsal joint) arthrodesis in the treatment of Hallux valgus using an anatomically contoured plantar plate and applying an early weight-bearing regime. METHODS:A retrospective study of consecutive patients who underwent this surgical technique between June 2019 and January 2025 were reviewed. Patients were evaluated at 8 weeks post operation for weight bearing x rays and returned for final clinical review at 6 months post operation. Clinical outcomes were validated through the Manchester-Oxford Foot Questionnaire (MOXFQ) and patient satisfaction (PSQ10) survey. Union of the arthrodesis and complications were reported. RESULTS:A total of 72 patients (60 female and 12 male) with a mean age of 60.60 (range 29 - 75) were analysed. The mean MOXFQ score improved across all domains. All three domains demonstrated highly significant post-operative improvement (p < 0.001 for all). Mean reductions were 26.2 points for Walking Standing (95% CI: 18.6-35.0; Cohen's d = 0.93), 25.6 points for Pain (95% CI: 18.7-32.9; Cohen's d = 1.03), and 37.5 points for Social Interaction (Cohen's d = 1.66). Effect sizes ranged from large to very large, indicating clinically meaningful improvements. There were no reported non-unions or plate failures. Fixation removal was required in 1 patient (1.5%). Ninety percent of patients were back to normal supportive footwear by 8 weeks. CONCLUSION:This study has demonstrated the low complication rates and acceptable safety profile of an immediate weight bearing post-operative regime following a first MCJ arthrodesis procedure with a single locking plantar plate fixation modality. It provides a larger cohort of patients to support the benefits of plantar plate fixation highlighted in other supporting systematic reviews for a first tarsometatarsal joint arthrodesis. [2] LEVEL OF EVIDENCE: IV.
Isolated cuboid dislocation is rare, with only 7 cases described in the literature. We describe three cases, two in professional rugby league players. The mechanism of injury was the same in the rugby league players with an external rotation injury to the midfoot during a tackle. The dislocation is easily missed on X-rays and CT would appear to be the investigation of choice. None of the dislocations could be reduced closed and all underwent open reduction and wire stabilisation. The wires were removed at 6 weeks. The short and long term functional results were good. Both rugby league players returned to play. One player was reviewed 6 years and 8 months post dislocation. He was still playing professional rugby league. His AOFAS midfoot score was 100. His X-rays however showed marked post traumatic arthritis in his 4th and 5th tarsometatarsal joints. Clinically this was asymptomatic. The second player was reviewed 4 years and 2 months after the injury, achieving an AOFAS Midfoot Score of 88/100. He reported some clicking and discomfort in the affected foot, particularly in the mornings. However, he did not require analgesia and had no limitations to activity.
Background Minimally invasive surgery for hallux valgus (MIS-HV) has become a prominent topic in orthopaedic research, with a rapidly growing body of literature. Purpose This study provides a bibliometric analysis of the scientific literature on MIS-HV to identify publication trends, influential contributors, collaboration networks, and major research themes. Methods A systematic search was conducted in the Web of Science Core Collection database for articles published between 2005 and 2025. The bibliometrix was used to extract and analyse data, including annual scientific production, author and country productivity, journal distribution, and bibliometric laws (Lotka's and Bradford's). Results A total of 142 articles from 38 journals were analysed, involving 563 authors from multiple countries. Annual scientific production demonstrated a significant increasing trend with an annual growth rate of 16.7%. The authors with the highest number of publications were Lewis T.L. (n = 12). Foot & Ankle International was the journal with the highest number of publications with 31 publications (21.8%). Keyword co-occurrence analysis revealed major research clusters centred on surgical techniques (MICA, chevron osteotomy), patient-reported outcomes (MOXFQ), and the underlying pathophysiology and anatomical characteristics of the deformity. Retrospective case series were the most common study design (n = 94), followed by prospective case series (n = 19), with only nine randomised controlled trials identified. Conclusions Research on MIS-HV has grown exponentially over the last decade, mirroring the global adoption of third and fourth-generation techniques. This analysis maps the field's intellectual structure and highlights key contributors, collaborative networks, and evolving research trends, while underscoring the critical scarcity of multicentre randomised controlled trials. Study design Bibliometric analysis. Level of evidence V
BACKGROUND:Midfoot osteoarthritis affects approximately 12% of adults over 50 years and is a common cause of chronic foot pain and disability. When conservative management fails, midfoot arthrodesis remains the standard surgical treatment but carries significant morbidity, including nonunion rates of 3-10% and prolonged non-weightbearing. Deep peroneal nerve (DPN) neurectomy has emerged as a motion-preserving alternative; however, clinical evidence has not been systematically evaluated. METHODS:A systematic review following PRISMA 2020 guidelines was conducted (PROSPERO: CRD420251266344). MEDLINE, Cochrane CENTRAL, and Web of Science were searched from inception to October 2025. Quality was assessed using the ROBINS-I tool. Data were synthesised narratively due to heterogeneity in outcome reporting. RESULTS:Four retrospective case series (Level IV evidence) comprising 88 patients (106 feet) met inclusion criteria. Mean age was 66.3 years; 80% were female. Follow-up ranged from 4 weeks to 51 months. Patient satisfaction was approximately 75% across studies, though variably defined and best regarded as an illustrative estimate.The pooled surgical complication rate was 5.7% (6/106 feet), comprising predominantly minor wound complications. Reoperations, including revision neurectomy, exostosis excision, and conversion to arthrodesis, were required in 7.5% of feet (8/106). Conversion to midfoot arthrodesis occurred in 4.7% of feet (5/106). All four studies were assessed as having serious risk of bias using ROBINS-I. CONCLUSION:DPN neurectomy may provide clinically meaningful pain relief with low complication rates in selected patients with midfoot osteoarthritis, offering faster recovery than arthrodesis. Current evidence is limited to small retrospective case series; prospective comparative studies are needed.
Background Individuals with plantar heel pain (PHP) are often excluded from randomised clinical trials (RCTs) despite having care-seeking behaviour and symptoms consistent with PHP. This study aimed to describe their clinical course over 12 months after not being included in the FIX-Heel Trial. Methods We conducted a prospective cohort study of individuals with PHP who did not meet one or more of the inclusion criteria: 1) pain on palpation at the medial calcaneal tubercle, 2) plantar fascia thickness > 4.0 mm, or 3) pain > 30 mm on a 100-mm visual analogue scale. Individuals completed the Foot Health Status Questionnaire (FHSQ) and care-seeking behaviour at baseline and after 4, 12, 26, and 52 weeks. Results We included 28 individuals who were primarily not included in the trial due to their plantar fascia thickness (86%). Significant improvements were observed in FHSQ Pain and Function scores at 12 weeks compared to baseline (mean difference 9.0 (95%CI: 1.5;16.5, P = 0.019) and 7.7 (95%CI: 0.3;15.2, P = 0.043), respectively), with continued improvement at 26 and 52 weeks. Less than half received treatment at any time point. Conclusion Despite limited care, individuals not included in an RCT experienced clinically meaningful long-term improvement. These findings shed light on the clinical course of individuals excluded from trials.
Background Falls in older adults remain a major clinical concern. Although the Enhanced Paper Grip Test (EPGT), provides an objective measure of lower limb strength and has shown promise in controlled settings, its use in routine podiatric practice has not been described. Aim To audit the implementation of the EPGT in routine private podiatric practice and to explore whether EPGT measures are associated with self-reported recent falls in older adults. Methods The EPGT was introduced on a trial basis in three independent private UK podiatry clinics for six months. People (aged ≥60 y) were tested when the treating podiatrist considered the assessment clinically appropriate. Anonymised routine clinical data were extracted retrospectively at the end of the audit period, including EPGT outcomes, age, sex, and self-reported history of an unexplained fall in the previous twelve months. Results Seventy-eight participants (mean age 72 ± 7 years) were assessed; 17 reported a fall. Median EPGT force was statistically significantly lower in fallers (11.9 N) than in non-fallers (21.4 N), U= 283,z = -3.554,p < .0005. Differences remained significant after adjustment for age and sex and were robust to outlier exclusion. Hallux-related pathology was not associated with EPGT outcomes. Conclusions In this pragmatic private practice audit, the EPGT could be incorporated into routine podiatric assessment and lower EPGT values were associated with self-reported recent falls. These findings support the EPGT as a potentially useful adjunct to falls risk screening that could be offered as part of routine podiatry care. Prospective studies are needed before predictive use or clinical thresholds can be established.
BACKGROUND:The anterior ankle approach is one of the most commonly used surgical approaches in foot and ankle surgery and requires incision of the superior extensor retinaculum. Traditional longitudinal or Z-shaped retinacular incisions can be challenging to accurately reapproximate when tissues are edematous and retracted following prolonged surgical procedures. We describe a novel crenellated incision technique that creates multiple anatomical landmarks to facilitate accurate retinacular closure. METHODS:The superior extensor retinaculum was incised in a crenellated (battlement) pattern through the standard anterior ankle approach between the tibialis anterior and extensor hallucis longus tendons. The pattern consisted of alternating rectangular notches creating three crenels on each retinacular edge (six total), with each notch measuring approximately 1 cm in depth. During closure, corresponding crenels were matched and repaired using interrupted 1-0 Vicryl sutures. RESULTS:The crenellated technique has been successfully utilized by multiple consultants in our department. This simplifies identification of corresponding edges, ensures even tension distribution, and restores native retinacular anatomy without requiring specialized equipment or increasing operative time. Operating surgeons reported improved confidence in achieving anatomically accurate closure compared to traditional techniques. The technique is easy to adopt and teach and highly reproducible. CONCLUSION:The crenellated retinacular incision is a simple, reproducible technical modification that enhances closure accuracy through creation of multiple anatomical landmarks. This technique can reduce the risk of tibialis anterior tendon bowstringing while maintaining retinacular integrity and may contribute to improved wound healing and reduced wound-related complications.
BACKGROUND:Fractures of the anterior process of the calcaneus (APC) are often misdiagnosed as ankle sprains. Some patients develop symptomatic non-union. There is limited evidence evaluating patient-reported outcome measures (PROMs) before and after excision of symptomatic non-union of Degan type II APC fractures. METHODS:A retrospective analysis of a single surgeon series of patients undergoing open excision of the APC between February 2021 and June 2024. Inclusion criteria were adults with symptomatic non-union of Degan type II APC fracture who had failed conservative management for at least 6 months. All patients had pre-operative European Foot and Ankle Society (EFAS) score, EQ-5D index, and Manchester-Oxford Foot Questionnaire (MOXFQ) PROMs collected. RESULTS:Six patients underwent surgery. Five completed pre- and post-operative PROMs and were included for analysis. Mean follow-up was 29.4 months (range 12-56). The mean EFAS improved from 7 (range 2-9) to 15.2 (range 9-18) (p = 0.000367). EQ-5D index improved from 0.632 (range 0.399-0.735) to 0.809 (range 0.679-1) (p = 0.0501). All MOXFQ domains improved: Pain decreased from 72 (range 50-95) to 29 (range 10-60) (p = 0.0231), Standing from 69.2 (range 57-96) to 24.4 (range 7-50) (p = 0.0160), and Social from 43.8 (range 31-81) to 14 (range 0-44) (p = 0.0313). No post-operative complications were reported. CONCLUSIONS:Open excision of symptomatic non-union of Degan type II APC fractures demonstrated significant improvements in patient reported outcomes. Surgical excision should be considered for symptomatic patients following failed conservative treatment.
Background While the relationship between foot posture and muscle activity has been extensively studied, limited research has examined how navicular drop relates to muscle activation timing during functional tasks. The purpose of the present study was to investigate the relationship between navicular drop measurements and onset timing of lower extremity muscle activation during single-leg stance. Methods Forty-two pain-free participants performed single-leg stance tasks while surface electromyography recorded activation onset times of six muscles: abductor hallucis, tibialis anterior, rectus femoris, gastrocnemius, gluteus medius, and rectus abdominis. Navicular drop was measured using standard protocols. Pearson correlation coefficients were calculated to examine relationships between navicular drop and muscle onset timing. Results A significant low positive correlation was found between navicular drop and gluteus medius onset timing (r = 0.322, p = 0.046), indicating some delayed activation with greater navicular drop. No significant correlations were found between navicular drop and onset timing of other muscles. Conclusions The findings suggest that increased navicular drop is associated with delayed gluteus medius activation during single-leg stance, highlighting the importance of considering both foot posture and hip muscle function in clinical assessment and rehabilitation strategies.
BACKGROUND:The deltoid-spring ligament complex (DSL) is recognised as an integrated stabilising structure of the ankle-hindfoot complex; however, the relative contributions of its individual components to talonavicular joint (TNJ) stability remain incompletely defined. While the tibiocalcaneal (TC) fibres are known to influence ankle and subtalar mechanics, their role in TNJ abduction stability has not previously been experimentally assessed. PURPOSE:To quantify the contribution of the tibiocalcaneal fibres to talonavicular joint abduction stability (primary outcome, degrees) and hindfoot eversion (secondary outcome, millimetres), and to compare their effect with that of other DSL components using a paired cadaveric sectioning model. METHODS:Eighteen embalmed cadaveric lower limbs were tested under controlled, non-weight-bearing conditions. Specimens were randomised to anterior-posterior or posterior-anterior sequential sectioning of the tibionavicular, tibiospring, spring, and tibiocalcaneal fibres. Changes in TNJ abduction and hindfoot eversion were recorded following isolated and sequential ligament sectioning. The primary comparison was the effect of isolated tibiocalcaneal sectioning versus isolated tibionavicular and tibiospring sectioning on TNJ abduction. RESULTS:Sequential DSL sectioning resulted in significant, stepwise increases in TNJ abduction and hindfoot eversion (p < 0.05). Isolated sectioning of the tibiocalcaneal fibres produced greater TNJ abduction than isolated tibionavicular or tibiospring sectioning. Across protocols, the tibiocalcaneal fibres accounted for approximately 28-40% of total TNJ abduction stability. Hindfoot eversion increased progressively with ligament disruption, reflecting combined tibiotalar and subtalar contributions. CONCLUSIONS:Tibiocalcaneal fibres contribute substantially to talonavicular joint abduction stability despite not directly spanning the joint. These findings support the concept of integrated medial ligament function and provide biomechanical insight to inform future experimental and modelling studies of ankle-hindfoot stability.
BACKGROUND:Excessive forefoot plantar pressures are associated with pain, ulceration risk, and functional limitations in both healthy individuals and those with pathologies such as rheumatoid arthritis (RA). Limited ankle dorsiflexion, often related to gastrocnemius-soleus tightness, may contribute to forefoot overload. Although foot orthoses (FOs) are widely used to redistribute plantar loads, it remains unclear whether the existing evidence includes orthotic interventions designed to promote posterior chain flexibility. OBJECTIVE:To systematically evaluate the effectiveness of foot orthoses in reducing forefoot plantar pressure and pressure-time integral (PTI), and to identify whether current evidence addresses orthoses specifically intended to facilitate calf muscle stretching. METHODS:A systematic review was conducted in accordance with PRISMA 2020 guidelines. Five databases were searched up to December 2024. Inclusion criteria encompassed adult populations, studies reporting plantar pressure outcomes, and interventions involving foot orthoses. Methodological quality was assessed using RoB 2 and ROBINS-I tools. Due to substantial clinical and methodological heterogeneity, a meta-analysis was not undertaken and findings were synthesized narratively. RESULTS:Twelve studies involving 456 participants met the inclusion criteria. No eligible studies directly evaluated orthoses designed to stretch the triceps surae. All included studies reported reductions in peak plantar pressure (PPP) and/or pressure-time integral (PTI). Descriptively, PPP reductions were greater in healthy cohorts (unweighted mean 20.2%) compared to RA populations (14.5%), whereas PTI reductions were descriptively higher in RA participants (22.2% vs. 14.7%). Interventions incorporating metatarsal pads and soft contoured orthoses showed consistent reductions in forefoot loading across studies. CONCLUSIONS:Foot orthoses appear to be consistently associated with reductions in forefoot plantar loading across populations, particularly in individuals with inflammatory or structural pathology. The absence of studies specifically evaluating posterior chain flexibility represents a clear evidence gap. Future research should explore whether orthotic designs combining forefoot offloading with mechanisms that may influence ankle dorsiflexion or posterior chain mechanics could have biomechanical relevance.
AIMS:We compared the long term outcomes and clinical survival of two mobile bearing ankle replacements; the Zenith ankle prosthesis and the Salto ankle prosthesis, in a demographically similar group of consecutive patients from a single, non designer centre. METHODS:Between December 2010 and February 2017, 118 consecutive Zenith prosthesis and 41 consecutive Salto prostheses were implanted in a total cohort of 153 patients. Demographic and clinical outcome measures were collected. The end point of the study was failure of the implant requiring revision of one or more of the components. Kaplan Meier survival tables were generated. RESULTS:25 patients (28 ankles) died during follow-up, but none required revision. Of the surviving 128 patients (131 ankles; 91 Zenith, 40 Salto), mean follow-up was 10.1 years (6.5 - 14.6 years) for the Zenith and 8.4 years for the Salto (5.0 - 11.0 years). A total of 11 implants (9.3%) failed for the Zenith and 6 implants (14.6%) failed for the Salto, thus requiring revision. The implant survival at ten years, using revision as an endpoint, was 90.5% (CI 84.8-94.8% for Zenith and 80.7% (CI 65.1-92.9%) for Salto. The three commonest reasons for revision were aseptic loosening, recurrent mal-alignment and pain. CONCLUSIONS:Our results show no significant differences in clinical outcomes or long term survival rates across the two mobile bearing devises (p = 0.369). Survival rates are comparable with those reported in the literature.
BACKGROUND:Subtalar coalition (SC) is a rare pathological connection between the talus and calcaneum. SC can be osseous, fibrous, or cartilaginous forms, with the type of coalition affecting symptoms and management. Although the impact of osseous coalition has been studied, the subtalar joint's articular cartilage thickness remains inadequately explored across patients with osseous, fibrous subtalar coalition and those without coalition. Cartilage thinning is of particular clinical importance as it may represent early degenerative change and influence surgical decision-making. This study aimed to analyse and compare articular cartilage thickness between these patient groups. MATERIAL AND METHODS:We conducted a retrospective study using our Computerized Radiology Information System, searching with the keyword 'subtalar coalition'. Utilising our Picture Archive and communication system, we measured articular cartilage thickness of the posterior facet of the subtalar joint (PFSJ) on foot and ankle MRI and CT scans for patients with normal joints, osseous coalition, and fibrous coalition. Statistical analyses were performed using ANOVA with a significance threshold set at p < 0.05. RESULTS:In the anterior 1/3 region of the PFSJ, articular cartilage thickness measurement was higher in fibrous subtalar coalition (2.3 mm) in comparison to normal (1.7 mm) and bony subtalar coalition (1.4 mm). Similar results were noted in middle 1/3 region, posterior 1/3, medial, and lateral 1/3 too. Across all measured regions, osseous subtalar coalition demonstrated relative cartilage thinning compared to both fibrous coalition and normal joints. CONCLUSION:Our study showed that there is relative hypertrophy of articular cartilage in fibrous subtalar coalition. Importantly, osseous subtalar coalition is associated with relative cartilage thinning, which may represent reduced joint loading and a potential precursor to osteoarthritis. This finding is likely to be more clinically relevant when considering management options, as preserved or hypertrophic cartilage may support excision, whereas cartilage thinning may favour fusion. These findings can have potentially affecting treatment decisions and patient care. ADVANCES IN KNOWLEDGE:There is relative hypertrophy of articular cartilage in fibrous subtalar coalition.
