Background: The role of ankle arthroscopy as an adjunct to open reduction and internal fixation (ORIF) for ankle fractures remains debated. This study aimed to compare clinical and radiographic outcomes between arthroscopic-assisted ORIF (AA-ORIF) and standard ORIF for ankle fractures. Methods: A single-center cohort study was conducted from May 2020 to November 2023. A total of 115 patients with unstable ankle fractures were included: 28 underwent AA-ORIF (group I), and 87 underwent standard ORIF (group II). Primary outcomes were the incidence of posttraumatic osteoarthritis (PTOA) and length of hospital stay (LOS). Secondary outcomes included operative time, revision surgery rates, and analysis of confounding variables such as age and fracture pattern. Results: The AA-ORIF group demonstrated a statistically significant reduction in the rate of PTOA (7.1 vs 34.5%, p = 0.003) and a shorter median LOS (6 vs 16 days, p = 0.005). However, the AA-ORIF group was significantly younger (median age 42.5 vs 59 years, p = 0.003) and had a more complex case mix, with a higher proportion of Weber C/Maisonneuve fractures (35.7 vs 9.2%, p = 0.006) and a significantly higher rate of syndesmotic injuries in bimalleolar fractures (71.4 vs 7.9%, p = 0.002). Operative time was longer for AA-ORIF (median 147 vs 117 minutes, p < 0.001). No significant difference was found in revision rates or sex distribution. Conclusion: AA-ORIF was associated with superior early radiographic outcomes (lower PTOA) and a shorter hospital stay. However, significant baseline differences in age and fracture complexity were identified as major confounding factors. While promising, the perceived benefits of AA-ORIF may be influenced by these factors, necessitating further controlled studies to confirm its independent advantage. Level of evidence: Therapeutic level III (retrospective comparative cohort study).
Background: Surgical treatment of plantar fibromatosis is associated with high recurrence and complication rates. The purpose of this systematic review is to determine the efficacy of radiotherapy in treating plantar fibromatosis and to provide a local case series to add to the growing body of literature. Materials and methods: A systematic review was performed according to PRISMA guidelines, identifying primary research of radiotherapy in the treatment of plantar fibromatosis. A consecutive case series of local patients who had received radiotherapy for plantar fibromatosis was retrospectively identified. A quality assessment of the studies included in the systematic review was performed, and data were collected pertaining to outcome measures and complications. Patients in the local series were assessed for patient-reported outcome measures and, in a subset of patients, radiological response to treatment. Results: Six studies were found to meet the inclusion criteria, including one randomized controlled trial, four case series, and one case study, comprising 307 patients. The studies were of high quality considering the study designs. An improvement in pain was demonstrated in 74% of patients, improvement in gait in 62%, and improvement in size/number of lesions in 65%. This is comparable to the local findings of 51 cases, wherein 37 cases had improved symptoms with a median NRS and EQ-5D-5L at final follow-up of 2.0 and 0.92, respectively. Pre- and post-treatment MRI also demonstrated complete resolution in 66% of patients. Conclusion: This review and case series demonstrate that radiotherapy represents an effective treatment for plantar fibromatosis. Level of Evidence: Level IV.
Background: Lisfranc injuries are complex disruptions of the tarsometatarsal joint complex. Although frequently missed or misdiagnosed, timely and appropriate treatment is crucial to prevent long-term complications such as chronic pain, deformity, or arthritis. A rarer subset of these injuries extends beyond the tarsometatarsal joints, involving the intercuneiform joints, cuboid, naviculocuneiform, and other adjacent articulations. There is limited literature addressing the management of these rarer injury patterns. Inadequate treatment can result in significant midfoot instability or severe arthritis. This study examines a patient cohort with such injury patterns and their surgical outcomes. The aim of the study is to shed light on technical challenges and management of these complex injuries. Materials and methods: A total of 7 patients with atypical Lisfranc injury patterns were studied retrospectively from January 2023 to January 2025. Diagnosis was made on radiographs and/or computed tomography (CT) scan as well as intraoperative stress tests for instability. Surgical fixation was individualized, and patients were followed up for a mean period of 26 weeks (range: 24–30 weeks), after which implant removal was done. Foot and Ankle Disability Index (FADI) was used to assess the functional outcome. Results: All patients had stable plantigrade foot and radiological consolidation after their follow-up period. Average FADI score was 86.57 with a p-value (paired t-test) <0.0001, showing significant improvement. Conclusion: Lisfranc injuries pose significant challenges when it comes to diagnosis and treatment, particularly in the case of atypical subtypes involving the intercuneiform and naviculocuneiform joints, cuboid, and other adjacent joints. It is crucial that treatment approaches be highly individualized, tailored to the unique needs of each patient, and based on thorough clinical and radiological evaluation.
Progressive collapsing foot deformity (PCFD) is a complex, heterogeneous condition characterized by failure of the static and dynamic stabilizers of the medial longitudinal arch and progressive peritalar instability. Recent consensus has redefined its nomenclature and classification, recognizing that the deformity extends beyond isolated posterior tibial tendon dysfunction and involves multiple osseous and soft-tissue structures. This review aims to provide an updated overview of the pathophysiology, imaging modalities, classification systems, and current surgical and nonsurgical strategies for the treatment of PCFD, integrating the latest biomechanical and clinical evidence.
Introduction: Ankle sprains are among the most common ligament injuries of the lower limbs and are highly prevalent among athletes. While conservative treatment is effective for most patients, approximately 20% progress to chronic instability, which may require surgical intervention. The modified Broström–Gould technique is considered the gold standard, and the arthroscopic arthro-Broström technique has emerged as a minimally invasive alternative. This study aims to compare the functional outcomes of both techniques using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale with a 10-year follow-up period. Materials and methods: This retrospective longitudinal study compared two treatment groups. A total of 113 patients with chronic lateral ankle ligament instability who underwent surgery between January 2011 and December 2014 were evaluated. They were divided into two groups—modified Broström–Gould (n = 46) and arthro-Broström (n = 67). All patients had previously undergone at least 6 months of conservative treatment. The AOFAS score was applied pre- and postoperatively. Results: No statistically significant differences were found between the groups regarding clinical characteristics. Both groups showed significant postoperative improvements in AOFAS scores (p < 0.001), with mean increases of 38.6 (Broström–Gould group) and 39 points (arthro-Broström group). The arthro-Broström group had a slightly higher final mean score (92.1 vs 91.4), though there was no statistical difference between the techniques (p = 0.847). Conclusion: The modified Broström–Gould and arthro-Broström techniques were effective in treating chronic ankle instability. These techniques provided significant functional improvement and a low complication rate. The arthroscopic approach offers several advantages, including reduced morbidity and better visualization of associated injuries, making it a safe and effective option, similar to traditional open surgery. The choice of technique should be based on the surgeon's experience, the patient's characteristics, and the prospect of better outcomes.
Background: Osteochondral lesions of the talus (OLT) can severely impair ankle function and lead to early osteoarthritis. Arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC®) combines marrow stimulation with scaffold protection through a minimally invasive approach. Purpose: To evaluate pain relief, functional recovery, and return to activity following AT-AMIC®, and to compare these results with those reported for microfracture, osteochondral autograft transfer (OATS), and open AMIC. Methods: A total of 94 patients undergoing AT-AMIC® for OLT were retrospectively analyzed at a mean follow-up of 44 months. Pain (VAS), AOFAS, activity level, and walking distance were collected pre- and postoperatively and compared using paired statistical testing. Results: Significant improvements were observed in all domains. VAS scores improved from 6.09 ± 2.22 to 1.62 ± 1.54 at final follow-up (p < 0.0001). Activity scores increased from 3.2 ± 1.7 to 9.1 ± 1.2 (p < 0.0001), and walking distance from 2.3 ± 1.5 to 4.7 ± 0.6 (p < 0.0001). Most patients resumed sports and daily physical activities without restrictions. Conclusion: AT-AMIC® offers durable pain reduction and functional recovery in OLT, enabling reliable return to activity. Compared with microfracture, OATS, and open AMIC, AT-AMIC® provides equal or superior outcomes with reduced morbidity.
Background: Chronic lateral ankle instability (CLAI) is a common sequela of ankle sprains, often necessitating surgical intervention when conservative management fails. The Broström–Gould (BG) procedure is considered the gold standard; however, in patients with cavovarus alignment or peroneal tendon pathology, adjuvant procedures such as sliding lateralizing calcaneal osteotomy (SLCO) and peroneal tendon debridement or repair are frequently required. These are traditionally performed through a dual-incision technique, potentially increasing the risk of wound complications. Methods: This retrospective cohort study reviewed 110 patients who underwent BG with SLCO and peroneal tendon procedures from 2011 to 2022. Patients were grouped based on surgical approach: single-incision (n = 60) or dual-incision (n = 50). Preoperative assessment included clinical examination and imaging studies. Functional outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), and postoperative complications were documented through chart review. Statistical comparisons were made using t-tests and Chi-square analysis. Results: Demographic characteristics were similar between groups, except for a higher mean age in the dual-incision cohort (p = 0.001). Mean FAAM scores were not significantly different (single-incision: 83.33%; dual-incision: 83.02%; p = 0.056). However, skin bridge breakdown occurred exclusively in the dual-incision group (13%; p = 0.013). Rates of infection, neuroma, and nerve palsy were comparable between groups. Conclusion: The single-incision approach for BG with SLCO and peroneal tendon procedures yields functional outcomes comparable to the dual-incision technique, with a significantly lower incidence of wound complications, particularly skin bridge necrosis. This method offers a less invasive yet comprehensive surgical option for CLAI, especially in patients with comorbidities that elevate wound healing risks. Further prospective studies are warranted to validate these findings and determine broader applicability.
Aims and background: Ankle arthroscopy (AA) is a minimally invasive surgical technique widely used by foot and ankle surgeons. Because of the complex anatomy of the ankle, its limited joint space, and its proximity to critical structures, there is a potential for complications associated with surgical manipulation of these areas. With the increased popularity of arthroscopic procedures, reports of complications have increased, ranging from 3.5% to 14%. The most common complication of AA is neurological injury, particularly to the superficial peroneal nerve. Pseudoaneurysm (PA) is a rare complication of arthroscopic procedures, with a reported incidence of 0.008%. Most cases involve the popliteal vessels following knee arthroscopy, and the literature on this complication in AA is limited. Case description: A 32-year-old female patient was admitted with a 10-month history of right ankle sprain with chronic anterolateral pain. She was diagnosed with anterolateral ankle impingement syndrome associated with a lateral ligament tear of the right ankle, and arthroscopic treatment was indicated. AA was performed using two anterior portals: One anterolateral and one anteromedial. The patient had an atypical postoperative course with pain, swelling of the anterior ankle, and inability to walk. Sixteen days after surgery, the anterior ankle mass became pulsatile. A Doppler ultrasound was requested and showed endovascular turbulence in the anterior tibial artery (ATA). Angiography was scheduled along with a proposed endovascular therapeutic approach. Angiography revealed a saccular aneurysm in the ATA, and an endovascular stent was implanted to correct the PA. Conclusion: The possibility of PA formation, although rare, should always be considered when a patient complains of postoperative pain, swelling, or inability to walk following AA. Although the anterolateral and anteromedial portal approaches are the safest techniques for anterior AA, patients may have anatomical variations in their vascular structures that place them in a high-risk group for the procedure. Clinical significance: Although rare, vascular complications after AA should be suspected and investigated in atypical postoperative cases. Assessment of the patient's vascular anatomy preoperatively may suggest variations that increase the risk of vascular injury.
Aim and background: Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting up to one-third of individuals with psoriasis, with the foot and ankle frequently serving as early and predominant sites of involvement. Despite their functional importance, foot and ankle manifestations remain under-recognized, particularly in low- and middle-income countries (LMICs). This narrative review aims to synthesize global and regional epidemiological trends, clinical patterns, and the functional and quality-of-life burden associated with foot and ankle PsA, with a special focus on the Indian experience. Methods: A comprehensive narrative review of peer-reviewed literature was conducted, incorporating epidemiological studies, cohort analyses, registry data, and patient-reported outcome measures related to PsA. Evidence addressing prevalence, foot and ankle manifestations, regional disparities, functional impairment, and healthcare challenges was analyzed to identify key trends and unmet needs. Results: Global PsA prevalence ranges from 0.1 to 1% in the general population, with 20–30% of individuals with psoriasis affected. Foot and ankle symptoms occur in 50–90% of cases and may be the first or predominant disease site in up to 20% of patients. Western cohorts report high rates of Achilles and plantar fascia enthesitis, MTP/IP synovitis, and toe dactylitis. Indian and South Asian cohorts demonstrate disproportionately high enthesitis (>60%) and dactylitis (25–30%), influenced by barefoot ambulation, occupational microtrauma, and genetic factors. Foot-dominant PsA results in moderate-to-severe disability in 60–80% of patients, with significant reductions in HAQ and SF-36 scores, marked footwear intolerance, psychosocial distress, and substantial economic burden. LMICs face additional challenges, including delayed diagnosis, limited rheumatology access, absent multidisciplinary foot care, and sociocultural stigma. Conclusion: Foot and ankle PsA is a highly prevalent and functionally disabling component of the disease, yet it remains undervalued in clinical assessment and management. Pronounced regional variations highlight the influence of environmental, genetic, and healthcare system factors. Early recognition, improved screening, and context-appropriate multidisciplinary management strategies are essential for reducing disability and improving long-term outcomes. Clinical significance: Understanding the burden and regional variability of foot and ankle PsA is critical for enhancing diagnostic vigilance and delivering targeted care. Prioritizing foot assessment, expanding access to rheumatology and orthotic services, and developing standardized foot-specific tools may substantially improve functional outcomes, particularly in resource-limited settings such as India.
Aim and background: Avascular necrosis (AVN) of the talus is a devastating complication following high-energy trauma, often resulting in collapse of the talar body and progressive arthritis of the ankle and subtalar joints. Salvage procedures traditionally include arthrodesis, which sacrifices joint motion and may predispose adjacent joint degeneration. Recent advances in 3D printing have enabled the development of custom total talus replacements (TTRs) as a motion-preserving alternative. This report presents a 2-year follow-up of a patient with post-traumatic talar AVN successfully managed with a custom 3D-printed TTR. Case description: A 70-year-old female sustained a complete talar extrusion following a motor vehicle accident. The talus was reduced, and she initially managed nonweight-bearing for 3 months, recovering well before developing progressive pain. Radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated AVN with collapse of the talar body, medial subtalar subluxation, and osteoarthritis of the ankle and subtalar joints. After discussion of treatment options, she underwent a custom 3D-printed TTR combined with calcaneal and first metatarsal osteotomies. Postoperatively, she reported minimal pain, initiated weight-bearing in a controlled ankle motion (CAM) boot at 1 month, and transitioned to full activity by 4 months. At 2 years, she remained pain-free with stable implant positioning on radiographs and reported an American Orthopaedic Foot and Ankle Society (AOFAS) score of 90. Conclusion: Custom TTR can restore alignment, relieve pain, and preserve ankle and hindfoot motion in patients with advanced talar AVN and collapse. At 2-year follow-up, this patient demonstrated excellent pain relief, functional recovery, and radiographic stability. Clinical significance: This case highlights TTR as a viable alternative to arthrodesis for post-traumatic talar AVN. By preserving ankle motion and restoring function, this approach may improve long-term outcomes and quality of life for patients with severe talar collapse.
Background: First metatarsophalangeal (MTP) joint arthrodesis is commonly used to treat severe forefoot pathologies, including hallux valgus and hallux rigidus, aiming to relieve pain and restore foot stability. This study assesses functional and biomechanical outcomes postarthrodesis using low-profile dorsal plate fixation. Materials and methods: A cross-sectional study was conducted with 44 participants—22 cases (22 feet) with first MTP arthrodesis and 22 matched controls. Functional outcomes were measured using the Manchester–Oxford Foot Questionnaire (MOXFQ), while gait and plantar pressure were evaluated with the gait analysis instrumented treadmill (GAITRite) and EMED sensor foot (EMED-SF) systems, respectively. Radiographic assessments were also performed to confirm joint fusion and assess secondary arthritis. Results: MOXFQ scores indicated high patient satisfaction in the arthrodesis group, with no significant difference from controls (p = 0.129). Gait analysis showed no disruption in step width, step length, or stance phase, demonstrating preserved gait mechanics (p > 0.05). Plantar pressure analysis revealed normal weight distribution, with no significant differences in peak pressures or total foot force compared to controls (p > 0.05). Radiographs confirmed 100% fusion and no adjacent joint arthritis. Conclusion: First MTP arthrodesis using low-profile dorsal plates provides effective symptom relief, preserves gait mechanics, and maintains normal plantar pressure, proving beneficial for patients with severe forefoot pathologies. Clinical significance: The technique achieves high fusion rates and stable joint function, with minimal risk of secondary complications, offering a reliable surgical option for advanced MTP pathologies.
Introduction: Ankle fractures are common, with about a quarter requiring surgical intervention. Plate-and-screw fixation remains the standard for fibula fractures, but intramedullary nails have gained attention for their minimally invasive approach and reduced hardware removal rates. The FibuLock nail offers biomechanical advantages and may lower soft-tissue complications, though adoption has been limited by mixed long-term outcome evidence. This study evaluates our early experience with the FibuLock system, focusing on complications, pitfalls, and the learning curve. Materials and methods: We retrospectively reviewed patients who underwent intramedullary fibula nailing from 2019 to 2024 at a single center. Demographics, fracture classification, and radiographic outcomes were collected. Complications included fixation failure, malpositioning of trans-syndesmotic fixation, and >2 mm fibular shortening. Reduction quality was graded using Kho's criteria. Three senior foot and ankle surgeons independently reviewed cases to determine the causes of complications. Results: Thirty procedures were analyzed; 70% of patients were female, and 42% were over 60 years old. Injuries were most often caused by falls (65%), followed by sports (19%), road traffic accidents (11%), and direct impact (4%). Comorbidities included peripheral vascular disease (11%), diabetes (23%), and end-stage renal failure (4%). Fractures were classified by AO criteria. Reduction quality ranged from good to excellent to fair and poor. Complications occurred in 19% of cases, including fibula shortening, tightrope malposition, and fixation failure requiring revision. Deep infection occurred in 6%, and early revision in 20%. Importantly, no complications or deep infections occurred after the first 19 cases. Conclusion: Intramedullary fibula nailing with the FibuLock system has a notable learning curve, with early technical complications decreasing as experience grew. Refinements in technique improved outcomes, offering guidance for surgeons adopting this method, especially in elderly patients, where soft tissue preservation is vital. Level of evidence: III
Background: Foot and ankle injuries constitute a substantial proportion of musculoskeletal trauma following road traffic accidents, particularly among vulnerable road users such as motorcyclists and micromobility riders. Due to direct exposure of the distal lower extremity, these injuries frequently result in complex fracture patterns and long-term functional impairment. Despite the growing burden of two-wheeler-related trauma, foot and ankle-specific epidemiological data from Türkiye remain limited in the international literature. Materials and methods: This narrative review synthesizes national epidemiological data from the Turkish Statistical Institute (TÜİK) and the General Directorate of Highways, together with recent evidence retrieved from PubMed, Web of Science, and Google Scholar. Emphasis was placed on road traffic-related foot and ankle injuries, including fracture patterns, injury mechanisms, and vulnerable road user profiles, particularly motorcycle and electric scooter riders. Findings were interpreted within the framework of global road safety and injury prevention strategies. Results: In 2024, Türkiye recorded 1.44 million road traffic accidents, resulting in 6,351 deaths and 385,117 nonfatal injuries. Vulnerable road users accounted for approximately 42% of fatalities. Motorcycles, representing 20% of registered vehicles, were involved in 31.5% of injury- or fatal-related crashes. Orthopedic trauma patterns consistently demonstrated a predominance of lower-extremity injuries, with foot and ankle fractures frequently observed in motorcycle- and micromobility-related accidents. Reported injuries included metatarsal, ankle, and hindfoot fractures, reflecting high-energy direct impact and rotational mechanisms. The rapid postpandemic expansion of motor courier services has further increased exposure among young male riders, while recent prospective data from Istanbul highlight a rising incidence of foot and ankle injuries following electric scooter falls in adolescents and young adults. Occupational motorcycle courier data further demonstrate that the foot and ankle region represents the most frequently injured anatomical site in high-exposure rider populations. Conclusion: Road traffic-related foot and ankle injuries represent an underrecognized yet clinically significant component of trauma in Türkiye, particularly among motorcycle and micromobility users. As two-wheeler transportation continues to expand across the Asia-Pacific region, foot and ankle surgeons should anticipate evolving injury patterns and advocate targeted preventive strategies focusing on speed regulation, protective equipment use, infrastructure adaptation, and optimized postinjury care. As mortality rates decline, the relative importance of survivable but functionally disabling foot and ankle injuries is likely to increase within trauma systems.
Introduction: Foot and ankle disorders cause substantial pain, disability, and reduced quality of life. Although surgery can restore function, patients' willingness to undergo surgery is influenced by sociocultural, economic, and experiential factors. Materials and methods: An analytical cross-sectional study was conducted on 240 patients with foot and ankle disorders at Hasan Sadikin General Hospital, Bandung, West Java, Indonesia. Sociodemographic, clinical, and contextual variables were analyzed using multivariable logistic regression to identify independent predictors of surgical willingness. Results: Seventy percent of patients expressed willingness to undergo surgery. Higher pain intensity (OR 1.34, p < 0.001), lower AOFAS scores (OR 0.76, p = 0.015), previous surgical experience (OR 2.38, p = 0.016), and shorter expected recovery time (OR 2.07, p = 0.034) independently predicted willingness. Sociodemographic factors showed no significant association. Discussion: Clinical severity and surgical experience strongly influence surgical decisions, while demographic and financial factors play a minor role. Patient-centered counseling emphasizing symptom burden and recovery expectations is essential to enhance shared decision-making.
Hallux rigidus predisposes a person to insidious moderate to severe pain on ambulation and chronic disability. Current treatment options include conservative management with injections, anti-inflammatory medications, physical therapy, orthotics, and shoe wear modifications. For patients unresponsive to conservative measures, operative treatment with cheilectomy is considered the ideal treatment for moderate stages, and arthrodesis is the gold standard treatment for advanced hallux rigidus. Interpositional arthroplasty and osteotomies are alternative options for joint-preserving procedures. Emerging treatments in first-world countries include 1st metatarsophalangeal arthroplasty. This paper describes a case of severe hallux rigidus with poor response to conservative management. Due to the patient's desire to return to predisease level of active lifestyle and the limited availability of surgical implants in the country, cheilectomy combined with the technique of hyaluronic acid nonwoven scaffold interposition with platelet-rich plasma infusion of the first MTP joint was performed. Improvement in functional and pain scales was noted at 1 year postoperative, and the patient was back to his premorbid state at 2 years postoperative. No recurrence of pain and no limitation on ROM were noted on the most recent follow-up.
Background: Haglund deformity is an abnormal bony prominence on the posterosuperior aspect of the calcaneum. In conjunction with retrocalcaneal bursitis and Achilles tendinopathy, it constitutes Haglund syndrome, a common cause of heel pain. In recent years, endoscopic techniques have increasingly been adopted as alternatives to open procedures because of their minimally invasive nature. Endoscopic calcaneoplasty involves resection of the posterosuperior calcaneal prominence along with excision of the inflamed retrocalcaneal bursa. Materials and methods: A prospective study was carried out at a tertiary care center on 14 consecutive patients who had undergone endoscopic Haglund deformity resection surgery from May 2023 to October 2024. All patients were polled in person about their pain levels at rest and during physical activity. Patients were clinically evaluated at regular postoperative intervals, and complications were recorded. Radiological outcomes were assessed by examining the improvement in the Fowler–Philip angle (FPA), and clinical results were evaluated using the hindfoot scale from the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: In the study, 14 patients underwent endoscopic calcaneoplasty with a mean follow-up of 6 months. After surgery, the AOFAS score increased from 54.00 preoperatively to 90.50 at 6 months postoperatively (p < 0.001). Subjective improvement was observed in 11 patients (83.7%). There were no wound-related complications, infections, or neurovascular injuries. Conclusion: Endoscopic calcaneoplasty was associated with favorable short-term clinical outcomes in this cohort, while offering several advantages, including rapid recovery, small incisions, and less rate of complications.
To evaluate functional outcomes, quality of life, and complications after repair of acute Achilles tendon rupture using a minimally invasive Dresden technique. Achilles rupture is common, and management remains debated; minimally invasive approaches aim to preserve functional outcomes while reducing soft-tissue complications and sural nerve injury risk. Single-center case series (2015–2024) at a tertiary orthopedic institute. Adults with noninsertional acute ruptures (≤2 weeks) underwent repair with the Dresden technique, using minor instrument modifications and a standardized rehabilitation protocol. Outcomes included Foot and Ankle Outcome Score (FAOS), Achilles Tendon Total Rupture Score (ATRS), EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L), Patient Reported Outcomes Measurement Information System (PROMIS), heel-rise test, calf circumference, maximum plantarflexion/dorsiflexion, and gravitational equinus angle. Thirty-one patients (mean age 37.0 ± 10.55 years; 64.5% male) completed follow-up. Mean scores: FAOS 99.03 ± 1.73, ATRS 98.29 ± 2.64, EQ-5D-5L 0.98 ± 0.03, PROMIS 61.0 ± 0.51 (range 60.3–61.5). Heel-rise: 24/31 (77.4%) maintained single-leg support. Complications: none for infection, wound dehiscence, rerupture, or deep vein thrombosis; two transient sural nerve-related symptoms resolved by 2 months. Plantarflexion: 25.42° (operated) vs 25.45° (nonoperated), mean difference 0.03° (SD 0.18), p > 0.05. Dorsiflexion and gravitational equinus: no significant side-to-side differences. Calf circumference difference 1.08 cm (p < 0.05), not correlated with functional scores (p > 0.05). Very strong, statistically significant intercorrelations were observed among FAOS, ATRS, EQ-5D-5L, and PROMIS. The modified minimally invasive Dresden repair yielded excellent functional outcomes, high quality-of-life scores, and very low complication rates, with no meaningful deficits in ankle range of motion. Calf atrophy was small and not functionally relevant.
