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.
BackgroundBöhler's and Gissane's angles are used in calcaneal fracture assessment, but measurement consistency varies. ImageJ may offer a low-cost alternative to Picture Archiving and Communication System (PACS). This study aimed to define margin of error (MOE) and evaluate whether ImageJ provides measurement agreement and reliability comparable to PACSMethodsMargin of error was predefined based on previously reported variability and expert consensus. Three observers measured Böhler's and Gissane's angles on 42 radiographs using PACS and ImageJ; a consensus PACS measurement served as the reference measurement. Reliability (intraclass correlation coefficient), deviation from the consensus reference (mean/median absolute error; bias), agreement within MOE, and Bland-Altman analyses were performed.ResultsThe predefined margins of error were ±2.5° (Böhler) and ±5° (Gissane). Interobserver reliability was good to excellent for Böhler and poor to moderate for Gissane. Within-observer inter-method agreement was excellent for Böhler and variable for Gissane. Deviations for Gissane frequently exceeded the MOE, with minimal method bias.ConclusionImageJ performed comparably to PACS for Böhler's angle measurements. However, Gissane's angle demonstrated poor reproducibility with both methods, likely due to anatomical and projectional factors.Level of evidence:Diagnostic, level III.
Renal cell carcinoma (RCC) is known for its propensity for distant metastasis, including skeletal involvement; however, metastatic spread to the foot, particularly the calcaneus and talus, is exceptionally rare, with fewer than 15 cases documented in the literature. We report a 59-year-old woman with a history of RCC treated with partial nephrectomy 7 years earlier who presented with 6 months of progressive left foot pain initially attributed to plantar fasciitis. Over the course of 4 emergency department visits spanning approximately 1 month, her oncologic history was not incorporated into the differential diagnosis. Advanced imaging ultimately revealed a 6.2 cm × 6.0 cm × 5.2 cm enhancing soft tissue mass infiltrating both the calcaneus and talus. Histopathology confirmed metastatic clear cell RCC. Given the extent of osseous destruction precluding viable reconstruction, the patient underwent below-knee amputation. Staging identified a concurrent pulmonary lesion, and postoperative systemic immunotherapy was initiated, though interval imaging demonstrated disease progression. This case highlights the diagnostic pitfalls of atypical RCC metastasis and underscores that a prolonged disease-free interval following nephrectomy should not diminish clinical suspicion. Inclusion of metastatic disease in the differential for refractory foot pain in any patient with an oncologic history is essential to enable timely diagnosis and preserve limb-salvage options.Levels of Evidence:Level V: Case reportStudy Design:Diagnostic case study (Level V); structured single-case analysis with systematic review of the published literature.
BackgroundChronic Achilles tendon rupture (CATR) is a debilitating condition affecting activities such as walking and jumping. Surgical reconstruction remains preferred for larger defects, with local tendon transfers including the flexor hallucis longus (FHL) and peroneus brevis (PB). However, these techniques carry risks of donor-site morbidity and neurovascular injury, particularly in high-risk patients.ObjectivesThis article describes a novel minimally invasive endoscopic technique and reports 3 cases of CATR reconstruction using peroneus longus (PL) tendon transfer as an alternative.MethodsThis technique employs standard posterolateral and posteromedial hindfoot portals without requiring additional peroneal tendoscopy portals. A small incision is made near the calcaneocuboid joint to perform tenodesis between PB and PL tendons, with the foot in maximum eversion to maximize tendon harvest. The PL tendon is then pulled through the posterolateral portal with the aid of the tag sutures, then passed through a calcaneal tunnel, and secured using an interference screw under fluoroscopic guidance.ResultsThe procedure was performed in 3 patients with complete CATR (2 insertional, 1 noninsertional). At 1-year follow-up, all patients demonstrated clinical improvement in American Orthopaedic Foot & Ankle Society (AOFAS) and Achilles tendon Total Rupture Score (ATRS) measurements, with no gross clinical weakness in ankle eversion or lateral instability. One patient developed localized plantar heel hypoesthesia, while no major neurovascular complications or lateral ankle instability were observed.ConclusionEndoscopic PL transfer was feasible in 3 patients with CATR and was associated with improved short-term clinical scores. This technique may be considered a potential alternative or salvage option when FHL transfer is unsuitable. However, larger comparative studies are needed before definitive conclusions can be made regarding this technique.Levels of Evidence:Therapeutic studies, Level IV: Case series.
ObjectiveTo compare the efficacy and safety of different intra-articular injections in the non-surgical management of ankle osteoarthritis (AOA) in adults.MethodsCINAHL, Medline, PubMed, Embase, and the Cochrane Library were used as our databases from conception to May 2025 using the following string ((Ankle joint) AND (osteoarthritis)) AND (injection OR injectable technology OR intraarticular injection OR stem cell OR MSC OR mesenchymal STEM cell OR PRP OR corticosteroid OR botulinum toxin A) searching for randomized control trials which were manually screened for eligibility and then risk of bias. Eight studies were included, 4 placebo trials (3 comparing hyaluronic acid (HA) with saline, 1 comparing platelet-rich plasma (PRP) with saline) and 4 randomized comparative trials (comparing differing HA regimens, HA with exercise, botulinum toxin type-A (BoNT-A) with exercise + HA and corticosteroids (CS) with CS + HA, respectively).ResultsHA seems to be an effective form of management for AOA, either alone as multiple small doses or combined with either CS or exercise therapy. BoNT-A also seems effective (compared with the current recommended treatment); however, PRP and CS alone do not have any evidence of being effective.ConclusionHA seems to be the most effective in managing AOA symptoms. However, this could not be very objective due to how little research there is on the other forms of injectable technologies.Level of Evidence:Level II: Systematic review of all relevant RCTs (of varying quality).
BackgroundHigh-energy fractures of the tibial pilon, hindfoot, and midfoot are frequently associated with severe soft tissue injury, delaying definitive fixation. The "wrinkle sign" is a clinical marker of edema resolution and readiness for surgery. Corticosteroids may accelerate soft tissue recovery, but their role in orthopaedic trauma remains underexplored. We hypothesized that intravenous methylprednisolone would reduce the time to wrinkle sign appearance compared with intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with these types of fractures.MethodsThis prospective, multicenter cohort study included 40 patients treated at 2 hospitals between June 2022 and September 2024. Patients received either intravenous methylprednisolone (1 mg/kg/day, tapered every 3 days) or dexketoprofen (50 mg every 8 hours) starting at admission and based on the routine clinical practice of each hospital (treatment allocation was not randomized). The primary outcome was time to wrinkle sign appearance, and secondary outcomes included hospital length of stay and the incidence of soft tissue and infectious complications.ResultsThe median time to wrinkle sign was shorter in the corticosteroid group (CG) (4.5 days [interquartile range, IQR = 3.5-8.0]) than in the NSAID group (NG) (7.5 days [IQR = 3.5-8.0]), though not statistically significant (P = .192). However, patients receiving corticosteroids were significantly more likely to develop the wrinkle sign within 10 days (65% vs 30%; odds ratio = 4.33, 95% CI: 1.15-16.32; P = .03). No surgical site infections occurred in the CG, while 2 superficial infections were reported in the NG. Median hospital stay was shorter in the CG (11.5 vs 17.5 days), though not statistically significant (P = .277).ConclusionsIn our sample, intravenous methylprednisolone was associated with a higher probability of achieving surgical readiness within 10 days in high-energy tibial pilon, hindfoot, and midfoot fractures, while maintaining a comparable safety profile.Level of Evidence:Level II.
BACKGROUND:Early revision of primary Achilles tendon repair is sometimes necessary, and the Achilles tendon's inherent hypovascularity creates a uniquely challenging biological environment for reoperation. However, the optimal timing for revision and its associated complication risks remain poorly characterized. PURPOSE:To evaluate the relationship between the timing of early Achilles tendon revision, performed within 8 weeks of primary repair, and the incidence of acute postoperative complications. METHODS:Using the PearlDiver M91Ortho data set, patients who underwent Achilles tendon revision 0 to 8 weeks after primary Achilles tendon repair and did not have a diagnosis of diabetes mellitus were stratified into groups based on the interval between operations: 0 to 2 weeks, 2 to 4 weeks, 4 to 6 weeks, and 6 to 8 weeks. The rates of complications, including deep vein thrombosis, pulmonary embolism, superficial and deep surgical-site infection (SSI), wound dehiscence, debridement, and complex regional pain syndrome, were identified. Complication rates across timing groups were compared using chi-square tests and Fisher's exact tests with Bonferroni correction for pairwise analyses. RESULTS:Among 759 patients, sex and age distributions did not differ significantly across timing groups. Overall complication rates varied significantly by revision interval, as did wound dehiscence and deep SSI. Superficial SSI occurred only in the 2-to 4-week group. The post hoc testing showed significantly higher overall complication rates for the 2- to 4-week and 4- to 6-week groups compared with the 0- to 2-week and 6- to 8-week groups. Wound dehiscence was more frequent in the 2- to 4-week and 4- to 6-week groups compared with the 0- to 2-week group. Deep SSI occurred more often in the 2- to 4-week and 4- to 6-week groups compared with the 6- to 8-week groupConclusion:Revision occurring at 2-6 weeks after primary Achilles tendon repair is associated with a significantly higher risk of complications compared with revisions within 0-2 weeks or at 6-8 weeks, thereby suggesting an optimal revision-timing window to mitigate adverse outcomes. LEVEL OF EVIDENCE:Retrospective cohort study (Level of Evidence III).
Background Hyaluronic acid (HA) has emerged as a potential biologic adjunct in the management of various foot and ankle pathologies due to its viscoelastic, anti-inflammatory, and chondroprotective properties. Methods A scoping review of the currently available literature evaluating HA use in foot and ankle pathology was performed, with emphasis on osteoarthritis (OA), osteochondral lesions of the talus (OLTs), and soft tissue disorders. Results Current evidence suggests that HA injections may provide pain relief and functional improvement across multiple foot and ankle conditions. The most consistent evidence supports potential HA use in soft tissue disorders, including Achilles tendinopathy, plantar fasciitis, and acute lateral ankle injuries. HA may be used as an adjunct in OLT and selected OA applications, although outcomes remain heterogeneous across studies. Conclusion Although HA demonstrates a favorable safety profile and potential clinical benefit in selected foot and ankle conditions, currently available evidence remains limited by heterogeneous study designs, inconsistent treatment protocols, and short-term follow-up. Additional high-quality, comparative, and long-term studies are warranted to better define the role of HA in foot and ankle pathology. Level of Evidence: Level V, Scoping Review
Foot and ankle injuries are among the most common musculoskeletal conditions encountered in both athletic and general populations, accounting for a substantial proportion of emergency and sports medicine visits. These injuries encompass a wide spectrum, from acute ligamentous sprains to more subtle and frequently misdiagnosed conditions such as Lisfranc ligament injuries, tarsal coalitions, and posterior tibial tendon dislocations. The complex anatomy and biomechanics of the foot and ankle, combined with the high functional demands placed upon them during gait and athletic activity, underscore the importance of accurate diagnosis and appropriate management. This article reviews the relevant anatomy of the foot and ankle, discusses common and clinically significant injuries, and highlights key aspects of diagnosis, imaging, and treatment. Both nonoperative and operative treatment strategies are addressed, with consideration given to injury severity, stability, and patient-specific factors. Finally, the importance of rehabilitation and injury prevention in reducing recurrence and optimizing long-term outcomes is discussed.
Lateral ankle instability is a common problem with substantial morbidity in both the athletic and general population. Guidelines for use of ligament augmentation devices continue to be developed. The below is a case describing surgical treatment of ankle instability using TEKBRACE (TheraMicro, LLC), a new ligament augmentation scaffold, for the anterior talofibular ligament in a patient at high risk of failure. Level of Evidence: Level V
Achilles tendon rupture is a common injury among active adults and frequently requires surgical repair in high-demand patients. Augmentation techniques have been developed to improve repair strength and reduce re-rupture risk, particularly in cases of degenerative tendon tissue. TeKBrace, a woven polyester mesh, provides mechanical reinforcement while allowing biologic integration. We present the case of a 36-year-old recreational athlete who underwent open Achilles tendon repair with TeKBrace augmentation following an acute rupture. Intraoperative findings of degenerative tendon tissue and mild gapping under tension supported the decision to augment the repair. At 6 months, the patient demonstrated symmetric ankle range of motion and approximately 90% restoration of plantarflexion strength compared with the contralateral limb. The patient demonstrated excellent functional recovery and returned to recreational basketball without pain or limitation at 9 months, and no complications or re-rupture were observed. This case highlights the biomechanical rationale and clinical utility of TeKBrace scaffold augmentation in selected patients, although larger studies with longer follow-up are needed to better define its clinical effectiveness.
BackgroundThe management of osteochondral lesions of the talus (OLT) is challenging, with 2 main options being conservative and surgical management. Orthobiologic therapies come to bridge the gap between these 2 options; however, inconsistencies in indication, composition, and heterogeneous evidence limit clinical decision-making. To address these challenges, 3 International Congress Meetings on Cartilage Repair of the Ankle were convened in Pittsburgh, USA (2017), Dublin, Ireland (2019), and New York, USA (2025) to establish agreement on the role of conservative management and injectable orthobiologic strategies in the treatment of OLT.MethodsSeventy-five multidisciplinary experts from over 25 countries and 1 territory participated in a structured Delphi-based consensus process. Blinded surveys, structured questionnaires, and in-person discussions were used to develop and refine statements, supported by literature review and graded evidence (A1-E). Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%)ResultsIn total, 29 consensus statements were achieved across the 3 meetings. Strong agreement was reached regarding indications and expected outcomes of conservative management, including the role of immobilization and appropriate timing for surgical intervention. Orthobiologic injections, including platelet-rich plasma, concentrated bone marrow aspirate, and hyaluronic acid, were considered appropriate in select patients with persistent symptoms, although no superiority was demonstrated among formulations, preparation methods, or injection strategies. When used as adjuncts to surgical procedures, orthobiologics may improve radiological outcomes, with limited evidence for improvement in clinical outcomes. Technical considerations, including preferred harvest sites and a lack of standardized preparation protocols, were identified, along with key principles for patient counselingConclusionThese international consensus statements establish a standardized framework for the conservative management and use of injectable orthobiologic therapies in OLT. By clarifying indications, technical considerations, and current limitations, this work aims to improve consistency in clinical practice, guide treatment decision-making, and inform future research.
Background Extensor hallucis longus (EHL) tendon lacerations are relatively uncommon but can have significant functional consequences, particularly in high-demand athletes where dorsiflexion strength, toe-off mechanics, and dynamic foot control are critical for performance. While primary repair remains the standard of care, concerns persist regarding early loading, elongation, and delayed return to sport. Purpose To present a case of primary EHL tendon repair augmented with a synthetic reinforcement scaffold (TeKBrace, TheraMicro, LLC) in a professional athlete, highlighting the role of load-sharing constructs in facilitating accelerated rehabilitation and return to high-level function. Case Presentation A professional athlete sustained an acute laceration to the EHL tendon. Surgical management consisted of primary end-to-end repair augmented with the TeKBrace scaffold reinforcement designed to provide immediate mechanical support while permitting physiologic motion. Results. The patient progressed through an accelerated rehabilitation protocol with early protected motion. At 6 weeks, the patient demonstrated functional strength and active participation in therapy. Return to sport was achieved at 10 weeks postoperatively without complications. Conclusion Augmentation of EHL tendon repair with the TeKBrace scaffold may provide additional mechanical support in high-demand patients by supporting early load-sharing while maintaining native tendon mechanics. This approach may facilitate accelerated rehabilitation and return to sport.
Platelet-rich plasma (PRP) has emerged as a regenerative treatment option for various foot and ankle pathologies, containing growth factors and anti-inflammatory proteins to promote tissue healing. The most consistent clinical evidence supports PRP use for plantar fasciitis and osteochondral lesions of the talus, with significant improvements in pain and function observed. In contrast, outcomes for Achilles tendon pathologies and ankle osteoarthritis are mixed, demonstrating heterogeneity in PRP preparation and implementation. Future high-quality, standardized studies are necessary to determine the efficacy, optimal protocols, and long-term outcomes of PRP in foot and ankle pathologies.
BackgroundCharcot-Marie-Tooth disease (CMT) commonly produces progressive cavovarus/equinovarus deformity, and severe pediatric deformity may require complex reconstruction when bracing and therapy fail. Postoperative wound complications can occur after extensive hindfoot/midfoot surgery, but genotype-specific factors influencing wound healing remain poorly defined. Charcot-Marie-Tooth disease type 2C (CMT2C) is associated with transient receptor potential vanilloid 4 (TRPV4) variants, and experimental data suggest that TRPV4 signaling may influence fibroblast behavior and extracellular matrix depositionCaseA 10-year-old girl with genetically confirmed CMT2C due to TRPV4 c.806G>A (p.Arg269His) presented with progressive ambulatory difficulty, severe bilateral stiff equinovarus (left worse), and a left knee flexion contracture (~25°). Weightbearing cone-beam computed tomography confirmed severe left cavovarus deformity. She underwent left anterior distal femoral hemiepiphysiodesis followed by complex left foot/ankle reconstruction, including Achilles Z-lengthening with posterior capsulotomy, multiple soft-tissue releases, posterior tibial tendon transfer to the lateral cuneiform, talonavicular release, peroneus longus-to-brevis transfer, and calcaneocuboid fusion. Within weeks, she developed severe multifocal wound dehiscence across multiple incision sites without clinical or microbiologic evidence of infection. She required readmission, serial debridements, and negative-pressure wound therapy. Adjunct dermal punch-biopsy-derived fibroblast explant culture showed delayed early outgrowth and reduced adherence/spread versus control, with preserved proliferation after passage. Plastic surgery performed operative debridement; perfusion imaging confirmed viable tissue, and biodegradable temporizing matrix was applied to key wounds with bridged vacuum-assisted closure, resulting in wound healing with long-term follow-up.ConclusionThis case highlights unusually severe, noninfectious, multifocal wound dehiscence following technically appropriate, consensus-guided reconstruction in a child with TRPV4-associated CMT2C. Although causality cannot be established, the complication pattern raises the possibility of genotype-associated wound-healing vulnerability and supports heightened postoperative surveillance, early multidisciplinary involvement, and consideration of staged reconstruction in similarly high-risk patients.Level of EvidenceTherapeutic, Level V (Case Report).
IntroductionTourniquet use for ankle fracture fixation surgery is a common but not universally accepted practice due to concerns regarding soft tissue complications. Although prior literature has demonstrated increased short-term postoperative pain, tourniquet use's association with other complications remains under-investigated.MethodsA retrospective cohort study was performed of adult patients undergoing open reduction and internal fixation of a closed rotational ankle fracture (OTA Type 44) between 2012 and 2024 at an urban academic health system. Patients were stratified by tourniquet use. Demographic information, injury characteristics, and operative variables were collected. The primary outcome was the development of postoperative complications-wound dehiscence, fracture-related infection, superficial wound infection, delayed wound healing, peripheral nerve injury, venous thromboembolism, and nonunion. Secondary outcomes were operative time and estimated blood loss. Multivariable logistic regression was used to evaluate the association between tourniquet use and postoperative complications.ResultsA total of 617 patients met the inclusion criteria, including 446 who had a tourniquet inflated during surgery and 171 who did not. No significant differences in baseline patient demographics or comorbidity were observed. After multivariable logistic regression, tourniquet use was not associated with higher odds of any wound complication, fracture-related infection, delayed wound healing, or peripheral nerve injury. Among patients in the tourniquet cohort, 4 developed venous thromboembolism and 7 developed a fracture nonunion. No such complications were observed among patients treated without a tourniquet. Tourniquet use was associated with a modest decrease in estimated blood loss (47.3 ± 44.2 vs 33.9 ± 36.0 mL, P < .001) with no significant increase in operative time.ConclusionTourniquet use during operative fixation of closed rotational ankle fractures was not associated with increased soft tissue or bony complications. The findings support the safety of continued tourniquet use per surgeon preference, provided that appropriate patient selection is employed.
Background Ligament and tendon pathology of the ankle is frequently complicated by chronic instability, poor tissue quality, and prior failed repairs. Augmentation devices have been introduced to reinforce primary repair and protect healing tissues during the early postoperative period. A novel synthetic augmentation device was used as an adjunct in primary ankle ligament repair across a range of clinical presentations. Methods This retrospective case series evaluates early clinical outcomes in 5 patients who underwent ankle ligament repair augmented with TEKBRACE (Theramicro, Cordova, Tennessee). The cohort included 3 males and 2 females with a mean age of 52 years (range, 37-65) and mean body mass index of 29.9 (range, 22.7-39.1). Diagnoses included acute lateral instability (n = 3), acute-on-chronic instability (n = 1), and chronic instability with concomitant tendinopathy (n = 1). All diagnoses were confirmed by clinical examination and magnetic resonance imaging. Mean follow-up was 18 weeks (range, 16-24 weeks). All patients followed a standardized postoperative immobilization and rehabilitation protocol. Results At early follow-up, all patients demonstrated stable clinical courses without device-related complications. There were no postoperative infections, wound complications, thromboembolic events, skin reactions, or mechanical failures. Visual Analog Scale pain scores improved from a mean of 4.8/10 preoperatively to a mean of 0.6/10 at final follow-up. Range of motion was within normal limits compared to preoperative baseline in all patients. Four of 5 patients returned to full unrestricted activity. No gross instability was detected on clinical examination at any postoperative visit. Conclusion Early outcomes following TEKBRACE augmented ankle ligament repair were encouraging in this small preliminary series, with no device-related complications observed. These findings support the feasibility of the technique and provide rationale for prospective investigation with standardized outcome collection and longer follow-up.
Concentrated bone marrow aspirate (cBMA) is an autologous biologic increasingly used in orthopaedic surgery for its regenerative potential. It contains mesenchymal stem cells (MSCs), growth factors, and cytokines that contribute to tissue repair and immunomodulation. Mesenchymal stem cells primarily exert their effects through paracrine signaling and macrophage reprogramming, promoting a shift from a pro-inflammatory (M1) to a reparative (M2) phenotype. Emerging evidence also suggests a role for mitochondrial transfer in this process. In foot and ankle surgery, cBMA has been investigated in the management of osteochondral lesions of the talus, fracture healing, and tendon disorders. Early clinical studies suggest potential improvements in functional outcomes, healing rates, and revision rates; however, the available evidence remains heterogeneous and is largely limited to small, non-randomized studies. Variability in cBMA preparation and reporting further limits comparability across studies. As such, while cBMA represents a promising adjunct in foot and ankle surgery, its clinical role is not yet fully defined. Future research should focus on prospective, controlled studies with standardized methodologies and explore emerging cell-free approaches, including MSC-derived extracellular vesicles, to optimize regenerative strategies.
Background. The optimal surgical approach for mild-to-moderate insertional Achilles tendinopathy (IAT) with Haglund deformity remains controversial. This study compares the clinical and radiological outcomes of Zadek Calcaneal Closing Wedge Osteotomy (ZCCWO) and Calcaneal Exostectomy with Tendon Repair (CE-TR). Material and methods. This retrospective study included 30 patients (15 ZCCWO, 15 CE-TR) with mild-to-moderate IAT associated with calcaneal exostosis. Clinical outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score and Numeric Pain Rating Scale (NPRS). Radiological evaluations included the Fowler–Phillip (FP), Calcaneal Pitch (CP), and Chaveaux-Liet (CL) angles. The mean follow-up was 39 ± 8.8 months (ZCCWO) and 31.4 ± 5 months (CE-TR). Results. Both groups demonstrated significant improvements in AOFAS and NPRS scores (P < .00001) with no statistically significant differences between them (AOFAS: P = .6, NPRS: P = .65). The postoperative decline in FP angle was comparable (ZCCWO: 10.1°±3.9°, CE-TR: 9.7°±4.4°; P > .05). Non-union occurred in 1 ZCCWO case (6.6%), while superficial wound infections were more common in the CE-TR group (13.3% vs 6.6%). Conclusion. The ZCCWO and CE-TR provide equivalent functional and radiological outcomes for mild-to-moderate IAT associated with Haglund deformity. Both procedures are effective and safe, with complication profiles that warrant consideration in surgical planning. level III Not applicable.
Background. This systematic review and meta-analysis aimed to evaluate the outcomes of intra-articular hyaluronic acid (HA) injections for the treatment of ankle osteoarthritis (OA). Methods. A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was conducted in February 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extracted included patient demographics, injection protocols, subjective clinical outcomes, ankle range of motion, complications, and failures. Results. Six randomized controlled trials (RCTs) were included, comprising 145 patients (149 ankles) who received intra-articular HA injections and 129 patients (138 ankles) in the control cohorts. The weighted mean follow-up was 5.2 ± 3 months for the HA group. There were no significant differences between HA and control groups in terms of visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, and ankle osteoarthritis scale (AOS) scores. Complication rates were similar between groups, with transient injection site pain being the most common complication. Conclusion. This systematic review and meta-analysis indicate that intra-articular HA injections provide limited clinical benefit for ankle OA, with no significant improvements in pain or functional outcomes compared to control treatments. Further high-quality randomized trials are needed to determine the precise role of HA in the management of ankle OA. Levels of Evidence : I, meta-analysis of randomized controlled trials
