BACKGROUND:Re-amputation after transtibial or transfemoral amputation may compromise healing and rehabilitation. Inflammatory markers may aid risk stratification. PURPOSE:To evaluate associations between preoperative inflammatory biomarkers, especially systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), and re-amputation risk. STUDY DESIGN:Retrospective cohort study. METHODS:We included 146 consecutive diabetic patients who underwent transtibial or transfemoral amputation for diabetic foot-related complications from January 2021 to December 2023. Patients with documented or imaging-confirmed peripheral arterial disease were excluded. Laboratory values within 48 hours before surgery were analyzed. Re-amputation was defined as additional bone resection at the same or a more proximal level. Patients without re-amputation were censored at death or last follow-up. Cox regression and receiver operating characteristic analyses were performed. RESULTS:Re-amputation occurred in 26 patients (17.8%). Re-amputation was associated with higher white blood cell, neutrophil, monocyte, platelet, C-reactive protein (CRP), SII, SIRI, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio values. In exploratory multivariable Cox models adjusted for age and amputation level, SIRI (hazard ratio [HR], 1.048; 95% confidence interval [CI], 1.022-1.076; p < .001), SII per 1,000-unit increase (HR, 1.066; 95% CI, 1.011-1.123; p = .018), and CRP per 10 mg/L increase (HR, 1.094; 95% CI, 1.053-1.137; p < .001) remained associated with re-amputation. CRP had the highest area under the curve (0.762), followed by SII (0.746) and SIRI (0.740). CONCLUSIONS:Higher preoperative systemic inflammatory burden was associated with re-amputation. CRP performed best, while SII and SIRI showed moderate complementary value. External validation is required.
BACKGROUND:Diabetes causes toe deformities leading to trophic ulcers, intertrigo, and amputations. PURPOSE:Percutaneous long flexor tenotomy rapidly heals flexible claw toe ulcers with low recurrence, outperforming conservative offloading and strongly recommended by International Working Group for Diabetic Foot (IWGDF) guidelines. METHODS AND STUDY DESIGN:This retrospective cohort study analysed single author cases from February 2019 to April 2026, evaluated percutaneous long flexor tenotomy effectiveness in resolving diabetic toe pathologies including ulcer healing, callosity prevention, fungal lesion clearance, resolution timelines, and rates of recurrence and complications. RESULTS:Of 49 percutaneous long flexor tenotomies in 25 patients for intertrigo and trophic toe changes across all toes, mean follow-up was 16.93 months, with healing times of 38.5 days for intertrigo and 27.4 days for trophic changes; no serious complications occurred, recurrences were minimal and manageable yielding 4.08 percent failure, and 9 transfer lesions resolved after secondary procedures. CONCLUSION:Our cohort demonstrated high healing rates for intertrigo and trophic toe changes, with low failure rates, manageable recurrences and transfer lesions, and minimal complications affirming broad safety and efficacy of the procedure. This procedural efficacy is particularly significant given the high rates of diabetic foot complications, where even minor toe deformities can precipitate severe ulceration and subsequent limb loss.
BACKGROUND:Progressive Collapsing Foot Deformity (PCFD) is a complex multiplanar deformity commonly treated with osteotomy-based reconstruction in flexible cases. Although weightbearing CT (WBCT) has improved assessment of PCFD, WBCT-based predictive planning models remain unexplored. PURPOSE:To evaluate the accuracy of a WBCT-based predictive surgical planning model in estimating postoperative alignment following reconstruction for flexible PCFD. STUDY DESIGN:Retrospective cohort study METHODS: Thirty-four patients with PCFD who underwent reconstruction with medial displacement calcaneal osteotomy, lateral column lengthening, and/or first-ray plantarflexion osteotomy and had preoperative and 3-month postoperative WBCT were included. The model estimated postoperative hindfoot moment arm (HMA), axial talus-first metatarsal angle (TFMA-A), talonavicular coverage angle (TNCA), and sagittal talus-first metatarsal angle (TFMA-S) using correction magnitudes. Predicted alignment was compared with postoperative WBCT measurements using Bland-Altman analysis, mean absolute error (MAE), root-mean-square error (RMSE), and paired t-tests. RESULTS:Predictive accuracy was highest for HMA, with a mean bias of +2.73 mm (p = 0.005), narrowest limits of agreement (-7.66 mm to +13.12 mm), and lowest MAE and RMSE values (approximately 2.9 mm and 3.7 mm). TFMA-A, TNCA, and TFMA-S demonstrated wider limits of agreement (approximately -17° to +21°) and greater case-level variability, although no significant systematic differences between predicted and postoperative values were observed (p = 0.21-0.90). CONCLUSIONS:A WBCT-based predictive surgical planning model estimated postoperative alignment accurately for hindfoot valgus correction, while predictions of midfoot/forefoot abduction and arch collapse demonstrated greater individual variability. Despite this variability, the model accurately reproduced mean multiplanar correction, supporting patient-specific surgical planning in PCFD.
BACKGROUND:Insertional Achilles tendinopathy may require surgery when nonoperative treatment fails. Flexor hallucis longus (FHL) tendon transfer is used as an adjunct in advanced insertional degeneration. PURPOSE:To compare 1-year outcomes, minimal clinically important difference (MCID) achievement, and complications between FHL transfer with debridement/retrocalcaneal ostectomy and debridement/ostectomy alone. STUDY DESIGN:Retrospective comparative cohort study (indication-based group allocation). METHODS:Thirty consecutive patients treated surgically between 2017 and 2023 were reviewed retrospectively. Preoperative magnetic resonance imaging (MRI) planimetry guided selection: patients with >50% degeneration underwent FHL transfer plus debridement and retrocalcaneal ostectomy (n = 15), whereas patients with ≤50% degeneration underwent debridement and ostectomy alone (n = 15). Outcomes were assessed preoperatively and at 1 year using the Victorian Institute of Sport Assessment-Achilles (VISA-A), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH), Foot and Ankle Ability Measure (FAAM), Foot and Ankle Disability Index (FADI), and visual analog scale (VAS) pain. MCID was calculated using a distribution-based method. RESULTS:Both groups improved significantly at 1 year (all p < 0.05). No between-group differences were observed for VAS, AOFAS-AH, FAAM, or FADI (all p > 0.05). The FHL group had higher postoperative VISA-A scores (65.9 ± 15.3 vs 49.9 ± 19.7; p = 0.031) and higher VISA-A MCID achievement (93.3% vs 66.6%; p = 0.046). Minor wound complications occurred in 4 patients (2/15 in each group). CONCLUSIONS:Both surgical approaches improved pain and function at 1 year. In this indication-based cohort, adding FHL transfer for >50% MRI-defined degeneration was associated with higher Achilles-specific function (VISA-A) without increased wound complications.
BACKGROUND:The distal tibiofibular syndesmosis plays a critical role in ankle stability and its anatomical variations may influence the diagnosis and management of syndesmotic injuries.However,the extent to which these variations are affected by age and sex remains unclear. PURPOSE:To evaluate age- and sex-related morphological variations of the distal tibiofibular syndesmosis and their potential clinical implications. STUDY DESIGN:Retrospective study. METHODS:A total of 110 patients (65 males-45 females) presenting with ankle fractures between 2024 and 2025 who had appropriate bilateral CT imaging were retrospectively analyzed.Measurements included ATFI,LI,DI,ATFCS,PTFCS,FW, and TSA.Data were compared across age groups (0-20,20-40,40-60 and 60-80 years) and sex. RESULTS:Significant differences were observed in PTFCS (p =0.001) and TSA (p =0.039) among age groups.Younger patients had higher PTFCS values, whereas older patients (60-80 years) exhibited greater TSA.In sex-based comparisons, males had significantly higher PTFCS (p =0.011) and LI (p<0.001) than females.Although FW was higher in males,the difference was not statistically significant (p =0.050).No significant sex differences were found in ATFCS,ATFI,DI or TSA. CONCLUSIONS:The morphology of the distal tibiofibular syndesmosis demonstrates significant variations according to age and sex.This finding suggests that commonly used diagnostic parameters and reference values may not be universally applicable to all patients.Therefore, individual anatomical variations should be carefully considered in the diagnosis and surgical management of syndesmotic injuries.Furthermore, this morphologic variability may influence intraoperative assessment and supports a more individualized, anatomy-based approach to surgical planning.
