BACKGROUND:Three-dimensional weightbearing CT (WBCT) has been widely used to assess foot and ankle alignment. However, most current measurement methods are based on 2-dimensional concepts-distance, long axis, angulation, etc-and are sensitive to changes in orientation of the WBCT images. This study demonstrated how changes in positioning of the image can significantly influence the evaluation of hindfoot alignment. METHODS:WBCT scans of 10 feet without deformities were used. In the horizontal view, the long axis of the foot image was aligned to a neutral position and then rotated 5, 10, 15, and 20 degrees both internally and externally to simulate malposition. The Calcaneal Moment Arm (CMA) was measured by 2 investigators independently in the above positions. An intraclass correlation coefficient (ICC) model was used to assess the intra- and interobserver reliabilities. The correlation between the CMA and the rotation angle of the foot images was analyzed using linear regression. RESULTS:The CMA measurements demonstrated that internal rotation of the image changed the neutral hindfoot into valgus, whereas external rotation led to varus. A 1-degree internal or external rotation of the image correlated with 0.48 (±0.03) mm increase or decrease in the modified WBCT-CMA value (P < .0001, R2 = 0.6406). CONCLUSION:This study demonstrated that although 3D WBCT provides the ability to observe the foot from different perspectives, current alignment evaluation tools are limited to 2 dimensions. Therefore, positioning the WBCT images in a consistent orientation is important to generate correct data.

Objective: This study introduced a modified weight-bearing computed tomography to measure the calcaneal moment arm (WBCTCMA) and compared the CMA values between the original and modified techniques. Methods: The WBCT scans of 10 healthy feet were loaded in the CubeVue software, correctly oriented in the transverse plane. Instead of using a specific single coronal cut of the tibia, as in the original WBCT-CMA method, the modified method includes the full thickness of the tibia in the coronal plane to better define the tibia axis. The CMA of each foot was evaluated using both methods. Intraclass correlation coefficient (ICC) model was used to assess the intra- and interobserver reliabilities of both techniques. Results: There was no statistically significant difference between the CMA values generated from the two measurement techniques (p = 0.99). Both methods demonstrated excellent intra- and interobserver reliabilities (0.93 and 0.97 for the modified WBCT-CMA, and 0.93 and 0.94 for the original WBCT-CMA). Conclusion: The modified WBCT-CMA is equivalent to the original WBCT-CMA in both intra- and interobserver reliabilities. Instead of using a relatively shorter tibia from one specific single cut, as in the original technique, the modified WBCT-CMA provides a reconstructed tibia with a longer and clearer shaft for measurement. This has the potential advantages of being easy to perform and less time-consuming, also reducing errors. Level of Evidence III; Retrospective comparative study.

Osteochondral lesions of the talus (OLT) frequently manifest following ankle joint trauma, causing ankle pain, swelling and impaired mobility, thereby significantly impeding daily activities of the patients. Presently, clinical treatment approaches encompass both conservative management and surgical intervention. Conservative management endeavors to alleviate symptoms, while patients experiencing persistent symptoms resort to surgical intervention. Commonly employed surgical treatments encompass bone marrow stimulation, autologous osteochondral transplantation, and allogeneic osteochondral transplantation. Bone marrow stimulation is employed as a therapeutic approach for the management of smaller OLT, demonstrating favorable short-term effectiveness; however, the long-term prognosis remains uncertain. Autologous osteochondral transplantation is a viable option for larger OLT lesions, albeit it carries the potential of complications at the donor site. Conversely, allogenic osteochondral transplantation exhibits a diminished success rate. In recent times, the utilization of cell transplantation techniques has garnered escalating interest in the treatment of OLT due to their capacity to regenerate cartilage resembling hyaline and their diverse range of cellular origins. The authors reviewed the progress of cell transplantation in the treatment of OLT, providing a reference for the clinical treatment.

跌倒多发于老年人群体,我国老年人的年跌倒发生率约为20.8％,已成为65岁及以上老年人因伤致死的首位原因,平衡能力是老年人维持身体姿势的重要能力,良好的平衡能力有助于预防老年人跌倒.因此有必要了解影响老年人平衡能力的感觉输入、中枢整合和运动输出因素及其发生机制,帮助医务工作者更好地认识平衡能力在老年人跌倒中的作用,及时准确干预,有效降低老年人的跌倒风险和发生率.

外翻是构成第一跖趾关节的趾向外侧偏移的前足畸形,主要累及第一跖列,可引起囊炎、锤状趾、足底胼胝等众多并发症,会影响足部观感和功能.目前关于外翻的病因学研究颇多,但并不完全一致,其病因也尚未完全明确,但已知的因素包括穿鞋习惯、遗传、足部结构异常、全身性疾病等.外翻在不同地区、性别、年龄及职业等人群中的患病率不同,患病率为3.22％～89％.本文将对外翻的病因及流行病学的相关研究展开综述.

PurposeIn recent years, minimally invasive surgery (MIS) for hallux valgus has emerged and gained popularity. To date, evidence on the benefits of MIS for hallux valgus is still controversial. This updated meta-analysis aimed to comprehensively evaluate the efficiency of MIS vs. open surgery for hallux valgus.MethodsA systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Two independent reviewers conducted data extraction and analyzed data with R software. Data were presented with risk ratio (RR) and standardized mean difference (SMD) along with 95% confidence interval (CI).ResultsA total of 22 studies in which there were 790 ft treated with the MIS procedure and 838 ft treated with an open procedure were included. The correction of sesamoid position was better in the MIS group. The post-operative distal metatarsal articular angle (DMAA) of the MIS group was lower. There was less pain at the early phase in the MIS group. The MIS group had a shorter surgery time and shorter hospitalization time compared with the open group. Our meta-analysis revealed no statistically significant difference in hallux valgus angle (HVA), first intermetatarsal angle (IMA), the first metatarsal shortening, the American Orthopedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS) score at the final follow-up or complication rate (when all studies were considered). When taking into consideration only randomized controlled trial (RCT), the AOFAS score was higher in the MIS group while HVA, IMA, DMAA, and complication rate remained no significance. Post-operative IMA of the MIS group was significantly lower when only studies reporting the second-generation (2G) MIS were included. When just studies adopting the third-generation (3G) MIS were included, the HVA and DMAA were lower in the MIS group.ConclusionThe MIS procedures were more effective than open surgeries in the treatment of hallux valgus. Moreover, the MIS group achieved better radiologic and clinical outcomes compared with the open group.