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Accurate diagnoses of peroneal pathologies remains a challenge due to limitations of conventional 2D (dimensional) imaging, which can impact long-term patient outcomes. This study evaluates MRI accuracy and inter-reader reliability of peroneal compartment pathology for 2D and 3D MRI. A consecutive series of patients who underwent peroneal compartment surgery with preoperative 1.5- or 3.0-Tesla ankle MRIs from 2009 to 2024 included 32 scans (22 with 2D, 10 with 2D+3D) from 31 patients (ages 17-74 years, all genders). Three musculoskeletal readers blinded to surgical findings independently analyzed MRI scans for common peroneal tenosynovitis, peroneus brevis and peroneus longus tenosynovitis, tendinopathy, and tears. Inter-reader reliability and diagnostic performance measures were calculated. Using majority vote, overall accuracy, sensitivity, and specificity for peroneal tendons using 2D MRI were 80%, 81%, and 79%, respectively. Using 3D MRI sequences, whether in isolation or combination with 2D MRI, accuracy, sensitivity, and specificity increased to 85%, 88%, and 83%, respectively. The inter-reader reliability for peroneus brevis lesions was 0.45-0.75 for 2D, 0.25-0.35 for 3D, and 0.31-0.54 for combined 2D+3D, while for peroneus longus lesions, it was 0.45-0.90 for 2D, 0.20-0.71 for 3D, and 0.64-0.81 for combined 2D+3D scans. The inter-reader reliability for tenosynovitis ranged from 0.62-0.64 for 2D, 0.25-0.37 for 3D, and 0.57-0.66 for combined 2D+3D scans. The addition of 3D MRI to 2D high-resolution ankle MRI protocol or 3D MRI alone increases accuracy of peroneal compartment lesion detection with minor decrease in inter-reader reliability for peroneal brevis tendon assessment. Larger studies may help validate our findings., Competing Interests: Declaration of competing interest AC receives royalties from Jaypee and Wolters Kluver. AC also serves as a consultant with ICON Medical, Celery, Inc., and Treace Medical Concepts, Inc. AC is a speaker for Telemedicine clinics and Siemens. AC is a medical advisor and has a research grant from Image Biopsy Lab Inc and Qure-AI. Declaration of interest: none., (Copyright © 2024. Published by Elsevier Inc.)

Plantar fasciitis is one of the most common foot conditions presenting to a foot and ankle specialist. Surgical treatment outcomes following plantar fasciotomy vary but short-term studies have reported excellent early pain relief and significant improvements in symptoms. This study evaluates patient reported pain scores collected pre- and post-op for patients who underwent percutaneous ultrasonic microtenotomy (PUT) plantar fasciotomy with PRP injection vs without the use of PRP. We compared pain visual analog scale (VAS) scores, for patients treated surgically by Orthopedic Surgery department of foot and ankle faculty members between December 2007 and December 2022. A total of 30 patients were identified that met inclusion and exclusion criteria. Our results showed that there was a significant decrease in pain VAS scores from pre-op visit (at least 1 month prior to operation) to post-op visit (at least 1 month following operation) for both groups, with a paired t test (p value <.0001). However, patients who received PRP had a statistically significant decrease in pain level compared to the group who did not receive PRP. Statistical analysis completed with a 2-sample t test (p-value <.0325). Our results found the mean time between the initial pre-op visit and last post-op follow-up visit was 19 months. The mean for time following surgical intervention was 10 months. The findings of our study suggest that the dual use of PUT and PRP to treat plantar fasciitis, could potentially lead to an improvement in pain reduction and longevity of pain relief., (Published by Elsevier Inc.)

There is a paucity of literature characterizing risk factors for nonunion associated with the modified Lapidus procedure for correction of hallux valgus. The purpose of this study was to evaluate risk factors associated with nonunion for Lapidus bunionectomies. Patients who underwent modified Lapidus procedure from 2009 to 2018 were retrospectively reviewed. Patient's age, sex, body mass index, prior bunionectomy, history of tobacco use, presence of diabetes mellitus or hypothyroidism, and fixation method were recorded along with pre- and postoperative radiographic parameters. A multiple logistic regression analysis was implemented to estimate the odds of nonunion. Of the 222 patients who met inclusion criteria, nonunion with modified Lapidus procedure was observed in 20 patients (9.01%). Odds of nonunion with modified Lapidus procedure were greater for patients who had undergone previous bunionectomy (odds ratio [OR] = 3.957, 95% confidence interval [CI]: 1.021-15.338), as body mass index increased (OR = 1.091, 95% CI: 1.018-1.170), and as preoperative HV angle increased (OR = 1.108, 95% CI: 1.020-1.203). Odds of nonunion were lower for patients as preoperative intermetatarsal angle increased (OR = 0.739, 95% CI: 0.580-0.941). No significant increased odds of nonunion were found between fixation methods., (Copyright © 2022 the American College of Foot and Ankle Surgeons. All rights reserved.)

Diabetic foot infections (DFI) are an increasingly common cause of hospitalizations. Once hospitalized with DFI, many patients require some level of amputation, often undergoing multiple operations. With increasing importance on patient-centered metrics, self-reported health-related quality of life (HRQOL) tools have been developed. This prospective cohort study aimed assessed the impact of DFI on HRQOL. Two hundred twenty-four patients completed the 29-item Patient-Reported Outcome Measurement Information System (PROMIS) and 12-Item Short Form (SF-12) survey. Secondary outcomes using the Foot and Ankle Ability Measures survey were obtained and included in the analysis. The study group was comprised of hospitalized patients with DFIs (n = 120), and the control group was comprised of patients with diabetes who were evaluated for routine outpatient foot care (n = 104); diabetic foot screening, wound care, onychomycosis, and/or callosities. Using this cohort, a propensity score-matched sample of hospitalized patients with DFI (n = 35) and control group patients (n = 35) was created for comparative analysis. The 2-independent sample t test was used to test for group differences on each of the PROMIS subscale outcomes. Using PROMIS, we found that hospitalized patients with DFI reported significantly worse HRQOL in 6 of 7 subscales (physical function, anxiety, depression, fatigue, social role, pain intensity; p value range: .0001-.02) compared to outpatients with diabetes evaluated for routine foot care. There was no significant difference between the 2 groups on sleep disturbance (p = .22). Patients hospitalized for DFI report lower HRQOL compared to patients with diabetes receiving routine outpatient foot care., (Copyright © 2021 the American College of Foot and Ankle Surgeons. All rights reserved.)

Charcot neuroarthropathy is a complication of neuropathy often secondary to diabetes mellitus and most commonly affects the midfoot. In these patients, reconstruction of the foot may be required for limb salvage. A superconstruct technique has previously been described using intramedullary beaming fixation of the midfoot and hindfoot to span the zone of injury. Inclusion of the subtalar joint in the arthrodesis construct is not consistently performed among different surgeons. The aim of this study was to describe midfoot beaming constructs and postoperative complications after midfoot reconstruction with and without subtalar arthrodesis. We reviewed medical records of patients who underwent midfoot Charcot reconstruction with an intramedullary beaming superconstruct. Patients included in the study had at least 3 months of follow-up and had Sanders-Frykberg II/III classification of Charcot neuroarthropathy. Postoperative radiographs were evaluated for evidence of hardware failure at the latest follow-up evaluation. The main variables of interest were: hardware failure or nonunion requiring revision operation, deep infection, and unplanned reoperation. Thirty patients who underwent midfoot reconstruction were included. The mean follow-up was 67.4 ± 25.9 weeks. Twenty-two (73.3%) patients had concomitant subtalar arthrodesis and midfoot beaming. Overall complications were lower in patients with subtalar arthrodesis (40.9%) than those without subtalar arthrodesis (75%) resulting in an odds ratio of 0.271 (0.042-1.338, p = .146). Furthermore, increased number of screws used in the midfoot construct was negatively correlated with complications (r = -0.44, p = .01). An intramedullary midfoot beaming superconstruct with subtalar arthrodesis has previously been proposed to provide better fixation after midfoot beaming Charcot neuroarthropathy reconstruction. Our results suggest including the subtalar joint as part of a superconstruct for the reconstruction of Sanders-Frykberg II/III Charcot results in an 80% lower complication rate than intramedullary beaming alone. We also found an increased number of screws used in the midfoot results in a lower complication rate., (Copyright © 2020 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Cuboid fracture accounts for a minority of all foot fractures in adults and often is indicative of a multiply injured foot. Understanding the normal anatomy and function of the cuboid and its relation to foot biomechanics is necessary for appropriate management. Clinical evaluation includes history, physical examination, and thorough assessment of the skin and soft tissues. Plain radiographs and CT are helpful in preoperative planning. Cuboid fractures may be managed either nonsurgically (splinting or casting) or surgically (closed reduction and external fixation or open reduction and internal fixation). Careful handling of the soft tissues is important, as is restoration of articular congruity, lateral column length, and a stable midfoot. Postoperative care consists of prolonged immobilization followed by 3 months of progressive weight bearing. Published reports of long-term outcomes and functional postoperative assessments are lacking.

Unlabelled: The purpose of the study was to review the incidence rate of new and recurrent ulcerations in transmetatarsal amputations after original ulcers healed with percutaneous Achilles' tendon lengthening as an isolated procedure. We reviewed 35 charts from period of January 1995 to March 2007, and 28 were included for the final review. Twenty-four ulcers were grade 1A, 2 were 0A and 1B, and 1 was 1C using the University of Texas Grading System. Time to heal of ulceration post-TAL was 9.4 weeks (range 3-72 weeks). For statistical analysis, we used binomial distribution for dichotomous variables. Results demonstrated 4 limbs did not heal, 10 patients had an ulcer recurrence (p<0.001), and 6 developed new ulcers. Of the 28 patients in which TAL was performed, 16 developed new neuropathic ulcers (including recurrent ulcers; p=0.0099). High recurrence and new ulcers formation exist after TAL in patients with an unbalanced metatarsal amputation, and extrinsic/ intrinsic factors may need to be addressed to prevent recurrence., Level of Clinical Evidence: 4.