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The plantar heel pain is very common complaint that causes significant discomfort. Plantar fasciitis is due to degenerative change of the plantar fascia at attachment site. Corticosteroids and autologous PRP injections are effective in the treatment of plantar fasciitis. We compared the local corticosteroid (methyl prednisolone acetate) injection and platelet-richplasma in terms of patient outcome in chronic plantar fasciitis. Materials and methods: The study was conducted at Pain clinic and in Department of Orthopaedics, Government District hospital Chitradurga, Karnataka from November 2022 to October 2023. Forty patients were enrolled in this study. The patients were selected randomly and were divided in two groups of 20 patients each (PRP and Steroid groups). Follow up done at 2 weeks, 6 weeks, 3 months and 6 months. Results: Significant pain relief after 6 weeks of platelet rich plasma therapy and after at 3 months and 6 months follow up. Significant improvement in both groups with respect to AOFAS score and VAS scores. This improvement was significantly more in PRP group. Conclusion: PRP injection is more effective in resulting pain relief and function as compared to corticosteroid injection in the treatment of plantar fasciitis. [ABSTRACT FROM AUTHOR]

Objectives: Acute rupture of achilles tendon is a commonly occurring injury affecting mostly the young individuals involved in sports activities. Operative management is most often employed to treat such injuries. This study was aimed to evaluate the functional outcome in patients with acute tendo achilles tear managed by open repair using a suture anchor. Methods: This was a prospective study conducted between September 2018 to August 2020 on patients who underwent suture anchor repair for acute tendo achilles tear. All patients were followed up for at least 9 months. The patients were clinically evaluated and AOFAS score was used to assess their functional outcome. Results: In a total of 38 patients, 28 (73.7%) patients showed Excellent and 7 (18.4%) patients had Good results whereas 1 (2.6%) had Fair and 2 (5.3%) patients demonstrated Poor surgical result at the final follow-up. 89.5% patients did not have any complication. The average AOFAS score was 90.97 ± 10.24. Conclusion: Operative treatment with suture anchor in acute tendo achilles tear has a high success rate, quick recovery after surgery, lower rate of complications, faster return to daily activities, excellent aesthetic and comparable functional results and is also a safe, simple and accepted surgical technique.

Objectives: Acute rupture of achilles tendon is a commonly occurring injury affecting mostly the young individuals involved in sports activities. Operative management is most often employed to treat such injuries. This study was aimed to evaluate the functional outcome in patients with acute tendo achilles tear managed by open repair using a suture anchor. Methods: This was a prospective study conducted between September 2018 to August 2020 on patients who underwent suture anchor repair for acute tendo achilles tear. All patients were followed up for at least 9 months. The patients were clinically evaluated and AOFAS score was used to assess their functional outcome. Results: In a total of 38 patients, 28 (73.7%) patients showed Excellent and 7 (18.4%) patients had Good results whereas 1 (2.6%) had Fair and 2 (5.3%) patients demonstrated Poor surgical result at the final follow-up. 89.5% patients did not have any complication. The average AOFAS score was 90.97 ± 10.24. Conclusion: Operative treatment with suture anchor in acute tendo achilles tear has a high success rate, quick recovery after surgery, lower rate of complications, faster return to daily activities, excellent aesthetic and comparable functional results and is also a safe, simple and accepted surgical technique. [ABSTRACT FROM AUTHOR]

Background: Soft tissue reconstruction around ankle and distal third of the leg is challenging due to paucity of the skin around ankle and prominence of lateral and medial malleolus. Lower third of the leg and ankle defects are best reconstructed by a free flap particularly if the defect is larger in size. However small to medium size defects around ankle and distal third of leg, lateral malleolus, medial malleolus and tendoachilles areas can be managed by locoregional flap. Local flaps are also useful in situations where patient is unfit for prolong duration of surgery. With better understanding of vascular anatomy and pre operative localization of perforators many local flaps can be designed for such defects. Commonly used pedicle flaps for ankle and distal third leg includes reverse sural artery flap, posterior tibial artery based perforator flap, peroneal artery perforator based flap, propeller flap, lateral supramalleolar flap, and peroneus brevis muscle flap. However there in no algorithm for their use in these sites. Method: Retrospective analysis of 31 post traumatic patients who underwent reconstruction for small to medium size defects over lateral malleolus, medial malleolus, posterior aspect of heel and tendoachilles area were included in the study. Large defects reconstructed with free flap were excluded from the study. Defects were analyzed in term of site, size of the defect, mode of reconstruction and functional outcome using AOAFS. Result Out of the 31 patients who were eligible, 25 (80.64 %) were men and 6 (19.35%) were women with a mean age 36.41 with SD 1.07. (Range 8-58) years. 83.87 % were less than 50 years. Size of the defect ranged from 4 cm² to 120 cm². Lateral malleolus was involved in 7 cases. Medial malleolus in 10 cases, tendoachilles in 12 cases, intermalleolar area in 2 cases. Small to moderate size defects of lateral malleolar area < 4 cm were reconstructed with peroneus brevis muscle flap (5 cases). Large defects of lateral malleolar area > 4cm were reconstructed with RSA flap (2 cases). Medial malleolus was reconstructed with propeller flap in 3 cases, Posterior tibial artery based perforator flap in 3 cases and Reverse Sural artery flap in 4 cases. Tendoachilles area were reconstructed with RSA flap in 9 cases, peroneal perforator flap in 3 cases. Anterior aspect of ankle resurfaced with lateral supramalleolar flap in 2 cases. The mean follow-up was 8 month. Statistical analysis of functional outcome was done using ANOVA method. There were no statistically significant difference between various methods used for reconstruction of flaps (P= 0.58). Conclusion: Good functional outcome can be achieved with careful selection of flap for small and medium size defect around ankle defect. [ABSTRACT FROM AUTHOR]

Plantar fasciitis in Indonesia, occur after 30 years of age, 77% of sufferers between 40 to 69 years old, men to women is 1:2. There are risk factors for plantar fasciitis include structural abnormalities, being overweight, age-related degenerative changes, activities that require prolonged standing and/or ambulation, and errors in training, especially in athletes. We present 20 case series of all patients diagnosed with plantar fasciitis who went to the Orthopedic Polyclinic in 2018 and 2019, they received conservative management with Calf Stretch workouts for 30 days and were evaluated with AOFAS Score. Calf stretch exercises in which the patient stands with the sore leg behind and both hands pushing against a wall, also known as the wall stretch. This exercise is performed 2 times a day with a duration of 10-15 minutes each session. This exercise is done routinely for 30 days. A simple, progressive training protocol consisting of strength training with heavy weights will produce better results in the first three months when compared to plantar-focused stretching and may aid in more rapid relief of symptoms on pain. Conservative management with calf exercises still provides a good outcome in patients with plantar fasciitis, based on the AOFAS score.

Minimally invasive surgery (MIS) is currently used to correct hallux valgus deformities. Most studies reporting on MIS techniques to correct hallux valgus deformities included patients with postoperative complications. These reported complications, with an average rate of 23%, had significant negative effects on the clinical outcomes in this patient population. In the present study, a cohort of 63 women who underwent MIS hallux valgus correction was assessed preoperatively and at a mean follow-up of 1.0, 4.7, and 6.5 years using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Manchester Oxford Foot Questionnaire (MOXFQ). The main criterion for inclusion in this cohort was a lack of complications during the entire follow-up period. The results showed significant improvements in both AOFAS and MOXFQ scores between the preoperative and 1-year follow-up assessments. By contrast, clinically small and nonsignificant changes were observed among postoperative follow-up values. The number of enrolled patients needs to be increased in future studies, with different surgeons and techniques included. Nevertheless, our study findings will inform patients about the outcomes they can expect over the years if no complications occur. [ABSTRACT FROM AUTHOR]

Introduction: Because one-third of the tibia is subcutaneous throughout most of its length and its location, it is more prone to open fractures. Open distal tibia fractures are mostly due to RTA and sports injuries. The goal of treatment is to obtain a healed, well-aligned fracture; pain-free weight-bearing; and functional range of motion of the knee and ankle. Materials and Methods: 33 patients of the 18–60-year age group with open distal tibia extra-articular fractures (without vascular injury), less than 3 weeks old trauma were included in the prospective study for 1 year period (1st June 2019 to 31st May 2020). 17 cases were treated with the Hybrid external fixator (HEF) and 16 cases were treated with the Ilizarov fixator (IF). Results: Significantly (P < 0.05), the mean duration of surgery was less in the HEF group (67.6 min), faster union of open type-II fractures in the HEF group (16.4 weeks), and also a higher AOFAS score at 6 months in open type-II fractures in the HEF group (84.4). There were two cases of equinus deformity in the IF group and one case of valgus deformity in the HEF group. Conclusion: HEF and IF are both equally effective in the treatment of open distal tibia extra-articular fractures with the advantage of stable fracture fixation, early weight-bearing, preserving soft tissue, minimal periosteal stripping, and providing one-staged definitive intervention. However, HEF is preferred over IF in terms of less operating time, faster union, and a better functional outcome with minimal complications. [ABSTRACT FROM AUTHOR]

We aimed to systematically evaluate the clinical and radiological outcomes reported in comparative studies evaluating combined arthroscopic microfracture and mesenchymal stem cell (MSC) injection versus isolated microfracture for osteochondral lesions of the talus (OLT). A total of 5 studies were included. Demographics, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale score, Foot and Ankle Outcome Scale (FAOS), visual analogue scale (VAS), and Magnetic Resonance Observation of Cartilage Repair Tissue Score (MOCART) were analyzed. A total of 348 patients were evaluated, 171 of whom underwent combined microfracture and MSC injection and 177 of whom underwent isolated microfracture. The frequency-weighted mean ages were 38.9 ± 13.5 and 36.9 ± 11.4 years and the mean follow-up were 36.7 ± 13.3 and 36.2 ± 16.2 months in the combined microfracture and MSC injection and isolated microfracture groups, respectively. The combined microfracture and MSC injection group showed significantly better postoperative AOFAS score (81.5 ± 7.4 vs 68.2 ± 5.1, p < .001), and MOCART score (74.3 ± 16.3 vs 63.9 ± 15.5, p < .001) with differences beyond the minimum clinically important difference. The combination of arthroscopic microfracture and MSC injection significantly improved functionality and radiological outcomes compared to those of isolated microfracture for OLT., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Congenital vertical talus foot is a complex deformity, characterized by a dislocation of the talus-calcanear navicular joint. It is a rare form of congenital flat foot, where the hindfoot is valgus and equine, the midfoot dorsiflexed and the forefoot abducted. Regardless of the type of classification, the therapeutic approach and prognosis must take into account the functionality and motility of the foot. Initial treatment is manipulative. After 3 months of age, it is possible to think about soft tissue surgery. In this study, we present congenital vertical talus feet treated at the Pediatric Orthopedics Department of SS. Antonio Biagio and Cesare Arrigo Children’s Hospital of Alessandria from 1995 to 2022. All 8 patients (12 feet) underwent through the surgical operation technique of open reduction described by Tachdjian and further reviewed and subjected to the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. The mean follow up is 13 years. Global functional result was good and surgery allowed the growth of the foot, which would otherwise be blocked by an ax that is the vertical talus. Questioned remotely, all patients perform sporting activities and wear normal footwear.

Background: Despite the low incidence of pilon fractures amongst lower limb injuries, their high impact nature presents difficulties in surgical management and recovery. The high complication rate and long recovery times presents a challenge for surgeons and patients. Current literature is varied, with no universal treatment algorithm. We aim to highlight differences in outcomes and complications between open and closed pilon fractures, and between patients treated by open reduction internal fixation (ORIF) or fine wire fixator (FWF) for open and closed fracture subgroups.Methods: This retrospective study was conducted at a major trauma centre including 135 patients over a 6-year period. Primary outcome was AOFAS score at 3, 6, and 12-months post-injury. Secondary outcomes included time to partial weight-bear (PWB) and full weight-bear (FWB), bone union time, and complications during the follow-up time. AO/OTA classification was used (43A: n = 23, 43B: n = 30, 43C: n = 82). Interobserver agreement was high for bone union time (kappa=0.882) and AO/OTA class (kappa=0.807).Results: Higher AOFAS scores were seen in ORIF groups of both open and closed fractures, compared to FWF groups. The difference was not statistically significant apart from 12-month AOFAS score of 43C open fractures (p = 0.003) and in 43B closed fractures 3 and 6 months post-injury (p<0.001 and p<0.001, respectively). The majority of ORIF subgroups, open and closed fractures, also had shorter time to PWB, FWB, time to union, and follow-up. Statistically significant differences were seen in the following cases: ORIF-treated 43B closed fracture subgroup had shorter time to PWB and FWB (p<0.001 and p = 0.017, respectively), ORIF-treated 43C closed fractures had shorter time to union (p = 0.005). Common complications for open fractures were non-union (24%), post-traumatic arthritis (16%); for closed fractures they were post-traumatic arthritis (24%), superficial infection (21%). All occurred more frequently in FWF-treated patients.Conclusion: Most ORIF-treated subgroups in either open or closed pilon fractures showed better primary and secondary outcomes than FWF-treated subgroups, yet few were statistically significant. Overall, our use of a two-staged approach involving temporary external fixation, followed with ORIF or FWF achieved low complication rates and good functional recovery. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to detect the effect of a modified chevron osteotomy on hallux valgus (HV) deformity at five-year follow up.Methods: Twenty patients with symptomatic HV who underwent modified chevron osteotomy between June 2014 and January 2016 were included in the present study. The minimum follow-up duration was five years. Each patient was evaluated preoperatively, six weeks postoperatively and five years postoperatively using the visual analog scale (VAS) pain score, the American Orthopedic Foot & Ankle Society (AOFAS) score and cosmetic and radiological outcomes.Results: The AOFAS score improved from 54.40 ( ± 4.58) preoperatively to 94.30 ( ± 2.15) six weeks postoperatively (p < 0.001) and 96.95 ( ± 1.54) five years postoperatively (p < 0.001). The VAS scores decreased from 6.30 ( ± 1.17) preoperatively to 0.15 ( ± 0.37) five years postoperatively (p < 0.001). The mean intermetatarsal angle improved from 16.00° ( ± 2.20°) preoperatively to 4.15° ( ± 1.22°) six weeks postoperatively (p < 0.001) and 4.40° ( ± 1.39°) five years postoperatively (p < 0.001). The mean HV angle also improved, from 32.70° ( ± 5.34°) preoperatively to 4.80° ( ± 1.40°) six weeks postoperatively (p < 0.001) and 5.20° ( ± 1.32°) five years postoperatively (p < 0.001). The cosmetic results were either excellent or good in 19 patients (95%). There was no recurrence in this study during the five postoperative years.Conclusion: A modified chevron osteotomy can achieve successful correction of moderate-to-severe HV, with excellent outcomes at five-year follow up. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis can be defined as inflammation at the insertion of plantar fascia and is thought most commonly due to overuse injury. It usually presents as sharp shooting heel pain which is worse in the morning. The location of pain is usually plantar surface of the foot and pain may radiate proximally in long standing and severe cases. In mild cases of plantar fasciitis non steroidal anti-inflammatory drugs and activity modification may be sufficient. Severe cases may require interventions such as night splints and orthotic devices which works by reducing loading of plantar fascia. Recently local injection of autologous platelet rich plasma is used by many researchers with promising results. Aims and Objectives: This prospective cohort study was undertaken to analyze the functional and clinical outcome in patients with plantar fasciitis who were treated by autologous injection of platelet rich plasma. Materials and Methods: This was a prospective cohort study conducted in department of orthopedics of a tertiary care medical college located in an urban area. The patients diagnosed to be having plantar fasciitis were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were assessed for severity of pain by the Visual Analogue Score for pain and American orthopedic foot and ankle score (AOFAS). A VAS score of 0-3 was taken as pain relief and VAS score of 4-10 was considered as no pain relief. Whereas AOFAS scores of 90-100, 80-89, 60-79 and less than 60 were taken as excellent, good, fair and poor outcome respectively. All patients were treated by local injection of autologous platelet rich plasma. The patients were followed up at 4 weeks, 8 weeks and 12 weeks. During follow up visits the pain relief was assessed by VAS and AOFAS scores. For statistical purposed SSPS 21.0 software was used and p value less than 0.05 was taken as statistically significant. Results: A total of 60 patients were included in this study out of which there were 22 (36.67%) males and 38 (63.33%) females with a M:F ratio of 1:1.72. The most common affected age group was between the age of 41-50 years (35%) followed by 51-60 years (21.67%) and 31-40 years (20%). Twenty-seven (45%) patients were either overweight or obese. A statistically significant reduction in pain was documented at the time of follow up of 4 weeks. At the end of 12 weeks 58 (96.67%) patients experienced significant pain relief and only 2 (3.33%) patients had significant pain. Also, there was statistically significant difference between AOFAS scores at the time of presentation and at 4 weeks, 8 weeks and 12 weeks follow up visits. Conclusion: Injection of autologous platelet rich plasma for chronic plantar fasciitis is found to have promising results in terms of pain relief (reduced VAS score) and functional outcome (Improvement in AOFAS score).

Background: Displaced intra-articular calcaneus fractures (DIACF) Sanders type IV represent a challenge in its management and questions remain about the best treatment option available. This study aimed to compare the outcomes of primary subtalar arthrodesis (PSTA) and osteosynthesis in these fractures.Methods: Studies concerning DIACF Sanders type IV, from 2005 to 2020 were systematically reviewed. Only studies evaluating functional outcomes with American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS) score were admitted allowing for results comparison.Results: In total, 9 studies met the inclusion criteria. These reported on the results of 142 patients, from which 41 submitted to PSTA and 101 to osteosynthesis, with an average follow-up period over 2 years. We found a significant moderate negative correlation between the reported AOFAS score and the Coleman Methodology Score obtained. Late subtalar arthrodesis was 13.63% of the total osteosynthesis performed.Conclusions: Clinical outcomes after PSTA and osteosynthesis, for the treatment of Sanders type IV fractures, do not seem very different, yet careful data interpretation is crucial. Additional powered randomized controlled trials are necessary to assess which surgical strategy is better. [ABSTRACT FROM AUTHOR]

Introduction/Objective. When choosing the appropriate treatment for Achilles tendon rupture, there may be a dilemma when choosing the optimal treatment. The objective of this study was analyzing groups of patients with acute closed Achilles tendon injury, comparing early recovery and functional parameters in relation to treatment and first choice treatment suggestion. Methods. The prospective study included 80 patients with acute Achilles tendon rupture. The treatment was surgery or immobilization. Results. There is a difference in the mechanism of injury between surgically and non-surgically treated (p = 0.026). In total, 50 (62.5%) patients were operated and 30 (37.5%) patients were treated with circular plaster. The difference (p = 0.000) between the groups in the duration of treatment, The American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analogue Scale of pain (VAS) was shown. Patients undergoing surgery in the first two days had better clinical results in terms of The Achilles tendon Total Rupture score (ATRS), AOFAS and VAS. Higher satisfaction was achieved in younger people (p = 0.036). Patients whose treatment lasted shorter were more satisfied with their status (p = 0.001). ATRS and AOFAS score are higher in patients who are more satisfied with their own status (ATRS p = 0.301; AOFAS score p = 0.001). Six months after the treatment, 78.75% (63/80) of patients were fully functional. Conclusion. The therapy of choice in the treatment of acute Achilles tendon rupture is surgical, as surgical treatment is shorter; rehabilitation is faster and shorter, and the total costs associated with treatment and absence from work are lower.

The Achilles tendon, the body's largest tendon, is often vulnerable to rupture, primarily as a result of sudden dorsiflexion of a plantar-flexed foot. This injury predominantly affects individuals in their youth and middle age. In this case series, we describe three middle-aged men with neglected insertional Achilles tendon ruptures, each presenting an average 10 cm defect. They underwent a surgical procedure involving flexor hallucis longus (FHL) tendon transfer with concurrent gastrocnemius augmentation. The FHL tendon was repositioned proximally and securely tenodesed to the proximal stump of the excised Achilles tendon. Following this intervention, substantial clinical improvements were observed at the six-month follow-up, with the American Orthopaedic Foot and Ankle Society (AOFAS) score improving from 35 to 85 and the Visual Analog Scale (VAS) pain score decreasing from 8 to 2. These results highlight the efficacy of flexor hallucis longus tendon transfer with gastrocnemius augmentation as a superior treatment option for neglected insertional achilles tendon tears characterized by substantial defects, promising improved functional outcomes and pain relief., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, B et al.)

Introduction Haglund's deformity is an abnormal bony postero-superior calcaneal prominence which causes the posterior heel pain. Surgery is the choice of treatment after failed conservative management. Both open and endoscopic techniques are used to treat this condition. In this article, we discuss endoscopic calcaneoplasty for the management of such cases. Methods All included patients underwent bi-portal endoscopic calcaneoplasty. Clinical outcomes were assessed by using the visual analog scale (VAS) score and the American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological outcome was assessed by a change in the Fowler-Philip angle (FPA). All patients were followed at one month, three months, and six months postoperatively. Results A total of 22 patients were included in this prospective study. Patients were followed up to six months postoperatively. The mean VAS score was 6.32 ± 0.65 which was significantly reduced to 0.91 ± 0.68 (p < 0.001) at six months. Similarly, AOFAS Score was improved to 90.01 ± 2.67 (p < 0.001) from 64.36 ± 7.07 preoperatively. The mean Fowler Philip Angle was reduced from 72.45° ± 3.74° to 65.77° ± 2.25° at six months (p < 0.001). Conclusion Bi-portal endoscopic calcaneoplasty significantly improves clinical outcomes in Haglund's deformity. Compared to open procedures, bi-portal endoscopic calcaneoplasty offers several advantages, including shorter recovery times, smaller incisions, and better clinical results for Haglund's deformity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical Comittee, King George's Medical University, Lucknow issued approval 102nd ECM IIB/P117. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Saini et al.)

Introduction: Insoles are recommended for the treatment of patients with neuropathic foot to distribute the foot plantar pressure while preventing recurrent ulceration. Different types of insole are available but the cost is the major limiting factor. Thus, it is justifiable to conduct this study to evaluate the efficacy of cost effective locally-designed bilayer Lunairmed insoles as an adjunctive treatment for patients with Eichenholtz Stage III Charcot neuroarthropathy in our centre. Methods: This was a prospective observational study conducted in tertiary centre, Malaysia from September 2016 to September 2017. A total of ten patients with Stage III Charcot neuroarthropathic foot without ankle instability were included. All patients were evaluated for foot plantar pressure by using Tekscan, short form (SF-36) and American Orthopaedic Foot and Ankle Society(AOFAS) score before and after using insoles. Results: Fifteen out of twenty feet showed reduction in peak plantar pressure (PP) and force-time-integral (FTI) at forefoot and heel after using bilayer Lunairmed insoles. There was a mean reduction of 24.8% of total foot PP. Conclusion: Locally designed bilayer Lunairmed insoles could be used to reduce PP in Eichenholtz Stage III Charcot neuroarthropathic foot without ankle instability. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis can be defined as inflammation at the insertion of plantar fascia and is thought most commonly due to overuse injury. It usually presents as sharp shooting heel pain which is worse in the morning. The location of pain is usually plantar surface of the foot and pain may radiate proximally in long standing and severe cases. In mild cases of plantar fasciitis non steroidal anti-inflammatory drugs and activity modification may be sufficient. Severe cases may require interventions such as night splints and orthotic devices which works by reducing loading of plantar fascia. Recently local injection of autologous platelet rich plasma is used by many researchers with promising results. Aims and Objectives: This prospective cohort study was undertaken to analyze the functional and clinical outcome in patients with plantar fasciitis who were treated by autologous injection of platelet rich plasma. Materials and Methods: This was a prospective cohort study conducted in department of orthopedics of a tertiary care medical college located in an urban area. The patients diagnosed to be having plantar fasciitis were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were assessed for severity of pain by the Visual Analogue Score for pain and American orthopedic foot and ankle score (AOFAS). A VAS score of 0-3 was taken as pain relief and VAS score of 4-10 was considered as no pain relief. Whereas AOFAS scores of 90-100, 80-89, 60-79 and less than 60 were taken as excellent, good, fair and poor outcome respectively. All patients were treated by local injection of autologous platelet rich plasma. The patients were followed up at 4 weeks, 8 weeks and 12 weeks. During follow up visits the pain relief was assessed by VAS and AOFAS scores. For statistical purposed SSPS 21.0 software was used and p value less than 0.05 was taken as statistically significant. Results: A total of 60 patients were included in this study out of which there were 22 (36.67%) males and 38 (63.33%) females with a M:F ratio of 1:1.72. The most common affected age group was between the age of 41-50 years (35%) followed by 51-60 years (21.67%) and 31-40 years (20%). Twenty-seven (45%) patients were either overweight or obese. A statistically significant reduction in pain was documented at the time of follow up of 4 weeks. At the end of 12 weeks 58 (96.67%) patients experienced significant pain relief and only 2 (3.33%) patients had significant pain. Also, there was statistically significant difference between AOFAS scores at the time of presentation and at 4 weeks, 8 weeks and 12 weeks follow up visits. Conclusion: Injection of autologous platelet rich plasma for chronic plantar fasciitis is found to have promising results in terms of pain relief (reduced VAS score) and functional outcome (Improvement in AOFAS score). [ABSTRACT FROM AUTHOR]

Background: Endolog is an intra-medullary titanium device used for a minimally-invasive hallux valgus correction. The aim of this study was to evaluate clinical and radiographic outcomes of this device.Methods: A retrospective study with a prospective data collection was conducted. Patients underwent to Endolog procedures from September 2009 to April 2017 were enrolled. Mild HV deformity (HVA ≤ 19° and IMA ≤ 13°) or associated procedure to Endolog technique were excluded. The radiological (HVA, IMA and PASA) and clinical (AOFAS score) pre and post-operative data were compared through Wilcoxon Signed-Rank test.Results: 194 feet (144 moderate and 50 severe HV) underwent HV correction respecting study's criteria. AOFAS scores significantly improved from 31.0 ± 12.7 points preoperatively to 88.5 ± 8.0 at 24 months. Even all radiographic measurements significantly improved during 2 years' follow-up. Only 6 patients experienced complications: 4 cases of HV recurrence and 2 cases of intolerance device-related pain.Conclusions: Endolog technique proved to be a valid option in the moderate-to-severe hallux valgus treatment, comparable to other surgical techniques described in literature. [ABSTRACT FROM AUTHOR]

Congenital vertical talus foot is a complex deformity, characterized by a dislocation of the talus-calcanear navicular joint. It is a rare form of congenital flat foot, where the hindfoot is valgus and equine, the midfoot dorsiflexed and the forefoot abducted. Regardless of the type of classification, the therapeutic approach and prognosis must take into account the functionality and motility of the foot. Initial treatment is manipulative. After 3 months of age, it is possible to think about soft tissue surgery. In this study, we present congenital vertical talus feet treated at the Pediatric Orthopedics Department of SS. Antonio Biagio and Cesare Arrigo Children's Hospital of Alessandria from 1995 to 2022. All 8 patients (12 feet) underwent through the surgical operation technique of open reduction described by Tachdjian and further reviewed and subjected to the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. The mean follow up is 13 years. Global functional result was good and surgery allowed the growth of the foot, which would otherwise be blocked by an ax that is the vertical talus. Questioned remotely, all patients perform sporting activities and wear normal footwear. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The current imaging standard for diagnosing plantar fasciitis is B-Mode ultrasound (B-US). The aim of this study was to determine the diagnostic potential of Shear Wave Elastography (SWE) and the correlation of clinical scores to elastographic parameters.Materials and Methods: Diagnostic case-control study with n = 82 plantar fascia (PF). PF were divided into three subgroups: (1) symptomatic PF (n = 39); (2) control group of unilateral asymptomatic PF (n = 23); (3) bilateral asymptomatic PF (n = 20). Reference standard for positive findings in B-US was a PF thickness greater than 4 mm. For SWE tissue elasticity (Young's modulus kPa; shear wave speed m/s) was measured at Location 1: directly at the calcaneus; Location 2: +1 cm distal of the calcaneus and Location 3: central part of the calcaneus. Sensitivity, specificity, and diagnostic accuracy as well as correlation to American Orthopaedic Foot and Ankle Score (AOFAS) and Food Functional Index (FFI) were determined.Results: Symptomatic PF are thicker (4.2 mm, n = 39) than asymptomatic (3.0 mm, n = 43) (p < 0.001). Thickness of the PF (n = 82) correlated poorly to clinical scores (p = 0.001): FFI-pain (r = 0.349); FFI-function (r = 0.381); AOFAS (r = -0.387). Cut-off point for positive SWE finding was 51.5 kPa (4.14 m/s). Symptomatic PF (31.9 kPa, 3.26 m/s, n = 39) differ significantly from asymptomatic PF (93.3 kPa, 5.58 m/s, n = 43) with significant differences at L1 between all groups (p < 0.001). Correlation between Young's modulus (n = 82) and clinical scores was strong (p < 0.001): FFI-pain (r = -0.595); FFI-function (r = -0.567); AOFAS (r = 0.623,). B-US: sensitivity (61%), specificity (95%); SWE sensitivity (85%), specificity (83%). The combination of SWE and B-US increases the sensitivity (100%) with a diagnostic accuracy of 90%.Conclusion: Based on our results, we could show that SWE can improve the diagnostic accuracy in patients with plantar fasciitis compared to B-US.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Background: End-stage ankle arthritis impairs joint function and patients' mobility. Total ankle replacement is a surgical procedure to treat severe ankle arthritis. Salto Talaris Anatomic AnkleTM (STAA) was designed to mimic the normal ankle anatomy and flexion/extension of the ankle movement. The purpose of this study was to examine the effect of an STAA ankle replacement on ankle joint function and mechanics during gait. Methods: Five patients with end-stage unilateral ankle arthritis were recruited. Patients performed level walking in a laboratory setting on 2 occasions, prior to and 3 months after the STAA ankle surgeries. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score was obtained. A 12-camera motion capture system was used to perform walking analysis. Gait temporo-spatial parameters and ankle joint mechanics were evaluated. Paired Student's t tests and non-parametric Wilcoxon matched tests were performed to examine the differences in biomechanical variables between the pre- and post-surgery walking conditions. Results: Compared to the pre-surgical condition, at 3 months of post-STAA surgery, patients experienced greater improvement in AOFAS hindfoot score (p = 0.0001); the STAA ankle demonstrated a 31% increase in ankle joint excursion (p = 0.045), a 22% increase in ankle plantarflexor moment (p = 0.075), a 60% increase in ankle power absorption (p = 0.023), and a 68% increase in ankle power production (p = 0.039). Patients also demonstrated a 26% increase in walking speed (p = 0.005), a 20% increase in stride length (p = 0.013), a 15% decrease in double support time (p = 0.043), and a 5% decrease in total stance time (p = 0.055). Conclusion: Three months after surgeries, the STAA patients experienced improvements in ankle function and gait parameters. The STAA ankle demonstrated improved ankle mechanics during daily activities such as walking.

Surgical treatment of displaced intra-articular calcaneal fractures using a standard extended lateral approach for plate fixation is frequently associated with substantial wound healing complications and infections. This matched pairs analysis compares the new minimally-invasive calcaneal interlocking nailing technique to standard locking plate fixation in terms of reduction capacity, complication rates, and functional outcomes. Forty feet in 38 patients (mean patient age 52.5 years, range 27–78) were treated with calcaneal locking nail (LN)(n = 20) or locking plate (LP)(n = 20) and followed clinically and radiologically for 20 months. Follow-up included radiological assessments and functional evaluations including the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Foot Function Index (R-FFI). Times for surgery were similar for both techniques (LN 93 min, range 34 to 175 vs. LP 101 min, range 53 to 305). Length of hospital stay was significantly lower in the LN group (7.6 days, range 3 to 14 vs. LP 11 days, range 6 to 37). Time away from work was shorter by 3.5 days in LN group. LP group had superior range of motion in plantarflexion, eversion, and inversion at follow-up, while LP patients were superior in demonstrating a secure heelstrike (79% vs. LN 58%) and fewer needed permanent walking aids. AOFAS and FFI scores revealed no differences for both groups. Radiographs indicated an adequate reconstruction in both groups, followed by a slight loss of reduction at follow-up (LP 4.7° postoperative vs. follow-up; LN 5.1°). The overall complication rate between groups was significant with 5% complications in the LN group vs. 50% in the LP group (5% deep infection, 35% impaired wound healing, 5% hardware breakage, 5% superficial wound infection; LN: 5% superficial wound infection). The new calcaneal interlocking nail shows promising results in terms of reduction capacity and safety. Use of the minimally invasive locking nail technique minimized the risk of postoperative wound complications and achieved superior functional outcomes compared with standard locking plate fixation via the extended lateral approach. [ABSTRACT FROM AUTHOR]

• Outcomes of current distal surgical techniques to treat moderate onwards hallux valgus are far from optimal. • A new surgical procedure is needed to improve results, increase patient satisfaction and lower complication or recurrence rate. • A reproducible surgical alternative called minimally extended distal chevron osteotomy (MEDCO) along with a percutaneous soft tissue release (PSTR) is presented. • The results of this new set of techniques and procedure are explained in detail. • The findings of this study indicate that the technique exceeds the efficacy of previous procedures to date, avoiding also the complication risk of more aggressive current techniques. • This procedure is also a good alternative to diaphyseal or proximal techniques in moderate or severe hallux valgus. Surgical treatment of moderate hallux valgus (HV) onwards by Chevron osteotomy and all variants described to date including the recent extended distal Chevron osteotomy (EDCO), yields improvable outcome but with recurrence rate. A new modification of this technique is needed to achieve better results. 34 consecutive female patients suffering from moderate HV underwent a new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR). Outcome was assessed using pre-post operative VAS-Pain, AOFAS Hallux Score and radiological measurements. Mean age was 53.7 years, follow-up 2.7 years and satisfaction score 8. VAS improved from 7 to 1 (p < 0.001) and AOFAS score from 64 to 90.7 (p < 0.001). Comparing postoperative HV and intermetatarsal (IM) angles of previous studies (either employing a Chevron osteotomy alone or a double Chevron-Akin) with our results, an improvement from 15.6/14.8 to 9.1 and 8.2 /8.8 to 5.6 respectively (p < 0.05) was achieved. Complication and recurrence rates were both 5.8%, lower than the documented rates of other techniques. The modified technique in the present study was found to be a more effective and reliable method of correcting hallux valgus when compared to other previous procedures. It provides a higher level of satisfaction and excellent outcomes with low complication and recurrence rates. Furthermore, the percutaneous lateral incision improved the cosmetic results by avoiding formation of a dorsal first web space scar. Medial incision is also shorter than the one used for EDCO. Level IV, case series. [ABSTRACT FROM AUTHOR]

Introduction The purpose of this study was to evaluate the management of distal tibial fractures treated by interlocking nail and plate osteosynthesis and to assess their functional outcome according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and complications. Methods Twenty patients were operated on in each group, i.e., intramedullary nailing (IMN) and plating (minimally invasive plate osteosynthesis, MIPO). The patients were regularly followed up at six weeks, 12 weeks, six months, and one year and evaluated clinically and radiologically with respect to operating time, union time, and functional outcome on the basis of AOFAS score and complications. Results The mean union time for the IMN group was 18.45±2.45 weeks and for the MIPO group was 20±3.21 weeks (p-value >0.05). The mean AOFAS score in the MIPO group was 91.2±6.81 and in the IMN group was 92.6±5.41 (p-value >0.05). Lesser complications in terms of implant irritation, ankle stiffness, and infection were observed in the IMN group than in the MIPO group (p-value <0.05). Conclusion Both the IMN and MIPO groups had satisfactory outcomes for treating distal tibial fractures, with a higher risk of wound complications in the MIPO group., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Nath et al.)

Background: The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scoring System (AOFAS-AH) has not been validated and has significant risk for researcher bias, given that 40 out of 100 points are assessed by study staff subjectively. The purpose of this study is to evaluate its recent use in the orthopaedic literature to determine the percentage of previously published studies for which study conclusions would be changed if the AOFAS-AH scores were artificially altered, representing the effect of a systematic researcher bias.Materials and Methods: Articles from January 2012 and February 2015 in three orthopaedic journals were queried for use of the AOFAS-AH. Quantities of 4, 8, or 12 points were added to or subtracted from mean AOFAS-AH scores for each study while otherwise maintaining the reported standard deviation to simulate a researcher bias when scoring the subjective sections. Statistical analysis was performed with the adjusted AOFAS-AH mean scores in order to elucidate a potential "reversal" in statistical significance and conclusion.Results: A 1582 original research articles were published during this time period. 128 articles utilized the AOFAS-AH score. 30 articles (23.4%) reported the required statistical data to permit manipulation of AOFAS-AH scores. Nine of the 30 articles (30%) had a reversal following a manipulation of 12 or fewer points. Seven (5.5%) reported the blinding status of the researchers.Conclusion: The potential for bias is high with the AOFAS-AH and its continued is questionable. Researchers utilizing the AOFAS-AH should at a minimum appropriately blind study staff and consider pre-study clarification of subjective terminology.Levels Of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

In the treatment of fracture-dislocations of the tarso-metatarsal joints, early accurate diagnosis combined with prompt anatomical reduction and stable internal fixation provides optimal results. Aims and Objectives: Open reduction and internal fixation has been recommended as the treatment for most unstableinjuries of the Lisfranc (tarso-metatarsal) joint. In many of cases Lisfranc injuries are diagnosed late or missed because of associated injuries and treated by other methods like cast application, closed reduction etc. and are associated with poor outcome. Material and Methods:We performed a retrospective study of patients who underwent open reduction and screw fixation or k wire fixation of a Lisfranc injury in a three-year period. Among 20 adults treated for that injury, they were followed for minimum of 5 years. 5 injuries were purely ligamentous, and 15 were combined ligamentous and osseous. Patient outcome was assessed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Results: The average AOFAS midfoot score was 79.8 points (on a scale of 0 to 100 points, with 100 points indicating an excellent outcome), with patients losing points for pain, decreased recreational function, and orthotic requirements. The major determinant of a good result was anatomical reduction (p = 0.05). Patients with purely ligamentous injury showed a trend toward poorer outcomes despite anatomical reduction and screw fixation/k-wire fixation. Conclusion: This study support the concept of stable anatomical reduction of Lisfranc fracture-dislocations leads to the best long-term outcomes as patients so treated have less arthritis as well as better AOFAS midfoot scores. [ABSTRACT FROM AUTHOR]

The modified Broström technique (MBT) is considered the reference standard for surgical management of ankle instability, with good short-term outcomes. However, limited evidence is available regarding outcomes for delayed presentations of instability. We report our outcomes for patients who underwent ligament repair using the MBT, from a single-surgeon retrospective study of consecutive patients. The minimum postoperative follow-up period was 6 months during a 5-year study period. The patients were retrospectively divided into 3 groups according to the delay in presentation: group 1, 6 months to 2 years; group 2, 2 to 4 years; and group 3, >4 years. We collected data on patient demographics, injury pattern, and intraoperative surgeon findings. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale (AHS) was used to evaluate patient outcomes and satisfaction with surgery. Twenty-six patients were treated with MBT. The mean follow-up period was 36.9 (range 6–42) months. Twenty-five (96.2%) patients had unilateral injuries, and 1 (3.85%) had bilateral repairs. Of the 26 patients, 21 (80.8%) completed the AOFAS-AHS, with a mean score of 87.4 (range 12 to 100). The mean interval from injury to surgery was 47.9 months. The results were excellent in 15 (71.4%), good in 3 (14.3%), fair in 1 (4.8%), and poor in 2 (9.5%) using the AOFAS-AHS. We found no significant difference in the overall AOFAS-AHS score or postoperative satisfaction among the groups ( p  > .05). All patients had a stable ankle joint at their final follow-up visit. In conclusion, patients with persistent or chronic ankle instability have good clinical outcomes and satisfaction after the MBT, irrespective of the time from injury to presentation. [ABSTRACT FROM AUTHOR]

The present prospective study examined the utility of the intraoperative tap test/technique for distal tibiofibular syndesmosis in the diagnosis of deltoid ligament rupture and compared the outcomes of transsyndesmotic fixation to deltoid ligament repair with suture anchor. This diagnostic technique was performed in 59 ankle fractures with suspected deltoid ligament injury. The width of the medial clear space of 59 cases was evaluated to assess the sensitivity and specificity. Those with deltoid ligament rupture were randomly assigned to 2 groups and treated with deltoid ligament repair with a suture anchor or with syndesmosis screw fixation. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, short-form 36-item questionnaire (SF-36), and visual analog scale (VAS). The tap test was positive in 53 cases. However, surgical exploration demonstrated that 51 cases (86.4%) had a combined deltoid ligament injury and fracture. The sensitivity and specificity of the tap test was 100.0% and 75.0%, respectively. Finally, 26 cases (96.3%) in the syndesmosis screw group and 22 (91.7%) in the deltoid repair group were followed up. No statistically significant differences were found in the AOFAS ankle-hindfoot scale score, SF-36 score, or VAS score between the 2 groups. The malreduction rate in the syndesmosis screw group was 34.6% and that in the deltoid repair group was 9.09%. The tap test is an intraoperative diagnostic method to use to evaluate for deltoid ligament injury. Deltoid ligament repair with a suture anchor had good functional and radiologic outcomes comparable to those with syndesmotic screw fixation but has a lower malreduction rate. We did not encounter the issue of internal fixation failure or implant removal. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the clinical and radiologic results of surgically treated isolated medial malleolar fractures and compare the clinical and radiologic results of the fixation methods of headless cannulated fully threaded compression screws and cancellous lag screws and tension band wiring. We included 32 patients who attended the final follow-up examination. Group 1 consisted of 11 patients (34.4%) treated with headless cannulated fully threaded compression screws. Group 2 consisted of 10 patients (31.2%) treated with cancellous lag screws. Group 3 consisted of 11 patients (34.4%) treated with Kirschner wires and intraosseous tension wiring. Standard ankle radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and visual analog scale for pain were assessed. No statistically significant differences were found among the groups in regard to age, gender, preoperative fracture type, follow-up time, radiologic bone union time, and baseline AOFAS scale scores. The interval to fracture healing was 2.2 ± 0.42 months in group 1, 2.5 ± 0.71 months in group 2, and 2.45 ± 0.52 months in group 3. The AOFAS ankle-hindfoot scale score was 96.73 ± 5.55 in group 1, 93.1 ± 5.43 in group 2, and 93.73 ± 5.52 in group 3. Hardware removal was not required in any patient in group 1 but was required in 2 patients (20%) in group 2 and 3 patients (27.3%) in group 3. The visual analog scale score for pain on palpation at the medial malleolus was significantly lower statistically in the headless compression screw group (group 1; p  = .003). [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the utility of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping in evaluation of type II osteochondral lesions (OCLs) of the talus and define cutoff values for identifying patients with good/poor clinical outcomes.Materials and Methods: 28 patients (mean age, 42.3 years) underwent T2 mapping and dGEMRIC at least 1.5 years (mean duration, 3.5 years) after microfracture (n = 12) or conservative (n = 16) treatment for type II OCL. Clinical outcomes were considered good with an American Orthopedic Foot and Ankle Society score ≥80. The T1 /T2 -values and indices of repair tissue (RT; cartilage above the OCL) were compared to those of the adjacent normal cartilage (NC) by region-of-interest analysis. The ability of the two methods to discriminate RT from NC was determined by area under the receiver operating characteristics curve (AUC) analysis. The Youden index was maximized for T1 /T2 measures for identifying cutoff values indicative of good/poor clinical outcomes.Results: Repair tissue exhibited lower dGEMRIC values (629.83 vs. 738.51 msec) and higher T2 values (62.07 vs. 40.69 msec) than NC (P < 0.001). T2 mapping exhibited greater AUC than dGEMRIC (0.88 vs. 0.69; P = 0.0398). All T1 measures exhibited higher maximized Youden indices than the corresponding T2 measures. The highest maximized Youden index for T1difference was observed at a cutoff value of 84 msec (sensitivity, 78%; specificity, 83%).Conclusion: While T2 mapping is superior to dGEMRIC in discriminating RT, the latter better identifies good/poor clinical outcomes in patients with type II talar OCL.Level Of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1601-1610. [ABSTRACT FROM AUTHOR]

Background End-stage ankle arthritis impairs joint function and patients' mobility. Total ankle replacement is a surgical procedure to treat severe ankle arthritis. Salto Talaris Anatomic Ankle TM (STAA) was designed to mimic the normal ankle anatomy and flexion/extension of the ankle movement. The purpose of this study was to examine the effect of an STAA ankle replacement on ankle joint function and mechanics during gait. Methods Five patients with end-stage unilateral ankle arthritis were recruited. Patients performed level walking in a laboratory setting on 2 occasions, prior to and 3 months after the STAA ankle surgeries. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score was obtained. A 12-camera motion capture system was used to perform walking analysis. Gait temporo-spatial parameters and ankle joint mechanics were evaluated. Paired Student's t tests and non-parametric Wilcoxon matched tests were performed to examine the differences in biomechanical variables between the pre- and post-surgery walking conditions. Results Compared to the pre-surgical condition, at 3 months of post-STAA surgery, patients experienced greater improvement in AOFAS hindfoot score ( p  = 0.0001); the STAA ankle demonstrated a 31% increase in ankle joint excursion ( p  = 0.045), a 22% increase in ankle plantarflexor moment ( p  = 0.075), a 60% increase in ankle power absorption ( p  = 0.023), and a 68% increase in ankle power production ( p  = 0.039). Patients also demonstrated a 26% increase in walking speed ( p  = 0.005), a 20% increase in stride length ( p  = 0.013), a 15% decrease in double support time ( p  = 0.043), and a 5% decrease in total stance time ( p  = 0.055). Conclusion Three months after surgeries, the STAA patients experienced improvements in ankle function and gait parameters. The STAA ankle demonstrated improved ankle mechanics during daily activities such as walking. [ABSTRACT FROM AUTHOR]

Percutaneous and minimally invasive open techniques for the treatment of calcaneal fractures are now frequently used with good results, although a comparison between these different techniques has not yet been performed. The aim of the present review was to search for studies evaluating the outcomes of patients after treatment with percutaneous and minimally invasive open techniques for calcaneal fractures. A search was performed using PubMed/MEDLINE, Embase, and the Cochrane Library. Studies from the previous 15 years in English were included. Data on the Sanders classification, operation technique, infection rate, American Orthopaedic Foot and Ankle Society ankle-hindfoot score, radiographic evaluation, and follow-up were extracted. The techniques were divided into 4 groups: minimally invasive open, percutaneous reduction and screw osteosynthesis, external fixation, and other. Forty-six studies were included, with 1776 patients and 2018 calcaneal fractures. Of the 2018 fractures, 924 (46%) were classified as Sanders II, 558 (28%) as Sanders III, and 245 (12%) as Sanders IV; the fractures of 291 patients(14%) were not classified or were classified as complete extra-articular. Of the 46 studies, 15 used a minimally invasive open technique, 19 evaluated the outcome of percutaneous reduction and screw osteosynthesis, 10 investigated the results of an external fixation system, and 2 studies used other operative techniques. The median infection rate was 3% (range 0% to 33%). The median American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 83 (range 67 to 94). The median angle of Böhler postoperatively was 24° (range 14° to 35°) and had increased after operative treatment, with a median of 16° (range 0° to 39°). The percutaneous reduction and screw osteosynthesis and minimal invasive open technique resulted in significantly better outcomes compared with external fixation and other techniques. In conclusion, percutaneous reduction and screw osteosynthesis and minimal invasive open techniques have the best outcomes for the minimal invasive open surgical treatment of calcaneal fractures. [ABSTRACT FROM AUTHOR]

Background: Hallux valgus is an increasingly common deformity in young female athletes that constricts their daily athletic activities and influences foot cosmesis. The aim of this study was to evaluate the outcome of modified Chevron osteotomy for hallux valgus deformity in this specific population.Methods: Forty-two cases of modified Chevron osteotomies were carried out in 33 patients with mild to moderate hallux valgus deformity. Each participant was evaluated for AOFAS score, pain, range of motion, cosmetic and radiological outcome.Results: Mean AOFAS score improved to 96.3 (p<0.001) while the mean range of motion of the metatarsophalangeal joint was maintained (p=0.138). The cosmetic result was excellent/good in 40 cases (95%). Mean metatarsophalangeal and intermetatarsal angles were decreased from 29.8° and 14.2° preoperatively to 12.2° and 8.1° postoperatively (p<0.001 and p<0.036), respectively.Conclusions: Modified Chevron osteotomy could offer substantial correction of hallux valgus deformity in young female athletes, with excellent clinical outcome. [ABSTRACT FROM AUTHOR]