Introduction. Brachymetatarsia is a fairly rare pathology that is characterized by shortening of the metatarsal (or metatarsals) bones due to premature closure of the growth plate. However, most patients suffering from this pathology require surgical treatment. Purpose of the study: to improve the results of treatment of patients with brachymetatarisis by introducing into surgical practice the method of simultaneous lengthening of the metatarsal bone using an autograft from the tubular bones of the foot. Materials and methods. This article presents a comparison of treatment results between two groups of patients. The main group of patients (40 patients, 50 feet) underwent simultaneous lengthening of the shortened metatarsal bone using autografts from tubular bones of the foot. The control group of patients (25 patients, 33 feet) underwent distraction osteosynthesis of the metatarsal bone using an external fixation device. Results. The results obtained during the study suggest the advantage of the method of one-step lengthening of the metatarsal bone using autografts from tubular bones of the foot over the distraction method. Patients in the main group had a shorter healing period compared to the control group (8.1±1.3 and 16.2±2.4 weeks, respectively), and fewer complications. Also, patients of the main group in the early postoperative period noted a high cosmetic result of the operation. Conclusions. By using the developed method of surgical treatment, we were able to significantly reduce the treatment time for patients, as well as achieve high aesthetic results.

Background: Central metatarsal pressure is increased in patients with hallux valgus, but the pedographic outcomes after hallux valgus (HV) correction are inconclusive. No known literature reports the pedographic outcomes after HV correction with Minimally Invasive Chevron and Akin Osteotomy (MICA). Methods: A consecutive series of 31 feet from 25 patients with moderate-to-severe symptomatic HV without metatarsalgia underwent MICA and were prospectively evaluated using radiographic parameters and pedographic measurements (Footscan®, RSscan International, Olen, Belgium). Data were collected preoperatively and 3 months after surgery. Results: Radiographic parameters of hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, first metatarsal head lateral shape, and lateral sesamoid grade significantly improved after MICA. The corrected first metatarsal length was significantly shortened by 2.3 mm, with consistent second metatarsal protrusion distance, lateral Meary’s angle, and calcaneal pitch angle. Max force, max pressure, cumulative force, and cumulative pressure on the central metatarsals did not show significant changes between pre- and post-operative measurements, while these parameters significantly decreased in the hallux and first metatarsal area. Conclusion: MICA effectively corrects radiographic parameters but does not reduce central metatarsal loading in patients with moderate-to-severe HV without metatarsalgia.

Background: Minimally Invasive Chevron-Akin (MICA) hallux valgus (HV) deformity correction utilizes an extra-articular distal first metatarsal chevron osteotomy that is held with rigid fixation using two fully threaded screws, of which one is bicortical to provide stability. However, the necessity of two screws is debated, as is the necessity of bicortical fixation. Despite the clinical success of MICA, there is a lack of biomechanical studies assessing the stability and strength of different fixation constructs. Methods: A 3D foot finite element model was developed from computed tomography images of a female patient with moderate HV deformity. Five different screw configurations were assessed using FEA, including fourth-generation MICA fixation with 2 screws (one bicortical and one intramedullary), 2 intramedullary screws, 2 bicortical screws, 1 intramedullary screw, and 1 bicortical screw. Loading conditions involved a vertical ground reaction force applied to the midfoot, with simulated 150N and 300N loads. Stress analysis considered osteotomy displacement, maximum and minimum principal stresses, and equivalent von Mises stress for both implants and bone. Results: FEA indicated that MICA fixation with two screws (one bicortical and one intramedullary) demonstrated the lowest values for osteotomy displacement, minimum and maximum total stress, and equivalent von Mises stress on the bone and screws in both loading conditions. Conclusion: This biomechanical analysis provides valuable insights into the strength of different MICA screw fixation configurations, highlighting the superiority of classical MICA fixation configurations with two screws in terms of stability and stress distribution.

Objective: To investigate the impact of decompressive chevron osteotomy on subchondral bone density at the first MTP joint. Methods: Sixteen feet (12 patients) with hallux rigidus underwent decompressive chevron osteotomy. Pre- and post-operative standing cone beam 3DCT were assessed, and clinical data was collected. Radiologic measurements, including bone density using Hounsfield units (HU), were conducted. Statistical analyses were performed to evaluate changes and correlations. Results: Post-operative bone density significantly decreased in proximal (Pre, 650.9±149.1; Post, 312.4±115.9; p<0.001) and distal (Pre, 910.4±143.3; Post, 639.0±167.1; p<0.001) components of the first MTP (joint and the first TMT (Pre, 762.9±166.6; Post, 611.5±165.9; p=0.015) joint. No significant difference was measured at the TT joint (Pre, 497.5±143.6; Post, 534.3±130.7; p=0.463). Length of the first metatarsal (Pre, 60.4±3.4; Post, 54.3±3.0; p<0.001) and metatarsal protrusion index (MPI) (Pre, -0.9±3.0; Post, -9.0±3.6; p<0.001) significantly decreased post-operatively. Clinical assessments showed significant improvements in AOFAS scores (36.1±14.5 points) and pain on VAS scale (- 5.3±1.9). Conclusion: Decompressive chevron osteotomy leads to a significant decrease in subchondral bone density of the first MTP joint. A decrease in bone density occurs also in the first TMT joint.

Aims Ligamentous Lisfranc injuries often feature avulsion fractures of the tarso-metatarsal joint (TMTJ). A proportion of these will have a congruent TMTJ joint on initial imaging, and many of these patients will have an unstable TMTJ which requires stabilisation. The study aimed to determine the relationship between the presence of an avulsion fracture on initial imaging and instability of the first TMTJ. Methods A prospective database of Lisfranc fracture-dislocations was analysed for the presence of TMTJ1 avulsion fractures. All cases were managed with examination under anaesthesia (EUA) and stress testing under image intensification prior to fixation or arthrodesis surgery. The rate of TMTJ1 instability and the sensitivity and specificity of the presence of an avulsion in detecting instability was determined. Results 153 patients with a mean age of 35.2 years were included. 99 injuries (64.7%) had an avulsion fracture of TMTJ1 on imaging. Of these, 76.7% had a congruent joint on XR or CT scan. 91.9% of patients with an avulsion fracture demonstrated instability on EUA stress testing. Amongst the 54 cases showing no avulsion, 23 (42.6%) were unstable on EUA. The presence of an avulsion had a sensitivity of 79.8% and a specificity of 79.5% in the detection of instability. Conclusions The presence of an avulsion fracture of TMTJ1 is highly suggestive of instability. This finding should lower the threshold to perform EUA stress testing. A high proportion of Lisfranc injuries without avulsion fractures have TMTJ1 instability, and therefore the absence of this finding does not reliably exclude instability.

Aim: Compare the wound healing rate, cost, and convenience between Negative Pressure Wound Therapy (NPWT) and Copper Oxide Dressings (COD) in the management of diabetic foot wounds (DFW). Method: A Randomized controlled trial (RCT) with 46 DFW, in whom NPWT was indicated. Twenty-three patients were enrolled in the COD and NPWT arm for three months or wound closure. The primary endpoint was wound size reduction, assessed by "Tissue Analytic" program. Secondary endpoints were convenience, application time, pain, and cost. Results: The initial wound area was 19.9±4.36 and 14.1±2.32 cm2 in the COD and NPWT arms, respectively (p=0.25). Wound size reduction was statistically significant non-inferior of the COD Arm compared to the NPWT (p=0.04) and superior in the last visit (T-test, p=0.032). 11 (47.8%) and 8 (34.8%) wounds were closed during the study in the COD and NPWT arms respectively (P=0.37). COD therapy was more convenient for the patients (Visual Analog Score [VAS] was 8.44 vs. 5.33; p=0.002) and the medical personnel (8.29 vs. 6.0; p=0.007), and less painful (1.15 vs. 2.19; p=0.67) in the COD arm compared to NPWT. The COD's mean application time was shorter (8.5 vs. 13.25 minutes; p<0.001). The cost of COD is estimated to be 84% less than NPWT treatment. Conclusion: This RCT study indicates statistically significant non-inferiority of COD dressing therapy than NPWT in terms of wound healing rate of DFW. Better convenience and reduced costs in the COD arm justify initial copper dressing attempts in patients with diabetic foot wounds before NPWT treatment.

Introduction: Middle facet subluxation (MFS) and middle facet incongruence angle (MFIA) are commonly reported as marker of peritalar subluxation (PTS) in Progressive Collapsing Foot Deformity (PCFD). In the literature MFS and MFIA are assessed a true coronal plane which differs from the plane of the middle facet. We hypothesized that changes in the plane’s of measurement would lead to changes in the MFS and MFIA and as well its “dysplastic” appearance. Method: retrospective case-control study, 89 patients with PCFD and 11 controls. Measurements of MFS, MFIA, and middle facet dysplasia were conducted using both the classical method (taking measurements in the coronal plane as described in the literature) and the new method ( taking measurements after rotation of the coronal plane until it was perpendicular to the middle facet plane). A p-value of <0.05 was considered statistically significant. Results: Significant differences were observed between the two methods across all parameters, the new method demonstrated lower MFS (25.4% vs. 40.3%, p<0.0001), lower MFIA (4.7 degrees vs. 13.1 degrees, p<0.0001), and fewer dysplastic joints (1% vs. 37%, p<0.0001) For controls, only the MFIA was significantly different (p:0.0045) between methods. Conclusion: MFS is a complex deformity influenced by multiple parameters. The new method showed lower MFS, MFIA, and dysplasia measurements compared to current classical method. When assessing MFS, surgeons should be mindful that the plane of measurement relative to the structure is critical. We suggest using a plane of measurement perpendicular to the plane of the middle facet when assessing its subluxation.

Background: While many studies were able to determine the hind- and midfoot alignment after a medializing calcaneal osteotomy (MCO), the subtalar joint alignment remained obscured by superposition on plain radiography. Therefore, we aimed to assess the hind-, midfoot- and subtalar joint alignment pre- compared to post-operatively using 3D weightbearing CT (WBCT). Methods: Seventeen patients with a mean age of 42±17 years were retrospectively analyzed. Inclusion criteria consisted of PCFD deformity corrected by a MCO as main procedure and imaged by WBCT before and after surgery. Exclusion criteria were patients who had concomitant calcaneal lengthening osteotomies, mid-/hindfoot fusions, hindfoot coalitions, and supramalleolar procedures. Image data were used to generate 3D models and compute the hindfoot (HA), midfoot (MA) - and subtalar joint (STJ) alignment in the coronal, sagittal and axial plane, as well as distance maps. Results: Pre-operative measurements of the HA and MA improved significantly relative to their post-operative equivalents p<0.05). The post-operative STJ alignment showed significant inversion (2.8°±1.7), abduction (1.5°±1.8), and dorsiflexion (2.3°±1.7) of the talus relative to the calcaneus (p<0.05) compared to the pre-operative alignment. The displacement between the talus and calcaneus relative to the sinus tarsi increased significantly (0.6 mm±0.5;p<0.05). Conclusion: This study detected significant changes in the sagittal, coronal, and axial plane alignment of the subtalar joint, which corresponded to a decompression of the sinus tarsi. These findings contribute to our clinical practice by demonstrating the magnitude of alteration in the subtalar joint alignment that can be expected after PCFD correction with MCO as main procedure.

Introduction: This study aims to evaluate differences with Weight-Bearing CT (WBCT) among a cohort of symptomatic Progressive Collapsing Foot Deformity (PCFD) patients with a history of pediatric flat foot (=pediatric PCFD), without (=non-pediatric PCFD), and a control group. We hypothesized that pediatric PCFD would display distinct WBCT parameters. Method: In this retrospective case-control study, pediatric PCFD was defined as flat feet since childhood, non-pediatric PCFD as foot shape changed in adulthood. 37 pediatric PCFD patients were compared to 52 non-pediatric PCFD patients and 11 control. Significance was set at a p-value < 0.05. A multivariate regression analysis was conducted to identify parameters associated with pediatric PCFD. Results: Compared to non-pediatric PCFD, the pediatric PCFD group showed a lower Foot and Ankle Offset (p<0.001), lower sagittal talus-first metatarsal angle (TFM) (p<0.001), lower axial TFM (p 0.0001), lower hindfoot moment arm (HMA)(p=0.0002), lower talonavicular uncoverage (p<0.0001), lower middle facet subluxation (p=0.0021), higher sinus tarsi (p<0.001), higher subfibular impingement (p<0.0001. Differences between the pediatric and control groups in (HMA) (p=0.053) and SF (p=0.07) were not statistically significant. When considering only WBCT parameters, multivariate regression analysis indicated that axial TFM (p:0.005), MFS (p:0.013), and ST (p:0.03) were the best predictors of pediatric PCFD. (R2 : 0.27). Conclusion: Pediatric PCFD is characterized by distinct WBCT parameters compared to non-pediatric PCFD, notably exhibiting less forefoot abduction, less middle facet subluxation a lower FAO and a hindfoot alignment closer to that of the control group. TFM, MFS, and ST stand out as parameters associated with pediatric PCFD.

Introduction Higher body mass index (BMI) levels can increase the risk of complications and poor outcomes following surgical interventions for various orthopaedic conditions, including insertional Achilles tendinopathy (IAT). However, the exact impact of BMI on postoperative outcomes for IAT is still unclear and warrants further investigation. Methods Prospectively collected registry data of 75 patients who underwent surgery for unilateral IAT were reviewed. Patients were separated into 2 groups based on BMI: normal (<30 kg/m2) and obese (≥30 kg/m2). Clinical assessment at preoperative, 6-month and 2-year follow-up was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) physical (PCS) and mental (MCS) component summary scores, as well as assessment of postoperative satisfaction. Results There were 47 patients in the normal BMI and 28 patients in the obese group. Both groups showed significant improvement in AOFAS score, VAS score, SF-36 PCS and MCS at 6 months and 2 years postoperatively. However, there were no significant differences in these scores between the two groups and both groups achieved similar final postoperative scores at 2 years. Wound complications were more common in obese (n = 2, 7.1%) compared to normal BMI (n = 1, 2.1%) patients, but did not reach statistical significance (p =.284). Postoperative satisfaction (p = .394) were also similar between the two groups. Conclusion Obese patients undergoing surgery for IAT can achieve similar outcomes as those with normal BMI without the increased risk of complications.

INTRODUCTION Gastrocnemius-soleus complex (GSC) tightness leads to functional pseudoequinism in the gait cycle, which translates into increased forefoot pressure. One of the most used tests to diagnose it is the Silfverskiöld test. We propose a different test to objectively evaluate the GSC shortening: In a standing position, a goniometer is used to evaluate ankle dorsiflexion. OBJECTIVES The main objective is to compare the reliability of the Silfverskiöld test versus the standing test. MATERIALS AND METHODS A cross-sectional observational study was conducted with 2 independent observers. The Silfverskiöld test was performed with goniometric measurement. Then, in standing position with both feet parallel facing forward, patients move one leg backwards with the knee fully-extended, progressively bending the knee placed in front. When discomfort appears in the calf region, a goniometric measurement is performed. Next, patients bend the knee placed backwards and same measurement is taken maintaining the heel touching the floor. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) Two-way-Random-effects, mean of 2 raters, Absolute agreement (ICC2k) statistical test. RESULTS We performed 50 measurements for each test. Higher ICC was observed in the standing test (ICC=0.75) than Silfverskiöld test (ICC=0.68), making it more reliable (p<0,001). Normal dorsiflexion values in standing test ranged from 110,49º with knee extension to 119,85º with knee flexion. Patients with positive Silfverkiöld test, increased 13º in ankle dorsiflexion with standing test. CONCLUSION The standing position test could be a reliable alternative to the Silfverskiöld test in the diagnosis of GSC tightness, but more studies are needed.

Background We aimed to investigate the effect of Haglund’s deformity size on insertional Achilles tendinopathy (IAT) using a new measurement system and identify independent risk factors of IAT with Haglund’s deformity. Methods We reviewed medical records of patients with IAT and age/sex-matched patients with diagnoses other than Achilles tendinopathy. Radiographs were reviewed to identify posterior/plantar heel spur, and intra-Achilles tendon calcification, and to measure Fowler-Philip angle, calcaneal-pitch angle, and Haglund’s deformity angle/height. Multivariate logistic regression analysis was performed to identify independent risk factors of IAT with Haglund’s deformity. Results 50 patients were enrolled in the study group, equaling the size of the age/sex-matched control group. Our new Haglund’s deformity measurement system showed excellent intraobserver /interobserver reliability. No significant differences between the two groups were noted in Haglund’s deformity angle and height: 6.0° in both groups, and 3.3mm Vs.3.2mm in the study and control group, respectively. The study group had significantly higher calcaneal pitch angle, incidence of posterior heel spur, plantar heel spur, and intra-Achilles tendon calcification: 5.2° Vs.23.1°(P=.044); 81.8% Vs.36.4%(P<.001); 76.4% Vs.34.5%(P=.003); 67.3% Vs.5.5%(P<.001), respectively. Multivariate logistic regression analysis identified independent risk factors of IAT: posterior heel spur(OR=3.650), intra-Achilles tendon calcification(OR=55.671) and increased calcaneal pitch angle(OR=6.317). Conclusion Based on our results, the Haglund’s deformity size was not associated with IAT, suggesting a routine Haglund’s deformity resection may be unnecessary in the surgical treatment of IAT. If patients with Haglund’s deformity have posterior heel spur, intra-Achilles tendon calcification, or increased calcaneal pitch angle, a higher chance of IAT can be predicted.