Topics of interest in foot and ankle surgery are discussed in the new JBJS Guest Editorial What’s New in Foot and Ankle Surgery. Here, we highlight the 5 most compelling studies, as selected by coauthor Jared T. Scott, DO.
Forefoot
In a case series of 116 feet with moderate to severe hallux valgus, the outcomes following proximal chevron metatarsal osteotomy and Akin osteotomy were reported. Hallux alignment correction improved valgus angulation by 37.1%, 27%, and 44.5% in the second, third, and fourth toes, respectively. Patients with recurrent hallux valgus or metatarsal adductus had less correction1.
A retrospective review of 31 patients assessed the effectiveness of treating early-stage hallux rigidus with minimally invasive cheilectomy plus first metatarsophalangeal arthroscopy. Patients reported improved outcomes at 1 year and had low complication and revision rates2.
Ankle and Hindfoot
Physical function and pain following proximal medial gastrocnemius recession were retrospectively studied in 167 patients with recalcitrant plantar fasciitis. At 1 year postoperatively, significant improvements were observed in the mean scores for the Foot and Ankle Ability Measure-Activities of Daily Living scale and the Visual Analog Scale for pain3.
Tendon and Ligament Pathology
Nine randomized controlled trials (RCTs) that had reported equivalent rerupture rates between functional rehabilitation and surgery for the treatment of acute Achilles tendon ruptures were evaluated in a level I systematic review. The strength of neutrality with regard to rerupture rates between groups was assessed using the reverse fragility index (RFI). The operatively and nonoperatively treated groups had median rerupture rates of 4.0% and 10.0%, respectively4. The median RFI was 3, “meaning that an outcome reversal would be necessary in only 3 patients to change the results from nonsignificant to significant,” write Guest Editorial authors Dr. Scott et al.
Trauma
An RCT compared the functional outcomes of 157 patients who were randomized to either early motion and directed exercise (EMADE) or cast immobilization at 2 weeks after ankle fracture surgery. In both groups, weight-bearing was not permitted until 6 weeks postoperatively. At 12 weeks, the mean Olerud-Molander Ankle Score was significantly better in the EMADE group (62.0 vs. with 48.8; p < 0.001)5.
What’s New in Foot and Ankle Surgery is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org.
Recent OrthoBuzz posts include: What’s New in Sports Medicine, What’s New in Hand and Wrist Surgery, and What’s New in Pediatric Orthopaedics.
References
- Kang HJ, Lim JW, Im JM, Woo Y, Jung HG. Improvement of valgus deviation of the lesser toes of moderate to severe hallux valgus after proximal Chevron metatarsal osteotomy and Akin osteotomy. Foot Ankle Int. 2024 May;45(5):485-95.
- Gauthier C, Lewis T, O’Keefe J, Bakaes Y, Vignaraja V, Jackson JB 3rd, Franklin S, Kaplan J, Ray R, Gonzalez T. Minimally invasive dorsal cheilectomy and hallux metatarsophalangeal joint arthroscopy for the treatment of hallux rigidus. Foot Ankle Surg. 2024 Jul;30(5):400-5.
- Slullitel GA, Martinez de Albornoz P, Oller Boix A, Rey Cañas R, Vazquez Vidosa J, Monteagudo de la Rosa M. Proximal medial gastrocnemius recession for recalcitrant plantar fasciitis. Foot Ankle Int. 2024 Aug;45(8):833-8.
- Bragg JT, Ruelos VCB, McIntyre JA, Puzzitiello RN, Pagani NR, Menendez ME, Moverman MA, Salzler MJ. Reverse Fragility Index comparing rates of rerupture after open Achilles tendon repair versus early functional rehabilitation: a systematic review of randomized controlled trials. Am J Sports Med. 2024 Mar;52(4):1116-21.
- Matthews PA, Scammell BE, Coughlin TA, Nightingale J, Ollivere BJ. Early Motion and Directed Exercise (EMADE) following ankle fracture fixation: a pragmatic randomized controlled trial. Bone Joint J. 2024 Sep 1;106-B(9):949-56.
