Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes. Cite this article:
Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome.Aims
Methods
This study reports the outcomes of a technique of soft-tissue coverage and Chopart amputation for severe crush injuries of the forefoot. Between January 2012 to December 2016, 12 patients (nine male; three female, mean age 38.58 years; 26 to 55) with severe foot crush injury underwent treatment in our institute. All patients were followed-up for at least one year. Their medical records, imaging, visual analogue scale score, walking ability, complications, and functional outcomes one year postoperatively based on the American Orthopedic Foot and Ankle Society (AOFAS) and 36-Item Short-Form Health Survey (SF-36) scores were reviewed.Aims
Patients and Methods
The treatment of peri-prosthetic joint infection
(PJI) of the ankle is not standardised. It is not clear whether
an algorithm developed for hip and knee PJI can be used in the management
of PJI of the ankle. We evaluated the outcome, at two or more years
post-operatively, in 34 patients with PJI of the ankle, identified
from a cohort of 511 patients who had undergone total ankle replacement.
Their median age was 62.1 years (53.3 to 68.2), and 20 patients
were women. Infection was exogenous in 28 (82.4%) and haematogenous
in six (17.6%); 19 (55.9%) were acute infections and 15 (44.1%)
chronic. Staphylococci were the cause of 24 infections (70.6%).
Surgery with retention of one or both components was undertaken
in 21 patients (61.8%), both components were replaced in ten (29.4%),
and arthrodesis was undertaken in three (8.8%). An infection-free
outcome with satisfactory function of the ankle was obtained in
23 patients (67.6%). The best rate of cure followed the exchange
of both components (9/10, 90%). In the 21 patients in whom one or
both components were retained, four had a relapse of the same infecting organism
and three had an infection with another organism. Hence the rate
of cure was 66.7% (14 of 21). In these 21 patients, we compared
the treatment given to an algorithm developed for the treatment
of PJI of the knee and hip. In 17 (80.9%) patients, treatment was
not according to the algorithm. Most (11 of 17) had only one criterion against
retention of one or both components. In all, ten of 11 patients
with severe soft-tissue compromise as a single criterion had a relapse-free
survival. We propose that the treatment concept for PJI of the ankle
requires adaptation of the grading of quality of the soft tissues. Cite this article
Injuries to the foot in athletes are often subtle
and can lead to a substantial loss of function if not diagnosed
and treated appropriately. For these injuries in general, even after
a diagnosis is made, treatment options are controversial and become
even more so in high level athletes where limiting the time away
from training and competition is a significant consideration. In this review, we cover some of the common and important sporting
injuries affecting the foot including updates on their management
and outcomes. Cite this article:
