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The ability to return to physical activity is an important indicator of surgical success for end-stage ankle arthritis. There is paucity of literature comparing outcomes between surgical procedures. This study aimed to compare outcomes for physical activity and return to function between total ankle replacement (TAR) and ankle arthrodesis (AA) at 1-year follow-up. This was a single-centre prospective follow-up study. Patients who underwent TAR (n=33) or AA (n=25) between 2022–2023 completed questionnaires on FAOS scores (Pain, Symptoms, ADL and QOL domains), International Physical Activity Questionnaire (IPAQ), satisfaction scores and return to work/driving. IPAQ physical activities were compared across domains of work, transportation, domestic and leisure activities.Background
Methods
Acute Achilles Tendon Ruptures (ATR) cause lasting muscular deficits and impair function and quality of life. This study aimed to understand recovery post rupture by examining tendon structure using ultrasound tissue characterisation (UTC), isometric plantarflexor strength, physical activity and patient reported outcomes (PROM). Cross-sectional study design consisting of 90 participants. Data were collected from 15 participants at six different rehabilitation timepoints (0, 8, 10 weeks, 4, 6, 12 months). Participants were recruited from a National Health Service clinic using non-surgical management.Introduction
Methods
The number of total ankle replacements (TAR) is increasing each year and with that an associated rise in the burden of revision ankle arthroplasty (RAA). The preferred option in our center, following network discussion, is to convert the failing TAR to a RAA. There is uncertainty whether this is best done in a single staged approach or two stages. The aim of this review was to assess the safety of single to two staged approaches in RAA A review was carried out of the prospectively collected data of all RAA performed in our center between Nov 2016 and Jan 2024. We reviewed; preoperative micro sampling, intraop micro and histology results, infection rate, tourniquet time, length of hospital stay, wound complications and PROMS of all patients who had undergone single staged RAA, compared to two staged.Background
Method
Definitive treatment for ankle arthritis is either Total Ankle Replacement (TAR) or Ankle Fusion (AF). AF may pre-dispose to hindfoot fusion resulting in a debilitatingly rigid ankle-hindfoot complex. In comparison, TAR may protect against adjacent joint disease but is associated with high revision rates. We do not know the life-time risks of further surgery, adjacent joint disease progression and rare but serious complications of TAR versus AF. An England population cohort study was performed using the ONS mortality linked Hospital Episode Statistics database (1998–2023). The primary outcome was Kaplan-Meier curve analysis of revision surgery free survival of TAR versus AF. Secondary outcome measures were the rates of any re-operation to the ankle/hindfoot, including hindfoot fusion rate, 90-day complications, and peri-operative mortality.Introduction
Methods
Diabetic midfoot Charcot neuroarthropathy (CN) is a progressive condition which presents as a hot swollen foot to a rocker bottom deformity with ulcer and resultant osteomyelitis. Literature report of a subjective indications for surgery generally after a failed prolonged immobilization in a total contact cast. The aim of this study is to define objective indications of progression of midfoot CN and interventions at each stage of the disease. Notes and radiographs of consecutive patients presented to Basildon Diabetic foot unit since 2018 with midfoot CN were reviewed. Inclusion criteria were all patients with midfoot CN and were followed for a minimum 12 months with radiographs. Exclusion criteria were patients lost to follow before 12 months or where inadequate radiographs were available. Patients with ankle/ subtalar Charcot were excluded.Introduction
Patients and Methods
Acute Achilles tendon ruptures can be a devastating injury with a prolonged recovery period (1). Following the UKSTAR trial, Achilles tendon ruptures are predominately treated with a functional rehabilitation bracing program (2). The aim of treatment is to avoid lengthening of the tendon, and hence the resultant loss of function. The Achilles tendon resting angle (ARTA) provides a simple assessment of tendon length that can be performed in the clinical setting (3). This study assesses the Achilles tendon resting angle over a 52-week period and the correlation with functional outcome. A total of 182 consecutive patients with an acute Achilles tendon rupture were treated with a 10-week functional rehabilitation regime. The relative Achilles tendon resting angle was recorded as the difference between the limbs at the time of injury, then once treatment commenced at 4-, 11-, 26- and 52-weeks post injury. Patients with a previous Achilles rupture of the contralateral leg were excluded. The functional outcome was assessed using the Achilles tendon rupture score at 26- and 52-weeks post injury.Background
Methods
Fourth-generation percutaneous or minimally invasive hallux valgus surgery utilizes a transverse osteotomy to achieve deformity correction. There are only a small number of series reporting the clinical and radiological outcomes of transverse osteotomies, many of which have methodological limitations such as small sample size, limited radiographic follow up or use of non-validated outcome measures. The aim of this study was to provide a methodological robust investigation into percutaneous transverse osteotomies for hallux valgus deformity. A prospective series of consecutive patients undergoing fourth generation metatarsal extra-capsular transverse osteotomy (META) performed by a single surgeon (PL) between November 2017 and January 2023. The primary outcomes were radiographic deformity correction and clinical foot function assessed using the Manchester-Oxford Foot questionnaire (MOXFQ). Radiographic deformity (Hallux valgus angle (HVA) and intermetatarsal angle (IMA), sesamoid position) was assessed according to AOFAS guidelines. Secondary outcomes included Visual Analogue Scale for Pain and radiographic deformity recurrence (defined as HVA >20° at final radiographic follow up).Background
Method
Medial wall blowout (MWB) ankle fractures have not previously been described in the literature. Our aim in this study was to analyse the morphology of medial wall blowout fractures and their radiological outcomes. The MWB fracture fragments were characterised into four groups. A type 1A fracture was described as an anteromedial column fragmentation. Type 1B fractures consisted of posteromedial column fragmentation. Type 2 fracture consisted of both column wall fragmentation and type 3, any medial wall fragmentation with medial joint impaction.Background
Methods
Freibergs infraction is osteonecrosis of lesser metatarsal heads, most commonly affecting adolescent females. They usually present with pain and swelling of the forefoot. Surgical options include open debridement, cheilectomy, micro fracture osteotomy and excision arthroplasty. The aim of the study is to present the results of our surgical method based on the principle of neo-angiogenesis, neo-osteogenesis and neo-chondrogenesis with bone grafting and AMIC membrane application for Freiberg's disease of lesser metatarsals. A prospective analysis of twelve patients who had Freiberg's infraction of the lesser toe metatarsals treated with open debridement, microfracture, bone grafting and application of AMIC membrane was carried out. The patients were followed up to seven years and the outcome measures were scored using Smillie's classification, radiological findings and the Manchester-Oxford Foot Questionnaire (MOxFQ).Background
Methods
The treatment of critical-sized bone defects in foot and ankle surgery remains challenging. Traditional methods, such as bone transport, bulk allograft, vascularized bone graft, and Masquelet procedures carry risks including multiple surgeries, donor site morbidity, infection, and non-union. Recently, custom 3D-printed implants have emerged, offering improved anatomical compatibility, eliminating the need for tissue harvesting, and often requiring only a single operation. This study aims to present the largest UK series of custom 3D-printed implants in foot and ankle surgery. A retrospective multicentre collaborative study was conducted in 10 NHS Trusts. Demographic, surgical and radiographic variables were recorded including: age; sex; side; type of operation; complications; and postop imaging at 6 weeks, 3 months, 6 months and 12 months. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages.Introduction
Methods
The aim was to demonstrate that Supramalleolar osteotomy is a valuable treatment method in eccentric ankle arthritis in young and middle aged since it is an under-utilised procedure. We retrospectively analysed the outcome of it performed over 12 year period. We also compared the results of recently introduced computer-assisted PSI Integrated custom-made implants with standard implants. Data was analysed from 48 patients over a period of 12 years of which 40 were by standard implant and 8 by computer assisted custom implant. 31 varus, 18 valgus deformity. The mean age was 57 (26–79 y/o), male:female ratio was 27:19. Mean follow-up was 15.25 months for standard implants; For the computer-assisted procedures the follow up range is 24 to 2 months. TAS, TTS and TT angels were measured pre and post-operatively. Fixation using a plate with/without bone graft or custom-made implant was performed by a single surgeon. MOXFQ and AOFAS questionnaires were completed pre and post-operatively. All followed similar rehabilitation programme. Average radiological healing time was 24.3 weeks. MOXFQ score improved from 55.17 to 25.11 and AOFAS from 20.16 to 56.21. Complications were 2 non-unions, 1 delayed union, 1 stress fracture. 8 patients require fusion/replacement between 3–5 years. The PSI Integrated computer-assisted technique gave improved accuracy than standard freehand method with better scores and a smoother approach for the surgeon. Early results with this technique are encouraging as we were able achieve 3 dimentional correction compared to the 2 dimentional correction achieved by the freehand method. Our results are comparable to similar studies. Being a joint preserving technique, Supra Malleolar Osteotomy should be considered either as an interim or definitive procedure especially with the development of computer assisted technologies which makes the technique easier to reproduce.
Osteochondral lesions of the talus (OLTs) are common pathologies, associated to chronic pain and disability. Currently, there is no agreed gold standard for surgical treatment of OLTs, due to lack of superiority trials. Aim: Compare the post operative outcomes of osteochondral autologous transplantation (OATS) and matrix associated stem cell transplantation (MAST), as primary and revision procedures Methods: Prospective study of OATS and MAST from 2013 to 2023, in a single surgeons practice Primary study outcome: rate of revision. Secondary outcomes: PROMS (VAS and FAOS), complications and return to sports. Data collected via chart, radiological review, and telephonic survey. Inclusion criteria: aged 16 years and above; OLTs greater than 10mm2, Primary and Revision. Exclusion criteria: Unable to/Refused consent (N=1), Rheumatological joint disease (N=1). Degenerative joint. Lost to follow up. Statistical analysis with Chi-squared test, Fischers exact test, Wilcoxon sum test, and linear regression. Results: N=90. Equal distribution of OATS being used for primary and for revision (50% (16) /50% (16)), MAST had a slight prevalence of revision over primary (55% revision (32) / 45% primary (26) p 0.6). There was a significant association between prior surgery and the need for a revision procedure in the MAST cohort. (β = 1.491, SE = 0.562, p = 0.008). Return to sport was seen in 90% of the OAST and 67% of MAST (p 0.11). There was statistically significant improvement in PROMs for both techniques (VAS and FAOS), but no significant change between the outcomes in primary versus revision surgeries. Conclusion: OATS is an appropriate technique for managing OLTs, both as a primary and salvage procedure, with significant improvement of PROMS (VAS and FAOS), and elevated rate of return to sports (90%). MAST as a primary intervention showed similar outcomes to those of OATS, but poorer outcomes as a salvage procedure, with higher rates of revision thereafter (p .01).
First metatarsal Pronation is increasingly recognised as an important component of Hallux valgus (HV) and can contribute towards intraoperative malreduction, postoperative recurrence and patient reported outcome measures (1,2,3). There are numerous radiological ways to measure metatarsal rotation on plain radiographs and weight bearing CT (WBCT), however there are no clinical tests to evaluate metatarsal pronation pre- or intra-operatively. This study therefore aimed to examine the relationship between clinical pronation of the toe and metatarsal pronation. Single-centre, retrospective analysis over 5 years. Measurements were performed on WBCT images with digital reconstructions to add soft tissues. First metatarsal rotation was measured using the Metatarsal Pronation Angle as previously described (4). Toe rotation was measured by the Phalangeal Condylar Angle (PCA), the angle between the condyles of the proximal phalanx and the floor, and the Nail Plate Angle (NPA), the angle of the base of the nail plate to the floor in the coronal Plane. These were obtained from 50 feet in Hallux valgus patients, and 50 control patients with CTs done for osteochondral lesions without hallux valgus or hindfoot malalignment.Aims
Methods
Distinguishing stable from unstable ankle fractures is key to successful ankle fracture management. Gravitational stress views (GSV) may be a convenient and less painful alternative to manual stress testing. The aim of this study was to assess whether this test accurately predicts ankle instability. Patients presenting to a single trauma centre between 2011 and 2013 with an isolated fibula fracture and a an anatomically-aligned mortise on initial plain film radiographs were reviewed. After initial x-ray, patients underwent a gravity stress view. Measurements from plain film radiographs were recorded and analysed. Electronic case notes and National Imaging Archives were reviewed retrospectively at a minimum of 10 years post-injury. Patients were contacted to complete patient reported outcome measures (PROMS).Background
Methods
Minimally invasive (percutaneous) distal first metatarsal osteotomy with internal fixation is an established technique for hallux valgus deformity correction. Published data is limited to 2–3 years follow-up. This study aimed to assess patients undergoing MICA (Minimally Invasive Chevron and Akin) with minimum 5-year follow up, to evaluate the longer-term results of this procedure using validated patient reported outcome measures (PROMs). Five-year PROM data was prospectively collected from 117 patients who underwent 169 primary MICA osteotomies between July 2014 and April 2018, performed by a single surgeon. Primary clinical outcome measures included visual analogue scale for pain (VAS-pain), Manchester-Oxford Foot Questionnaire (MOXFQ) and EuroQol-5 Dimensions Index (EQ-5D). Data were collected preoperatively, at 2 years and after a minimum of 5 years. Statistical significance was set at p< 0.05.Introduction
Methods
Hallux Valgus (HV) is a common forefoot deformity that can cause pain and difficulty with walking. There are a range of surgical techniques to treat HV deformity, but there is a risk of recurrence. This paper reviews the clinical assessment and management of recurrent HV as well as a detailed description of how percutaneous surgical techniques can be used to treat recurrent HV. This paper identifies technical challenges of percutaneous HV surgery for recurrent HV deformity as well as strategies to address and mitigate these. This was a multicenter retrospective review of adult patients who had recurrent hallux valgus deformity (defined as hallux valgus angle>15° and having previously undergone primary surgical intervention for HV deformity correction) who were treated with a percutaneous metatarsal extra-capsular transverse osteotomy (META) technique, with at least one year of follow-up data. Demographic information, hallux valgus angle, intermetatarsal angle, Manchester-Oxford Foot Questionnaire (MOXFQ), visual analog scale (VAS), and EQ-5D-5L scores were collected.Background
Method
The distal metatarsal metaphyseal articular angle (DMMA) is a measurement used in the surgical decision making of hallux valgus correction. However, it is difficult to measure on plain radiographs, is subject to projection bias, and its role in pathology is unclear. With the advent of weight-bearing CT (WBCT), our understanding of hallux valgus as a multiplanar deformity has evolved. The aim of this study was to investigate whether there is a relationship between the DMAA and pronation of the first metatarsal head in patients with hallux valgus. This was a single-centre, retrospective analysis of 50 patients with hallux valgus deformity who had WBCTs obtained as part of routine pre-operative work-up. Patients with metatarsophalangeal joint arthritis, hindfoot deformity and previous surgery were excluded. From the WBCT images digital radiographs were created and the DMMA measured. Measurements were taken by 2 authors, each repeated twice and the average of all four measurements used in analysis. We also measured intermetatarsal angle (IMA), hallux valgus angle (HVA) and metatarsal pronation angle (MPA).Aims
Methods
Global data on BKA mortality is dominated by US Veterans population studies, while smaller single-centre UK cohorts observe a wide range of 1 year mortality (13.8%-61.1%). There is no consensus on mortality rates, perioperative complications and at-risk groups post diabetic BKA in England. England Hospital Episodes Statistics (HES) data was combined with ONS mortality data (2000–2022) and cleaned using STATA 18. The primary outcome was the rate of all cause mortality. Secondary outcomes were causes of death, re-amputation rates, temporal variation in mortality, and 90 day peri-operative complications. Mortality and amputation free survival was calculated with Kaplan-Meier curve analysis using R, STATA 18. Multivariate logistic regression stratified patient variables associated with mortality and/or re-amputation rate.Introduction
Methods
Osteochondral defects (OCDs) of the talus were identified as a “TOP 10” research priority in foot and ankle surgery by the James Lund Alliance in partnership with BOFAS, BOA and NIHR. To develop a research strategy, the views of BOFAS members regarding OCDs of the talus were surveyed. The results are reported here. A questionnaire concerning the presentation, investigation and management of OCDs was formulated with input from the BOFAS National Clinical Study Group and ratified by the Scientific Committee. It concerned primary OCDs of the talus that had failed non-surgical management. It was distributed to BOFAS members via email using _Microsoft Forms_.Introduction
Methods
Fifth metatarsal fractures have been regularly classified by zones, with the description of a Jones fracture commonly being misrepresented. The aim of this study was to map the fracture patterns across the entire metatarsal shaft, and correlate with their outcomes. A historic cohort study was completed of all fifth metatarsal fractures presenting to our unit between February 2016 – July 2021. Fracture patterns were individually mapped and designated as zone 1-shaft, including designation of fractures which bridge each zone (zone 1–2 etc). Fracture patterns were cumulatively combined using GNU Image Manipulation Program to show the combined fracture map patterns per outcome. The clinical notes were examined to assess patient outcome.Introduction
Methods
We compared the clinical outcomes of a fixed bearing (Infinity) and a mobile bearing (Zenith) ankle replacement in a demographically similar group of patients, from a single, non designer centre. Between December 2010 and May 2016, 118 consecutive mobile bearing prostheses (Zenith) and between September 2017 and November 2019, 118 consecutive fixed bearing (Infinity) prostheses were implanted in a total cohort of 230 patients. Demographic, clinical, and patient reported outcome measures (PROMs) data were collected. The end point of the study was failure of the implant requiring revision of one or more of the components. Kaplan Meier survival tables were generated.Aims
Methods
The use of an arthroereisis screw is well described in the paediatric population for the correction of flexible flat feet. There are no long-term studies of its use in adults. We performed a functional and radiographic evaluation of a single centre, single surgeon series following the use of a subtalar arthroereisis screw, to augment reconstruction in adult patients with acquired adult flat foot deformity secondary to spring ligament / tibialis posterior tendon failure. We performed a retrospective review of 40 consecutive feet with stage 2 PTTI that underwent flexor digitorum longus transfer, reefing of the spring ligament, translational medialising calcanaeal osteotomy and augmentation with an arthroereisis screw (Kalix, Integra; 22 feet or ProStop, Arthrex; 3 feet), between 2005 and 2021. All arthroereisis screws were electively removed at 6 months. Radiographic values were assessed pre- and post-operatively at 1-year with functional results both at 1-year and average 10-year follow-up.Introduction
Methods
