bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Academic Background on Orthopaedic Foot and Ankle Fellowship Match Outcomes
Authors: Bryan Choy Kenneth , Cannada Lisa K. , White Peter , Steinmann Scott , Cohn Randy , Bitterman Adam 
Published: December 2024

Category: Other Introduction/Purpose: In recent years, there has been an increase in doctors of osteopathic medicine (DO) applying for orthopaedic residency, which has led to an increase in osteopathic residents applying for fellowships. The purpose of this study was to evaluate the change in degree type of applicants to foot and ankle fellowships over the last 12 years and to evaluate the differences in match rates between osteopathic and allopathic applicants. Methods: SF Match data from 2012 to 2023 was analyzed. There were 1082 applicants for adult foot and ankle fellowships from 2012-2023. There were 74 osteopathic applicants (11.4%) and 573 allopathic applicants (88.6%). There were 435 (40.2%) international medical graduates who were excluded from this analysis. The degree type, number of applicants, and number of matched applicants into orthopaedic foot and ankle fellowship was reviewed. Trends regarding number of applicants and match rates based on applicant degree were evaluated. Results: Osteopathic applicants ranged from a low of 2 in 2018 to a high of 11 in 2016, (mean 6.2 +/- 2.6), with no statistically significant change (r=-0.12, p=0.34). Match rate for osteopathic applicants increased from 75.0% (6 of 8) in 2013 to 100.0% (5 of 5) in 2023, (mean 91.2% +/- 9.9%), with a significant increase (r=0.72, p=0.003). Allopathic applicants ranged from a low of 37 in 2022 to a high of 63 in 2014 (mean 47.8 +/- 6.9), with a significant decrease (r=-0.7, p=0.003). Match rate for allopathic applicants ranged from a low of 88.0% (44 of 50) in 2013 to a high of 100.0% (37 of 37) in 2022, (mean 94.5% +/- 4.5%), with a significant increase over the study period (r=0.79, p=0.0007). Conclusion: Since 2012, there has been no statistically significant change in the number of osteopathic applicants for foot and ankle fellowship. While both osteopathic and allopathic applicants experienced a significant increase in match rates, there was no significant difference in match rates.
Impact of Social Deprivation on Forefoot Surgical Outcomes
Authors: Compton Tyson , Wagers Kade , Braun Emma , Presson Angela , Nixon Devon 
Published: December 2024

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: The impact of social environment on specific health outcomes is a topic of increasing interest in orthopedics. Conflicting lines of research suggest that social deprivation may impact orthopedic outcomes. There are limited reports on the influence of social deprivation on orthopedic foot and ankle procedures. The purpose of this study was to examine the effect of social deprivation on patient reported outcomes for patients undergoing forefoot surgery. Methods: This retrospective cohort study included 477 patients who underwent hallux valgus correction or hallux rigidus procedures between 2015 and 2022. Patient social deprivation was defined using the Area Deprivation Index (ADI), a validated metric of deprivation discretized geographically by zip code and defined by factors including education, income, employment, and housing quality. Patients meeting inclusion criteria were categorized into either a high or low social deprivation group based on the national median ADI of 50. PROMIS (Patient-Reported Outcomes Measurement Information System) Physical Function (PF) and Pain Interference (PI) scores were collected pre-operatively and then at 6 weeks and 6 months post-operatively. We compared high and low social deprivation groups at baseline and then longitudinally at 6 weeks and 6 months post-operatively, adjusting for demographic covariates including age, gender, race/ethnicity, marital status, and employment status. Statistical significance was defined as p < 0.05. Results: At baseline before surgery, PROMIS-PF and PROMIS-PI scores were similar between high and low social deprivation groups. At 6 weeks and 6 months after surgery, there were also no significant differences between high and low deprivation groups for either PROMIS-PF or PROMIS-PI. The only variable that delineated outcomes was employment status, with disabled and unemployed patients exhibiting greater pain (p < 0.001, p = 0.006, respectively) and less function (p < 0.001, p = 0.010, respectively) before surgery. When adjusting for baseline pain score, disabled patients also had greater pain on average after surgery (p = 0.031). Both groups (high and low social deprivation) demonstrated similar improvements in pain and function at 6 months after surgery. Conclusion: Patients undergoing forefoot surgery with greater social deprivation reported similar pain and physical function outcomes as patients with low deprivation before and after surgery. These findings suggest that patients with higher social deprivation can achieve equivalent post-surgical outcomes after forefoot surgery as compared to patients with lower social deprivation. Further investigations are needed to explore these relationships at longer-term follow-up as well with other common foot and ankle surgeries.
In Step or Out of Sync? Analyzing Gender Variances in Orthopaedic Foot and Ankle Fellowship Match Rates
Authors: Choy Kenneth Bryan , Cannada Lisa K. , White Peter , Steinmann Scott , Cohn Randy , Bitterman Adam 
Published: December 2024

Category: Other Introduction/Purpose: Previous literature has noted that a higher proportion of females than males matched into all orthopaedic surgery fellowships from 2010-2014. However, this has not been investigated specifically in regards to foot and ankle fellowships or with more recent match data. Therefore, the purpose of this study was to evaluate the trends in applicant gender for orthopaedic surgery foot and ankle fellowships over the last 11 years and to evaluate the differences in match rates between male and female applicants. Methods: San Francisco Match from 2013 to 2023 was analyzed. There were 986 applicants for foot and ankle fellowships from 2013-2023. There were 395 (40.1%) international medical graduates who were excluded from this analysis, leaving 591 applicants in the study cohort. There were 126 female applicants (21.3%) and 465 Male applicants (78.7%). The gender, number of applicants, and number of matched applicants into orthopaedic foot and ankle fellowship was reviewed. In addition, trends regarding number of applicants and match rates based on gender were evaluated. Results: Female applicants ranged from a low of 6 in 2013 to a high of 14 in 2023, (mean 11.5+/- 2.8) with no statistically significant change (r=0.4, p=0.097). Match rate for female applicants increased from a low of 76.9% (10 of 13) in 2017 to 100.0% (14 of 14) in 2022, (mean 92.1% +/- 8.7%), with no statistically significant change (r=0.45, p=0.07). Male applicants ranged from a low of 32 in 2023 to a high of 58 in 2014 (mean 42.3 +/- 8.0), with a significant decrease (r=-0.89, p=0.00004). Match rate for male applicants ranged from a low of 86.5% (45 of 52) in 2013 to a high of 100.0% (32 of 32) in 2023 (mean 95.1% +/- 4.9%), with a significant increase (r=0.95, p=0.000002). Conclusion: Since 2013, there has been no statistical significant change in the number of female applicants and female applicant match rate for orthopaedic foot and ankle fellowship. The number of male applicants experienced a significant decrease over the study period, with a significant increase in match rate. Although male applicants had a slightly higher match rate than female applicants, there was no statistical significant difference.
Influence of Normal and Pathologic Windlass Mechanism During Dorsiflexion of the Hallux
Authors: Kihara Takumi , Wukelic Corey , Thorhauer Eric , Sangeorzan Bruce , Ledoux William R. 
Published: December 2024

Category: Midfoot/Forefoot; Other Introduction/Purpose: When the windlass mechanism (WM) is engaged, the plantar aponeurosis (PA) is pulled distally by extension of the first metatarsophalangeal joint (MTPJ1), shortening the sole of the foot and raising the medial longitudinal arch (MLA). It has also been reported that the WM is associated with hallux valgus and hallux rigidus. Although this function has been known for a long time, there are few reports on the movement of the foot bones under pathological conditions. In this study, we used cadaveric feet to compare the movements of the foot bones under three conditions: normal tendon loads, an overpulled Achilles tendon, and a sectioned PA with normal tendon loads. Methods: Ten fresh cadaveric foot specimens were used. The foot was attached to a tibial loading frame with 20% body weight loads applied. Each specimen was scanned in seven configurations (first proximal phalanx angles 0-60°, each 10° apart) and three conditions (normal loads, overpulled Achilles, and sectioned PA) using a LineUP cone-beam computed tomography (CBCT) scanner. The foot bones in the neutral position under normal loading were segmented from the CBCT scan volumes in Mimics Research software v23.0. Bone kinematics between the 20 additional scans were determined via volumetric image registration in custom MATLAB software for each segmented bone. Using additional custom MATLAB code, we calculated the height of the navicular, the MLA angle defined as the three points (the farthest point of the first metatarsal head, the medial process of the calcaneus, and the apex of the navicular tuberosity), and the motion of the joints on the foot in 3D. Results: The height of the navicular was significantly lower at 0, 30, and 60 degrees in the pathological conditions compared to normal (Normal vs overpulled Achilles: 2.9, 3.2, 5.4 mm, p< 0.01, normal vs sectioned PA: 5.2, 5.6, 5 mm, p=0.04, at 0°, 30°, and 60° respectively). The MLA angle was significantly different at all angles for the overpulled Achilles compared to the normal (-3°, -3.5°, -3.6°, p< 0.02). At the tarsometatarsal (TMT) joint, there was no significant differences in any direction. At the cuneonavicular joint, there was less plantarflexion (normal: -6.1, -10.8, overpulled Achilles: -2.8, -6.6, p< 0.01 at 30° and 60° respectively) and less eversion (normal: 24.7, overpulled Achilles: 27.9, p< 0.01 at 60°) in the overpulled Achilles compared to normal. Conclusion: In this study, a three-dimensional model was used to measure the function of the WM. We found that the WM was affected by the pathological conditions of the Achilles tendon and sectioning the PA. The results of this study suggest that WM dysfunction may not affect the TMT joint but does affect the cuneonavicular joint. This might suggest the WM induced MTPJ1 pathologies are driven by the cuneonavicular joint.
Insurance Payor Status and Outcomes in Foot and Ankle Surgery
Authors: Luo Emily Joan , Rowe Dana , Wu Kevin , Bethell Mikhail Alexander , Adu-Kwarteng Kwabena , Anastasio Albert T. , Adams Samuel B. 
Published: December 2024

Category: Other Introduction/Purpose: The increasing prevalence of foot and ankle procedures in the United States has coincided with rising costs of care, exposing socioeconomic disparities within this area of orthopedics. Insurance payor status is one such factor that can affect the quality and accessibility of medical care and has been implicated in orthopedic patient outcomes. While previous studies in other fields of orthopedics have demonstrated an association between insurance status and access to treatment, length of hospital stay, postoperative outcomes and complication rates, no comprehensive review has explores this relationship in foot and ankle surgery. Thus, the goal of this study is to examine the association between insurance payor status and outcomes in foot and ankle procedures. Methods: A systematic review of five databases was conducted, focusing on the interplay between insurance coverage and foot/ankle procedures. Included studies reported on insurance payor status and patient outcomes following foot and ankle surgery. Extracted outcomes included time to be seen by a provider, complication and revision rates, post-operative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to work/activity, and follow-up. Meta-analyses were performed using the Revman 5.3 software. Studies that did not qualify for meta-analyses were described qualitatively. Results: Of 1401 studies identified, 24 texts met inclusion and exclusion criteria. Across the 24 studies, there were a total of 20,950 patients. Noninsured patients had a 59% higher risk of ED/urgent care utilization within 30 days of surgery compared to insured patients [Risk Ratio (RR) = 1.59, 95% Confidence Interval (CI) = 1.18 to 2.12, p < 0.05]. Privately insured patients were seen 3.65 days earlier than patients with government insurance [95% CI = 2.02 to 5.27, p < 0.0001]. Worker’s Compensation patients tended to have poorer outcomes, higher pain scores, and lower functional scores. Similarly, Medicaid patients also fared worse on functional scores and had delayed access to appointments and treatments. Conclusion: Patients without private insurance have worser pain and functional outcomes, delayed access to care, and increased utilization of emergency resources following foot and ankle procedures. It is crucial for providers to be cognizant of these discrepancies when caring for patients. Further research is needed to better understand the nuances of these insurance-related disparities within foot and ankle subspecialties.
Is Age but a Number? Age-Related Outcomes for Total Ankle Replacement
Authors: Khan Ryan , Halai Mansur , Daniels Timothy R. , Pinsker Ellie , Ha Joon 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is increasingly performed on patients across a wide age spectrum, though historically it has been reserved for older patients (>60). In this study, we seek to determine how age influences patient outcomes. Methods: This is a retrospective, comparative cohort study of consecutive patients that underwent TAR from 2004-2021. Patients were categorized into three age groups: < 55, 56-70, and >70. We evaluated surgical complications and patient-reported outcome measures, including Ankle Osteoarthritis Pain & Disability Scores (AOS) and Short Form-36 Health Survey (SF-36). Analysis of covariance was performed, adjusting for patient factors. Results: We reviewed 812 consecutive TARs from a single-centre with 407 (50.1%) male and mean BMI of 29.8±5.78. The median follow up was 64.0 months (IQR,76.0). Patients ≤55 had worse pain preoperatively than both older patient groups (p=0.03) and worse mental health (p< 0.001), however, this difference was not observed in postoperative AOS pain (p=0.15) or SF-36 MCS scores (p=0.87). Patients >70 had worse physical health than patients 56-70 (p=0.02) and less change in pre- to postoperative SF-36 PCS scores (p=0.02). Patients from all groups improved similarly according to the AOS pain (p=0.15) and disability (p=0.12). Conclusion: These results show that TAR patients younger than 55 have worse pain and mental health preoperatively but have similar long-term clinical outcomes to patients 56 and older.
Malreduction of Syndesmosis and Outcomes Following Trans-Syndesmotic Screw vs Suture Button Fixation Under Direct Visualization and Reduction Technique: A Prospective Randomized Controlled Study
Authors: Rungprai Chamnanni , Sripanich Yantarat , Pangkanon Suthavee , Suksintharanon Methasit 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: Syndesmotic injury commonly accompanies rotational ankle fractures, with malreduction significantly affecting outcomes. While suture button fixation has demonstrated efficacy in reducing malreduction rates compared to trans-syndesmotic screw fixation, it incurs higher implant costs. However, the introduction of a direct visualization and reduction technique offers the possibility to mitigate the difference. This study aims to compare the syndesmotic malreduction rate and outcomes between trans-syndesmotic screw fixation and suture button fixation, utilizing the direct syndesmotic visualization technique. Methods: One hundred patients with unstable rotational ankle fractures and arthroscopically-confirmed syndesmotic injury who underwent open reduction and internal fixation were prospectively randomized into two parallel groups, receiving either trans-syndesmotic screw (SS) fixation (n=50) or suture button (SB) fixation (n=50). All syndesmoses were reduced under direct visualization at the anterior tibiofibular line. The primary outcome was the syndesmotic malreduction rate, evaluated by bilateral post-operative CT scan with a 2-mm side-to-side difference threshold. Secondary outcomes included visual analog scale (VAS), Short Form-36 (SF-36), and Foot and Ankle Ability Measure (FAAM) scores, as well as complications. Results: The malreduction rate was higher in the SS group (14%) compared to the SB group (4%), but it did not reach statistical significance (p = 0.160). Both groups showed significant improvement in pain VAS, FAAM scores, and SF-36, without a significant difference between the groups. The complication rate was not significantly different. Conclusion: The syndesmotic malreduction rates and post-operative outcomes were comparable between trans-syndesmotic screws and suture button fixation under direct visualization and reduction technique. Direct visualization and reduction of the syndesmosis with screw fixation can be a useful technique for better adjustment, potentially reducing malreduction to levels closer to those achieved with suture button fixation.
Modern Percutaneous Hallux Valgus Surgery for Revision of Recurrent Hallux Valgus
Authors: Toepfer Andreas Kurt , Chomej Pawel , Mococain Pablo , Liszka Henryk , Ray Robbie , Lewis Tom , Lam Peter , Gordon David 
Published: December 2024

Category: Bunion; Other Introduction/Purpose: Hallux valgus is the most common foot deformity, and recurrent deformity is the most common complication after primary hallux valgus correction. The principles of HV revision surgery do not differ from the initial goal of hallux valgus correction, which is to restore physiologic alignment and alleviate symptoms. Choosing the appropriate procedure to address the given deformity pattern and the technical competence to perform the corrective procedure are the keys to success. To date, no 3rd or 4th generation minimally-invasive technique for the correction of recurrent hallux valgus has been described in the literature. The aim of this multicenter analysis is to evaluate the use of modern percutaneous bunion surgery techniques in the revision of recurrent hallux valgus. Methods: A total of 100 cases operated between 2013 and 2023 and contributed by 7 surgeons from 6 countries, all performing percutaneous 3rd and 4th generation Minimally-Invasive Chevron Akin (MICA) / Percutaneous Chevron Akin (PECA) / Minimally Invasive Extra-articular Transverse and Akin (META), were retrospectively evaluated. Minimum follow-up was 12 months (range 12-104). Radiological correction (HVA, IMA, tibial sesamoid position), surgery associated complications using the modified Clavien-Dindo-Sink classification and functional outcome (MOXFQ) were evaluated. Results: The complication rate was 21%. Most complications could be managed non-surgically. The most common complication was screw prominence leading to revision surgery with hardware removal in 8.5% of all cases. Major complications such as deep infection requiring revision surgery were extremely rare. HVA was corrected from a mean of 33.5° to 10.3° at 6 weeks and 9.0° at 12 months, IMA from a mean of 13.9° to 4.8° and 5.1°, respectively. The mean Clapham-Hardy tibial sesamoid position was classified as type 6 preoperatively and improved to type 2 postoperatively. PROMs using the MOXFQ score improved from a preoperative index score of 46.0 to 8.9. Conclusion: Modern percutaneous hallux valgus techniques have proven to be a reliable tool in the primary correction of hallux valgus and metatarsus primus varus, aiming to minimize surgical morbidity and maximize surgical efficiency without compromising safety. To date, there have been no reports of these procedures for recurrent hallux valgus. With adequate training and experience, the use of 3rd and 4th generation MICA/PECA/META is a safe procedure for the revision of recurrent hallux valgus resulting in significant improvements in radiographic parameters, functional outcome and patient satisfaction. The rate of relevant complications is not increased compared to traditional open surgical techniques.
Modified Gift Box Repair Technique in Achilles Tendon Rupture: A 5-Year Follow-Up
Authors: Kord Mohammad Hossein Chegini , Ebrahimi Alireza , Nazari Leili , Waryasz Gregory R. , Razi Mohammad , Ashkani-Esfahani Soheil , Ebrahimpour Adel 
Published: December 2024

Category: Sports; Trauma Introduction/Purpose: Achilles Tendon (AT) rupture is one of the most prevalent adult tendon injuries, with the incidence rate estimated to range between 7 to 40 in 100,000 person-years. This study aimed to assess the clinical and functional outcomes of a modified “Gift box” open technique for AT rupture repair. Methods: After receiving IRB approval, in a single center study in Tehran, Iran, we conducted a consecutive case-series study including 36 patients with acute AT rupture who underwent modified gift box AT repair using two mini-incisions and gift box sutures by expert surgeons affiliated with the local hospitals (Figure 1). The postoperative protocol involved all patients discontinuing the use of crutches after 4 weeks and removing their boot after 8 weeks. The AT rupture score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) measure scores were obtained from all patients at 6, 9, 18, and 36 months postoperatively with a complementary follow-up in an average of 24 months (range of 18 to 48 months) after the last follow-up. The study also included other variables such as visual analog scale (VAS) for pain, calf atrophy, and the range of sagittal ankle motion, wound complications, sural nerve injury, and re-rupture rate. Results: The patients treated with modified gift box technique yielded AOFAS scores of 85±3 and ATRS of 84.7±5.4 at 36 months postoperatively, further improving to 86±7 and 85.2±5.1 respectively during extended follow-up (up to 2 years). Approximately 82% of patients regained normal activities of daily living within 4 months, while 91.5% recovered preinjury vigorous activity levels by 6 months postoperatively. Mean VAS pain scores decreased from 7.9±0.9 at 2 months to < 4 after 3 months. Isokinetic testing demonstrated plantar flexion and dorsiflexion strength deficits of 84.9±5.3% and 89.8±4.7% respectively compared to the contralateral uninjured side at 3 months, resolving to equivalent strength by 42 months. Dorsiflexion range of motion reached 94% of normal at 5 years follow-up, though calf circumference remained < 95% of normal size. Conclusion: The modified gift box technique for AT rupture repair using two mini-incisions and gift box sutures, which we assume to be less invasive compared to the previously reported method, demonstrated favorable clinical outcomes with high patient satisfaction levels. Patients experienced significant improvements in functional scores, pain levels, strength, and range of motion over time, with most regaining their ability to perform activities of daily living and returning to preinjury levels of physical activity. While some residual deficits were observed, the procedure was well-tolerated with no significant complications, suggesting it is a safe and effective treatment option.