Charcot-Marie-Tooth disease (CMT) is a hereditary peripheral neuropathy leading to neuromuscular impairments, muscle atrophy, and functional limitations. Currently, no specific treatment exists to restore muscle strength in patients with CMT, and the disease can be severely disabling. Surgical correction of cavus foot has been suggested as a potential intervention to alleviate pain and improve gait in selected patients. This study aimed to evaluate the therapeutic effects and analyze the subsequent improvement in quality of life. A retrospective analysis was conducted on 45 patients (57 feet) who underwent surgical correction of cavus foot due to CMT. Annual follow-up assessments involved clinical symptoms, and patient-reported outcomes, including the Foot and Ankle Disability Index (FADI) and the Short-Form 12 (SF-12). Radiological evaluation was performed using the Meary angle, calcaneal pitch angle, talocalcaneal angle, talo-first metatarsal angle, and calcaneal-fifth metatarsal angle. After 2 years of follow-up, most radiographic and symptomatic outcomes improved significantly. Functional scales showed a significant increase (P < .001) in median FADI (23 vs. 40) and physical component score of the SF-12 (26 vs. 41). Therefore, surgical correction of cavus foot should be considered an effective intervention for patients with CMT, leading to sustained improvements in function and quality of life. LEVEL OF CLINICAL EVIDENCE: 4.

First metatarsophalangeal (MTP) joint fusion is a frequently employed surgical treatment option for hallux rigidus and hallux valgus. Implant-related complications are common, necessitating further investigation into predisposing factors. The altered mechanics of pes planus may influence surgical outcomes; however, its direct impact on implant removal rates post-fusion remains unclear. We retrospectively analyzed the TriNetX US Collaborative Network database to identify patients undergoing first MTP joint arthrodesis by ICD-10 and CPT coding, the data was stratified by preoperative pes planus status. Implant removal rates were compared between pes planus (PP) and non-pes planus (noPP) cohorts. Odds ratios (OR) were calculated to assess associations. Patients in the PP cohort exhibited significantly higher rates of subsequent hardware irritation (OR 1.30, 95 % CI 1.010-1.675), and hardware removal (OR 1.27, 95 % CI 1.007-1.604) compared to patients in the noPP cohort. Our findings highlight patients with preoperative pes planus have significantly increased likelihood of implant irritation, removal, and reoperation following first MTP joint arthrodesis surgery. Biomechanical alterations associated with pes planus likely contribute to accelerated implant wear and compromise fusion stability leading to higher rates of future surgery.

Subluxation or dislocation of the second metatarsophalangeal joint may be commonly associated with crossover toe, metatarsalgia, and painful calluses. This retrospective study aims to evaluate the clinical and functional results in patients with irreducible second metatarsophalangeal joint dislocation treated by double percutaneous osteotomy in one step: Haspell's osteotomy and Distal Metatarsal Mini-Invasive Osteotomy. A total of 39 patients were included in this study. 31 patients had a simultaneous procedure on the first ray for hallux valgus correction. The American Orthopaedic Foot and Ankle Society score (AOFAS), the degree of joint range of motion (ROM) and hyperkeratosis of the second ray were assessed as outcomes at the baseline (T0), at 6 months (T1), and at 1 year (T2) from surgery. The mean pre-operative AOFAS score was 62.76 ± 5.5, at 6 months after surgery it increased to a value of 78.81 ± 8.15 and at one year to a value of 88.78± 6.51. No differences in term of ROM were found between pre and postoperative values at 6 months. A significant improvement in ROM at 12 months was found. Hyperkeratosis, assessed with a nominal scale classification, decreased statistically significantly and, one year after surgery, in 88.88 % of cases they completely resolved. The double percutaneous osteotomy brings advantages in terms of pain reduction. In conclusion, DMMO associated with Haspell's osteotomy is a safe and effective and reproducible technique in the resolution of metatarsalgia in patient with irreducible instability of the second metatarsophalangeal joint. LEVEL OF CLINICAL EVIDENCE: 4.

This study describes the results of first metatarsal (M1) distal osteotomy with an intramedullary locking plate in persistent/recurrent painful hallux valgus (HV) deformity (without advanced degenerative changes) after primary surgery. Outcomes included postoperative incidences of HV angle (HVA)<16°, intermetatarsal angle (IMA)<9°, proximal articular set angle (PASA)<10°, and the American Orthopedic Foot and Ankle Society (AOFAS) score. Data normality was assessed with the Shapiro-Wilk test, and preoperative vs. postoperative comparisons, as well as postoperative angles vs. preestablished thresholds, were performed with the Wilcoxon signed rank test or the paired Student's t-test, as applicable. Firth's penalized logistic regression analyzed the association between severe complications and undergoing surgery before 2017. Thirty-two patients were included, with a median (range) age of 62.5 (40.0 - 84.0) years; 31 (96.9 %) were females. The minimum follow-up was 24 months. Postoperative incidences (95 %CI) of HVA<16°, IMA<9°, and PASA<10° were, respectively, 75.0 % (57.9 - 86.8 %), 93.8 % (79.9 - 98.3 %), and 56.0 % (33.6 - 66.4 %). Median postoperative HVA, IMA, PASA, and AOFAS score values improved significantly (p < 0.001 for all). Postoperative HVA and IMA were significantly better than preestablished thresholds (p = 0.008 and p < 0.001, respectively), but the PASA was not (p = 0.507). Seven (21.9 %) patients experienced Clavien-Dindo ≥IIIa complications, all in the early implementation period (first 5 years), corresponding to the first 20 surgeries performed (p = 0.046). In conclusion, distal M1 osteotomy plus stabilization with an intramedullary plate offers a viable joint-preserving alternative for recurrent moderate to severe HV deformities in patients without severe arthritic changes or hypermobility of the first TMT joint. LEVEL OF EVIDENCE: IV.

Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve and its branches in the tarsal tunnel. The literature on surgical release of the tarsal tunnel shows variable outcomes with no studies reporting validated patient reported outcomes. We aim to determine clinical response after tarsal tunnel release using the Patient-Reported Outcomes Measurement Information System (PROMIS). CPT code 28035 was used to identify patients who underwent isolated tarsal tunnel release (TTR) between 1/1/2015 and 12/15/2022 at a single institution. Patient demographic data and PROMIS physical function (PF), pain interference (PI), and depression scores were prospectively collected at the initial pre-operative clinic visit and in follow-up throughout the episode of care after TTR. The validated distribution-based method (1/2 sd) was used to assess minimal clinically important difference (MCID) and bivariate analysis was used to determine postoperative recovery. A total of 39 patients who underwent TTR were included. The mean t-score change (pre- to post-operation) was 7.2 for PF, -6.1 for PI, and -5.93 for depression. MCID thresholds were calculated as PF increase of 4.7, PI decrease of 3.9, and depression decrease of 5.1. Fourteen (35 %), 24(62 %), and 27 (69 %) patients reached MCID for PF, PI, and depression, respectively. No relationship was observed between space-occupying lesions and patient outcomes. This study provides validated outcomes after TTR. Though there is significant improvement after surgery, the patients still experience some pain and physical limitations.

First metatarsophalangeal joint (MTPJ) fusion an effective surgical intervention for conditions such as hallux valgus and hallux rigidus. This systematic review and meta-analysis aims to compare safety and efficacy of crossed screws versus plating supplemented with an interfragmentary screw. A literature search of the Scopus, Embase, Web of Science, and MEDLINE databases was performed to identify all studies directly comparing the two techniques. Meta-analysis was carried out using RevMan Web. Nine studies with 976 patients (1,035 toes, 512 toes in the crossed screws group and 523 toes in the plate supplemented with screws group) were included. There was no significant difference in union rates (OR=0.75, CI 0.45 - 1.27, p = 0.29), overall complication rates (OR = 1.13, CI = 0.71 - 1.77, p = 0.61), superficial complications, (OR = 0.41, CI = 0.10 - 1.68, p = 0.22), revision surgery (OR = 1.92, CI 0.81 - 4.57, p = 0.14), hardware removal (OR = 1.07, CI = 0.55 - 2.08, p = 0.85), and malunion (OR = 1.63, CI 0.27 - 10.00, p = 0.60). Plate and screws had a significantly shorter time to fusion than crossed screws (MD = 0.51, CI = 0.10 - 0.92, p = 0.02). No significant difference was noted in patient-reported outcome measures or in postoperative hallux valgus, intermetatarsal and lateral metatarsophalangeal angles. Other potential factors that should influence the decision to use one technique over the other include the indication for MTPJ fusion, the patient's bone quality, and the differing costs of surgery. Level of Clinical Evidence 3.

Joint arthrodesis is a very common surgical approach in foot and ankle surgery at various anatomic levels. Several techniques have demonstrated the ability to provide successful fusion with appropriate preparation of the joint in question. With that in mind, the joint preparation, regardless of approach or instrumentation, is consistently the most time-consuming. Additionally, this step is prone to eventual complications like shortening with saw cuts or inadequate preparation with curettes and osteotomes alone, not to mention the persistent threat of non-union as is the case with any osteotomy or arthrodesis. Power rasp instrumentation presents a potential alternative for the surgeon to not only improve operating room efficiency, but also provide fast, reproducible, and adequate joint preparation thereby yielding excellent union rates. This study retrospectively analyzed 418 total arthrodesis attempts performed on 198 patients. Procedures included Lapidus bunionectomy/1st tarsometatarsal joint (TMTJ) fusion, midfoot fusions involving more than one TMTJ, isolated subtalar joint fusions (STJ), isolated talonavicular fusions (TNJ), and triple arthrodesis (STJ, TNJ, CCJ). The procedures were performed at a single institution with power rasp joint preparation (PJRP) as the primary tool for debridement of all cartilage from the articular surfaces of the joint in question. Minimum follow-up was 12 months. Radiographic union was defined on X-rays with osseous bridging and trabeculation across the fusion site using standard weightbearing foot radiographs taken at 3-, 6-, and 12-month intervals postoperatively. Four- and one-half percent of all arthrodesis attempts went on to develop a radiographic non-union after 12 months (19/418). This study demonstrates excellent overall union rates using a simple device that provides ease of surgeon use, minimal risk of non-union, and time-cost efficiency for providers, patients, and facilities alike.

Ankle fractures are often accompanied by syndesmotic injuries, contributing to instability and potential long term complications. Syndesmotic injuries are traditionally fixed with either small fragment (3.5-mm diameter) or large fragment (4.5-mm diameter) syndesmotic screws. With regards to the recent emergence of less prominent implants for ankle fracture, this study was set out to compare the outcomes of mini fragment screws (2.7-mm or 2.8-mm diameter) and small fragment screws in syndesmotic fixation. Eighty-seven patients with traumatic syndesmotic injuries were retrospectively included for this study. Forty-four patients underwent mini fragment fixation and 43 patients underwent standard small fragment fixation. After-treatment was similar in both groups. Primary outcome consisted of the incidence of malreduction and secondary dislocation within three months. Secondary objectives were the incidence of the overall complication rate and implant removal rate. In total, malreduction was observed in three patients (3.4%) and secondary dislocation in two patients (2.3%), with no significant differences between the mini fragment and small fragment groups. Mini fragment fixation demonstrated a significantly lower overall complication rate (2.3%) compared to the small fragment group (16.3%)(p = .030). Implant removal rates were similar between the groups (27.3% for mini fragment and 27.9% for small fragment screws). This study suggests that both screw types are effective for fixation of acute syndesmotic injuries, with comparable malreduction and secondary dislocation rates. Prospective studies with longer follow-up, including functional outcome, are needed for comprehensive insights into optimal syndesmotic screw selection.

Ankle fractures are common injuries and post-operative protocols continue to vary. We aim to compare postoperative complications between early weight bearing (EWB), intermediate weight bearing (IWB), and delayed weight bearing (DWB) in adult patients with isolated ankle fractures treated with open reduction internal fixation (ORIF). This retrospective cohort study includes 233 adult patients with isolated (medial malleolar, lateral malleolar, posterior malleolar, bimalleolar equivalent) or complex (trimalleolar, trimalleolar equivalent, bimalleolar, and Maisonneuve) ankle fractures treated with ORIF between 2020 and 2022 at a level I trauma center. Patients were weight bearing postoperatively at < 3 weeks (EWB), 3-6 weeks (IWB), or > 6 weeks (DWB). Main outcome measurements include rates of complications requiring reoperation and minor complications. Thirty-one and eight tenths percent (74/233) were EWB, 25.8% (60/233) were IWB, and 42.5% (99/233) were DWB. 73.0% of patients (170/233) had complex fractures, and 27.0% (63/233) had isolated malleolar fractures. 16.3% of patients (38/233) developed complications, with 7.7% (18/233) requiring reoperation. We found no differences in overall complications (14.86% vs. 11.67% vs. 20.20%; p = 0.3396) or complications requiring reoperation (9.46% vs. 3.33% vs. 9.09%; p = 0.3337) among the weight bearing groups for all fractures. Between the complex fracture group and the isolated malleolar fracture group, there were no differences in overall complications (7.94% vs. 19.41%; p = 0.0566) or complications requiring reoperation (9.41% vs. 3.17%; p = 0.1664). There is not statistical significance between timing to weight bear and complications in ankle fractures treated with ORIF. Level of Evidence: Level 3.

With the increased use of computed tomography scans in cases with trimalleolar ankle fractures, bone fragments between the posterior malleolus and the rest of the articular surface tibial plafond surface - described as intercalary fragments (ICFs) - can be recognized. The aim of this study was to determine the ICF size threshold for a significant change in the pressure distribution at the ankle joint, having a considerable impact on the remaining cartilage of the joint.

The definitive guideline for the osteotomy technique or the superiority of a particular surgical approach for severe hallux valgus correction remains elusive. Here, we investigated the clinical and radiographic outcomes following modified distal chevron osteotomy coupled with proximal Akin osteotomy to correct severe hallux valgus. A prospective cohort study was performed on 45 patients (62 feet) diagnosed with severe hallux valgus, undergoing the modified distal chevron osteotomy technique described in this study, combined with proximal Akin osteotomy. The radiographic variables: hallux valgus angle and intermetatarsal angle, were measured, and the American Orthopaedic Foot and Ankle Association scoring system was used to assess the clinical curative effect at six weeks and one-year intervals following surgery. Compared to the preoperative assessments, the hallux valgus and intermetatarsal angles were significantly decreased, and the American Orthopaedic Foot and Ankle Association score was increased markedly in both postoperative follow-ups. The difference between the variables was comparable at the six-week and one-year postoperative reassessments. No severe surgical complications or recurrences were observed. The combined use of modified distal chevron osteotomy and proximal Akin osteotomy demonstrated favorable therapeutic outcomes and satisfactory surgical correction. The above-mentioned surgical technique can be, therefore, recommended to correct the severe hallux valgus deformity. Level of Clinical Evidence: 2.

The combination of high energy fractures, extensive soft tissue trauma, and high infection rates in pilon fractures of the distal tibia have long challenged surgeons. Despite the ample evidence, there is no consensus regarding the factors that may influence postoperative infections following surgical management of these fractures. This study aimed to investigate the risk factors for postoperative infections in patients undergoing surgical management for pilon fractures. This retrospective cohort study evaluated demographic variables, smoking status, nutritional status (i.e., pre-and postoperative albumin, pre-and postoperative white blood cell count, use of antibiotics, time to external fixation and ORIF, and hospital length of stay. A multivariate logistic regression model was used to predict risk factors associated with postoperative infection after fixation of a pilon fracture for several independent parameters. A receiver operator characteristic (ROC) curve was constructed, and a threshold was found for the investigated continuous variables, which were significant in the regression analysis. Overall, 416 patients following surgical management for a pilon fracture were identified. A multivariate logistic regression analysis revealed that preoperative albumin, preoperative WBC, and hospital length of stay were associated with postoperative infection following surgical management of pilon fractures. Thresholds determined by the Youden index were 3.05 for preoperative albumin levels, 12.65 for preoperative WBC levels, and 7.1 days for hospital length of stay. Furthermore, older patients were less prone to develop postoperative infection than younger patients. Lower preoperative albumin levels (< 3.05 mg/dL), higher preoperative WBC levels (>12.65 mg/dL), and a longer duration of hospitalization (>7.1 days) were related to an increased risk for postoperative infection after fixation of a pilon fracture.

Orthopedic screws are widely used to achieve bone reduction, compression, and construct stability. However, the relationship between insertion torque, interfragmentary compression, and fixation strength, especially when comparing standard screws with NiTiNOL/sustained dynamic compression (SDC), has not been thoroughly investigated. This study measured insertion torque, interfragmentary compression, and fixation strength for two types of headed orthopedic devices-standard and SDC-using solid foam bone replicates and cadaver validation. The study also assessed the interfragmentary compression produced by these devices in the context of simulated bone resorption. Results showed that compression force increased with insertion torque until thread stripping occurred, resulting in a 91.9% loss of compression in the standard screw group. In contrast, the SDC device maintained significantly higher compression, even beyond the point of stripping. These findings suggest that SDC devices offer increased safety by continuing to apply interfragmentary compression after stripping. The SDC device's ability to generate internal compression allows it to re-engage threads into undamaged bone, potentially compensating for compression loss due to stripping. Clinically, these results indicate that surgeons might benefit from deliberately undershooting peak insertion torque, regardless of the device type, and may prefer NiTiNOL-based SDC devices for their resilience to stripping and bone resorption, ultimately optimizing patient outcomes in foot and ankle surgery.

Metal allergies in surgery are often underreported and under diagnosed. Oftentimes, the symptoms of metal allergy closely resemble those of infection and the protocol is removal of the offending implant. Identification of metal allergies in the preoperative workup is imperative to provide the best patient care and outcomes. The purpose of this report is to present considerations to approach to both preoperative and postoperative identification of patients with metal allergies. Utilizing published algorithms for total knee arthroplasty (TKA) and the author's experience, considerations for both preoperative and postoperative metal allergy have been developed to help the foot and ankle surgeon with the complicated task of addressing patients with metal allergies. To date, the authors have utilized this guidelines for total ankle arthroplasty, ankle fracture open reduction internal fixation, and first metatarsophalangeal joint arthrodesis. While literature has been published with metal allergy algorithms for total knee arthroplasty, this is the first of its kind for adaptation to foot and ankle surgery in general to the author's knowledge. To date, the authors have favorable outcomes utilizing these approaches to not only guide patient care but to help prevent future complications or address them if they present. With a thorough patient history, identification of metal allergies, a multidisciplinary approach and pre-operative planning, good outcomes can be achieved.

This study aims to examine whether the preoperative controlling nutritional status (CONUT) score was associated with SSI following elective foot and ankle surgeries. This study retrospectively reviewed adult undergoing elective foot and ankle surgeries in a tertiary university-affiliated hospital between January 2019 and May 2023, and identified who subsequently developed an SSI within 12 months postoperative. CONUT score was calculated from serum albumin, lymphocyte count, and toral cholesterol concentration, and its optimal cut-off value for differentiating SSI risk was determined by the receiver operating characteristic curve. Three independent hierarchical multivariable logistic regression models, adjusting demographics, confounders or covariates were constructed to examine the association. Among 1,424 surgical procedures performed in 1,221 patients, 36 (2.5 %) SSIs were identified, with 21 (1.5 %) superficial cases and 15 (1.1 %) deep cases, respectively. The optimal cut-off for CONUT was 3, and significant differences were observed between patients with CONUT ≥ 3 and those <3, in terms of age, BMI, anesthesia, procedure, bleeding, preoperative prophylactic antibiotics, and admission sodium. Multivariate analyses showed consistent significant results (OR 4.66 and 95 % CI 2.32 to 9.37 after adjustment for demographics; OR 4.72 and 95 % CI 2.22 to 10.02 for adjustment for confounders, and OR 3.80 and 95 % CI 1.68 to 8.59 for further covariates). This finding may aid clinicians in conducting individualized assessments of SSI and developing a more tailored SSI risk profile for patients undergoing such procedures.

As the incidence of total ankle arthroplasty (TAA) for the management of end-stage arthritis is on the rise, identification of risk factors for periprosthetic joint infection (PJI) is essential. There has been limited research exploring the use of radiographic soft tissue thickness in TAA despite its predictive value in other forms of arthroplasty. This study evaluated the predictive capabilities of radiographic soft-tissue thickness for PJI following TAA. A retrospective analysis of 323 patients at a single institution who underwent primary TAA from 2003 to 2019 was conducted. Patient demographics, comorbidities, indication for surgery, prosthesis type and tourniquet time were recorded. Tibial-Tissue and Talus-Tissue distances were measured on preoperative lateral radiographic imaging. Logistic regression was utilized to determine the Odds Ratio (OR) of risk factors for the occurrence of PJI. Of the 323 patients, 6 patients (1.86%) developed a PJI. Average duration of follow-up was 8.42 ± 2.52 years. Neither Tibial-Tissue (OR= 0.975; 95% CI [0.947 - 1.004]; p = 0.09) nor Talus-Tissue thickness (OR= 0.976; 95% CI [0.940 - 1.012]; p = 0.18) were significant predictors of PJI. Although not statistically significant, the infected cohort had smaller average Tibial-Tissue (2.20 vs. 2.53 cm; p=0.05) and Talus-Tissue thickness (2.19 vs. 2.44 cm; p=0.36) compared to the non-infected cohort. Measurements such as Tibial-Tissue length and Talus-Tissue length were not significant predictors of PJI following primary TAA. These findings underscore the necessity for additional research to identify modifiable risk factors aimed at reducing PJI rates and enhancing patient outcomes.

Plantar fasciitis is a common musculoskeletal issue that can cause severe pain and limit functionality. This study aimed to compare the effectiveness of Extracorporeal shock-wave therapy and Low-dye taping in relieving pain and improving functionality in plantar fasciitis. The study included cases with a confirmed diagnosis of plantar fasciitis, which were randomly divided into two groups: Extracorporeal shock-wave therapy and Low-dye taping. The subjects in the Extracorporeal shock-wave therapy group were treated with Extracorporeal shock-wave therapy, while the subjects in the Low-dye taping group were treated with Low-dye taping and sham Extracorporeal shock-wave therapy. Both treatments were administered in three sessions, once a week. Pain and functionality levels were evaluated using the Visual analog scala and Foot&Ankle Outcome Score. Evaluations were conducted pre- and post-treatment, and at the six-week follow-up. Seventy-two subjects completed the study, and at the end of the treatment and follow-up periods, both groups showed a significant decrease in pain levels (p≤0.001) and an increase in functionality levels (p≤0.001) compared to the beginning. However, there was no significant difference between the groups regarding pain and functionality levels at the end of the treatment and follow-up period (p > 0.05). Therefore, both Extracorporeal shock-wave therapy and Low-dye taping treatments were found to have similar effects in treating plantar fasciitis. These findings can guide clinicians in choosing the most effective conservative treatment for plantar fasciitis patients.

Accurate diagnoses of peroneal pathologies remains a challenge due to limitations of conventional 2D (dimensional) imaging, which can impact long-term patient outcomes. This study evaluates MRI accuracy and inter-reader reliability of peroneal compartment pathology for 2D and 3D MRI. A consecutive series of patients who underwent peroneal compartment surgery with preoperative 1.5- or 3.0-Tesla ankle MRIs from 2009 to 2024 included 32 scans (22 with 2D, 10 with 2D+3D) from 31 patients (ages 17-74 years, all genders). Three musculoskeletal readers blinded to surgical findings independently analyzed MRI scans for common peroneal tenosynovitis, peroneus brevis and peroneus longus tenosynovitis, tendinopathy, and tears. Inter-reader reliability and diagnostic performance measures were calculated. Using majority vote, overall accuracy, sensitivity, and specificity for peroneal tendons using 2D MRI were 80%, 81%, and 79%, respectively. Using 3D MRI sequences, whether in isolation or combination with 2D MRI, accuracy, sensitivity, and specificity increased to 85%, 88%, and 83%, respectively. The inter-reader reliability for peroneus brevis lesions was 0.45-0.75 for 2D, 0.25-0.35 for 3D, and 0.31-0.54 for combined 2D+3D, while for peroneus longus lesions, it was 0.45-0.90 for 2D, 0.20-0.71 for 3D, and 0.64-0.81 for combined 2D+3D scans. The inter-reader reliability for tenosynovitis ranged from 0.62-0.64 for 2D, 0.25-0.37 for 3D, and 0.57-0.66 for combined 2D+3D scans. The addition of 3D MRI to 2D high-resolution ankle MRI protocol or 3D MRI alone increases accuracy of peroneal compartment lesion detection with minor decrease in inter-reader reliability for peroneal brevis tendon assessment. Larger studies may help validate our findings.

Plantar heel pain is a prevalent condition affecting 10 % of the population, with plantar fasciitis being the most common cause. Plantar calcaneal spurs are frequently associated with plantar fasciitis, yet their role in the condition and surgical outcomes remains unclear. This study investigates the impact of plantar calcaneal spur excision on the outcomes of plantar fascia surgery, utilizing a radiofrequency microtenotomy and bone marrow aspiration technique. A retrospective review of 136 plantar fascia surgeries was conducted with 83 cases including plantar calcaneal spur excision. Demographic and operative factors were analyzed. Outcomes included time to weight-bearing in a boot and shoes, symptom resolution, and complications. Plantar calcaneal spur excision was associated with a statistically significant delay in symptom resolution (p = 0.006) and time to weight-bearing in shoes (p = 0.020). A statistically significant difference was observed regarding operative laterality, with right-sided surgeries demonstrating an increased time to symptom resolution (p = 0.007) and a higher retreatment rate (p = 0.017) compared to left-sided surgeries. There was no significant difference in complication rates or the need for retreatment between excision and non-excision groups. These findings highlight the need for careful consideration of plantar calcaneal spur excision in surgical planning for plantar fasciitis, with implications for patient education and management strategies.

Many fixation options exist for correction of a hallux valgus deformity with a first tarsometatarsal joint arthrodesis with pros and cons to each. Few have looked at utilizing a shape memory alloy staple made from nitinol for fixation. This study evaluates the effectiveness of a modified Lapidus technique using a nitinol (shape memory alloy) staple combined with a two-screw construct for first tarsometatarsal joint arthrodesis in correcting hallux valgus deformity. The non-union rate, time to weightbearing in both a boot and a shoe, hardware removal of the staples, and the need for revision surgeries were all evaluated. A retrospective review of 42 patients meeting the inclusion criteria was conducted, with an average follow-up time of 12.3 months (SD 4.5). Bony union was achieved in 47 of 48 (97.92 %) cases for a non-union rate of 2.08 %. The average time to weightbearing in a boot was 27.35 days (SD 3.47), while in a shoe, it was 55.58 days (SD 10.03). There was a total of 3 procedures requiring staple removal (3/48) (6.25 %), and no revision surgeries were needed due to loss of correction or non-union. These outcomes suggest that the nitinol staple and two-screw construct is a reliable option for first tarsometatarsal joint arthrodesis in hallux valgus deformity, showing similar results compared to other fixation methods. Level of Clinical Evidence: 4.