Weight-bearing computed tomography (WBCT) is an advanced imaging modality that allows for a three-dimensional assessment of the foot and ankle under a physiological load. It overcomes the limitations of traditional radiographs and non-weight-bearing CT/MRI by providing a more precise evaluation of the joint space narrowing, malalignment, and dynamic changes associated with ankle arthritis.Recent studies have shown the advantages of WBCT in classifying ankle arthritis, revealing previously unrecognized deformities such as valgus tilting in medial gutter arthritis. WBCT also enhances the diagnostic accuracy by quantifying talar rotation, hindfoot alignment, and subtalar joint compensation, which are critical for treatment planning. In addition, WBCT has proven useful in surgical applications, including supramalleolar osteotomy and total ankle arthroplasty, by aiding in preoperative planning, patient-specific instrumentation, and postoperative assessments. It also enables the early detection of complications such as implant malalignment and periprosthetic osteolysis. As WBCT technology continues to evolve, WBCT is expected to play a growing role in optimizing the diagnostic precision and improving treatment outcomes for ankle arthritis. Future research should focus on standardizing WBCT-based measurements and integrating quantitative analysis to enhance clinical decision-making.

Charcot neuroarthropathy (CN), also known as Charcot arthropathy, is a complex, progressive disorder primarily affecting the foot and ankle. This case report describes a multifaceted management strategy for a 54-year-old male with diabetes mellitus, end-stage renal disease, and presumed underlying Charcot arthropathy who experienced a traumatic ankle fracture. The initial surgical plans were delayed because of systemic infection indicators, including elevated C-reactive protein levels and high fever. The patient underwent multiple surgical interventions and faced challenges, including metal failure, implant-associated infection, and tibiotalar joint dislocation. A multidisciplinary approach involving orthopedic surgeons, nephrologists, and endocrinologists was crucial for managing the case effectively.In particular, the patient declined a below-knee amputation and opted for comprehensive surgical intervention, resulting in improved functionality at the latest follow-up. This case highlights the complexities of managing CN in patients with multiple comorbidities and emphasizes the need for a nuanced, patient-centered approach.

Purpose: This study compared the treatment outcomes between fixation using screws and suture buttons for addressing distal tibiofibular syndesmosis diastasis combined with ankle fractures. Materials and Methods: A retrospective study was conducted involving 20 patients with ankle fractures treated with screws and 21 patients treated with suture buttons for distal tibiofibular syndesmosis diastasis. The postoperative clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, while the radiological outcomes were determined by measuring the tibiofibular clear space, tibiofibular overlap, and medial clear space on the pre- and post-operative radiographs. In addition, factors such as the need for internal fixation removal surgery and the incidence of internal fixation damage were investigated. Results: One-year post-surgery, the average AOFAS score showed no significant difference between the screw and suture button surgery groups. Initially, measurements of the tibiofibular clear space, tibiofibular overlap, and medial clear space did not exhibit significant differences between the two groups. On the other hand, significant differences were observed one-year post-surgery. All patients in the screw surgery group underwent screw removal surgery. Within this group, two cases of screw breakage and one case of surgical wound infection were recorded. Conclusion When treating distal tibiofibular syndesmosis diastasis, the screw surgery group and the suture button surgery group showed similar clinical outcomes measured by AOFAS one year after surgery, but the suture button surgery group had better results in radiological evaluation and complication frequency.

The fundamental principles for treating ankle fractures, as with other intra-articular fractures, are anatomical reduction and stable internal fixation. Despite successful reduction, between 14% and 40% of patients continue to experience persistent pain or unsatisfactory functional outcomes. Furthermore, approximately 1% of patients progress to post-traumatic arthritis, necessitating further surgical intervention. Ankle fractures are frequently accompanied by intra-articular injuries, including osteochondral lesions, ligament tears, and syndesmosis injuries. Arthroscopy is becoming increasingly prevalent in managing acute ankle fractures by assessing intra-articular damage and facilitating accurate reduction. This review examined the role and indications for arthroscopy in ankle fractures, particularly emphasizing its benefits in diagnosing and managing associated injuries, including osteochondral lesions, syndesmosis, and deltoid ligament injuries. Furthermore, arthroscopy facilitates fracture reduction, offering a minimally invasive approach with a shorter recovery period and enhanced visualization. Its use extends to pediatric fractures and complex cases such as Maisonneuve and calcaneal fractures, potentially improving outcomes while minimizing complications. Understanding the evolving indications and benefits of arthroscopy for ankle fractures can lead to improved clinical outcomes and reduced complications.

Charcot–Marie–Tooth (CMT) disease is the most common hereditary peripheral neuropathy, affecting the motor and sensory nerves and manifesting a range of systemic symptoms. CMT disease encompasses a range of genetic subtypes, with symptoms often emerging in childhood and progressing into adulthood. More than 70% of CMT patients exhibit cavovarus foot deformities that impair normal gait, often requiring the use of a brace. A diagnosis relies heavily on a thorough physical examination of each tendon contributing to the deformity. Conservative treatments, such as shoe modifications and braces, are initially preferred. Surgical reconstruction may be considered if conservative management fails. Patients who require surgery typically present with progressive cavovarus deformities, muscular imbalances, soft tissue contractures, and abnormal bone morphology. For a CMT foot reconstruction, joint-sparing surgery with soft tissue release and osteotomy is recommended. Fusion surgery is advised for deformities that are irreducible by joint-preserving surgery or in cases with painful arthritis. CMT foot surgery can enhance the patient’s ability to ambulate without a brace, leading to high satisfaction and improved quality of life.

Multidirectional joint instability is a condition where laxity occurs in two or more directions. This condition typically arises congenitally or because of hypermobility or repetitive, excessive physical activity. It can also occur from chronic damage to the joint capsule and multiple ligaments, causing a breakdown in stability. Despite the numerous studies conducted on multidirectional instability of the shoulder, there is a lack of published research on multidirectional instability of the ankle. This paper reports the case of a male patient in his early 30s, engaged in high-demand physical activity, who presented with simultaneous medial and lateral ankle instability. The patient underwent a combination of procedures, including an anterior talofibular ligament reconstruction with suture tape, deltoid ligament reattachment with suture anchors, anteroinferior tibiofibular ligament reconstruction with suture tape, and syndesmotic screw fixation with Tightrope insertion. The patient was followed up for one year postoperatively. This paper reports the clinical outcomes with a review of the relevant literature.

The heel is the second most common area for pressure injuries, which can lead to serious and threatening extremity infections. The late stages of deep hindfoot ulcers, where osteomyelitis commonly coexists, can result in an extended therapeutic window. Standard treatments for hindfoot ulcers complicated by osteomyelitis encompass debridement and flap surgery. In severe cases, below-knee amputation is also considered. Recent studies have reported the efficacy of negative pressure wound therapy (NPWT) in addressing refractory foot ulcers. The authors developed a temporary tension suture (TTS) in combination with NPWT to shorten the treatment duration of refractory foot ulcers, providing additional appropriate tension for wound coverage. The authors report for the first time a case of a 73-year-old female patient who had been experiencing an intractable hindfoot ulcer with chronic osteomyelitis for 18 months. NPWT and TTSs were applied concurrently with favorable outcomes.

Weight-bearing computed tomography (WBCT) is an advanced imaging modality that allows for a three-dimensional assessment of the foot and ankle under a physiological load. It overcomes the limitations of traditional radiographs and non-weight-bearing CT/MRI by providing a more precise evaluation of the joint space narrowing, malalignment, and dynamic changes associated with ankle arthritis.Recent studies have shown the advantages of WBCT in classifying ankle arthritis, revealing previously unrecognized deformities such as valgus tilting in medial gutter arthritis. WBCT also enhances the diagnostic accuracy by quantifying talar rotation, hindfoot alignment, and subtalar joint compensation, which are critical for treatment planning. In addition, WBCT has proven useful in surgical applications, including supramalleolar osteotomy and total ankle arthroplasty, by aiding in preoperative planning, patient-specific instrumentation, and postoperative assessments. It also enables the early detection of complications such as implant malalignment and periprosthetic osteolysis. As WBCT technology continues to evolve, WBCT is expected to play a growing role in optimizing the diagnostic precision and improving treatment outcomes for ankle arthritis. Future research should focus on standardizing WBCT-based measurements and integrating quantitative analysis to enhance clinical decision-making.

Charcot neuroarthropathy (CN), also known as Charcot arthropathy, is a complex, progressive disorder primarily affecting the foot and ankle. This case report describes a multifaceted management strategy for a 54-year-old male with diabetes mellitus, end-stage renal disease, and presumed underlying Charcot arthropathy who experienced a traumatic ankle fracture. The initial surgical plans were delayed because of systemic infection indicators, including elevated C-reactive protein levels and high fever. The patient underwent multiple surgical interventions and faced challenges, including metal failure, implant-associated infection, and tibiotalar joint dislocation. A multidisciplinary approach involving orthopedic surgeons, nephrologists, and endocrinologists was crucial for managing the case effectively.In particular, the patient declined a below-knee amputation and opted for comprehensive surgical intervention, resulting in improved functionality at the latest follow-up. This case highlights the complexities of managing CN in patients with multiple comorbidities and emphasizes the need for a nuanced, patient-centered approach.

Purpose: This study compared the treatment outcomes between fixation using screws and suture buttons for addressing distal tibiofibular syndesmosis diastasis combined with ankle fractures. Materials and Methods: A retrospective study was conducted involving 20 patients with ankle fractures treated with screws and 21 patients treated with suture buttons for distal tibiofibular syndesmosis diastasis. The postoperative clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, while the radiological outcomes were determined by measuring the tibiofibular clear space, tibiofibular overlap, and medial clear space on the pre- and post-operative radiographs. In addition, factors such as the need for internal fixation removal surgery and the incidence of internal fixation damage were investigated. Results: One-year post-surgery, the average AOFAS score showed no significant difference between the screw and suture button surgery groups. Initially, measurements of the tibiofibular clear space, tibiofibular overlap, and medial clear space did not exhibit significant differences between the two groups. On the other hand, significant differences were observed one-year post-surgery. All patients in the screw surgery group underwent screw removal surgery. Within this group, two cases of screw breakage and one case of surgical wound infection were recorded. Conclusion When treating distal tibiofibular syndesmosis diastasis, the screw surgery group and the suture button surgery group showed similar clinical outcomes measured by AOFAS one year after surgery, but the suture button surgery group had better results in radiological evaluation and complication frequency.