Background: Patients with severe hindfoot Charcot neuroarthropathy may experience various complications following tibiotalocalcaneal arthrodesis. Therefore, it is crucial to establish appropriate treatment plans to prevent potential complications and predict prognosis before surgery. This study aimed to investigate the impact of the degree of preoperative deformity in hindfoot Charcot neuroarthropathy on the outcomes of tibiotalocalcaneal arthrodesis. Methods: Twenty patients who underwent tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy were grouped by the severity of their deformities into a mild deformity group (tibiotalar angle between 80° and 100° with minimal or no talar osteolysis) and a severe deformity group (tibiotalar angle < 80° or > 100°, or severe talar osteolysis precluding tibiotalocalcaneal arthrodesis and necessitating tibiocalcaneal arthrodesis). Their demographics, comorbidities, and various surgical outcomes were compared between the 2 groups. Additional analyses were conducted to determine the factors associated with poor clinical outcome, defined as the inability to achieve independent ambulation or the need for below-knee amputation. Results: There were no significant differences in demographics and comorbidities between the 2 groups. Postoperative clinical outcomes, including the rate of postoperative infection and poor clinical outcome (inability to walk independently or having undergone below-knee amputation), showed no significant differences between the 2 groups. In terms of radiological outcomes, the bony union rates were 66.7% in the mild deformity group and 54.5% in the severe deformity group, with no significant difference.Similarly, other radiological outcomes, such as postoperative malalignment and time to union, did not vary significantly between the 2 groups. Factors associated with poor clinical outcome were the presence of preoperative infected wound and postoperative infection. Conclusions The severity of preoperative coronal deformity or talar osteolysis was not associated with clinical or radiological outcomes of tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy. However, preoperative infected wound and postoperative infection were associated with poor clinical outcomes. Therefore, instead of early amputation in cases of severe coronal deformity or insufficient talar bone stock, limb salvage with tibiotalocalcaneal arthrodesis may be a viable alternative, with particular attention to patients with preoperative infected wound and postoperative infection.

Background: Patients with severe hindfoot Charcot neuroarthropathy may experience various complications following tibiotalocalcaneal arthrodesis. Therefore, it is crucial to establish appropriate treatment plans to prevent potential complications and predict prognosis before surgery. This study aimed to investigate the impact of the degree of preoperative deformity in hindfoot Charcot neuroarthropathy on the outcomes of tibiotalocalcaneal arthrodesis. Methods: Twenty patients who underwent tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy were grouped by the severity of their deformities into a mild deformity group (tibiotalar angle between 80° and 100° with minimal or no talar osteolysis) and a severe deformity group (tibiotalar angle < 80° or > 100°, or severe talar osteolysis precluding tibiotalocalcaneal arthrodesis and necessitating tibiocalcaneal arthrodesis). Their demographics, comorbidities, and various surgical outcomes were compared between the 2 groups. Additional analyses were conducted to determine the factors associated with poor clinical outcome, defined as the inability to achieve independent ambulation or the need for below-knee amputation. Results: There were no significant differences in demographics and comorbidities between the 2 groups. Postoperative clinical outcomes, including the rate of postoperative infection and poor clinical outcome (inability to walk independently or having undergone below-knee amputation), showed no significant differences between the 2 groups. In terms of radiological outcomes, the bony union rates were 66.7% in the mild deformity group and 54.5% in the severe deformity group, with no significant difference.Similarly, other radiological outcomes, such as postoperative malalignment and time to union, did not vary significantly between the 2 groups. Factors associated with poor clinical outcome were the presence of preoperative infected wound and postoperative infection. Conclusions The severity of preoperative coronal deformity or talar osteolysis was not associated with clinical or radiological outcomes of tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy. However, preoperative infected wound and postoperative infection were associated with poor clinical outcomes. Therefore, instead of early amputation in cases of severe coronal deformity or insufficient talar bone stock, limb salvage with tibiotalocalcaneal arthrodesis may be a viable alternative, with particular attention to patients with preoperative infected wound and postoperative infection.

Background: Patients with severe hindfoot Charcot neuroarthropathy may experience various complications following tibiotalocalcaneal arthrodesis. Therefore, it is crucial to establish appropriate treatment plans to prevent potential complications and predict prognosis before surgery. This study aimed to investigate the impact of the degree of preoperative deformity in hindfoot Charcot neuroarthropathy on the outcomes of tibiotalocalcaneal arthrodesis. Methods: Twenty patients who underwent tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy were grouped by the severity of their deformities into a mild deformity group (tibiotalar angle between 80° and 100° with minimal or no talar osteolysis) and a severe deformity group (tibiotalar angle < 80° or > 100°, or severe talar osteolysis precluding tibiotalocalcaneal arthrodesis and necessitating tibiocalcaneal arthrodesis). Their demographics, comorbidities, and various surgical outcomes were compared between the 2 groups. Additional analyses were conducted to determine the factors associated with poor clinical outcome, defined as the inability to achieve independent ambulation or the need for below-knee amputation. Results: There were no significant differences in demographics and comorbidities between the 2 groups. Postoperative clinical outcomes, including the rate of postoperative infection and poor clinical outcome (inability to walk independently or having undergone below-knee amputation), showed no significant differences between the 2 groups. In terms of radiological outcomes, the bony union rates were 66.7% in the mild deformity group and 54.5% in the severe deformity group, with no significant difference.Similarly, other radiological outcomes, such as postoperative malalignment and time to union, did not vary significantly between the 2 groups. Factors associated with poor clinical outcome were the presence of preoperative infected wound and postoperative infection. Conclusions The severity of preoperative coronal deformity or talar osteolysis was not associated with clinical or radiological outcomes of tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy. However, preoperative infected wound and postoperative infection were associated with poor clinical outcomes. Therefore, instead of early amputation in cases of severe coronal deformity or insufficient talar bone stock, limb salvage with tibiotalocalcaneal arthrodesis may be a viable alternative, with particular attention to patients with preoperative infected wound and postoperative infection.

Background: Patients with severe hindfoot Charcot neuroarthropathy may experience various complications following tibiotalocalcaneal arthrodesis. Therefore, it is crucial to establish appropriate treatment plans to prevent potential complications and predict prognosis before surgery. This study aimed to investigate the impact of the degree of preoperative deformity in hindfoot Charcot neuroarthropathy on the outcomes of tibiotalocalcaneal arthrodesis. Methods: Twenty patients who underwent tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy were grouped by the severity of their deformities into a mild deformity group (tibiotalar angle between 80° and 100° with minimal or no talar osteolysis) and a severe deformity group (tibiotalar angle < 80° or > 100°, or severe talar osteolysis precluding tibiotalocalcaneal arthrodesis and necessitating tibiocalcaneal arthrodesis). Their demographics, comorbidities, and various surgical outcomes were compared between the 2 groups. Additional analyses were conducted to determine the factors associated with poor clinical outcome, defined as the inability to achieve independent ambulation or the need for below-knee amputation. Results: There were no significant differences in demographics and comorbidities between the 2 groups. Postoperative clinical outcomes, including the rate of postoperative infection and poor clinical outcome (inability to walk independently or having undergone below-knee amputation), showed no significant differences between the 2 groups. In terms of radiological outcomes, the bony union rates were 66.7% in the mild deformity group and 54.5% in the severe deformity group, with no significant difference.Similarly, other radiological outcomes, such as postoperative malalignment and time to union, did not vary significantly between the 2 groups. Factors associated with poor clinical outcome were the presence of preoperative infected wound and postoperative infection. Conclusions The severity of preoperative coronal deformity or talar osteolysis was not associated with clinical or radiological outcomes of tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy. However, preoperative infected wound and postoperative infection were associated with poor clinical outcomes. Therefore, instead of early amputation in cases of severe coronal deformity or insufficient talar bone stock, limb salvage with tibiotalocalcaneal arthrodesis may be a viable alternative, with particular attention to patients with preoperative infected wound and postoperative infection.

Background: : A torn plantar plate (PP) is important pathologic anatomy related to a dislocated or subluxated metatarsophalangeal joint (MTPJ). Traditionally, a torn PP was treated with Weil osteotomy through a dorsal approach. However, because of the limited visualization of the dorsal approach, PP repair through a plantar approach has been proposed as a new technique. This study aimed to radiologically evaluate the outcome of PP repair through the plantar approach using an improved MTPJ overlap distance (MOD) on an anteroposterior view and the degree of subluxation on an oblique view. We also aimed to investigate the potential factors affecting the recurrence of MTPJ instability. Methods: In this study, we included 31 patients who had a subluxated or dislocated MTPJ of the second or third toe and underwent surgical PP repair. PP repair was performed via a plantar approach after shortening metatarsal (MT) osteotomy with a dorsal approach for longer MT bone. We assessed the severity of MTPJ subluxation by measuring the MOD and subluxation subtype on radiographs. Radiologic recurrence was defined as an increase in MOD or change from subluxation type A to subluxation type B.The relationship of recurrence with clinical and radiologic factors was evaluated by comparing the recurred group against the nonrecurred group. Results: Shortening MT osteotomy was performed in 26 of 31 cases (84%). Repeated measures analysis of variance comparing preoperation, pin removal, and the latest follow-up MOD values revealed the effectiveness of PP repair through the plantar approach (p < 0.001). The MOD did not significantly change after pin removal and the latest follow-up (p = 0.130), indicating that reduction was well maintained. None of the clinical and radiologic factors were significantly related to recurrence. However, 3 of 12 rheumatoid arthritis (RA) feet (25%) recurred and 3 of 5 recurred cases (60%) were RA feet. This result suggests that RA indicated a tendency for recurrence. Conclusions PP repair through the plantar approach has the advantage of excellent visualization of a torn PP and direct repair.We, therefore, recommend using the plantar approach for PP repair of the MTPJ.

Adult-acquired flatfoot deformity is a progressive, debilitating condition characterized by three-dimensional deformities, including hindfoot valgus, forefoot abduction, forefoot or midfoot varus, peritalar subluxation, and ankle instability. A consensus group recently proposed a new nomenclature for this condition, termed progressive collapsing foot deformity (PCFD), and introduced a new classification system for PCFD. Moreover, with a vigorous investigation into PCFD and the widespread use of new diagnostic tools, including weight-bearing computed tomography, the understanding of PCFD has improved considerably. As the understanding of the various components of PCFD has deepened, a range of treatment options, from conservative management to osteotomy and arthrodesis, have been reported to correct each component. Therefore, this paper provides an overview of the classification systems, diagnostic methods, and various treatment approaches for PCFD.

Adult-acquired flatfoot deformity is a progressive, debilitating condition characterized by three-dimensional deformities, including hindfoot valgus, forefoot abduction, forefoot or midfoot varus, peritalar subluxation, and ankle instability. A consensus group recently proposed a new nomenclature for this condition, termed progressive collapsing foot deformity (PCFD), and introduced a new classification system for PCFD. Moreover, with a vigorous investigation into PCFD and the widespread use of new diagnostic tools, including weight-bearing computed tomography, the understanding of PCFD has improved considerably. As the understanding of the various components of PCFD has deepened, a range of treatment options, from conservative management to osteotomy and arthrodesis, have been reported to correct each component. Therefore, this paper provides an overview of the classification systems, diagnostic methods, and various treatment approaches for PCFD.

Background: : A torn plantar plate (PP) is important pathologic anatomy related to a dislocated or subluxated metatarsophalangeal joint (MTPJ). Traditionally, a torn PP was treated with Weil osteotomy through a dorsal approach. However, because of the limited visualization of the dorsal approach, PP repair through a plantar approach has been proposed as a new technique. This study aimed to radiologically evaluate the outcome of PP repair through the plantar approach using an improved MTPJ overlap distance (MOD) on an anteroposterior view and the degree of subluxation on an oblique view. We also aimed to investigate the potential factors affecting the recurrence of MTPJ instability. Methods: In this study, we included 31 patients who had a subluxated or dislocated MTPJ of the second or third toe and underwent surgical PP repair. PP repair was performed via a plantar approach after shortening metatarsal (MT) osteotomy with a dorsal approach for longer MT bone. We assessed the severity of MTPJ subluxation by measuring the MOD and subluxation subtype on radiographs. Radiologic recurrence was defined as an increase in MOD or change from subluxation type A to subluxation type B.The relationship of recurrence with clinical and radiologic factors was evaluated by comparing the recurred group against the nonrecurred group. Results: Shortening MT osteotomy was performed in 26 of 31 cases (84%). Repeated measures analysis of variance comparing preoperation, pin removal, and the latest follow-up MOD values revealed the effectiveness of PP repair through the plantar approach (p < 0.001). The MOD did not significantly change after pin removal and the latest follow-up (p = 0.130), indicating that reduction was well maintained. None of the clinical and radiologic factors were significantly related to recurrence. However, 3 of 12 rheumatoid arthritis (RA) feet (25%) recurred and 3 of 5 recurred cases (60%) were RA feet. This result suggests that RA indicated a tendency for recurrence. Conclusions PP repair through the plantar approach has the advantage of excellent visualization of a torn PP and direct repair.We, therefore, recommend using the plantar approach for PP repair of the MTPJ.

Background: : A torn plantar plate (PP) is important pathologic anatomy related to a dislocated or subluxated metatarsophalangeal joint (MTPJ). Traditionally, a torn PP was treated with Weil osteotomy through a dorsal approach. However, because of the limited visualization of the dorsal approach, PP repair through a plantar approach has been proposed as a new technique. This study aimed to radiologically evaluate the outcome of PP repair through the plantar approach using an improved MTPJ overlap distance (MOD) on an anteroposterior view and the degree of subluxation on an oblique view. We also aimed to investigate the potential factors affecting the recurrence of MTPJ instability. Methods: In this study, we included 31 patients who had a subluxated or dislocated MTPJ of the second or third toe and underwent surgical PP repair. PP repair was performed via a plantar approach after shortening metatarsal (MT) osteotomy with a dorsal approach for longer MT bone. We assessed the severity of MTPJ subluxation by measuring the MOD and subluxation subtype on radiographs. Radiologic recurrence was defined as an increase in MOD or change from subluxation type A to subluxation type B.The relationship of recurrence with clinical and radiologic factors was evaluated by comparing the recurred group against the nonrecurred group. Results: Shortening MT osteotomy was performed in 26 of 31 cases (84%). Repeated measures analysis of variance comparing preoperation, pin removal, and the latest follow-up MOD values revealed the effectiveness of PP repair through the plantar approach (p < 0.001). The MOD did not significantly change after pin removal and the latest follow-up (p = 0.130), indicating that reduction was well maintained. None of the clinical and radiologic factors were significantly related to recurrence. However, 3 of 12 rheumatoid arthritis (RA) feet (25%) recurred and 3 of 5 recurred cases (60%) were RA feet. This result suggests that RA indicated a tendency for recurrence. Conclusions PP repair through the plantar approach has the advantage of excellent visualization of a torn PP and direct repair.We, therefore, recommend using the plantar approach for PP repair of the MTPJ.

Adult-acquired flatfoot deformity is a progressive, debilitating condition characterized by three-dimensional deformities, including hindfoot valgus, forefoot abduction, forefoot or midfoot varus, peritalar subluxation, and ankle instability. A consensus group recently proposed a new nomenclature for this condition, termed progressive collapsing foot deformity (PCFD), and introduced a new classification system for PCFD. Moreover, with a vigorous investigation into PCFD and the widespread use of new diagnostic tools, including weight-bearing computed tomography, the understanding of PCFD has improved considerably. As the understanding of the various components of PCFD has deepened, a range of treatment options, from conservative management to osteotomy and arthrodesis, have been reported to correct each component. Therefore, this paper provides an overview of the classification systems, diagnostic methods, and various treatment approaches for PCFD.