OBJECTIVE: To review the research progress on correction of severe foot and ankle deformities with digital hexapod external fixators. METHODS: The relevant research literature on digital hexapod external fixators at home and abroad in recent years was reviewed and analyzed. Taking Taylor spatial frame (TSF) as a representative, this article elaborates on the research progress of this technology in the treatment of severe foot and ankle deformities from aspects such as device principle, technical characteristics, clinical application, complication management, and controversial perspectives, aiming to provide theoretical references for clinical application. RESULTS: The treatment of severe foot and ankle deformities is a complex challenge in orthopedics, often involving multiple plane alignment abnormalities, muscle weakness, soft tissue contractures, and joint dysfunction. The digital hexapod external fixators (such as TSF), based on the principle of six degrees of freedom motion and combined with computer-assisted technology, enables precise correction of multi-dimensional deformities. CONCLUSION The digital hexapod external fixators provides a minimally invasive and efficient option for the treatment of severe foot and ankle deformities, and shows significant advantages in the treatment of complex post-traumatic deformities, neuromuscular deformities, diabetes Charcot arthropathy, and other diseases.
Humans ; External Fixators ; Foot Deformities/surgery* ; Ankle Joint/abnormalities* ; Ankle/abnormalities* ; Equipment Design

Schwannomas are benign neoplasms with a Schwann cell origin. A plexiform schwannoma is a rare variant of a schwannoma with a plexiform or multinodular growth pattern. The condition occurs mostly as a solitary lesion in the skin or subcutaneous tissue, or uncommonly located in the deep soft tissue. We report a rare case of recurred multiple plexiform schwannomas arising from the posterior tibial nerve and its branch, which was located in a deep anatomic location and accompanied by a bony deformity.
Ankle ; Congenital Abnormalities ; Foot ; Neurilemmoma ; Recurrence ; Skin ; Subcutaneous Tissue ; Tibial Nerve

PURPOSE: This study examined the radiological and clinical outcomes of tibiotalocacalcaneal arthrodesis using retrograde intramedullary nailing in a severe hindfoot deformity and ankle/subtalar arthritis. MATERIALS AND METHODS: A total of 22 patients (22 cases) with a severe hindfoot deformity and arthritis underwent tibiotalocalcaneal arthrodesis with retrograde intramedullary nails. The average age was 57.4 years (22–82 years) and the mean follow-up was 29.6 months (12–74 months). The radiological outcomes included an assessment of the preoperative and postoperative coronal ankle alignment, hindfoot alignment, sagittal alignment, and postoperative union time. The clinical outcomes were evaluated using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and postoperative complications. The results were analyzed statistically by dividing the patients into two groups based on a 10° angle of deformity. RESULTS: Regarding the preoperative coronal ankle alignment, 14 patients had a mean varus deformity of 17.8°±14.5° and six had a mean valgus deformity of 8.1°±6.6°. Postoperatively, a satisfactory postoperative coronal ankle alignment of less than 5° was obtained in all patients. Regarding the preoperative hindfoot alignment, 12 patients showed a mean varus deformity of 15.2°±10.5° and six had a mean valgus deformity of 8.1°±4.2°. In total, 94.4% (17 patients) had satisfactory postoperative hindfoot alignment of less than 5°. Radiological union was achieved in 90.9% at an average of 19.2 weeks (12–32 weeks) and there were 2 cases of nonunion. The clinical outcomes showed improvement in the mean VAS and AOFAS scores (p<0.001, p<0.001, respectively). Even a preoperative severe deformity more than 10° showed a significant deformity correction of coronal ankle alignment and hindfoot alignment, postoperatively (p<0.001, p<0.001, respectively). No significant differences were found between the patients with a preoperative coronal ankle deformity more than 10° and those less than 10° regarding the mean postoperative coronal ankle alignment (p=0.162). CONCLUSION: Tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing is an acceptable technique for achieving satisfactory deformity correction, high union rate with minimal complications, and improvement of the clinical outcomes. In addition, tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing is considered an effective treatment option, particularly in severe ankle and hindfoot deformities.
Ankle ; Arthritis ; Arthrodesis ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Fracture Fixation, Intramedullary ; Humans ; Postoperative Complications

PURPOSE: This paper reports an experience of rotational long scarf osteotomy for elderly patients with a hallux valgus deformity. MATERIALS AND METHODS: From January 2005 to July 2014, 37 cases in 24 patients over 70 years of age, who received rotational long scarf osteotomy for hallux valgus and were followed-up for at least 3 years, were evaluated. The bone mineral density (BMD) was checked in all cases preoperatively. The mean age at surgery was 73.9 years old. The mean follow-up period was 5.1 years. The plantar head fragment was rotated medially to correct the distal metatarsal articular angle (DMAA) and to cross the two cortices to form an “X” shape to prevent troughing. In the operating room, the DMAA was measured before and after rotation of the plantar head fragment. The hallux valgus angle, 1st intermetatarsal angle, range of motion of the first metatarsophalangeal (MTP) joint and American Orthopedic Foot and Ankle Society (AOFAS) score were measured both preoperatively and in the final follow-up. In addition, stress fractures were checked in the routine follow-ups. RESULTS: The average T-score of the preoperative BMD was −3.54. The mean DMAA measured in the operation room was corrected from 24.8° to 6.7°. The 1st intermetatarsal angle was corrected from 17.6° to 6.2° and hallux valgus angle was corrected 36.7° to 6.5°. The average range of motion of the first MTP joint was improved from 37.4° preoperatively to 64.3° in the final follow-up, and the average AOFAS scores were improved from 56.4 preoperatively to 89.2 at the final follow-up. No troughing was observed in any of the patients. In 3 cases, screw fixation failure made an additional screw necessary to obtain stability between the two fragments. No stress fractures were observed at the follow-up. CONCLUSION: The rotational long scarf osteotomy produced the effect of a DMAA correction. The rotational long scarf osteotomy might correct the DMAA and improve the clinical score in elderly hallux valgus patients.
Aged* ; Ankle ; Bone Density ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Fractures, Stress ; Hallux Valgus* ; Hallux* ; Head ; Humans ; Joints ; Metatarsal Bones ; Operating Rooms ; Orthopedics ; Osteoporosis* ; Osteotomy* ; Range of Motion, Articular

BACKGROUND: We developed a modified proximal scarf osteotomy technique for moderate to severe hallux valgus in an attempt to obtain better correction of the deformity. In addition, we compared the clinical and radiographic results of this modified technique with those of the classic scarf osteotomy reported in other studies. METHODS: Between December 2004 and July 2009, 44 cases of modified proximal scarf osteotomy was performed in 35 patients with moderate hallux valgus. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of motion of the first metatarsophalangeal joint, and radiographic results were evaluated. RESULTS: The mean hallux valgus angle and the mean first intermetatarsal angle improved from an average of 32.2° and 14.3°, respectively, to an average of 12.5° and 8.6°, respectively. The distal metatarsal articular angle improved from an average of 18.7° to 12.4°. The preoperative mean AOFAS and VAS scores were 47 points and 7 points, respectively, which improved to 86 points and 1 point, respectively, at the final follow-up. Limited range of motion occurred in two cases postoperatively. The height of the first metatarsal-cuneiform joint, which was an average of 15.9 mm preoperatively, did not change. The first metatarsal-talus angle increased from an average of 4.1° to 7.1°. CONCLUSIONS: The modified proximal scarf osteotomy for the treatment of moderate hallux valgus showed similar results with the classic scarf osteotomy with regard to changes in the first intermetatarsal angle and postoperative satisfaction. Therefore, we suggest the modified proximal scarf osteotomy be considered as well as other proximal osteotomy in the treatment of moderate to severe hallux valgus.
Ankle ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Hallux* ; Humans ; Joints ; Metatarsal Bones ; Metatarsophalangeal Joint ; Orthopedics ; Osteotomy* ; Range of Motion, Articular

Ankle arthrodesis is a common and standard treatment for patients with end-stage ankle arthritis. The surgical goals of ankle arthrodesis are to obtain bony union between the tibia and talus with adequate alignment, and provide a pain-free plantigrade foot for weightbearing activities. To achieve successful fusion, the surgeon should closely examine the patient's factors before surgery, particularly the following: adjacent arthritis and deformity, infection, avascular necrosis of talus, Charcot arthropathy, and rheumatoid arthritis. Recently, ankle arthroplasty has been reported to provide satisfactory clinical results. On the other hand, long-term follow-up results are still lacking, and considering the various complications of arthroplasty, ankle arthrodesis is still the primary surgical treatment for advanced arthritis of the ankle joint.
Ankle Joint ; Ankle* ; Arthritis ; Arthritis, Rheumatoid ; Arthrodesis* ; Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hand ; Humans ; Necrosis ; Talus ; Tibia ; Weight-Bearing

PURPOSE: The objective was to evaluate the relationship between side-to-side differences of lateral femoral bowing and varus knee deformity based on two-dimensional (2D) assessment in unilateral total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 143 patients with varus knee osteoarthritis who underwent unilateral TKA were enrolled. We evaluated the side-to-side differences of the frontal lower limb alignment by assessing lateral femoral bowing, anatomical medial distal femoral angle, and anatomical medial proximal tibial angle (aMPTA). RESULTS: The average values of all anatomical indices were significantly different between the operated side and the non-operated side (p < 0.05). The side-to-side difference in hip knee ankle (HKA) angle had a statistically significant correlation with that in lateral femoral bowing (intraclass correlation coefficient, 0.259; p=0.002) and that in aMPTA. Linear regression analysis showed 0.199° of side-to-side difference in lateral femoral bowing was associated with 1° of side-to-side difference in bilateral HKA angle. CONCLUSIONS: The side-to-side difference in lateral femoral bowing showed a tendency to increase in proportion to varus knee deformity based on 2D assessment in unilateral TKA patients.
Ankle ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Femur ; Hip ; Humans ; Knee ; Linear Models ; Lower Extremity ; Osteoarthritis ; Osteoarthritis, Knee

PURPOSE: The purpose of this study was to evaluate changes in the coronal alignment of the knee and ankle joints after open wedge high tibial osteotomy (OWHTO) to determine factors related to the recurrence (R) of the varus deformity by serial analysis. MATERIALS AND METHODS: Sixty-four OWHTOs were enrolled in this study. The weight bearing line (WBL) ratio, joint line convergence angle (JLCA), knee joint inclination, mechanical axis-tibial plateau angle, talar inclination (TI), and distal tibia articular angle (DTAA) were serially assessed. Serial correlation analysis between all parameters was performed. Patients were divided into R group and no recurrence (NR) group according to the WBL ratio (55%) at postoperative one year. RESULTS: The preoperative WBL ratio showed significantly negative correlation with serial changes of JLCA, TI, and DTAA (p < 0.05). The JLCA, TI, and DTAA as well as WBL ratio showed a significantly larger degree of varus alignment in the R group than in NR group at postoperative 6 weeks and 1 year after OWHTO (p < 0.05). CONCLUSIONS: Sufficient correction of the WBL and restoration of the JLCA during OWHTO are essential to prevention of the R of varus deformity after the surgery because they are the only modifiable factors during surgery. LEVEL OF EVIDENCE: IV, Case series
Ankle Joint ; Ankle ; Congenital Abnormalities ; Humans ; Joints ; Knee Joint ; Knee ; Osteoarthritis ; Osteotomy ; Recurrence ; Tibia ; Weight-Bearing

As the aging of the foot progresses, the stiffness of the soft tissues, the reduction of the range of motion, the decrease of the muscle strength, and the flattening of foot are manifested. These changes increase the risk of foot pain, the problem of weight distribution and transmission, and the risk of falls, resulting in secondary complications and lowering quality of life. The most common deformities and diseases of the elderly foot are hallux valgus, hammertoes, hallux rigidus, Achilles tendinitis, plantar fasciitis, metatarsalgia, hyperkeratosis, and other deformities of the feet caused by chronic conditions. Systemic diseases that promote these foot problems include diabetes, peripheral nerve damage, repetitive ankle ligament injuries, deformities due to fractures, and obesity. Understanding the mechanisms of aging and the processing of biomechanics in the elderly will enable them to reach a healthy life through appropriate rehabilitation, exercise and educations during aging. In addition, it is necessary to promote the healthy life in elderly by customized exercise, training, and shoes.
Accidental Falls ; Aged ; Aging ; Ankle ; Congenital Abnormalities ; Fasciitis, Plantar ; Flatfoot ; Foot Diseases ; Foot ; Hallux Rigidus ; Hallux Valgus ; Humans ; Ligaments ; Metatarsalgia ; Muscle Strength ; Obesity ; Peripheral Nerves ; Quality of Life ; Range of Motion, Articular ; Rehabilitation ; Shoes ; Tendinopathy

The prevalence of patients with adult spinal deformity (ASD) has been reported as high as 68%. ASD often leads to significant pain and disability. Recent emphasis has been placed on sagittal plane balance and restoring normal sagittal alignment with regards to the three dimensional deformity of ASD. Optimal sagittal alignment has been known to increase spinal biomechanical efficiency, reduce energy expenditure by maintaining a stable posture with improved load absorption, influence better bony union, and help to decelerate adjacent segment deterioration. Increasingly positive sagittal imbalance has been shown to correlate with poor functional outcome and poor self-image along with poor psychological function. Compensatory mechanisms attempt to maintain sagittal balance through pelvic rotation, alterations in lumbar lordosis as well as knee and ankle flexion at the cost of increased energy expenditure. Restoring normal spinopelvic alignment is paramount to the treatment of complex spinal deformity with sagittal imbalance. Posterior osteotomies including posterior column osteotomies, pedicle subtraction osteotomies, and posterior vertebral column resection, as well anterior column support are well known to improve sagittal alignment. Understanding of whole spinal alignment and dynamics of spinopelvic alignment is essential to restore sagittal balance while minimizing the risk of developing sagittal decompensation after surgical intervention.
Absorption ; Adult ; Animals ; Ankle ; Congenital Abnormalities ; Energy Metabolism ; Humans ; Knee ; Lordosis ; Osteotomy ; Posture ; Prevalence ; Spine