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Today's foot and ankle edition covers radiographic assessment techniques for pediatric deformities, biomechanical changes in first MTP osteoarthritis, predictors of calcaneoplasty success, and evidence on gastrocnemius recession procedures. All studies are open access and explore practical clinical questions relevant to daily foot and ankle practice.
OrthoDigest is a fully AI-generated daily podcast by Joint Venture Orthopaedics — from automated research discovery and manuscript selection to script writing, voice production, and multilingual translation. Every step of the pipeline is powered by artificial intelligence, making it one of the first fully autonomous medical podcasts. Each episode covers six open-access, peer-reviewed manuscripts on a rotating subspecialty schedule — hip, knee, shoulder & elbow, hand & wrist, foot & ankle, spine, trauma, sports medicine, pediatrics, and oncology. Every study discussed is freely available, with links in the episode notes. Whether you're a surgeon, resident, researcher, or allied health professional, OrthoDigest keeps you current in about 20 minutes a day.
Welcome to OrthoDigest, your daily podcast of orthopaedic literature summaries, brought to you by Joint Venture Orthopaedics. Today is Thursday, so we are covering foot and ankle. We have four open-access studies for you today, spanning pediatric foot deformity assessment, first metatarsophalangeal osteoarthritis biomechanics, calcaneoplasty outcomes, and gastrocnemius recession techniques. As always, links to every manuscript are in the episode description — all are open access. Let's get started.
Our first study is a retrospective cross-sectional study by Kim and colleagues, published in BMC Musculoskeletal Disorders. This research addresses a fundamental challenge in pediatric foot and ankle surgery: determining which radiographic measurements best correlate with functional outcomes when evaluating hindfoot deformities.
The authors conducted a retrospective review of sixty-four pediatric patients with hindfoot varus or valgus deformities treated between two thousand seventeen and two thousand twenty-four. The cohort included thirty-two patients with hindfoot varus and thirty-two with hindfoot valgus. All patients underwent weight-bearing radiographs and pedobarographic testing, which measures pressure distribution across the foot during weight-bearing activities. The researchers specifically compared the reliability and functional associations of the anteroposterior talo-second metatarsal angle versus the more traditionally used anteroposterior talo-first metatarsal angle. Radiographic variables were measured across forefoot, midfoot, and hindfoot regions, with interobserver reliability assessed and age-adjusted partial correlations calculated to evaluate associations with functional outcomes.
The key finding was that all radiographic parameters demonstrated excellent reliability, with intraclass correlation coefficients ranging from zero point eight seven two to zero point nine nine six. Most importantly, the anteroposterior talo-second metatarsal angle demonstrated comparable functional associations to the anteroposterior talo-first metatarsal angle and showed larger discriminative effect sizes between hindfoot varus and valgus groups. Significant differences were observed in anteroposterior talo-first metatarsal, anteroposterior talo-second metatarsal, lateral talo-first metatarsal, and naviculocuboid overlap measurements between the two deformity groups, with all comparisons reaching statistical significance at p less than zero point zero zero one. The pedobarographic analysis revealed distinct loading patterns between groups, particularly in the midfoot and lateral regions.
So what can you do differently? This data suggests considering the anteroposterior talo-second metatarsal angle as a complementary measurement when evaluating pediatric hindfoot deformities. The excellent reliability and comparable functional associations suggest it may provide additional discriminative value beyond traditional measurements, particularly when planning surgical corrections where precise deformity characterization is crucial.
As with any retrospective cross-sectional study, the usual caveats around selection bias and temporal relationships apply.
Shifting gears to adult pathology, our second study is a case-control study by Telfer and colleagues from the Journal of Foot and Ankle Research. This investigation examines how first metatarsophalangeal joint osteoarthritis affects plantar pressure patterns during various daily activities, which could inform orthotic prescription and activity modification strategies.
The researchers studied forty-three participants, including twenty-two with first metatarsophalangeal joint osteoarthritis and twenty-one matched controls. Participants performed four different activities while plantar pressures were measured: standing, walking, stair ascent, and heel raise maneuvers. The analysis included both discrete pressure variables at specific anatomical regions and statistical parametric mapping, which provides a more nuanced view of pressure distribution changes throughout the stance phase of each activity.
The primary finding was somewhat surprising: no differences were found for discrete pressure variables across any of the activities when comparing the osteoarthritis group to controls. However, the more sophisticated statistical parametric mapping revealed several important differences for the first metatarsophalangeal joint osteoarthritis group. These included reduced loading under the distal first metatarsal head during sixty to eighty percent of the stance phase, increased midfoot pressures at seventy to eighty percent of stair ascent, and decreased lateral forefoot pressure during the heel raise activity. The authors concluded that first metatarsophalangeal joint osteoarthritis is associated with limited but detectable changes in plantar pressures across different activities.
So what can you do differently? The authors suggest that these specific regions of pressure difference may be targeted by interventions such as foot orthotics as part of a personalized treatment program. This data supports focusing orthotic modifications on offloading the first metatarsal head region during mid to late stance and potentially supporting the midfoot during stair climbing activities for patients with first metatarsophalangeal joint osteoarthritis.
As with any case-control study, the usual caveats around matching and confounding variables apply.
Our third study is a prospective study by Altıntaş and colleagues from BMC Musculoskeletal Disorders, investigating whether preoperative radiographic measurements can predict surgical outcomes in patients with Haglund's deformity. This addresses the clinical question of whether deformity severity correlates with surgical success.
The authors prospectively followed twenty-two feet in twenty-two patients who underwent endoscopic calcaneoplasty for Haglund's deformity. The mean patient age was forty-six point two plus or minus thirteen point one years, with a mean follow-up duration of fourteen plus or minus two months and mean operative time of sixty-three plus or minus twenty-seven minutes. Demographic data and radiographic parameters including bump height, bump-to-calcaneus ratio, and various angular measurements were recorded preoperatively. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society score and visual analog scale for pain, measured preoperatively and at one, three, six, and twelve months postoperatively.
The results demonstrated significant clinical improvement across all time points. Both American Orthopaedic Foot and Ankle Society scores and visual analog scale scores showed statistically significant improvement at all follow-up points with p values less than zero point zero zero one. The effect sizes were substantial: d equals one point seven five for American Orthopaedic Foot and Ankle Society scores and d equals one point seven six for visual analog scale scores. The mean change in American Orthopaedic Foot and Ankle Society score at twelve months was forty-one point one plus or minus twenty-four point one points, exceeding established minimal clinically important difference ranges. Importantly, no significant associations were identified between preoperative bump height or bump-to-calcaneus ratio and clinical outcomes, with p values greater than zero point zero five for these correlations. No surgical complications or infections were observed.
So what can you do differently? This data suggests that endoscopic calcaneoplasty can provide excellent clinical outcomes for Haglund's deformity regardless of preoperative bump morphology. You shouldn't base surgical decision-making solely on radiographic deformity severity, as patients with varying bump heights and ratios achieved similar clinical improvements.
The authors acknowledge that the relatively small sample size limits the generalizability of these findings, and larger prospective studies are warranted.
Our final study is a systematic review by Gemini and colleagues from the Journal of Functional Morphology and Kinesiology, examining gastrocnemius release procedures for chronic recalcitrant plantar fasciopathy. This comprehensive review synthesizes evidence on an increasingly popular alternative to traditional plantar fascia release.
The authors conducted a systematic review following PRISMA guidelines, searching MEDLINE, Cochrane Database, and Scopus for studies published between January two thousand and January two thousand twenty-six on gastrocnemius release procedures for chronic recalcitrant plantar fasciopathy. The final analysis included nine hundred one patients across nine hundred twenty-three limbs. Data extracted included patient characteristics, surgical techniques, clinical scores using visual analog scale, American Orthopaedic Foot and Ankle Society scores, PROMIS, and SF-thirty-six measures, ankle dorsiflexion measurements, and complications. The mean patient age was forty-six point three one years, ranging from eighteen to seventy years. Patients had undergone conservative treatment for an average of nine point two months before surgery, ranging from six to twelve months, with mean follow-up duration of twenty-seven point eight months.
The primary outcome showed substantial pain reduction measured by visual analog scale scores. Mean preoperative visual analog scale score was seven point three, ranging from five point three to eight point six, while mean postoperative visual analog scale score was two point five six, ranging from one point two to three point three. This represented a sixty-four point nine three percent decrease in pain. American Orthopaedic Foot and Ankle Society scores improved from an average of fifty point one preoperatively to eighty-four point seven postoperatively. The average patient satisfaction rate was eighty-five percent, ranging from sixty-one point six to one hundred percent. Ankle dorsiflexion showed an average increase of seven point seven five degrees postoperatively, ranging from five to thirteen degrees. The proximal medial gastrocnemius release was the most commonly used procedure in four hundred nine cases, followed by the Strayer procedure in three hundred twenty cases. Minor complications included sural nerve lesions in fifteen cases, wound complications in seven cases, complex regional pain syndrome in two cases, and thrombosis in two cases.
So what can you do differently? This data suggests considering gastrocnemius release procedures as a viable alternative to open plantar fasciotomy, particularly in patients with isolated gastrocnemius contracture. The review shows fewer complications and good patient satisfaction rates compared to traditional plantar fascia release. Consider identifying isolated gastrocnemius contracture through a positive Silfverskiöld test as part of your patient selection process.
The authors note several limitations, including varied methodology among included studies, different follow-up durations and outcome measures, and lack of consensus on indications and best surgical approaches. They emphasize that further high-quality randomized controlled trials are needed to clarify optimal surgical indications.
And that wraps up today's edition of OrthoDigest. We covered pediatric hindfoot deformity assessment, first metatarsophalangeal osteoarthritis biomechanics, calcaneoplasty outcome predictors, and gastrocnemius recession techniques. As always, links to all manuscripts are in the episode description — they are all open access, so please do take a look. Thanks for listening, and we will see you tomorrow for hand.