Ankle-foot orthoses (AFOs) are often prescribed for lower leg muscle impairments. In order to conduct impactful research, we aimed to establish a list of prioritized research questions regarding AFO care in the Netherlands from the perspective of healthcare professionals and AFO users. A purposefully designed online survey. To identify relevant research questions regarding the AFO care process the online survey was sent to rehabilitation specialists, orthotists and AFO users in the Netherlands. The research questions were grouped into specific research needs according to the Process description of medical devices. The priority of the research needs was determined using a 11-point numeric rating scale (NRS), with 10 being the highest priority. The survey was completed by 62 rehabilitation specialists, 47 orthotists and 184 AFO users. Rehabilitation specialists prioritized research on "Effects of AFO properties" (numeric rating scale score: 8.3 ± 1.2) and "Choice of AFO type and design" (8.1 ± 2.0). Orthotists prioritized research on "How to cast and correct the plaster model" (8.9 ± 1.3) and "Effects of AFO properties" (8.7±1.4). Ankle-foot orthoses users prioritized research on "Improvement of AFO-shoe fitting and information on appropriate shoes'" (8.6 ± 1.8) and "Possibilities to choose and test different AFOs before provision" (8.5 ± 1.3). Our inventory of research needs has provided a list of research priorities that can be used to structure AFO-related knowledge development. Healthcare professionals and patients have different research priorities that should be taken into account when designing and setting up future AFO-related research.
ChatGPT-4 has demonstrated potential in offering treatment recommendations for orthopaedic conditions following American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines, including those pertaining to foot and ankle pathology. Although prior studies explored its performance in triaging causes of knee pain, ChatGPT-4o's application in triaging patients into appropriate health care settings remains largely unexamined. This study evaluated ChatGPT-4o's ability to generate differential diagnoses, recommend appropriate triage destinations, and formulate treatment plans when provided with expanded clinical information. However, its performance in foot and ankle triage remains incompletely characterized. Twenty-four standardized foot and ankle complaints were input into ChatGPT-4o, in an exploratory, hypothesis-generating vignette-based study with memory reset between entries to minimize bias. Twelve cases focused on ChatGPT-4o's ability to generate differential diagnoses and triage decisions (Primary Care Physician, Foot and Ankle Specialist, or Emergency Department/Urgent Care), which were compared against evaluations by 2 fellowship-trained orthopaedic foot and ankle surgeons. An additional 12 expanded clinical vignettes were used to prompt a primary diagnosis and treatment recommendations, which were then graded for accuracy and suitability. ChatGPT-4o generated differentials that were considered clinically appropriate for all triage conditions. The top diagnosis matched that of the surgeons in 9 of 12 cases (75%) and appeared within the first or second position of the differential list in 10 of 12 cases (83.3%). Across all differential lists, 26 of 36 diagnoses (72.2%) were identical. ChatGPT-4o's triage recommendations matched the surgeons' decisions in 6 cases (50%). With expanded clinical information, ChatGPT-4o maintained diagnostic accuracy (75%) and generated appropriate management plans in 11 of 12 cases (91.7%). ChatGPT-4o was able to generate clinically reasonable differentials for foot and ankle conditions. Although triage decision making showed variability, these findings support a limited role for ChatGPT-4o as an adjunct to central scheduling workflows, helping streamline patient triage and health care delivery.Level of Evidence:: Level V, expert opinion, vignette-based study.
Chronic ankle instability (CAI) can develop in up to 40% of patients after a first-time ankle sprain. Advanced imaging and statistical shape modeling (SSM) provide the opportunity to evaluate if subtle differences in foot and ankle morphology, such as hindfoot alignment or cavus features, may contribute to structural predispositions for recurrent instability. In this study, a 14-bone SSM was created from weight-bearing CT data (n = 80) from patients with CAI (n = 23), cavus foot type (n = 29), and rectus (n = 28) foot type. Scans for the CAI group were from pre-operative imaging of patients undergoing surgical stabilization. Meary's angle (MA), hindfoot ankle alignment (HAA), and calcaneal inclination were measured for each scan using in-house code. Principal component analysis revealed that arch height (Mode 1, 36.9% of the variance) statistically distinguished the CAI and cavus groups from the rectus group. Minimal differences were observed between the CAI and cavus groups, with only Mode 5 (4.47% variance, η 2 ${\eta }^{2}$  = 0.09) separating the groups and Hotelling's T2 confirming minimal variation (~2% of particles). Radiographic measurements supported these findings with higher MA in CAI (12°) and cavus (17°) versus rectus (0.2°), and varus HAA in CAI (6.0°) and cavus (5.9°) compared to rectus (9.8°). Individuals with CAI demonstrated cavus-like morphology, indicating that bony alignment may be a structural contributor to recurrent instability. Clinically, these findings enhance our understanding that foot alignment plays a role in CAI. Surgical correction, when clinically appropriate, may need to address both osseous deformities and soft tissue laxity to improve stability. Level III Orthopedic Research Society.
Surgical procedures of the foot and ankle commonly involve treatment of bone anatomy and include osteotomies and open reduction with internal fixation. A potential complication of these types of surgeries is delayed or non-union of bones. Delayed osseous healing prolongs post-operative recovery and may result in delayed return to work, increased financial costs and impaired health outcomes. Identifying additional non-invasive therapies that aid in bone healing may improve surgical outcomes. Focused Extracorporeal Shockwave Therapy (ESWT) and Electromagnetic Transduction Therapy (EMTT) are both procedures proposed to improve bone and soft tissue healing. A matched analysis was conducted on foot and ankle surgeries performed from June 2022 through April 2023. Ten patients (controls) were identified who had surgical management for talar osteochondral defects, foot and ankle fractures, and joint disease who were matched with ten patients who received ESWT and EMTT (ESWT + EMTT patients). The ESWT + EMTT patients received one session of focused ESWT ("Duolith"™, Storz Medical AG, Tägerwilen, CH) applied up to 0.35 mJ.mm2 to the surgical site within three weeks post-operation and two sessions of EMTT ("Magnetolith"™, Storz Medical AG, Tägerwilen, CH) set at 6000 pulses each, power level 8, and 8 Hz. The primarily outcome was differences in VAS score at the time of weight-bearing and time to return to activity calculated in weeks for ESWT + EMTT compared to control patients. An exploratory analysis included reviewing radiographs for evidence of radiographic healing on plain film radiographs performed four weeks post-operatively. Statistical analyses were performed using student t-tests and Fisher's Exact tests, with P < 0.05 set as statistically significant. Twenty patients (15 women and 5 men) of average age 52.1 ± 16.6 years (range 18-73 years-old) were included with similar age and sex between EMTT + ESWT and control patients. On average, ESWT + EMTT had lower post-operative VAS pain scores than control patients (0.2 ± 0.4 vs 3.1 ± 1.3, P = 0.0001). Additionally, the mean return to activity was reduced for ESWT + EMTT patients (13.2 ± 2.9 weeks vs 22.4 ± 9.2 weeks, P = 0.01). A larger portion of ESWT + EMTT patients had evidence of radiographic healing at four weeks post-operatively compared to controls (8 of 10 vs 2 of 10, P = .03). The combination of ESWT and EMTT post-operatively may improve pain and earlier return to activity, and treatment was well-tolerated after foot and ankle surgeries. These results can be further explored through placebo-controlled randomized clinical trials in surgical management of foot and ankle conditions and other indications.
This study aims to compare the quality, reliability, and readability of information provided by artificial intelligence-based language models, ChatGPT-5 and DeepSeek V3, regarding foot and ankle disorders. The quality, reliability, and readability of the texts generated by both AI models were analyzed using DISCERN, the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), the Global Quality Score (GQS), and the CLEAR scoring system. DISCERN was used to assess information reliability, PEMAT-P to evaluate understandability and actionability, GQS to assess overall quality, and CLEAR to evaluate content quality and accuracy. Standardized questions were asked to both models for 35 different foot and ankle disorders, and the generated texts were evaluated by two independent orthopedic specialists using a blinded method. Readability analysis was performed using word count, the Flesch-Kincaid Grade Level (FKGL; required reading level), and the Flesch Reading Ease (FRE; ease of readability) scoring systems. ChatGPT-5 scored significantly higher than DeepSeek V3 in DISCERN, PEMAT-P, GQS, and CLEAR evaluations (p < 0.05), indicating that ChatGPT-5 provides more reliable, comprehensive, and higher-quality information. DeepSeek V3 demonstrated better readability, producing simpler and more understandable content, as reflected in its lower FKGL score and higher FRE score. While ChatGPT-5 delivers more detailed and reliable health information, DeepSeek V3 offers simpler and more readable texts. Both models have distinct advantages for patient education. Future research should assess the impact of AI-generated health information on patient decision-making and its clinical application potential.
The foot and ankle ability measure (FAAM) scale is a patient-reported outcome measure used to assess lower extremity functional status in a variety of musculoskeletal disorders. It was first created in English (E-FAAM) to gauge its applicability across several languages, and other translations are accessible in different languages. This study aimed to translate the English version of the FAAM into Hindi (H-FAAM), evaluate its content validity, conduct cross-cultural adaptation, and assess its test-retest reliability. Following Beaton guidelines, the translation process involved forward and backward translations by two bilingual translators and a pain specialist, with approval from the original developers. Content validation was conducted using the Delphi method, involving 10 experts with over five years of experience. Cross-cultural adaptation was assessed with 30 outpatient participants who provided feedback on the clarity and relevance of the H-FAAM items. Test-retest reliability was evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC) in 51 patients, with responses collected at two time points. Of the 21 items in the H-FAAM, 19 achieved universal agreement (100% consensus), while two items received 80% agreement, indicating strong content validity overall. Cross-cultural adaptation was well-received, with 28 out of 30 patients providing positive feedback on the clarity and understanding of the scale. Test-retest reliability was excellent, with Cronbach's alpha and ICC values of 0.94 CONCLUSION: The Hindi version of the FAAM (H-FAAM) demonstrated excellent content validity and test-retest reliability, making it a reliable tool for assessing in native Hindi-speaking populations.
Ankle and hindfoot Charcot neuroarthropathy is a complex problem and should be carefully assessed and managed to prevent morbidity and limb loss. Circular frames offer a range of options to address a wide variety of clinical situations and also complement internal fixation techniques. Multidisciplinary care and specialist skills to provide frame treatment are essential for a successful outcome.
BackgroundThe role of arthroscopy in the management of ankle fractures is controversial. This study aims to evaluate the prevalence of intra-articular pathologies detected during arthroscopically assisted reduction and internal fixation (ARIF) of ankle fractures, stratified by fracture classification, for indirect comparison to current literature. We also present short- to mid-term patient-reported outcomes (PROs) for a subset of the participant cohort.MethodsWe retrospectively analyzed the intra-articular findings of 134 patients who underwent ARIF of ankle fractures. A statistical analysis was performed to assess for significant differences in the proportions of affected patients across fracture types for each intra-articular pathology. PROs included Visual Analog Scale (VAS) ratings and Foot and Ankle Ability Measure scores for Activities of Daily Living (FAAM ADL).ResultsIntra-articular pathologies were noted in 92.5% of patients including sources of anterior impingement such as synovitis (52.2%), soft tissue (29.9%), and loose bodies (33.6%), as well as syndesmotic injury (47.0%), deltoid injury (26.1%), and osteochondral defects (29.1%) (Figure 1). Deltoid injury was more frequently detected in Weber C fractures than in any other fracture type. Syndesmotic injury occurred significantly more frequently in Weber C fractures than in Weber A (P < .01) and Weber B fractures (P < .001) (Table 1, Figure 2). PROs obtained for a subset of patients at the final follow-up reflected low VAS scores (mean = 1.78, n = 49) and high FAAM ADL scores (mean = 71.1, n = 14).ConclusionArthroscopy during ankle fracture surgery is valuable in the detection of intra-articular pathologies that may require treatment to ensure positive patient outcomes. Furthermore, fracture type may be correlated with higher incidence of certain intra-articular pathologies. While future direct comparison is necessary between open reduction and internal fixation (ORIF) and ARIF, our study proposes that ARIF detects issues that may otherwise remain undetected during ORIF and suggests that concomitant arthroscopy is beneficial for ankle fracture fixation.Level of Evidence:Level IV-Case series.
Diabetes-related foot disease (DFD) is a leading cause of disability worldwide. In Australia, DFD affects approximately half a million people and is the primary driver of diabetes-related hospitalisations, amputations and costs. Guideline-based multidisciplinary footcare can halve these rates and improve quality of life, yet access remains inequitable, particularly for rural and remote communities for whom DFD hospitalisation and amputation rates are persistently high. Geographic isolation, workforce shortages and fragmented service delivery are barriers to DFD care, with Aboriginal and Torres Strait Islander Peoples experiencing additional cultural and systemic challenges. Telehealth-enabled models of care offer a promising solution to reducing inequities in access without compromising effectiveness. Four 'Foot Hubs' have been established across Queensland (Australia) to deliver specialist multidisciplinary footcare via a hub-and-spoke model, combining telehealth, outreach, and local partnerships to improve access for people living with DFD in rural and remote areas. This commentary provides an introductory overview of these Foot Hub services and how implementation science (the scientific study of methods and strategies to promote the systematic and sustainable uptake of new practices) can support the uptake and sustainability of these new models of care.
Charcot foot, characterized by progressive osseous and articular destruction, necessitates early diagnosis and a multidisciplinary approach to prevent severe complications. This study assessed the efficacy of an educational intervention in improving radiographic detection and referral for Charcot foot among health care professionals. Thirty health care professionals, including foot and ankle surgeons (FAs), orthopaedic/trauma specialists (OTs), and family physicians (FDs), participated in this quasi-experimental, pre-post study. Participants completed a baseline assessment and received an educational intervention (face-to-face/webinar or self-directed PDF), followed by a reassessment. Primary outcomes included changes in diagnostic and referral accuracy, evaluated through score improvements and Fleiss κ for interobserver agreement. Reliability in the Meary angle measurement was also assessed. FA specialists demonstrated consistently high baseline scores. Following the intervention, OT and FD groups exhibited significant improvements in both diagnostic and referral scores. Fleiss κ increased from 0.463 to 0.700 for OT diagnosis, and from 0.439 to 0.723 for referral. Fleiss κ values for FD improved from 0.352 to 0.546 for diagnosis and from 0.071 to 0.608 for referral. Face-to-face/webinar training outperformed the PDF format, yielding higher scores and agreement rates. Interobserver reliability for the Meary angle was excellent (intraclass correlation coefficient = 0.988). Structured educational interventions significantly enhanced clinicians' ability to diagnose and appropriately refer patients with Charcot foot. Face-to-face instruction proved more effective than self-directed formats. Level III, quasi-experimental pre-post study.
In order to maintain lateral ankle stability when performing a total ankle arthroplasty (TAA), there must be a lateral strut from an intact and competent distal fibula. The aim of the present case report is to describe an alternative approach to failed ankle arthrodesis with a staged custom fibular implant and subsequent TAA. At final follow-up of 36 months from index procedure, there was no reported nonunion about the hindfoot complex with adequate seating of the total ankle arthroplasty components and pain free patient ambulation. We hope this novel approach will add to the current body of literature and guide colleagues with broadened surgical options while approaching ankle arthrodesis.Level of Clinical Evidence: 5-Case study.
Diabetic foot disease is a major cause of preventable disability, hospitalization, and lower-extremity amputation worldwide, with a disproportionate burden in resource-limited settings. Although major amputation rates have declined in high-income countries through multidisciplinary care, many resource-limited settings still face delayed presentation, fragmented services, limited specialist access, and weak financial protection. Previous reviews have often examined diabetic foot care, digital health, or community interventions separately, with limited attention to how these approaches can be integrated in resource-limited settings and implemented through a health equity lens. This narrative review therefore aimed to examine, from a global health and health equity perspective, how digital health and community-based care may jointly support diabetic foot prevention and management in resource-limited settings, particularly in sub-Saharan Africa (SSA). A structured search of PubMed/MEDLINE, Web of Science, and Scopus, supplemented by relevant policy and guideline sources, identified evidence published between 2005 and 2025. Findings were synthesized across five domains: organized care in high-income settings, structural inequities in SSA, digital health approaches, community-based prevention and early referral, and system-level implementation considerations. Available evidence suggests that digital tools may improve risk identification and continuity of care, while community-based strategies may strengthen prevention and timely referral. However, their effectiveness and sustainability depend on integration with primary care, referral systems, workforce support, financing, and local adaptation. Digital and community-based approaches should therefore be viewed as complementary strategies for strengthening equitable diabetic foot care, rather than as stand-alone solutions.
The aim of this study was to evaluate microcirculatory perfusion and oxygen saturation in the foot sole of patients with chronic limb-threatening ischemia (CLTI) before and after endovascular intervention using a novel multimodal imaging system. This single-center observational cohort study included patients with CLTI due to infrainguinal arterial disease, scheduled for endovascular intervention over an 11-mo period. Inclusion required a CLTI diagnosis and at least one of the following: hemodynamic transcutaneous partial pressure of oxygen (TcPo2) <30 mmHg, toe pressure (TP) <30 mmHg, ankle-brachial index (ABI) <0.4, or ankle pressure <50 mmHg. For patients with diabetes, the TP threshold was adjusted to <50 mmHg. Measurements were performed preoperatively, early postoperatively, and at 1-mo follow-up using a multimodal optical system combining multi-exposure laser speckle contrast imaging and multispectral imaging to assess real-time microvascular perfusion and oxygen saturation. Conventional measures (toe pressure, TcPo2, and ABI) were used for comparison. Twenty-five patients were included: 20 successfully revascularized and 5 serving as a comparison group. Early postoperative results in the revascularized group showed significant increases in TcPo2 (P = 0.004) and-in the combined region of interest-microcirculatory median perfusion (P = 0.004), perfusion pulsatility (P < 0.001), and oxygen saturation (P = 0.01). At 1 mo, TcPo2 (P = 0.006), TP (P = 0.002), and perfusion pulsatility (P = 0.002) remained significantly elevated, whereas median perfusion (P = 0.642) and oxygen saturation (P = 0.397) returned to baseline levels. No significant changes were observed in the comparison group. The multimodal imaging system detected early microcirculatory improvements after endovascular intervention. Although perfusion and oxygen saturation average levels increased early but transiently, sustained increases in perfusion pulsatility suggest it being a marker of improved and lasting microvascular recovery.NEW & NOTEWORTHY This study presents a novel multimodal imaging system for real-time assessment of microvascular perfusion and oxygen saturation. In 25 patients with chronic limb-threatening ischemia, significant microcirculatory improvements were observed 1 day after endovascular intervention that persisted at 1 mo. Perfusion pulsatility in foot sole skin may serve as an early indicator of sustained microvascular recovery and could complement existing clinical and hemodynamic markers when evaluating treatment response.
Background: Rapid and accurate fracture detection is critical in emergency departments (EDs), where high patient volume and time pressure increase the risk of diagnostic error, particularly in radiographic interpretation. Multimodal large language models (LLMs) with image-recognition capability have recently emerged as general-purpose tools for clinical decision support, but their diagnostic performance within routine emergency department imaging workflows in orthopedic trauma remains unclear. Methods: In this retrospective diagnostic accuracy study, we included 1136 consecutive patients referred from the ED to orthopedics between 1 January and 1 June 2025 at a single tertiary center. Given the single-center, retrospective design, the findings should be interpreted as hypothesis-generating and may not be fully generalizable to other institutions. Emergency radiographs and clinical data were processed by a multimodal LLM (2025 version) via an official API using a standardized, deterministic prompt. The model's outputs ("Fracture present", "No fracture", or "Uncertain") were compared with final diagnoses established by blinded orthopedic specialists, which served as the reference standard. Diagnostic agreement was analyzed using Cohen's kappa (κ), sensitivity, specificity, accuracy, and 95% confidence intervals (CIs). False-negative (FN) cases were defined as instances where the LLM reported "no acute fracture" but the specialist identified a fracture. The evaluated system is a general-purpose multimodal LLM and was not trained specifically on orthopedic radiographs. Results: Overall, the LLM showed good diagnostic agreement with orthopedic specialists, with concordant results in 808 of 1136 patients (71.1%; κ = 0.634; 95% CI: 68.4-73.7). The model achieved balanced performance with sensitivity of 76.9% and specificity of 66.8%. The highest agreement was observed in knee trauma (91.7%), followed by wrist (78.8%) and hand (69.6%). False-negative cases accounted for 184 patients (16.2% of the total cohort), representing 32.4% of all LLM-negative assessments. Most FN fractures were non-displaced (82.6%), and 17.4% of FN cases required surgical treatment. Ankle and foot regions showed the highest FN rates (30.4% and 17.4%, respectively), reflecting the anatomical and radiographic complexity of these areas. Positive predictive value (PPV) and negative predictive value (NPV) were 69.4% and 74.5%, respectively, with likelihood ratios indicating moderate shifts in post-test probability. Conclusions: In an emergency department-to-orthopedics consultation cohort reflecting routine clinical workflow, a multimodal LLM demonstrated moderate-to-good diagnostic agreement with orthopedic specialists, broadly within the range reported in prior fracture-detection AI studies; however, these comparisons are indirect because model architectures, training strategies, datasets, and endpoints differ across studies. However, its limited ability to detect non-displaced fractures-especially in anatomically complex regions like the ankle and foot-carries direct patient safety implications and confirms that specialist review remains indispensable. At present, such models may be explored as hypothesis-generating triage or decision-support tools, with mandatory specialist confirmation, rather than as standalone diagnostic systems. Prospective, multi-center studies using high-resolution imaging and anatomically optimized algorithms are needed before routine clinical adoption in emergency care.
Diabetic foot ulcers are a leading cause of major limb amputations in diabetic patients. Timely intervention through early diagnosis of vascular insufficiency and aggressive ulcer management may mitigate these risks. This study evaluated the relationship between early and delayed referral pattern and major amputation and the impact of the coronavirus disease (COVID) 2019 pandemic on associated rates. This retrospective cohort study analyzed records from type 2 diabetic patients over 30 years old with lower-extremity ulcers treated at Western Michigan Health clinics between June 1, 2018, and December 31, 2021. The study period was divided into pre-COVID (59 patients) and intra-COVID (92 patients) phases. Patients were followed until diabetic foot ulcer resolution, death, amputation, or loss to follow-up. Early referral was defined as within 4 weeks after ulcer diagnosis. Referral rates to specialists and the use of noninvasive studies such as the ankle-brachial index were examined. Overall, 151 patients met the inclusion criteria. A total of 11 underwent major amputations, with a trend toward increased rates during the intra-COVID period. There was no significant difference in major amputation rates between early and delayed referrals. Although many of the major amputations had early referrals, this was likely due to late presentation. The study highlighted significant underutilization of noninvasive imaging, with only 37% of patients undergoing ankle-brachial index testing. Wound documentation inconsistencies and variability undermined the reliability of findings and patient treatment. No protocol was identified in ulcer management. Delayed referrals did not significantly affect major amputation rates, suggesting that factors other than referral timing may influence outcomes. The COVID-19 pandemic led to an increase in amputation rates, possibly owing to pandemic-related lapses in care. Underutilization of noninvasive vascular studies and lack of consistent treatment protocols represent missed opportunities for early intervention. Enhanced provider training, protocol-driven care, and consistent use of noninvasive vascular studies may help prevent major amputations.
The prevention of diabetic foot complications requires a comprehensive approach that includes the use of appropriate footwear, custom orthotics, insoles, hosiery, and braces. Clinical evidence supports the efficacy of these interventions in reducing the risk of foot ulcers and amputations as well as providing the diabetic patient the ability to maintain mobility safely. As the global burden of diabetes continues to rise, health care providers must prioritize foot care and recommend appropriate devices as part of routine diabetic management.
Diabetic foot ulcers (DFUs) are a leading cause of hospitalizations, amputations, and health care costs among individuals with diabetes, often due to delayed detection and treatment. Early identification of skin changes is critical for preventing ulcer progression, yet daily visual foot self-inspections are often limited by impaired mobility, visual deficits, and poor compliance. Although some foot-focused remote patient monitoring technologies are in use, most of these approaches do not provide standardized, full-color visual documentation, which can affect clinicians' ability to interpret findings using familiar visual cues. This formative evaluation aimed to assess the usability, compliance, and feasibility of an in-home full-color imaging scale for the remote monitoring of patients with DFUs to inform the design of larger prospective studies. We conducted a retrospective formative feasibility evaluation analyzing 7 months of preexisting data from adults with a history of DFUs who had enrolled in an outpatient remote monitoring program. During this program, participants were provided with an internet-connected in-home scale that captured high-resolution, full-color scans of the plantar surface of the feet during daily use. Scans were securely transmitted to a HIPAA (Health Insurance Portability and Accountability Act)-compliant web portal for podiatrist review. Usability was assessed through compliance with daily scanning, patient and physician surveys, and descriptive review of clinical workflows. A total of 21 participants aged 43 to 86 years (median 65, IQR 59-74; mean 65.3, SD 10.6 years) were retrospectively analyzed. Participants demonstrated high compliance and feasibility of home use, with device use on 82.5% (3638/4410) of possible days, a median use of 27 days (IQR 21-30) per 30-day period, and a mean use of 23 (SD 6.4) days per 30-day period. Participants reported high satisfaction and minimal burden associated with daily use, with most rating the device as physically easy to use (median 7.0, IQR 7-7; mean 6.9, SD 0.45), expressing willingness to use it daily (median 7.0, IQR 7-7; mean 6.9, SD 0.31), and indicating trust in the system (median 7.0, IQR 7-7; mean 6.9, SD 0.32) on a 7-point Likert scale (1=worst; 7=best). Clinician usability was supported by podiatrist review of 3295 scans, of which 3220 (97.7%) were rated as usable for clinical assessment. Three representative cases illustrated real-world device use and longitudinal image review, demonstrating the ability to visualize skin changes such as foreign body presence, new ulceration, and early skin breakdown. This retrospective formative evaluation demonstrates the preliminary usability and feasibility of an in-home, full-color imaging scale for daily remote visual monitoring of diabetic feet in a real-world outpatient setting. High compliance and usability in clinical workflows suggest that this approach may support early identification of foot-related concerns. Future prospective studies are warranted to evaluate the impact of this technology on clinical outcomes, including ulcer progression and health care use.
Ankle fracture incidence is increasing in the elderly. There is a growing trend toward early weightbearing. We investigated the effects of early weightbearing after ankle open reduction and internal fixation (ORIF) in the geriatric population. A retrospective cohort study was performed of patients aged ≥65 years who underwent ankle ORIF at 3 neighboring community hospitals from 2015 to 2024. A total of 97 were included, with 52 undergoing syndesmotic fixation. Postoperatively, patients were 50% partial weightbearing for 2-3 weeks. Afterward, patients were permitted to bear as much weight as tolerable. Recorded outcomes included fracture union, radiographic maintenance of alignment, hardware failures, wound complications, hardware removals, and the need for repeat surgery. Weightbearing as tolerated was initiated at an average of 16.6 days. All patients achieved fracture union without hardware failure, catastrophic loss of reduction (>2 mm displacement), accelerated posttraumatic arthritis, or need for revision surgery. Fourteen patients (14.4%) experienced minor complications not requiring return to surgery: 3 had delayed wound healing managed with protected weightbearing, 4 had surgical site infections treated with oral antibiotics, and 7 underwent elective hardware removal for symptomatic hardware at an average of 8.6 months postoperatively. This is the largest study to date reporting on the effects of early weightbearing in the geriatric ankle ORIF population. We report no major complications and a limited number of soft tissue-related complications. In a patient population with a known morbidity from prolonged immobility, and with advances in recent fracture fixation, we hope our data help build confidence in early postoperative weightbearing. Level IV, retrospective cohort study.
The Ankle-Brachial Index (ABI) is universally mandated for diabetic foot ulcer (DFU) risk stratification, yet its prognostic validity for tissue repair remains structurally inconsistent. To evaluate this diagnostic paradox, we implemented a target trial emulation framework in a dual-campus prospective cohort of 528 patients, utilizing doubly robust estimation and restricted cubic splines to characterize the non-linear relationship between continuous ABI and 20-week healing outcomes. The analysis revealed a profound hemodynamic divergence. The ABI maintained log-linear validity as a predictor against major amputation (OR 0.77 per 0.1-unit increase). In contrast, wound healing followed an inverted U-shaped trajectory. Healing efficacy reached a structural peak at an ABI of approximately 0.90, yielding a 27.9% predicted area reduction. Beyond this threshold, the incremental prognostic benefit of the metric plateaued and eventually collapsed. Sensitivity analyses confirmed that this loss of fidelity is a diagnostic artifact driven by extreme medial arterial calcification (≥1.30) rather than physiological perfusion loss. These findings demonstrate that reliance on categorical ABI thresholds induces a systemic misclassification of microvascular risk. Consequently, clinical guidelines should transition toward continuous hemodynamic profiling and multi-modal assessments to identify occult ischemia in pseudonormalized populations, effectively decoupling diagnostic strategies for limb salvage from tissue repair.