Flatfoot alignment alters foot biomechanics and lower limb coordination; however, its impact on dynamic performance during bilateral heel rises under varying knee conditions remains unclear. This study compared heel-rise kinematics and intersegmental coordination in 12 flatfoot and 12 normal-foot participants performing ten bilateral heel rises at 60 BPM under randomized knee extended and knee flexed conditions. The three-dimensional kinematics were recorded using a 12-camera Vicon system. The ascending and descending phases were divided into the early, middle, and late periods. The maximum normalized heel height, vertical and anterior center-of-mass displacement, anterior knee translation, pelvic and foot kinematics, and shank-hindfoot coordination via modified vector coding were analyzed. Under knee extension, the flatfoot group showed greater vertical center-of-mass displacement (p = 0.044). With knee flexion, anterior knee translation was larger in subjects with flatfoot (p = 0.022), who also exhibited greater hallux extension during the middle to late periods (p < 0.05). In the early ascending period with knee flexion, normal-foot participants displayed more proximal-dominant in-phase shank-hindfoot coupling (47.5 % vs. 23.3 %, p = 0.032), whereas flatfoot participants showed increased distal-dominant in-phase coupling (34.1 % vs. 12.4 %, p = 0.013). Individuals with flatfoot adopt compensatory forward knee translation and enhanced hallux/hindfoot motion, especially under knee flexion, reflecting reduced foot stiffness and altered coordination. Incorporating knee-flexed assessments and coordination metrics into clinical heel-rise testing may improve the detection of foot stiffness deficits and guide personalized rehabilitation.
Excessive forefoot plantar pressures are associated with pain, ulceration risk, and functional limitations in both healthy individuals and those with pathologies such as rheumatoid arthritis (RA). Limited ankle dorsiflexion, often related to gastrocnemius-soleus tightness, may contribute to forefoot overload. Although foot orthoses (FOs) are widely used to redistribute plantar loads, it remains unclear whether the existing evidence includes orthotic interventions designed to promote posterior chain flexibility. To systematically evaluate the effectiveness of foot orthoses in reducing forefoot plantar pressure and pressure-time integral (PTI), and to identify whether current evidence addresses orthoses specifically intended to facilitate calf muscle stretching. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Five databases were searched up to December 2024. Inclusion criteria encompassed adult populations, studies reporting plantar pressure outcomes, and interventions involving foot orthoses. Methodological quality was assessed using RoB 2 and ROBINS-I tools. Due to substantial clinical and methodological heterogeneity, a meta-analysis was not undertaken and findings were synthesized narratively. Twelve studies involving 456 participants met the inclusion criteria. No eligible studies directly evaluated orthoses designed to stretch the triceps surae. All included studies reported reductions in peak plantar pressure (PPP) and/or pressure-time integral (PTI). Descriptively, PPP reductions were greater in healthy cohorts (unweighted mean 20.2%) compared to RA populations (14.5%), whereas PTI reductions were descriptively higher in RA participants (22.2% vs. 14.7%). Interventions incorporating metatarsal pads and soft contoured orthoses showed consistent reductions in forefoot loading across studies. Foot orthoses appear to be consistently associated with reductions in forefoot plantar loading across populations, particularly in individuals with inflammatory or structural pathology. The absence of studies specifically evaluating posterior chain flexibility represents a clear evidence gap. Future research should explore whether orthotic designs combining forefoot offloading with mechanisms that may influence ankle dorsiflexion or posterior chain mechanics could have biomechanical relevance.
This study evaluated the point during Ponseti treatment when the foot reaches a neutral position and quantified how percutaneous Achilles tenotomy influences each component of clubfoot deformity. An additional aim was to provide a visual representation of correction trends using the Dimeglio scoring framework. Infants under six months of age with unilateral idiopathic clubfoot were assessed at each visit with the Dimeglio score. Changes in total and individual deformity parameters were analyzed throughout serial casting and following tenotomy. The total number of casts required before tenotomy ranged from 3 to 12 (mean 6.2). The largest drop in total Dimeglio score occurred between the initial and second casts. All the individual components exhibited the steepest reduction between the first and second casts (17.90 - equinus, 19.20 - hindfoot varus, 44.40 - midfoot rotation, and 18.80 - forefoot adduction). All the deformities except equinus approached neutral through the third cast and equinus through the fourth cast. Tenotomy improved (mean) equinus by 140, hindfoot varus by 20, midfoot rotation by 50 and forefoot adduction by 3.20. All major deformity elements show concurrent early improvement when managed with the Ponseti technique. Significant change occurs within the first few casts, with tenotomy offering additional correction beyond equinus alone. Larger-scale studies could help standardize the graphical correction profiles observed here. IV.
Midfoot osteoarthritis affects approximately 12% of adults over 50 years and is a common cause of chronic foot pain and disability. When conservative management fails, midfoot arthrodesis remains the standard surgical treatment but carries significant morbidity, including nonunion rates of 3-10% and prolonged non-weightbearing. Deep peroneal nerve (DPN) neurectomy has emerged as a motion-preserving alternative; however, clinical evidence has not been systematically evaluated. A systematic review following PRISMA 2020 guidelines was conducted (PROSPERO: CRD420251266344). MEDLINE, Cochrane CENTRAL, and Web of Science were searched from inception to October 2025. Quality was assessed using the ROBINS-I tool. Data were synthesised narratively due to heterogeneity in outcome reporting. Four retrospective case series (Level IV evidence) comprising 88 patients (106 feet) met inclusion criteria. Mean age was 66.3 years; 80% were female. Follow-up ranged from 4 weeks to 51 months. Patient satisfaction was approximately 75% across studies, though variably defined and best regarded as an illustrative estimate.The pooled surgical complication rate was 5.7% (6/106 feet), comprising predominantly minor wound complications. Reoperations, including revision neurectomy, exostosis excision, and conversion to arthrodesis, were required in 7.5% of feet (8/106). Conversion to midfoot arthrodesis occurred in 4.7% of feet (5/106). All four studies were assessed as having serious risk of bias using ROBINS-I. DPN neurectomy may provide clinically meaningful pain relief with low complication rates in selected patients with midfoot osteoarthritis, offering faster recovery than arthrodesis. Current evidence is limited to small retrospective case series; prospective comparative studies are needed.
Diabetic foot ulcers (DFUs) represent one of the most debilitating and costly complications of diabetes mellitus, leading to substantial morbidity, mortality, and healthcare burden. Their global incidence continues to rise in parallel with the increasing prevalence of diabetes and aging populations. To critically review the epidemiology, pathophysiological pathways, and contemporary management strategies of diabetic foot, with emphasis on translational advances and emerging therapeutic directions. A systematic literature search was conducted utilising the PubMed, Scopus, and Web of Science databases for publications from 2015 to 2025 employing the terms 'diabetic foot ulcer,' 'management,' 'therapy,' 'regeneration,' and 'emerging treatment.' Only studies published in English that concentrate on clinical or translational advancements in diabetic foot care were included. Reviews, case reports, and irrelevant articles were omitted. Following the evaluation of 286 records, 132 studies were selected for synthesis. Chronic hyperglycemia drives neuropathy, vasculopathy, and persistent inflammation, impairing the normal wound healing cascade. Standard management-including glycemic control, debridement, infection management, pressure offloading, and advanced dressings-remains essential. However, novel therapies such as bioengineered skin scaffolds, recombinant growth factors, stem cell applications, nanotechnology-based delivery systems, and negative-pressure wound therapy are transforming the field. Despite technological promise, widespread implementation remains challenged by regulatory and economic constraints. The future of diabetic foot care lies in multidisciplinary, precision-based paradigms integrating smart biomaterials, gene therapy, artificial intelligence, and telemedicine. These convergent technologies hold the potential to revolutionize wound healing outcomes and reduce the global burden of diabetic complications.
Diabetic foot ulceration represents a prevalent, persistent and resource-intensive complication of diabetes. These ulcers are slow to heal, prone to recurrence and impose a substantial burden on both patients and healthcare providers. The reducing the impact of diabetic foot ulcers (REDUCE) intervention has been designed as a multifaceted approach targeting psychological and behavioural determinants linked to diabetic foot ulcer (DFU) outcomes. Following a successful pilot trial, the REDUCE trial has been designed as a pragmatic, multicentre randomised trial to compare the effectiveness and cost-effectiveness of the REDUCE intervention plus usual care versus usual care alone in reducing recurrence in people with healed DFUs. Additionally, there is an embedded process evaluation and two sub-studies which will be carried out alongside the main trial. Adults over 18 years of age, with a recently healed DFU and two lower limbs, will be identified from around 30 specialist multidisciplinary diabetic foot clinics at participating National Health Service Trusts in the UK. Patients with active Charcot neuro-osteoarthropathy, active DFU or ulcers healed for more than 12 weeks will be excluded. We will aim to recruit 544 participants (1:1 randomisation). The primary outcome for this trial will be total ulcer-free days with limbs intact (ie, without amputation) between randomisation and the end of follow-up (18 months post-randomisation). Secondary outcomes include time to re-ulceration, total number of ulcers, amputation, quality of life (EQ-5D-5L), Patient Health Questionnaire-9, Nottingham Assessment of Functional Footcare, ICEpop capability measure for adults and resource use. As part of the process evaluation, up to 20 REDUCE intervention patient-participants will be interviewed, and the healthcare professionals delivering the intervention will also be interviewed. An assessment of intervention fidelity will also be carried out. Ethics approval was granted by Wales 3 Research Ethics Committee (REC reference 22/WA/0053) on 16 March 2022. The findings will be presented at relevant conferences and disseminated via peer-reviewed research publications and to relevant stakeholders. ISRCTN15570706.
To determine the optimal anatomical location for performing Achilles tendon tenotomy in children under 18 months of age, using MRI measurements to enhance surgical safety and efficacy during the Ponseti method for clubfoot correction. A retrospective study was conducted of children aged 18 months or younger without clubfoot deformity who underwent MRI scans of the foot and ankle in our tertiary center from January 2012 to December 2023 for unrelated clinical indications. T1-weighted post-gadolinium images were analyzed to measure the medial distance between the Achilles tendon and the posterior tibial neurovascular bundle, as well as tendon width, at four levels: at the superior border of the calcaneus, and 10 mm, 20 mm, and 30 mm proximal. Measurements were performed independently by three orthopedic team members, and mean values were calculated. Eleven patients were included in the final analysis. At the superior border of the calcaneus, the mean distance to the neurovascular bundle was 11.43 ± 1.54 mm, decreasing to 10.56 ± 2.17 mm at 10 mm, 8.39 ± 2.01 mm at 20 mm, and 7.10 ± 1.80 mm at 30 mm proximally. The Achilles tendon width was widest at the calcaneal border (11.33 ± 1.23 mm) and decreased significantly at more proximal levels. Performing the tenotomy 10-20 mm proximal to the superior calcaneal border offers an optimal balance between tendon width and a safe distance from the posterior tibial neurovascular bundle. This location may reduce the risk of iatrogenic vascular injury during Ponseti treatment of clubfoot in infants.
Equity, diversity and inclusiveness have been identified as areas for improvement across sports and biomechanics research. To identify and prioritise areas for improvement, it is important to understand the current 'state of play'. This protocol outlines an audit process designed to (1) characterise and compare demographic data of both participants and researchers in published performance shoe research and (2) profile considerations of equity, diversity and inclusiveness in performance shoe design. A comprehensive multi-language, search strategy will be conducted across 4 primarily English and 1 Chinese data base. Sport specific journals published in Chinese, Japanese, Korean, French, Spanish and Portuguese will be hand-searched. All studies, published since 2015, investigating the design or testing of a shoe, insert or orthotic required or facilitating for sports performance will be considered for inclusion. For the purposes of this audit, sports will be limited to those recognised by the International Olympic Committee Summer Olympic International Federations. Footwear company websites will be searched for details on specific performance footwear. Studies will be grouped based on the sports the shoe is designed for. Participants' gender and/or sex, race and ethnicity will be directly extracted from included studies or by contacting the authors. Researchers' gender and/or sex, position within the authorship group and location where the study was conducted will be extracted from included studies or obtained through university profiles, professional pages or by directly contacting authors. Differences in demographic data will be compared between shoe type and representativeness of participants, researchers and footwear will be calculated using participation to prevalence ratios. The proposed protocol represents a committed step towards improving equity, diversity and inclusiveness throughout footwear science.
Peroneal tendon pathologies are frequently associated with ankle sprains. However, the incidence and demographics of peroneal tendon pathology remain undetermined. This study aims to present surgeon- and patient-reported data of patients undergoing first-time surgery for peroneal tendon pathology with data extracted from the Swedish Foot and Ankle Register (Swefoot). Data from 719 patients between December 2015 and November 2022 underwent analysis. The data included patient characteristics, surgeon-reported findings and preoperative Self-Reported Foot and Ankle Score (SEFAS) and EuroQol 5-Dimension 3-Levels (EQ-5D-3L) assessments. The mean age at surgery was 49 years. Peroneal tendon rupture is the most frequent diagnosis. A higher prevalence of peroneal tendon pathology, specifically peroneus brevis rupture and tendinosis, was observed in women compared to men. Pre-operatively, patients exhibited moderate functional impairment and diminished health-related quality of life compared with normative values. This is Sweden's first large-scale demographic study of peroneal tendon pathologies. Further research is required to comprehensively elucidate demographic patterns. Observational study, Level 3.
Subtalar arthroereisis is widely used to treat flexible flatfoot in growing patients. Metallic implants have historically been standard, whereas bioabsorbable devices have emerged as an alternative that may reduce implant-related symptoms and avoid elective hardware removal. We systematically compared clinical and radiographic outcomes, complication rates, and patient-reported satisfaction between metallic and bioabsorbable implants. We performed a PRISMA-compliant systematic review and meta-analysis. PubMed, Embase, the Cochrane Library, and Web of Science were searched to December 2024. We included clinical studies of subtalar arthroereisis using metallic and/or bioabsorbable implants in pediatric and adolescent flexible flatfoot. Primary outcomes were complication rates (complications, non-routine implant removal, persistent sinus tarsi pain), radiographic parameters, and patient-reported outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects models were used for quantitative synthesis. Thirty-nine studies, mostly involving pediatric patients, reported consistent clinical and radiographic improvement after subtalar arthroereisis irrespective of implant material. Pooled single-arm analyses showed persistent sinus tarsi pain in 8.0% of metallic-implant cases and 6.3% of bioabsorbable-implant cases, and non-routine implant removal/revision in 7.7% and 5.2%, respectively. In the two comparative studies, metallic implants showed a trend toward higher odds of non-routine implant removal (pooled OR 2.20; 95% CI, 0.97-5.00) and significantly higher odds of persistent sinus tarsi pain (pooled OR 1.77; 95% CI, 1.03-3.03) compared with bioabsorbable devices. Radiographic correction and patient satisfaction were high in both groups, with no consistent evidence of superiority of either material. Subtalar arthroereisis with metallic or bioabsorbable implants yields substantial clinical and radiographic improvement in pediatric flexible flatfoot. Available data suggest that bioabsorbable devices may be associated with lower rates of implant-related symptoms, but comparative evidence, limited to two non-randomized studies, is of low-to-moderate certainty. High-quality randomized trials with standardized, long-term outcome reporting are needed to define the optimal implant choice.
Ulcer formation poses a serious clinical problem and has been associated with muscle function and tissue loss in diabetic feet and increased plantar peak pressures during walking. Reduced intrinsic and extrinsic foot muscle strength has been considered to increase the plantar peak pressure at the most affected metatarsal region. We aimed to investigate if a targeted strength training of the toe flexor muscles 1) enhances muscle strength and volume in the diabetic foot, and 2) improves plantar pressure distribution during walking in diabetic patients. Fourteen non-ulcerated diabetic patients performed a monitored toe flexor strength training at 70% of the maximal voluntary isometric contraction on a custom-made dynamometer for eight weeks. The maximal plantarflexion moment at the metatarsophalangeal joints on the dynamometer, the intrinsic foot muscle volume and the plantar pressure distribution during walking were quantified before and after the intervention. Right and left maximal plantarflexion moments increased significantly by 62% (p < 0.001) and 49% (p < 0.001), the intrinsic muscle volume increased by 6.4% (p = 0.018) and the peak pressures decreased at the second (p < 0.001) and lateral (p < 0.01) metatarsal region each by 11% following the training. Muscle function and tissue loss in diabetic feet can be counteracted by a targeted strength training program. Improved toe flexor muscle strength reduces plantar peak pressure at common ulceration sites.
Hallux rigidus is a common and debilitating condition that increasingly impacts UK healthcare resources. First metatarsophalangeal joint (MTPJ) fusion is a widely performed intervention with excellent clinical outcomes; however, its commissioning has faced restrictions in some regions in the UK due to perceived limited value. Robust national cost-effectiveness evidence is needed to guide policy and ensure equitable access to care. A cost-utility analysis was conducted using British Orthopaedic Foot & Ankle Society (BOFAS) Registry data for patients undergoing primary 1st MTPJ fusion. EuroQol-5 Dimension (EQ-5D-5L) outcomes at baseline and 1 year were utilised to estimate quality-adjusted life year (QALY) gains. A lifetime Markov model over 20 years simulated costs, utilities, and complication pathways from the UK NHS perspective. Costs were derived from national tariffs and discounted at 3.5 % per annum. Incremental cost-effectiveness ratios (ICERs) were calculated relative to conservative management, and deterministic sensitivity analysis tested uncertainty across cost and utility assumptions. Out of 1199 patients, 202 had completed full PROM datasets for cost-utility modelling. EQ-5D-5L improved from 0.53 pre-operatively to 0.77 at one year (p < 0.001), exceeding the MCID by six months and sustained thereafter. The base-case model demonstrated a discounted lifetime QALY gain of 3.331 and cost of £ 4698.15, yielding an ICER of £ 1410.58 per QALY gained. Across all sensitivity scenarios, including increased costs, reduced utility gains, and shortened duration of benefit, the ICER remained well below accepted NICE thresholds (£20,000-£30,000/QALY). In the low-cost scenario, 1st MTPJ fusion became cost-saving (negative ICER) by year 18. 1st MTPJ fusion is a highly cost-effective intervention for hallux rigidus, delivering clinically significant and durable improvements in quality of life at very low cost per QALY gained. This procedure provides greater value for money than many widely commissioned major orthopaedic operations, including hip and knee arthroplasty. Current NHS restrictions on access are not supported by health-economic evidence. These findings reinforce the essential role of 1st MTPJ fusion in value-based foot and ankle surgical care.
Regional anaesthesia is central to perioperative analgesia in foot and ankle surgery. Ultrasound-guided ankle and popliteal/saphenous nerve blocks are widely used, yet real-world evidence on their duration of action and factors associated with block failure is limited. This study aimed to document the duration of postoperative analgesia achieved with levobupivacaine ankle and popliteal/saphenous blocks and to explore contributors to failed or incomplete blocks. Ninety-two consecutive feet undergoing elective foot and ankle surgery received general anaesthesia with an ultrasound-guided ankle (n = 63) or popliteal (n = 29) block. The primary outcome was duration of postoperative analgesia, defined as time from block completion to first rescue analgesia. Secondary outcomes included sensory and motor recovery, pain scores, adverse events, satisfaction, and same-day discharge. Block failure was defined by early rescue analgesia, repeat block, pain-related delayed discharge, or unplanned postoperative contact. Forty-four ankle and eighteen popliteal blocks were successful. The mean duration of analgesia was 25.95 ± 11.25 h for ankle blocks and 22.25 ± 9.46 h for popliteal blocks. At 24 h, persistent sensory deficit occurred in 22 ankle and 15 popliteal blocks, reducing to one popliteal deficit at 48 h. No neurological injury, infection, readmission, A&E attendance, or helpline contact occurred. Despite a higher-than-expected failure rate, no single causative factor was identified; shorter soak-time before incision emerged as the most plausible contributor. Ultrasound-guided ankle and popliteal/saphenous blocks using levobupivacaine provided prolonged, safe, and effective analgesia. Variable soak-time appears to be a key modifiable factor influencing block reliability and warrants further investigation.
Multidisciplinary team care is the standard of care for diabetic foot ulcer (DFU) management, yet traditional models often involve sequential consultations that may delay treatment initiation. To evaluate whether a one-stop multidisciplinary clinic improves DFU healing outcomes compared with traditional sequential-consultation care. This retrospective cohort study included patients with new-onset DFUs between April 2016 and March 2024. A historical control group (April 2016-March 2020) was compared to an intervention group treated at a one-stop integrated clinic (April 2020-March 2024). The primary outcome was time to complete healing. Secondary outcomes included major lower extremity amputation, and mortality rates. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed. Among 237 patients (former clinic, n = 118; integrated clinic, n = 119), the integrated clinic group achieved an overall healing rate of 82%, compared to 71% in the traditional group (p = 0.103). After adjusting baseline characteristics, the integrated clinic was independently associated with faster healing (adjusted hazard ratio = 1.41; 95% CI: 1.04-1.90; p = 0.027). Major amputation and mortality rates remained comparably low across both groups. The one-stop multidisciplinary team model significantly improved healing outcomes by providing coordinated, same-day care, effectively overcoming the limitations of sequential referral pathways.
Hallux rigidus, or restricted dorsiflexion of the first metatarsophalangeal joint, is a frequent musculoskeletal disorder disrupting gait biomechanics and general health. This review extends existing literature by providing a focused synthesis of biomechanical and clinical outcomes associated with different orthotic designs in hallux rigidus, highlighting their moderate effectiveness and the substantial heterogeneity in outcome measures and orthotic configurations. Scopus, PubMed, and Web of Science were searched for randomized controlled trials that assessed the effects of orthotic devices on clinical and biomechanical outcomes among adults aged 18-65 years with clinically diagnosed Hallux rigidus. The methodological quality was evaluated using the Cochrane Risk of Bias Tool for Randomized Trials. Data were synthesized using both narrative (data summarization and description) and quantitative (using random-effects models meta-analyzed to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs)) approaches. Eleven RCTs were included. Cut-out insoles reduce transverse plane foot motion and redistribute pressure from the forefoot to the midfoot and heel, while anterior forefoot stabilizer insoles decrease ankle and midfoot stiffness and shift loading posteriorly. Shoe-stiffening insoles reduce ankle and first metatarsophalangeal joint dorsiflexion and increase knee flexion, whereas rocker-sole shoes decrease hip range of motion and alter spatiotemporal gait parameters. A 3 mm support under the first MPJ significantly increased maximum extension of the hallux. Additionally, orthoses led to decreased pain. First metatarsal plantarflexion during gait was significantly improved by cut-out orthoses (SMD: 0.61; 95% CI: (0.31-0.92); p < 0.05). However, foot function index scores showed no change (SMD: -4.27; 95% CI: (-8.55-0.01); p > 0.05) with high heterogeneity (I² = 97%). Orthotic appliances are of moderate effectiveness in remedying biomechanical function in Hallux rigidus. Clinical results differ significantly because of the diversity in orthosis design, the various measures used for outcomes, and the duration of follow-up.
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The deltoid-spring ligament complex (DSL) is recognised as an integrated stabilising structure of the ankle-hindfoot complex; however, the relative contributions of its individual components to talonavicular joint (TNJ) stability remain incompletely defined. While the tibiocalcaneal (TC) fibres are known to influence ankle and subtalar mechanics, their role in TNJ abduction stability has not previously been experimentally assessed. To quantify the contribution of the tibiocalcaneal fibres to talonavicular joint abduction stability (primary outcome, degrees) and hindfoot eversion (secondary outcome, millimetres), and to compare their effect with that of other DSL components using a paired cadaveric sectioning model. Eighteen embalmed cadaveric lower limbs were tested under controlled, non-weight-bearing conditions. Specimens were randomised to anterior-posterior or posterior-anterior sequential sectioning of the tibionavicular, tibiospring, spring, and tibiocalcaneal fibres. Changes in TNJ abduction and hindfoot eversion were recorded following isolated and sequential ligament sectioning. The primary comparison was the effect of isolated tibiocalcaneal sectioning versus isolated tibionavicular and tibiospring sectioning on TNJ abduction. Sequential DSL sectioning resulted in significant, stepwise increases in TNJ abduction and hindfoot eversion (p < 0.05). Isolated sectioning of the tibiocalcaneal fibres produced greater TNJ abduction than isolated tibionavicular or tibiospring sectioning. Across protocols, the tibiocalcaneal fibres accounted for approximately 28-40% of total TNJ abduction stability. Hindfoot eversion increased progressively with ligament disruption, reflecting combined tibiotalar and subtalar contributions. Tibiocalcaneal fibres contribute substantially to talonavicular joint abduction stability despite not directly spanning the joint. These findings support the concept of integrated medial ligament function and provide biomechanical insight to inform future experimental and modelling studies of ankle-hindfoot stability.
This article reflects on the 50-year journey of the British Orthopaedic Foot and Ankle Society (BOFAS), tracing its evolution from representing an underappreciated niche interest to being the British face of a mature, technically diverse, and internationally respected surgical sub-specialty. Against the political, social, and medical backdrop of 1970s Britain, the foundation of the original British Orthopaedic Foot Surgery Society (BOFSS) marked a quiet but significant challenge to conventional orthopaedic hierarchies. This review considers the society's origins, growth, professionalisation, and ongoing struggle for recognition, both within orthopaedics and the wider medical community.
Plantarflexion of the first ray is an important component of cavovarus foot deformities, which is thought to be due to the pull of the peroneus longus muscle. We inferred its action by studying its insertion into the peroneus longus tubercle (PLT). Our aim was to determine how PLT orientation and morphology differs in cavovarus feet compared to controls on weightbearing computed tomography (WBCT) imaging. We retrospectively analysed 30 WBCT scans from patients with cavovarus feet and Charcot-Marie Tooth disease. We compared these to 30 normal feet using previously described measurements of PLT morphology: tubercle-to-floor (T-F) distance; bisecting angle and tubercle-to-metatarsal (T-MT) angle. The intraclass correlation coefficient (ICC) was used to assess reliability. Individuals with cavovarus feet were found to have a higher T-F distance by an average of 9.63 mm (p < 0.001), a greater vertical bisecting angle (> 10 °, p = 0.002) and a lower T-MT angle (<11 °, p < 0.001). This suggests net forefoot supination with relative pronation of the first ray. Intra- and Inter-observer reliability was excellent. We observed the PLT is both greater in size and more vertically oriented in cavovarus feet, with relative pronation of the PLT orientation when compared to the rest of the forefoot. The height of the PLT from the floor is also greater. Overall, this likely infers that the action of peroneus longus in cavovarus feet is to plantarflex and pronate the first ray, relative to a supinated forefoot. III.
Isolated cuboid dislocation is rare, with only 7 cases described in the literature. We describe three cases, two in professional rugby league players. The mechanism of injury was the same in the rugby league players with an external rotation injury to the midfoot during a tackle. The dislocation is easily missed on X-rays and CT would appear to be the investigation of choice. None of the dislocations could be reduced closed and all underwent open reduction and wire stabilisation. The wires were removed at 6 weeks. The short and long term functional results were good. Both rugby league players returned to play. One player was reviewed 6 years and 8 months post dislocation. He was still playing professional rugby league. His AOFAS midfoot score was 100. His X-rays however showed marked post traumatic arthritis in his 4th and 5th tarsometatarsal joints. Clinically this was asymptomatic. The second player was reviewed 4 years and 2 months after the injury, achieving an AOFAS Midfoot Score of 88/100. He reported some clicking and discomfort in the affected foot, particularly in the mornings. However, he did not require analgesia and had no limitations to activity.