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Category: Ankle; Basic Sciences/Biologics; Hindfoot; Other Introduction/Purpose: Progressive collapsing foot deformity (PCFD), formerly termed Adult-Acquired Flatfoot Deformity (AAFD), is a complex 3-dimensional (3D) deformity characterized by peritalar subluxation (PTS) of the hindfoot through the triple joint complex. PTS severity is typically measured at the posterior facet of te subtalar joint, but recent studies have called this into question and presented the middle facet as a more accurate marker of deformity. The objective of this study was to use 3D distance mapping (DM) from weightbearing computed tomography (WBCT) images to assess PTS in PCFD patients and controls across the entire peritalar suface. We hypothesized that 3D DMs would identify the middle facet as a superior marker for PTS, as well as indicate increased extra-articular sinus tarsi and subfibular inpingements in PCFD patients. Methods: In this case control study, we analyzed WBCT data of 20 consecutive patients with flexible PCFD and 10 controls. Novel 3D distance mapping (DM) technique was used to objectively characterize joint coverage across the entire peritalar surface, including both articular (anterior, middle and posterior facets of the subtalar joint) and nonarticular regions (sisus tarsi and subfibular areas). Distance maps were measured in millimeters, and colored to highlight regions of interest. Distances from 1-4mm were shown in blue to indicate expected joint interaction/extra-articular proximity, while distances under 1mm were highlighted in yellow/red indicating close bone proximity consistent with joint space narrowing (articular) or impingement (extra-articular). Joint coverage was defined as percentage of articular area with DMs Results: Overall, coverage was decreased in articular regions and impingement was increased in nonarticular regions of PCFD patients. Objectively, a significant 46.6% average increase in the uncoverage of the middle facet of the subtalar joint was observed in PCFD patients (pConclusion: Our study results revealed that when compared to controls PCFD patients demonstrated that a significant decrease in 3D measures of subtalar joint coverage was only identified in the middle facet, but not at the anterior or posterior facets. We also determined significantly decreased inter-bone distances in the sinus tarsi and subfibular regions of PCFD patients, confirming the occurrence of extra-articular impingement in those areas. We hope that the use of these 3D accurate and objective measures of distance (DM) and coverage maps (CM) of middle facet subluxation will support early detection of PCFD patients at high risk for progressive collapse.

Background: Intractable hallucal ganglion cysts (HGCs) are often a symptomatic and recurrent condition. Its connection with the ankle joint is not well understood. Our aim was to evaluate the relationship between tenosynovitis of the flexor hallucis longus (FHL) tendon at the level of the ankle with formation of an HGC. In addition, we sought to analyze the outcomes of cyst excision combined with ankle capsulorrhaphy. Methods: Nineteen patients with HGC who underwent surgical intervention were included between June 2016 and June 2019. Eight had known recurrences. Ankle arthrography and cyst excision were performed on all patients. Clinical evaluations included the American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and evaluation of postoperative complications. The mean follow-up period was 16.5 ± 8.6 months. Results: Thirteen of the 19 HGCs (68.4%) had a connection with the FHL tendon sheath. Combined with ankle capsulorrhaphy, there was no recurrence after cyst excision. The VAS score decreased from 2.1 ± 1.5 to 0.4 ± 0.8, and AOFAS score significantly improved from 84.3 ± 8.7 to 97.4 ± 5.2 at final follow-up ( P < .001). Conclusions: Most of these patients had a connection between the HGC and ankle joint. Ankle arthrography appeared to be useful for diagnosis, and cyst excision combined with ankle capsulorrhaphy was an effective treatment without cyst recurrence. Level of Evidence: Level IV, case series.

In the last decade, cone-beam computed tomography technology with improved designs allowing flexible gantry movements has allowed both supine and standing weight-bearing imaging of the lower extremity. There is an increasing amount of literature describing the use of weightbearing computed tomography in patients with foot and ankle disorders. To date, there is no review article summarizing this imaging modality in the foot and ankle. Therefore, we performed a systematic literature review of relevant clinical studies targeting the use of weightbearing computed tomography in diagnosis of patients with foot and ankle disorders. Furthermore, this review aims to offer insight to those with interest in considering possible future research opportunities with use of this technology. Level of Evidence: Level V, expert opinion.

Background: Lower leg compartment syndrome can lead to severe sequelae affecting patient autonomy. Ischemic muscle fibrosis and retraction result in foot and ankle deformities ranging from claw toes to complex multiplanar dislocations with soft tissue impairment requiring amputation. Although these deformities have been reported in relation to compartment syndrome, they have rarely been discussed specifically in the light of a long term follow up. Materials and Methods: Between 1981 and 2006, 151 patients were treated in our hospital for compartment syndrome of the lower limb. Ten of them later required further surgery to treat sequelae on the foot and ankle and were followed up prospectively. Personal data and surgical events were recorded, as well as potential risk factors for sequelae and functional outcome. The data was analyzed and compared to that available in previous literature. We analyzed and describe the different surgical procedures available for the management of this condition including arthroscopic ankle arthrodesis which could be a less invasive and efficient technique in mild equinus deformities. Results: All ten patients were diagnosed late for compartment syndrome. The anterior and lateral compartments were most often involved but rarely accounted for late sequelae. The deep posterior compartment seems to be the key element in generating after effects. Functional results were good in eight patients. Two required amputation after failed secondary surgery. Conclusion: The late, post-compartment syndrome affecting the foot and ankle can be treated efficiently provided surgery is performed acurately, taking into account the multiplanar deformity. However, the best treatment for this condition remains prevention. Level of Evidence: IV, Retrospective Case Series