Search

ABSTRACT Background Flatfoot is a common foot disorder involving progressive foot deformity of the three‐dimensional structures of the forefoot, midfoot, and hindfoot. Currently, Chinese surgeons and patients favor subtalar arthroereisis (SA) due to its minimally invasive and low‐damage characteristics. HyProCure device is widely used. However, there is limited analysis of large sample sizes. This study utilized statistical evaluation with a large sample size to analyze clinical characteristics trends of SA for flatfoot, including baseline indicators, selection of HyProCure size and surgical strategy, complications, and implant removal. This study will enhance the understanding of SA in China. Methods A retrospective analysis of 732 patients (1008 ft) who underwent SA from June 2015 to June 2023, with 509 pediatric and adolescent patients (772 ft) and 223 adult patients (236 ft). Based on the patient's age, patients aged ≤ 18 were included in the children and adolescent group, while adult acquired flatfoot deformity (AAFD) patients aged > 18 were included in the adult group. General data was collected, including patient sex, age, side, body mass index (BMI), surgery date, HyproCure size, and surgical data, and trends were analyzed. Postoperative complications and HyProCure removal were collected as outcome measures during follow‐up. Results The age of patients treated with SA was gradually getting younger, with male patients predominating, mainly concentrated in the 11–14 age group. HyProCure 7 has the highest usage rate. In the children and adolescent group, 288 ft (37.31%) only underwent SA. In the adult group, 18 ft (7.63%) only underwent SA. Complications include sinus tarsi pain, peroneal spasms, achilles tendon tension, and muscle strength decline. The complication rate in the children and adolescent group was 5.05%, while in the adult group it was 28.81%. Overall, it was 10.62%. The removal rate of HyProCure in the children and adolescent group is 1.04%, in the adult group is 15.25%, and overall is 4.37%. Conclusions The trend in flatfoot treated with SA was towards children and adolescent male patients, and sinus tarsi pain was the most common complication after SA. The complication rate and removal rate in the children and adolescent group were lower than those in the adult group. HyProCure can be removed without additional adverse effects.

Abstract Purpose To investigate the treatment outcomes of subtalar arthroereisis (SA) in progressive collapsing foot deformity (PCFD) patients, to assess the clinical efficacy in PCFD patients after HyProCure removal, and to evaluate safety and effectiveness of SA. Methods In this retrospective study, 202 cases (213 feet) of PCFD patients treated with SA from June 2015 to December 2022 were selected. General data and surgical information were recorded, and clinical efficacy was evaluated through imaging and clinical indicators. Furthermore, for 36 patients (36 feet) who underwent secondary surgery to remove HyProCure, imaging and clinical evaluation indicators at 1-year post-removal were recorded. Complications were also documented. Results The main complications were sinus tarsi pain (91.37%), with partial relief or disappearance of symptoms in some patients after conservative treatment. The imaging indicators improved significantly after SA (P 0.05). Regarding clinical indicators, AOFAS score at post-SA was difference compared with preoperation and post-removal separately (P 0.05). Notably, there was a significant improvement at post-removal compared with post-SA (P

Abstract Background and objective Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was

Background: Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute LAS more effectively and efficiently, it is important to identify patients at substantial risk for developing CAI. This study identifies magnetic resonance imaging (MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients. Methods: All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1, 2017 to December 1, 2019 were identified. Data were collected using the Cumberland Ankle Instability Tool at final follow-up. Demographic and other related clinical variables, including age, sex, body mass index, and treatment were also recorded. Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS. Results: A total 131 out of 362 patients with a mean follow-up of 3.0 ± 0.6 years (mean ± SD; 2.0–4.1 years) developed CAI after first-episode LAS. According to multivariable regression, development of CAI after first-episode LAS was associated with 5 prognostic factors: age (odds ratio (OR) = 0.96, 95% confidence interval (95%CI): 0.93–1.00, p = 0.032); body mass index (OR = 1.09, 95%CI: 1.02–1.17, p = 0.009); posterior talofibular ligament injury (OR = 2.17, 95%CI: 1.05–4.48, p = 0.035); large bone marrow lesion of the talus (OR = 2.69, 95%CI: 1.30–5.58, p = 0.008), and Grade 2 effusion of the tibiotalar joint (OR = 2.61, 95%CI: 1.39–4.89, p = 0.003). When patients had at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, or inversion tilt test, they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI. Conclusion: MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.

Osteoid osteoma of the cuneiform bone is an exceedingly rare and easily missed cause of foot pain. The uncharacteristic and nonspecific radiographs of such intra‐articular osteoid osteoma further increase difficulty in making the diagnosis. To date, there has been no description of intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration in any published literatures. We present a case of intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration, who underwent curettage, allograft bone graft, and navicular‐cuneiform arthrodesis. The patient presented with radiographic bone union, full motor function recovery and pain‐free at the 22‐month follow‐up. This report adds to the existing literature. Intra‐articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration is an exceedingly rare and easily missed cause of foot pain. It proves a complicated and challenging task to identify intra‐articular osteoid osteoma. Clinicians should be particularly careful not to exclude the possibility of arthritis and, thus, vigilant when choosing the surgical option.

Abstract Purpose The aim of this study was to evaluate the relation between anteromedial ankle osteophytes (AMAO) and anteromedial ankle impingement (AMAI) in chronic lateral ankle instability (CLAI) through visualization and quantification. Methods Forty-three patients with unilateral CLAI between September 2018 and March 2020 accepted arthroscopic repair of an anterior talofibular ligament (ATFL) and were split into two groups: AMAI (AMAI including intraoperative AMAO resection) and pure CLAI (with AMAO but without AMAI, no AMAO resection). The AMAO protrusion lengths in each direction were measured and compared after all of the ankles were reconstructed. All patients were assessed preoperatively and at 2-year follow-up with ankle dorsiflexion, the American Orthopedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, and visual analog scale (VAS) score. Results Intelligent analysis showed that a large extent of osteophytes was found at the dorsomedial surface of the talar neck in AMAI group. The upper and inner bound protrusion distances of AMAO in AMAI group were greater than in the pure CLAI group. There was no significant difference in anterior bound protrusion distance of AMAO between the two groups. Preoperatively, the ankle dorsiflexion of AMAI group (7.6 ± 1.4°) was considerably lower than that of pure CLAI group (22.4 ± 1.9°) (p

IntroductionThe primary objective of this study is to examine the factors that affect farmers’ willingness to engage in traceability systems. Traceability systems are widely promoted as technologies that ensure the quality and safety of agricultural products. However, the participation rate of farmers in developing countries remains low.MethodsTo empirically address this issue, the study analyzed structured interview data from 408 fruit farmers in Henan Province, Central China, using structural equation modeling and system dynamics.ResultsThe results indicate that attitude, perceived behavioral control, subjective norms, moral norms, and safety awareness are crucial factors influencing farmers’ willingness to engage. It is particularly noteworthy that system dynamics simulations revealed the significant role of improving attitude and subjective norms in promoting farmers’ willingness. Moreover, subjective norms have a positive influence on moral norms. We also found that gender, education, orchard area, income and access to credit have a significant positive impact on farmers’ willingness to engage.DiscussionBy uncovering the internal decision-making mechanisms behind farmers’ engagement in traceability systems, this study extends the research scope of agricultural technology adoption. These findings can serve as a basis for formulating traceability system policies and interventions in China and other developing countries.

IntroductionAs a crucial technological tool for ensuring the quality and safety of agricultural products, the traceability system is of great importance in the agricultural sector. However, farmers’ participation in the system, especially among small-scale farmers, remains relatively low.MethodsThis study investigates the factors that influence farmers’ intentions to participate in traceability systems by integrating moral norms and policy support into the technology acceptance model (TAM) and using a three-stage approach of structural equation modeling (SEM), artificial neural network (ANN), and necessary condition analysis (NCA).ResultsThe findings indicated that farmers’ intentions were primarily influenced by perceived usefulness. Perceived usefulness and perceived ease of use were strongly affected by moral norms and policy support. To promote farmers’ intentions, it is necessary to achieve at least 75, 66.7, 45.5, and 50% of perceived usefulness, perceived ease of use, moral norms, and policy support, respectively.DiscussionThese findings provide valuable guidance to government agencies and technology developers in prioritizing adoption strategies. This study not only expands the scope of TAM research, but also represents an early application of a three-stage approach to agricultural technology adoption research.

IntroductionIn 2020, the outbreak of COVID-19 has forced consumers to shift their consumption patterns online. However, the problem of online fraud in green agricultural products seriously undermines consumer trust and is detrimental to the sustainable consumption of green agricultural products. Therefore, it is particularly important to enhance consumers’ trust in online sellers. This study aims to investigate how the product environmental information transparency(soil information transparency and water information transparency) affects online consumers’ purchasing behavior of green agricultural products.MethodsThis study constructs a theoretical framework of “product environmental information transparency - online consumer trust - online purchase behavior”.We conducted an online randomized questionnaire to collect data from a sample of 512 consumers who had experience buying green agricultural products online fitted a structural equation model (SEM).ResultsThe results show that (1) the two dimensions of product environmental information transparency have different effects on different dimensions of online consumer trust. Among them, soil information transparency has a significant positive effect on competence trust, while it does not have a significant positive effect on benevolence trust. Water information transparency has a significant positive effect on both dimensions of online consumer trust, (2) online consumer trust has a significant positive effect on online consumer purchase behavior, and (3) competence trust has a significant positive effect on benevolence trust.DiscussionOur study shows that consumer trust in merchants is significantly enhanced by increasing the transparency of environmental information about green agricultural products. different dimensions of environmental information transparency have different effects on different dimensions of online consumer trust. Product information transparency is proposed as a tool for producers to use in the online marketing of green agricultural products. Consumers’ access to information can be improved through online public disclosure of environmental quality indicators in the production process of green agricultural products, and ultimately enhance online consumption of green agricultural products.

PurposeThe common disease hallux valgus results in foot discomfort and dysfunction. Less soft tissue damage and faster wound healing have made minimally invasive surgery (MIS) more popular. However, little research has compared the fixation results of minimally invasive chevron-akin (MICA) osteotomy thus far. In this study, the clinical and radiographic results of MICA with first metatarsal single- or dual-screw fixation are being examined.MethodsA total of 107 feet of 103 patients with mild to moderate symptomatic hallux valgus treated MICA from January 2018 to June 2020 were retrospective evaluated, with at least 12-months follow-up. 51 patients underwent single-screw fixation procedures and 52 patients received dual-screw fixation procedures. Patients were assessed preoperatively and at the final follow-up with radiographic measurements [hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA)] and clinical scores (american orthopaedic foot and ankle society (AOFAS) forefoot score, visual analog scale (VAS) and Manchester-Oxford Foot Questionnaire (MOxFQ) scores). The coughlin satisfaction scores were also obtained.ResultsBoth groups showed significantly improved HVA, IMA and DMAA at the final follow-up (P

BackgroundLong recovery time, large scar, postoperative swelling and pain are possible side effects of open reduction internal fixation (ORIF) for tarsal navicular fractures. Early exercise instruction is made possible by the use of an intraoperative robot-assisted percutaneous invasive closed reduction internal fixation. The goal of the trial was to determine whether percutaneous screw internal fixation with robot assistance might be used to treat navicular fractures.Methods27 patients with navicular fractures had surgical treatment between June 2019 and December 2021. Of those, 20 instances were treated with ORIF, while 7 cases had robot-assisted percutaneous screw internal fixation. At the final follow-up, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and the visual analogue scale (VAS) score were compared to determine outcomes and function.ResultsFollow-up was obtained in all 27 patients after surgery, with a mean follow-up time of 21.81 months, ranging from 15 to 29 months . In the 7 instances of robot-assisted group, percutaneous guide wire insertion and screw placement only needed one attempt and the depth and position of the implant were both satisfactory. In the ORIF group, there were two patients who sustained cutaneous nerve injuries. The AOFAS score and the VAS score of the group receiving robot-assisted navigation percutaneous screw fixation were 92.25 ± 2.22 and 0.75 ± 0.25 respectively at the last follow-up, while 82.25 ± 7.15 and 0.50 ± 0.29 were the respective values for the ORIF group.ConclusionIntraoperative robot-assisted percutaneous closed reduction internal fixation for tarsal navicular fractures can accomplish exact localization of fracture site, reduce soft tissue damage and operative time. According to current view, this method offers fewer complications, a faster recovery after surgery, and more patient satisfaction.

ObjectiveThe study aims to investigate the functional outcome of the lateral approach for insertional Achilles tendinitis (IAT) with Haglund deformity.MethodsFrom January 2016 to September 2019, 14 cases of IAT with Haglund deformity that resisted conservative treatment received surgery in our department. A lateral approach was used to debride the bony and soft tissue and reattach the insertion of the Achilles tendon. The Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Score (AOFAS), and Victorian Institute of Sport Tendon Study Group-Achilles Tendinopathy score (VISA-A) were used to evaluate clinical outcomes.ResultThe mean patient age was 39.57 years at the time of surgery. The mean follow-up was 14.74 months. The mean VAS score significantly decreased from 4.86 ± 0.86 preoperatively to 1.21 ± 1.58 postoperatively (P

ObjectivesWith positive outcomes recorded, the mixed reality (MR) technology has lately become popular in orthopedic surgery. However, there are few studies that specifically address the utility of MR in talocalcaneal coalitions (TCC) resection. Our goal in this retrospective study is to assess certain data while examining the viability of using MR to treat TCC resection.MethodsSix consecutive patients with TCC diagnosed by computed tomography (CT) for which nonoperative therapy had failed and MR system assisted TCC resection were included in this study from March 2021 to December 2021. The feasibility and accuracy of TCC resection were assessed by post-operation radiography. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were used to assess the recovery condition and pain level pre- and post-operation.ResultsThe surgeon can accurately resect the TCC according to the preoperatively determined range by superimposing the holographic model with the actual anatomy of the TCC using an MR system. Additionally, no additional x-ray was necessary while operating. Mean follow-up was 10.3 months, with a minimum of 6 months. There is a significant difference between the preoperative AOFAS score of 53.4 ± 3.8 and the 6-month follow-up AOFAS score of 97.3 ± 2.2 (p

Background: Because of the rising prevalence of anterior talofibular ligament (ATFL) damage, there is a considerable interest in developing innovative techniques to improve the biological healing response of ATFL. Platelet-rich plasma (PRP) includes several growth factors linked to a favorable healing response, however none of the studies involved both quality evaluation and clinical results to evaluate this treatment.Purpose: To determine the clinical results of PRP injections into the ATFL in lateral ankle sprain (LAS) patients, as well as the quality of the ATFL based on radiographic outcomes.Methods: Patients with clinically confirmed grade II LAS for the first time (n = 83) were examined. The clinical outcomes of three types of injection methods were evaluated: none, once within 48 h after the sprain, and once more 4 weeks later after first injection. PRP was injected into the tear site of the ATFL using ultrasound guidance, and all ankles were immobilized for 2 weeks. The American Orthopedic Foot and Ankle Score (AOFAS) ankle-hindfoot scale and the Visual Analogue Scale (VAS) were used to assess the results at 2, 6, 8, 24, and 48 weeks of follow-up. The signal/noise ratio (SNR) value of Magnetic Resonance Imaging (MRI)-based ATFL signal intensity can disclose ATFL quality. The ATFL SNR results were then assessed 8, 24 and 48 weeks following the first injection to compare ATFL quality.Results: The PRP injection groups outperformed the control group in terms of clinical outcomes, and the two injections group outperformed other groups in terms of pain reduction and functional outcome at 8 weeks. The clinical results of all groups were comparable at 6 and 12 months follow-up. ATFL SNR findings improved significantly across all groups over time. At the same follow-up time, the PRP injection groups outperformed the control group, and the best SNR result showed in the two injections group at the final follow-up.Conclusion: PRP injection helped relieve early symptoms of LAS, although all patients saw a similar development after 6 months. The two PRP injections group produced considerably better clinical results and quality of the ATFL in short-term follow-up.

The “lemon effect,” which is the result of information asymmetry and barriers to trust, poses serious challenges to the sustainable development of green agricultural products. Therefore, enhancing consumers’ trust is critical to maintain sustainable purchasing behavior. Information transparency has been widely attention as a marketing tool, and previous research related to agricultural products has focused on the visible information. Based on signaling theory, this study takes an invisible information perspective and empirically investigates how production information transparency of green agricultural products affects consumer trust and online purchasing behavior. The results of structural equation modeling analysis show that production technology information transparency and production means information transparency have different effects on the dimensions of consumer trust (in competence and benevolence). Moreover, trust in competence has a significant positive impact on trust in benevolence; they both have significant impacts on consumers’ online green purchase behavior. The results of this study contribute to signaling theory and the product transparency literature, and offer significant implications to practitioners of the green agricultural sectors.

The outbreak of COVID-19 has brought global poverty to the forefront, and existing research suggests that socially responsible supply chains play an important role in poverty alleviation. However, there is limited research on how to improve the performance of socially responsible supply chains. This study innovatively chooses a dual perspective, i.e., companies and farmers in contract farming, the dominant model of socially responsible supply chains in Chinese agriculture, as the research object. Furthermore, it examines the role of social capital on the performance of socially responsible supply chains, as well as the moderating role of supply chain transparency, in order to find out how to improve the stakeholder performance. The empirical results found that the factors affecting socially responsible supply chain performance differed between the dual perspectives. From the firm’s perspective, all three dimensions of social capital (shared values, communication and reciprocity) have a significant positive effect on socially responsible supply chain performance (income increase), while supply chain transparency only positively moderates between communication and income increase. From the farmers’ perspective, only reciprocity and shared values had a significant positive effect on income increase; interestingly, supply chain transparency negatively moderated the relationship between reciprocity and income increase. This study expands the role of social capital theory, and the dual perspective examination provides insights for performance improvement of companies and farmers in socially responsible supply chains, as well as guidance for promoting sustainable social development.

BackgroundThe high success rate, minimal invasion, and safety of subtalar arthroereisis (SA) have made it a primary mode of surgical management for pediatric flexible flatfoot. The HyProCure procedure is a new surgery for SA, However, very few available studies reported the therapeutic effects of the HyProCure procedure, especially in pediatric flexible flatfoot. The main aim of the present study was to investigate the clinical and radiological outcomes of the HyProCure procedure for pediatric flexible flatfoot and analyze the risk factors for therapeutic outcomes and sinus tarsi pain.MethodsIn this retrospective cohort study, 69 pediatric flexible flatfoot patients (107 feet) who underwent the HyProCure procedure were included between July 2015 and September 2020. All patients underwent the HyProCure procedure with or without gastrocnemius recession. The Maryland foot score (MFS), visual analog scale (VAS), radiographic data, and complications were assessed at a minimum 1-year follow-up and statistically analyzed.ResultsThe mean follow-up was 35.9 months (range, 13–73 months). At the last follow-up, VAS (0.64 ± 1.16) was significantly lower than the preoperative VAS (4.06 ± 1.43) (p < 0.001); MFS (90.39 ± 12.10) was significantly higher than the preoperative MFS (71.36 ± 10.25) (p < 0.001). The AP talar-second metatarsal angle (T2MT angle) significantly decreased from 17.0 ± 5.4° preoperatively to 11.4 ± 5.2° at the last follow-up (p < 0.001). The lateral talar-first metatarsal angle (Meary's angle) significantly decreased from 13.8 ± 6.4° preoperatively to 6.3 ± 5.0° at the last follow-up (p < 0.001). The calcaneal declination angle (Pitch angle) significantly increased from 13.5 ± 4.9° preoperatively to 14.8 ± 4.4° at the last follow-up (p < 0.001). Logistic regression analysis indicated that patients with a longer distance from the tail end of the implant exceeding the longitudinal talar bisection line had 275.8% greater odds of MFS < 90. Yet, no risk factors were found in connection with sinus tarsi pain.ConclusionsThe HyProCure procedure for pediatric flexible flatfoot achieved satisfactory curative effects with a low complication rate; implant depth was associated with unsatisfactory postoperative outcome.