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Heel pain is a common condition and often involves the Achilles tendon and is classified as insertional or non-insertional. Several operative and non-operative treatments have been described, but there is no consensus on the most effective therapy. The aim of this study is to evaluate a case series of patients with insertional Achilles tendinopathy refractory to conservative treatment submitted to a single-dose ultrasound-guided injection of hyaluronic acid (40 mg/2.0 mL).We prospectively included 25 patients (29 feet) who underwent a single ultrasound-guided injection of hyaluronic acid after conservative treatment failure. Clinical outcomes such as pain (using the Visual Analog Scale - VAS), function (using the American Orthopedic FootAnkle Society - AOFAS score), personal satisfaction, and complications were evaluated. Statistical analysis was performed using the R software.Most patients were female (80%) and there was a right-side predominance (55%). The median VAS was 8 points [range 4-10] at baseline, decreasing to 3 points [range 0-8] at the six-month follow-up, with statistical significance (p .001). The median AOFAS score was 71 points [range 38-87] at baseline, increasing to 90 points [range 48-100] at the six-month follow-up (p .001). The personal satisfaction level was 69%, and 48% of patients considered the result excellent. There were no Achilles tendon ruptures, infections, or allergic reactions post injection.Single-dose injection of hyaluronic acid is a safe treatment option, improving function and reducing pain for six months in patients with insertional Achilles tendinopathy after conservative treatment failure.IV, case series.

Hallux valgus (HV) is a very common deformity among foot disorders, therefore attracting strong interest from foot and ankle surgeons. We investigated publication trends on HV in the literature. The analysis was conducted through an electronic search of the Web of Science database for publications between 1999 and 2019, studying the data of origin through bibliometrics. The following search string was utilized: TI = (hallux valgus* OR hallux abductovalgus*) with filters for the English language and documents in article format. The “Bibliometrix” package of R software was used for the bibliometric analysis, and the VOSviewer was used to create graphs. A total of 789 articles were found in the electronic search, with 2,723 cited articles. The most common Web of Science category was Orthopedics (83.0%), and Coughlin M.J. was the main researcher in this field with the largest number of publications (17). The United States led in terms of the number of published articles (26.7%). An increase in the number of publications over time was noted, with 2016 being the year with the highest number of articles (78). The journal with the most articles was Foot and Ankle International, with 35.2% of the publications. The number of published studies on HV has increased rapidly since 2012. The United States ranks first in related research worldwide. The journal with the most articles was Foot and Ankle International.

Resumo Objetivo Comparar o efeito da infiltração intraarticular do plasma rico em plaqueta com a do ácido hialurônico no tratamento de pacientes com osteoartrose primária de joelho. Métodos Realizou-se um ensaio clínico randomizado com 29 pacientes, sendo um grupo submetido à infiltração com ácido hialurônico (controle) e o outro com plasma rico em plaquetas. Os desfechos clínicos avaliados foram a escala visual analógica da dor; o questionário Western Ontario and McMaster Universities Arthritis Index (WOMAC), antes e depois da intervenção; e os efeitos adversos após as aplicações. Utilizou-se os testes do qui-quadrado e exato de Fisher para as variáveis categóricas, e o teste t de Student, análise de variância, e Wilcoxon para as variáveis contínuas, através do software de estatística R. Resultados A análise independente de cada grupo revelou uma diferença estatística nos meses iniciais, com melhora dos escores de dor e função; porém, com piora no 6° mês após o procedimento. Não houve diferença dos desfechos avaliados entre os grupos que foram submetidos à infiltração com ácido hialurônico ou com plasma rico em plaquetas. Não houve efeito adverso grave ou reação alérgica durante todo o seguimento. Conclusão A infiltração intraarticular com ácido hialurônico ou plasma rico em plaquetas nos joelhos dos pacientes com gonartrose primária apresentou melhora temporária dos sintomas de função e dor. Não houve diferença entre as duas intervenções.

Resumo Objetivo Desenvolver um protocolo, baseado em evidências, para guiar a solicitação de exames de ressonância magnética (RM) em pacientes idosos com suspeita de osteoartrose do joelho e avaliar a sua eficácia após implementação. Métodos O protocolo institucional foi desenvolvido após revisão da literatura durante o primeiro semestre do ano de 2018. Definiu-se como grupo de controle os pacientes do primeiro semestre de 2018, antes da aplicação/divulgação do protocolo institucional, e o grupo de estudo foi composto por pacientes atendidos no segundo semestre do mesmo ano após a padronização dos pedidos de RM para a suspeita de osteoartrose do joelho. Resultados Nossa amostra contou com 826 pacientes submetidos a RM do joelho, com média de idade de 69,3 anos. Após a implementação do protocolo, houve um decréscimo das solicitações de RM e um aumento no número de solicitações de radiografias (p Conclusão Após a introdução do protocolo, encontrou-se uma redução de 47,5% no número de pedidos de RM do joelho, sendo que a maioria (89%) dos pacientes não tiveram suas condutas ou diagnóstico alterados. Nível de evidência: estudo caso-controle (IIIB).

Background: Insufficiency fractures occur in bones with low elastic resistance. In contrast to stress fractures, which affect normal bones and have been extensively studied, insufficiency fractures of the foot and ankle have been the subject of little research. The objective of this study was to identify risk factors associated with the development of foot and ankle insufficiency fractures. Methods: The study included 55 postmenopausal sedentary women with foot and ankle insufficiency fractures and 51 women in the control group. The data collected were the fracture site, body mass index, use of corticosteroids, T scores of the femur and lumbar spine measured by bone densitometry, and serum 25-OH vitamin D level. The calcaneal pitch (CP), talar–first metatarsal, and metatarsus adductus (MA) angles were measured on radiographs. Results: In 49 patients (89%), fractures occurred in the metatarsals. All metatarsals were affected, and the most common fracture site was the base of the fifth metatarsal, with 21 cases (33%). Twenty patients (36%) in the study group reported chronic use of corticosteroids and had lower bone mineral density levels than controls ( P < .05). The factors associated with fracture development ( P < .05) were the CP and MA angles and low lumbar bone mineral density. Conclusion: Insufficiency fractures in this population were associated with low bone mineral density and unfavorable biomechanical characteristics such as pes cavus and metatarsus adductus. Level of Evidence: Level IIIB, case-control study.

Background:Bunionette is a common foot disorder, and several types of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region has become a suitable area for this type of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for a percutaneous approach.Methods:We prospectively evaluated 31 consecutive tailor’s bunion patients who underwent operative correction on a total of 42 feet between 2017 and 2019 after failure of conservative treatment. Clinical outcomes such as pain (visual analog scale [VAS]), function (American Orthopaedic Foot & Ankle Society [AOFAS] Lesser Toe Metatarsophalangeal-Interphalangeal Scale scoring system), personal satisfaction, and complications were evaluated. Radiographic aspects were also examined. Shapiro and Mann-Whitney statistical tests were conducted. The average age of the patients was 69.5 years, and the average follow-up was 13.1 months.Results:After the operative procedure, there was a decrease of 6.6 points on the VAS for pain ( P < .001) and an increase of 34.9 in the AOFAS score ( P < .001). Radiographic correction was achieved for both the fifth metatarsophalangeal angle ( P < .001) and the intermetatarsal angle ( P < .001), which showed decreased values. There was 1 case of superficial infection and 2 cases of nonunion (asymptomatic). A large majority of patients regarded the procedure outcome as satisfactory.Conclusion:This percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity produced improvements in pain and function and a high rate of satisfaction, with a low incidence of complications and a high capacity for correcting the deformity.Level of Evidence:Level II, prospective cohort study.

The objective of this systematic literature review was to investigate the effects of the clinical application of bone marrow aspirate (BMA) and/or bone marrow aspirate concentrate (BMAC) in tendon and cartilage injuries in the foot and ankle.A search of the Embase, MEDLINE/PubMed, CINAHL, and Cochrane databases was performed in January 2021. The risk of bias of the studies was assessed using the tool "A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies." The outcomes analyzed included pain reduction and functional improvement with the use of BMA/BMAC in patients with tendon and cartilage injuries in the foot and ankle.Eleven studies met the inclusion criteria for analysis, involving a total of 527 subjects with osteochondral lesions (OCLs) of the talus, cartilage lesions of the talus, and acute Achilles tendon rupture. BMAC was applied alone in 4 studies, and in 7 studies, it was compared with other techniques such as matrix-induced autologous chondrocyte implantation, particulate juvenile articular cartilage, or microfracture. Interventions demonstrated improved function and reduced foot and ankle pain and showed no serious adverse effects.Evidence indicates that BMAC provides good clinical results, with improved function and reduced pain in adults with OCL and cartilage lesions of the talus and acute Achilles tendon rupture.Level IV, systematic review of level II to IV studies.

The optimal treatment of symptomatic Morton's neuroma remains unclear; conservative methods are sometimes ineffective and neurectomy has significant rates of patient dissatisfaction. The aim of this study was to evaluate the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML) in patients with Morton's neuroma.Between January 2018 and November 2019, 27 patients (29 feet) diagnosed with Morton's neuroma after clinical and radiological evaluation underwent DMMO and percutaneous DTML release. The primary clinical outcomes were pain (VAS) and function (AOFAS score). Secondary outcomes included patient satisfaction, complications, and radiographic outcomes. Patients were followed up for a minimum of two years.The median age of the participants was 66 years (range 48-79) and the follow-up time was 28 months (24-47). There was a decrease of 5.7 points in the VAS for pain (p .001) and an increase of 19.9 in AOFAS (p .001) after the surgical procedure. There was one case of superficial infection and one patient required resection of the neuroma (neurectomy). The majority of patients (89.7%) were satisfied and considered the procedure outcome as excellent or good.Treatment of Morton's neuroma with minimally invasive distal metatarsal metaphyseal osteotomy and percutaneous release of the deep transverse metatarsal ligament showed significant improvement in pain and function with a low incidence of complications and a high rate of personal satisfaction.

Proximal femoral fractures have a high mortality rate among older adults, especially those aged80 years.To analyze predictive factors for hospital or late mortality of patients90 years old who showed proximal femoral fracture and subjected to surgery.The study included data from 230 patients aged90 years diagnosed with proximal femoral fracture and who underwent surgery between January and December 2017. The statistical evaluation was performed by multivariate analysis by a logistic regression. The associations were estimated by the odds ratio (OD) and confidence interval (95%). Statistical significance was determined with p0.05.Late death occurred in 51.3% (118 patients) of the sample and hospital death in 3.5% (8 patients). Most patients were women (83.5%) and the most common fracture was transtrochanteric (57.0%). There was association between late death and the surgery duration (p0.05), and between hospital death and the presence of heart diseases (p0.05) or endocrinopathies (p0.05).Most patients aged90 years with proximal femoral fracture subjected to surgery died in less than one year. Late death was associated with the surgery duration and hospital death was associated with the presence of previous endocrinopathies or heart diseases, and the female gender was a protective factor from this outcome.As fraturas do fêmur proximal têm alta taxa de mortalidade entre os idosos, especialmente entre os considerados superidosos (80 anos).Analisar fatores preditivos para mortalidade hospitalar ou tardia de pacientes com idade superior a 90 anos que apresentaram fratura do fêmur proximal e foram submetidos ao tratamento cirúrgico.O estudo incluiu dados de 230 pacientes com idade superior a 90 anos que apresentaram diagnóstico de fratura do fêmur proximal e foram submetidos ao tratamento cirúrgico entre janeiro e dezembro de 2017. A avaliação estatística foi realizada pela análise multivariada por meio da regressão logística. As associações foram estimadas pelo valor deO óbito tardio ocorreu em 51,3% (118 pacientes) da amostra e o hospitalar em 3,5% (8 pacientes). A maioria dos pacientes foram do sexo feminino (83,5%) e a fratura mais comum foi a transtrocanteriana (57,0%). Houve associação do óbito tardio com a duração do procedimento cirúrgico (p0,05), e do óbito hospitalar com a presença de cardiopatias (p0,05) ou endocrinopatias (p0,05).A maioria dos pacientes com idade superior a 90 anos com fratura do fêmur proximal submetida ao tratamento cirúrgico evoluiu para óbito em menos de um ano. O óbito tardio foi associado à duração do procedimento cirúrgico e o óbito hospitalar à presença de endocrinopatias ou cardiopatias prévias, sendo o sexo feminino fator de proteção para tal desfecho.

The third-generation percutaneous chevron and Akin osteotomy (PECA) technique for surgical management of hallux valgus has shown improvement in clinical and radiographic outcomes. During this procedure, lateral translation and fixation of the first metatarsal head results in the formation of a bony prominence on the medial side of the distal aspect of the first metatarsal which can cause pain and discomfort to the patient. We describe two techniques to address this bony prominence; either i) excision osteotomy and removal of the fragment or ii) a dorsal closing wedge osteotomy retaining the bony fragment. LEVEL OF EVIDENCE: Level V, expert opinion.

Background: Autologous grafting is widely used in orthopaedic surgery because of its high osteogenic capacity, immunologic compatibility, for the absence of risk of disease transmission, and for not requiring a bone bank. The posterior-superior calcaneal tuberosity is an option for obtaining a cortical and cancellous structural bone. This study aims to describe the operative technique and complications observed at the donor site of the posterior-superior calcaneal tuberosity. Methods: Patients who underwent graft harvesting from the posterior-superior calcaneal tuberosity were retrospectively evaluated by pain outcomes, imaging tests, and intra- and postoperative complications. Results: Twenty patients with a median age of 69 years (range 48-77) and follow-up of 16 months (12-26) were assessed. Median postoperative pain at the donor site was 0 (0-6), with 2 patients reporting persistent local pain. No case of Achilles tendon rupture or intra- or postoperative calcaneal fracture were identified. One patient developed a superficial infection that was quickly resolved using oral antibiotic therapy. Conclusion: The posterior-superior calcaneal tuberosity is an alternative source of autologous graft with low donor site morbidity. Level of Evidence Level IV, case series.

BACKGROUND A systematic review can be defined as a summary of the evidence found in the literature via a systematic search in the available scientific databases. One of the steps involved is article selection, which is typically a laborious task. Machine learning and artificial intelligence can be important tools in automating this step, thus aiding researchers. OBJECTIVE The aim of this study is to create models based on an artificial neural network system to automate the article selection process in systematic reviews related to “Mindfulness and Health Promotion.” METHODS The study will be performed using Python programming software. The system will consist of six main steps: (1) data import, (2) exclusion of duplicates, (3) exclusion of non-articles, (4) article reading and model creation using artificial neural network, (5) comparison of the models, and (6) system sharing. We will choose the 10 most relevant systematic reviews published in the fields of “Mindfulness and Health Promotion” and “Orthopedics” (control group) to serve as a test of the effectiveness of the article selection. RESULTS Data collection will begin in July 2021, with completion scheduled for December 2021, and final publication available in March 2022. CONCLUSIONS An automated system with a modifiable sensitivity will be created to select scientific articles in systematic review that can be expanded to various fields. We will disseminate our results and models through the “Observatory of Evidence” in public health, an open and online platform that will assist researchers in systematic reviews. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/26448

Background Plantar fasciitis is the most common cause of pain in the plantar region of the heel, and extracorporeal shockwave therapy (ESWT) is an option used in cases where conservative treatment fails. Hyaluronic acid (HA), initially used for osteoarthrosis, is a treatment option because it has been applied to extra-articular regions, such as tendons, ligaments, and fascia. The aim of the present study will be to evaluate the outcomes of pain, function, and personal satisfaction after a single injection of HA and to compare the results with those of ESWT in patients with chronic plantar fasciitis. Methods The study will include 80 patients who will be randomized to receive three sessions of ESWT (n = 40) or a single ultrasound-guided HA injection in the plantar fascia (n = 40). The outcomes will include the visual analog pain scale score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Outcome Score (FAOS). All of the assessments will be performed at baseline and 3, 6, and 12 months after treatment. Statistical analysis will be performed using the repeated measures ANOVA (analysis of variance test) for primary and secondary outcomes and also Fisher’s Least Significant Difference, a Post-Hoc test. We will use R software for statistical analysis, randomization, and sample size calculation. Results Recruitment and data collection will begin in November 2020, with completion scheduled for November 2022 and final publication available in March 2023. Conclusion This trial will evaluate the effects of a single ultrasound-guided HA injection for the treatment of chronic plantar fasciitis. Trial registration Brazilian Clinical Trials Registry (Register Number: RBR-97vkx4) http://www.ensaiosclinicos.gov.br/rg/RBR-97vkx4/.

Purpose The objective of the study is to compare the radiographic and clinical results of two techniques for the treatment of hallux valgus that have the same indication, the open scarf/Akin (SA) technique and the percutaneous Chevron/Akin (PECA). Methods A meta-analysis was performed with the studies found during a systematic review of articles included in electronic databases until 30 May 2020. The pooled analysis was summarized according to clinical outcomes, such as visual analog pain scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) score, radiographic outcomes and complications, with a 95% confidence interval. Results Three studies comparing the open scarf/Akin (SA) versus the PECA techniques were added to the analysis, corresponding to 235 feet, 102 in the PECA group and 133 in the SA. The final mean difference in the hallux valgus angle was 0.80 degrees and in the intermetatarsal angle 0.53, in the last radiographic evaluation. In the AOFAS score, the final mean difference was 4.97 points and in the VAS 0.14 in relation to the last clinical evaluation. Exposure to radiation during the surgical procedure was higher in the PECA group with a mean of 35.53 seconds. Conclusions The PECA surgical technique for the treatment of hallux valgus when compared with SA demonstrated similar radiographic correction, pain and function after six months of follow-up but with a longer radiation exposure time. Register of systematic review (PROSPERO) CRD42018096613.

Objective: This study evaluated the foot and ankle disorders developed among patients treated by a multidisciplinary team of the diabetic foot group outpatient clinic at our institution using a specific protocol. The natural disease progression of these patients was examined after a 12-year follow-up period. Methods: The data collected included gender, age, body mass index, disease duration, insulin use, duration of insulin use, tobacco use, peripheral pulse palpation, history of previous partial foot amputations, foot deformities secondary to peripheral neuropathy, degree of foot sensation assessed using the Semmes-Weinstein monofilament test, association with ulcers as evaluated by the Wagner classification, and the presence of Charcot foot as evaluated by the Brodsky anatomical classification and the Eichenholtz radiographic classification. Results: We prospectively evaluated 578 patients with type 2 diabetes and found that they had a mean disease progression of 14 years; 53% were insulin-dependent, with an average insulin use duration of 9.7 years; 9.8% of patients had previous amputations performed by a vascular surgeon due to acute arterial insufficiency; 72.6% lost protective sensation according to the sensation assessment associated with deformities secondary to peripheral neuropathy; and 21.5% presented with hallux valgus and claw toes, 12.6% presented with ulcers, and 9.5% presented with Charcot neuroarthropathy. Conclusion: A treatment protocol overseen by a multidisciplinary team and the use of therapeutic footwear to protect insensitive feet were associated with low rates of plantar foot ulcers and Charcot neuroarthropathy. Level of Evidence II; Therapeutic Studies; Comparative Prospective.

Objective: The objective of this study was to prospectively evaluate operated cases of AO type 43C tibial pilon fracture and assess which factors might influence functional outcomes during the late postoperative period.Methods: Patients were classified according to the OTA/AO Classification using X-ray and computed tomography (CT) scans. Patients with type 43C fractures were included in this study. A total of 98 tibial pilon osteosynthesis surgeries were performed, and 35 cases were selected for this study based on the inclusion criteria. The treatment protocol established was based on the Tscherne Classification. Results: We observed that immediate skin complications might be a prognostic factor for the late removal of osteosynthesis material (mean=2 years postoperation) because an association was found between skin complications and the removal of osteosynthesis material. We observed a high incidence of late arthritis complications in both groups, which indicates that the post-traumatic arthritis associated with 43C pilon fractures is practically certain. Conclusions: No differences were found between the groups when correlating the American Foot and Ankle Score (AOFAS), the degree of arthritis, and skin complications; therefore, complications did not determine the outcomes of tibial pilon fracture. Although the cartilage damage that occurs at the time of injury is a significant mediator of the clinical outcome, more important factors affect the final treatment outcome. In our study, these factors were the treatment protocol based on soft tissue involvement, the anatomical reconstruction of the joint, and rigid internal fixation with early range of motion. Level of Evidence II; Therapeutic Studies; Comparative Prospective.

Introduction Minimally Invasive Chevron Akin (MICA) can be used to treat hallux valgus (HV) associated with a hypermobility of the first metatarsal-cuneiform joint (1MTCJ). The aim of this study was to perform a radiographic analysis of the MICA, focused on evaluating the 1MTCJ. Methods Forty patients (50 feet) with moderate to severe HV underwent a MICA procedure. Radiographic analysis included hallux valgus angle (HVA), intermetatarsal angles between the first and second rays (IMA), the intermetatarsal angle between the proximal fragment of the osteotomy and the second ray (IAPF) and the distance between a point 3 cm distal from the base of the second metatarsal and a point located at the same height for the first metatarsal base (Dist 1-2). The IAPF was compared with the preoperative IMA, and the other parameters were compared preoperatively and postoperatively. The radiographic complications were also recorded. Results Most patients were female (92%). The mean age was 50.4 years (SD = 16.1) and the mean follow-up was 16.1 months (SD = 3.5). The average HVA improved from 32.5° to 7.3°, and the average IMA from 14.2° to 4.2°. The IAPF and Dist1-2 values showed an increase of 4.8° and 4.0 mm respectively. There were no radiographic complications. Conclusion. Minimally invasive Chevron Akin promotes a great correction of the moderate to severe HV conventional parameters and increase the transversal stability of the 1MTCJ fixing this joint as medial as possible. Level of Evidence Level IV, case series

Background:Anesthetic block of the peripheral nerves in the foot and ankle is generally used as anesthesia. The increased use of anesthetic blocks has made this technique an increasingly safe method, and its use has been expanded to postoperative analgesia in foot and ankle surgeries. The objective of this study was to evaluate the analgesia time and pain intensity, using objective scores, after peripheral nerve block in foot and ankle surgeries.Methods:Patients who underwent surgery by the foot and ankle group of our institution from March 2016 to January 2017 were invited to participate in this prospective, randomized, and blinded study after signing an informed consent form. The study was approved by the local ethics committee. In total, 57 patients and 59 feet (2 bilateral surgeries) were subjected to spinal anesthesia and were randomized into the group receiving peripheral nerve block in the foot and ankle (7.5 mg/mL ropivacaine) and the control group. The patients answered a questionnaire, administered by phone during the postoperative period, regarding measurement of pain intensity, using the visual analog scale (VAS), and the time of onset of pain.Results:Improved pain was noted in patients who received a supplemental peripheral nerve block in relation to the duration of postoperative analgesia and the intensity of pain during the immediate postoperative period. No significant difference was found between the 2 groups in terms of pain intensity on the first or second postoperative day.Conclusion:Peripheral nerve block in the foot and ankle region can be used effectively as postoperative analgesia to reduce pain intensity during the immediate postoperative period and prolong analgesia.Level of Evidence:Level I, high-quality prospective randomized clinical trial.

Objective: The objective of this study was to prospectively evaluate operated cases of AO type 43C tibial pilon fracture and to assess factors that might influence functional outcomes during the late postoperative period. Methods: Patients were classified according to the OTA/AO Classification using X-ray and computed tomography (CT) scans. Patients with type 43C fractures were included in this study. A total of 98 tibial pilon osteosynthesis surgeries were performed, and 35 cases were selected for this study based on the inclusion criteria. The treatment protocol established was based on the Tscherne Classification. Results: We observed that immediate skin complications might be a prognostic factor for the late removal of osteosynthesis material (mean = 2 years postoperation) because an association was found between skin complications and the removal of osteosynthesis material. We observed a high incidence of late arthritis complications in both groups, which indicates that post-traumatic arthritis associated with 43C pilon fractures is practically certain. Conclusion: No differences were found between the groups when correlating the American Foot and Ankle Score (AOFAS), the degree of arthritis, and skin complications; therefore, complications did not determine the outcomes of tibial pilon fracture. Although the cartilage damage that occurs at the time of injury is a significant mediator of the clinical outcome, more important factors affect the final treatment outcome. In our study, these factors were the treatment protocol based on soft tissue involvement, anatomical reconstruction of the joint, and rigid internal fixation with early range of motion.

Introduction: The objective of this study was to evaluate the difference in muscle strength between flexion and ankle extension to test the hypothesis that this predisposes to a dynamic equine and, thus, to evaluate this correlation with pain in the forefoot (metatarsalgias) and hindfoot (plantar fasciitis, tendinopathy of the tendon insertional and non-insertional calcaneus). Methods: In this prospective cohort study, 50 patients were consecutively diagnosed with forefoot pain (metatarsalgias) or pain in the hindfoot (plantar fasciitis, tendonopathy of the insertional and non-insertional calcaneal tendon), and 50 patients had no foot diseases. The body mass index (BMI) was evaluated, and IGT was evaluated through the Silfverskiöld test. The parameter of gastrocnemius contracture was considered in cases of limitation of ankle extension

Introduction: The surgical treatment of hallux valgus presents several techniques described in the literature. Recently, the percutaneous technique has appeared as a less invasive option in the correction of the deformity and is increasingly used by surgeons. Methods: A meta-analysis was performed using studies discovered by the systematic review of articles included in electronic databases (Medline, Scopus, Embase and the Cochrane Library) until June 2018 (Systematic Review Registry PROSPERO: CRD42018096613). A pooling analysis was synthesized from clinical outcomes such as the visual analogue scale of pain (VAS) and AOFAS score, radiographic outcomes and evaluation of complications. Results: Two studies, including 137 feet with a hallux valgus diagnosis were added to the analysis, comparing open surgery using the Scarf and Akin (SA) technique versus percutaneous Chevron and Akin (PECA). In the synthesis of the results, pain in the perioperative period was lower in the PECA group, with a reduction of 1.68 points in the fixed effect model (95% CI = -2.09 a -1.27, p < 0.01, i2 = 87%, t2 = 0.60). There were no differences between techniques in the radiographic results or in the risk of complications. The PECA technique demonstrated a longer radioscopy time compared with SA. Conclusion: Use of the PECA method to correct hallux valgus compared with the open SA technique demonstrated less pain in the perioperative period, a similar potential for radiographic correction and an equal risk of complications, with a longer radioscopy time.

Introduction: Hallux valgus (HV) is a very common deformity among affections of the foot, and interest in the subject is persistent in the daily routine of orthopedic surgeons. We investigated the trend in HV publications in the literature. Methods: The research was carried out by searching the Web of Science database between 1998 - 2018, analyzed using a bibliometric methodology. We used the "Bibliometrix" package for R software for the data compilation and VOSviewer for graphic creation. Results: A total of 703 articles were found from the electronic search until December 21, 2018, with 6266 citations. The major scholar in this field was Coughlin M.J., with the largest number of publications (17). The United States led in number of articles published with 26.74%, with Brazil ranked in 26 place. There was an increase in the number of publications, with the highest number of articles published in 2016 (78). Conclusion: The amount of published work on HV has grown rapidly since 2011. The United States has the leading position in global research. The journal with more articles was Foot and Ankle International.

Introduction: The prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an interventional option for older, untreated children. Methods: A metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model. Results: Twelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82-0.94, p < 0.01) relative to the total analyzed. The recurrence rate was 18% (95% CI = 0.14-0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03-0.15, p = 0.19). Conclusion: Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures that are likely to cause complications. The obtained results exhibited considerable heterogeneity