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Soft Tissue Procedures

Foot & ankle soft tissue procedures: plantar fascia release, tendon reconstruction, and management of pes cavovarus deformities.

Overview

Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot with significantly impaired quality of life [1]. Despite these risks, foot deformities in some older children can be successfully treated with soft-tissue procedures alone [2]. For complex cases involving simultaneous correction of foot and lower limb deformities, the therapeutic strategy using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective approach [6].

Soft tissue management relies on specific techniques tailored to the defect. Split-thickness skin grafting is a frequently used method for managing soft-tissue defects, relying on a well-vascularized wound bed for success [4]. Soft tissue transport serves as a feasible method for providing good soft tissue coverage on bone ends and acts as a good alternative when an experienced flap surgeon is unavailable [5]. The free thoracodorsal artery perforator (TDAP) flap is versatile for reconstructing different kinds of soft tissue defects of the extremities, allowing for individualized defect reconstruction while minimizing donor site morbidities and achieving an aesthetic appearance [12].

Emerging technologies and specific reconstructive options require careful consideration. Minimally invasive (MIS) hallux valgus techniques show promise with advantages in scar length and less early postoperative pain, though the evidence mainly comprises single-surgeon case series [9]. Outcomes of total clavicle reconstruction with free peroneal graft met patient satisfaction in a reported case, yet advantages and complications should be carefully discussed with patients due to limited evidence of superior clinical outcome [8]. Ideal sutures should exhibit high tensile strength, ease of handling, and minimal tissue reaction [15]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [16].

Anatomy & Pathophysiology

Soft Tissue Pathology and Outcomes: Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot with significantly impaired quality of life [1]. In contrast, foot deformities in some older children can be successfully treated with soft-tissue procedures alone [2]. For acquired adult flatfoot secondary to posterior tibial-tendon pathology, pain may be relieved and the ability to stand on the toes restored in most patients, despite the position and appearance of the flat foot remaining unchanged [35]. There is little histopathologic evidence to support an inflammatory etiology to the posterior tibial tendons in this deformity [11].

Plantar Fasciitis and Fasciotomy: Heel pain is the most common foot-related symptom, with plantar fasciitis being the most common cause [3]. Endoscopic fasciotomy for plantar fasciitis provides superior results compared to a controlled non-operative treatment protocol, with significant and clinically relevant superior results for the operative treatment measured by Foot Function Index at 1 year and by VAS activity at 2-year follow-up [43]. Ultrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal [33]. Loss of stability of the plantar arch must be strictly avoided during endoscopic fascial release in plantar fasciitis, requiring careful management of early weight bearing [20]. Findings on plantar fasciitis treatment focused the importance of causal factors to achieve sustained pain relief and functional improvement [29].

Hallux Disorders and Neuromas: Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint, often associated with mechanical block from periarticular osteophytes [17]. Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway [25]. The plantar approach for excision of Morton's neuroma is recommended if the patient needs a better appearance, as it had less influence on quality of life regarding foot appearance compared to the dorsal approach [30].

Reconstruction and Complex Deformity: The therapeutic strategy using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct complex foot deformities and lower limb deformities [6]. Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, while moderate nonprogressive deformity often does not require surgery [7]. The combination of technologies for repair and reconstruction of complex wounds of the extremities possesses potential for broader clinical application [22].

Biomechanics and Surgical Approach: Foot and ankle biomechanics, gait analysis, and treatment principles for common nail disorders are described in standard textbook chapters rather than reported as original clinical trial data [23]. The medial force ratio at the knee joint depends on both the tibiofemoral alignment and the nature of the activity involved and cannot be generalized to a single value [24]. Portal location for endoscopic calcaneoplasty is significantly more proximal in flat feet (15 mm) compared with cavus feet (22 mm) [28]. A versatile method for plantar plate repair via a dorsal approach uses standard operative instruments [34].

Classification

Hamada: The progression of the Hamada classification and the condition of the subscapularis tendon affect the occurrence of osteolyses following superior capsular reconstruction using autologous tensor fascia lata graft [37].

Navicular Stress Fracture: Navicular stress fractures are difficult injuries requiring assessment and classification via CT [21]. Surgery is recommended for navicular stress fractures classified as type II, type III, or those with sclerosis, cysts, or avascular necrosis [21].

Other Considerations: Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot and significantly impaired quality of life [1]. Foot deformities in some older children can be successfully treated with soft-tissue procedures alone [2]. Heel pain is the most common foot-related symptom, with plantar fasciitis being the most common cause [3]. Split-thickness skin grafting is a frequently used method for managing soft-tissue defects in orthopaedics, relying on a well-vascularized wound bed for success [4]. Soft tissue transport is a feasible method for providing good soft tissue coverage on bone ends, serving as a good alternative when an experienced flap surgeon is unavailable [5]. The therapeutic strategy using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct complex foot deformities and lower limb deformities [6]. Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, while moderate nonprogressive deformity often does not require surgery [7]. The procedure for deltoid muscle contracture resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula, with no infections or neuromuscular complications [10]. The free thoracodorsal artery perforator (TDAP) flap is versatile for reconstructing different kinds of soft tissue defects of the extremities to achieve individualized defect reconstruction, minimize donor site morbidities, and provide an aesthetic appearance [12]. Ideal sutures should exhibit high tensile strength, ease of handling, and minimal tissue reaction [15]. The combination of technologies for repairing and reconstructing complex wounds of the extremities performed well and possesses potential for broader clinical application [22].

Clinical Presentation

Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot with significantly impaired quality of life [1]. Heel pain represents the most common foot-related symptom, with plantar fasciitis identified as the primary etiology [3]. While foot deformities in some older children may be successfully treated with soft-tissue procedures alone [2], the therapeutic strategy for complex deformities often requires the Ilizarov procedure combined with osteotomy and soft tissue balance to simultaneously correct foot and lower limb deformities [6].

Surgical Indications: Management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, whereas moderate nonprogressive deformity often does not require surgery [7]. For chronic nonbacterial osteomyelitis, total clavicle reconstruction with a free peroneal graft has met patient satisfaction, though advantages and complications must be carefully discussed due to limited evidence of superior clinical outcomes [8]. Similarly, the approach of elbow sarcoma resection and triceps reconstruction with Achilles allograft serves as a valuable resource for rare cases, though such patients may ultimately develop metastatic disease [26].

Soft Tissue Coverage and Reconstruction: Split-thickness skin grafting relies on a well-vascularized wound bed for success [4], while soft tissue transport offers a feasible method for good coverage on bone ends and serves as a good alternative when an experienced flap surgeon is unavailable [5]. The free thoracodorsal artery perforator (TDAP) flap is versatile for reconstructing various extremity defects, allowing for individualized reconstruction, minimized donor site morbidity, and aesthetic appearance [12]. For deltoid muscle contracture, the procedure resolves pain, skin dimpling, palpable fibrous bands, and scapular winging without infections or neuromuscular complications [10].

Specific Pathologies and Techniques: There is little histopathologic evidence to support an inflammatory etiology for posterior tibial tendons in acquired-adult flatfoot deformity [11]. Early recurrence of Dupuytren's contracture is most common in individuals with Dupuytren's diathesis, where full-thickness skin grafts may be helpful [13]. A proposed plantar incision allows for successful fibromatosis removal with minimum scarring, showing no evidence of scar hypertrophy or patient complaints over six years of follow-up [14]. Ideal sutures must exhibit high tensile strength, ease of handling, and minimal tissue reaction [15]. Finally, patients with a Hylamer liner should be monitored frequently for signs of wear and osteolytic changes [27].

Investigations

Plain radiography: Standing X-rays are utilized to monitor the evolution of degenerative lesions following double semitendinosus anterior cruciate ligament reconstruction [48]. In pediatric and adolescent flexible flatfoot patients with accessory navicular, this modality assesses radiological manifestations following subtalar arthroereisis combined with medial soft tissue reconstruction [50].

MRI: Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty is resurfaced with fibrous tissue [31]. In patients with Hepple stage V osteochondral lesions of the talus treated with a platelet-rich plasma scaffold, MRI demonstrated complete regeneration of subchondral bone and cartilage in all cases [32].

CT: Navicular stress fractures require assessment and classification via CT [21].

Other Considerations: Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot with significantly impaired quality of life [1]. Foot deformities in some older children can be successfully treated with soft-tissue procedures alone [2]. Heel pain is the most common foot-related symptom, with plantar fasciitis being the most common cause [3]. Split-thickness skin grafting relies on a well-vascularized wound bed for success [4]. Soft tissue transport is a feasible method for providing good soft tissue coverage on bone ends and serves as a good alternative when an experienced flap surgeon is unavailable [5]. Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, whereas moderate nonprogressive deformity often does not require surgery [7]. Minimally invasive hallux valgus surgery techniques show advantages in scar length and less early postoperative pain, though evidence mainly comprises single-surgeon case series [9]. The procedure for deltoid muscle contracture resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula without infections or neuromuscular complications [10]. There is little histopathologic evidence to support an inflammatory etiology to the posterior tibial tendons in acquired-adult flatfoot deformity [11]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [16]. A novel arthroscopic excision technique for symptomatic os trigonum is hypothesized to demonstrate safety and efficacy comparable to other arthroscopic methods with less recovery than open procedures [19]. Treatment of navicular stress fractures should be individualized based on severity, previous treatment, and the athlete's sport; surgery is recommended for type II, III, or those with sclerosis, cysts, or avascular necrosis [21]. Patients with Hepple stage V osteochondral lesions of the talus treated with a platelet-rich plasma scaffold showed significant improvement in functional scores [32]. Bone peg fixation could be a good form of treatment for patients with osteochondral lesions of the talus who have an osteochondral fragment [44]. Distal metatarsal osteotomy by minimal invasive surgery is a safe and effective surgical procedure to be considered for metatarsalgias of the lesser rays [46]. Double semitendinosus anterior cruciate ligament reconstruction is efficient in restoring satisfactory stability for most patients [48]. Subtalar arthroereisis combined with medial soft tissue reconstruction significantly alleviated pain and improved functions in pediatric and adolescent flexible flatfoot patients with accessory navicular [50].

Treatment

Non-Operative

Moderate, nonprogressive deformity often does not require surgery, whereas surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy [7].

Operative

Indications: Surgical intervention is appropriate for foot deformities in some older children treated with soft-tissue procedures alone [2], while repeated soft-tissue releases can result in a stiff, painful, and arthritic foot with significantly impaired quality of life [1].

Surgical Approach / Technique: The therapeutic strategy using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct complex foot deformities and lower limb deformities [6]. Minimally invasive (MIS) techniques for hallux valgus surgery show promise with advantages in scar length and less early postoperative pain, though their evidence mainly comprises single-surgeon case series [9]. A novel arthroscopic excision technique for symptomatic os trigonum is hypothesized to demonstrate safety and efficacy comparable to other arthroscopic methods with less recovery than open procedures [19]. Endoscopic plantar fascia release (EPFR) yielded good to excellent outcomes in 85% of 17 patients with plantar fasciitis resistant to treatment by shock wave therapy after 2 years' follow-up [38], provided that loss of stability of the plantar arch is strictly avoided during the procedure, requiring careful management of early weight bearing [20]. Single-stage orthoplastic management of complex calcaneal osteomyelitis with large soft-tissue defects was associated with 77% eradication of infection and only one amputation in the studied patient group [36].

Implant Selection: Evidence regarding clavicle reconstruction indicates that while outcomes met patient satisfaction, advantages and complications should be carefully discussed with patients due to limited evidence of superior clinical outcome [8]. Clinical outcomes assessed 2 years postoperatively were superior in patients who underwent arthroscopic microfracture with atelocollagen augmentation compared to those who underwent arthroscopic microfracture alone, although the differences were not statistically significant [39].

Adjuncts: Split-thickness skin grafting is a frequently used method for managing soft-tissue defects in orthopaedics, relying on a well-vascularized wound bed for success [4]. Soft tissue transport is a feasible method for providing good soft tissue coverage on bone ends, serving as a good alternative when an experienced flap surgeon is unavailable [5]. The free thoracodorsal artery perforator (TDAP) flap is versatile for reconstructing different kinds of soft tissue defects of the extremities, can be used to achieve individualized defect reconstruction, minimize donor site morbidities, and provide an aesthetic appearance [12]. Free groin flaps are especially adaptable to the needs of amputees and are often the best alternative when local tissue cannot be transferred or cross-leg flaps are precluded [40].

Complications

Stiffness / Arthrofibrosis: Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot [1]. This progression is associated with significantly impaired quality of life [1].

Other Considerations: Outcomes of clavicle reconstruction should be carefully discussed with patients due to limited evidence of superior clinical outcome [8], as advantages and complications require similar caution [8]. Evidence for minimally invasive hallux valgus surgery techniques mainly comprises single-surgeon case series [9]. There is little histopathologic evidence to support an inflammatory etiology to the posterior tibial tendons in acquired-adult flatfoot deformity [11]. Early recurrence of Dupuytren's disease is most common in individuals with Dupuytren's diathesis [13]. Further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time in autologous matrix-induced chondrogenesis [18]. Major primary complications occur after bipolar radial head arthroplasty [42], with a high incidence of radiographic signs of degenerative changes after 8.8 years following the procedure [42].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity or driving across the provided literature. However, minimally invasive surgery (MIS) techniques for hallux valgus demonstrate advantages in scar length and less early postoperative pain compared to open approaches [9]. Similarly, the procedure for deltoid muscle contracture resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula without infections or neuromuscular complications [10].

Full activity (months): The therapeutic strategy using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct complex foot deformities and lower limb deformities [6]. For basal joint instability, 16 of 17 thumbs treated with electrothermal treatment achieved satisfactory subjective and functional stability at a minimum 2 years' follow-up [41]. Dorsoradial capsulodesis for stage I trapeziometacarpal joint arthrosis showed no midterm progression to advanced arthritis in the studied cohort [47].

Complete recovery / outcome plateau (months): Outcomes of total clavicle reconstruction with free peroneal graft met patient satisfaction, though advantages and complications should be carefully discussed due to limited evidence of superior clinical outcome [8]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis will maintain structural and functional integrity over time [18]. Regarding Dupuytren's disease, 50% of patients treated with percutaneous needle fasciotomy for recurrent disease remain free of recurrence for a mean of 4.4 years [49]. Additionally, the plantar incision for fibromatosis of the plantar fascia showed no evidence of scar hypertrophy or complaints related to the scar over six years of follow-up [14].

Rehabilitation protocol: Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot and significantly impaired quality of life [1]. Split-thickness skin grafting relies on a well-vascularized wound bed for success [4], while soft tissue transport serves as a good alternative when an experienced flap surgeon is unavailable [5]. Soft tissue transport is also a feasible method for providing good soft tissue coverage on bone ends [5]. Direct exchange arthroplasty can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used [45].

Functional milestones: Foot deformities in some older children can be successfully treated with soft-tissue procedures alone [2]. Heel pain is the most common foot-related symptom, with plantar fasciitis being the most common cause [3]. Early recurrence of Dupuytren's disease is most common in individuals with Dupuytren's diathesis [13]. The use of full-thickness skin grafts may be helpful in the setting of Dupuytren's diathesis [13]. Percutaneous needle fasciotomy can be applied effectively for recurrent Dupuytren disease [49].

Other Considerations: Minimally invasive surgery (MIS) techniques for hallux valgus show advantages in scar length and less early postoperative pain, though evidence mainly comprises single-surgeon case series [9]. A proposed plantar incision for fibromatosis of the plantar fascia allows for successful removal with minimum scarring [14].

Key Evidence

  • [L3] Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot and significantly impaired quality of life. (10.2106/00004623-200611000-00034)
  • [L4] Foot deformities in some older children can be successfully treated with soft-tissue procedures alone. (10.2106/00004623-198062060-00010)
  • [L5] Split-thickness skin grafting is a frequently used method for managing soft-tissue defects in orthopaedics, relying on a well-vascularized wound bed for success. (10.5435/jaaos-d-20-01389)
  • [L4] Soft tissue transport is a feasible method for providing good soft tissue coverage on bone ends, serving as a good alternative when an experienced flap surgeon is unavailable. (10.1186/s12891-020-03894-y)
  • [L4] The therapeutic strategy by using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct complex foot deformities and lower limb deformities. (10.1186/s13018-020-02021-w)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [Case_report] While outcomes met the patient's satisfaction, advantages and complications of clavicle reconstruction should be carefully discussed with patients due to limited evidence of superior clinical outcome. (10.1186/s12891-019-2588-y)
  • [L4] While MIS techniques show promise with advantages in scar length and less early postoperative pain, their evidence mainly comprises single-surgeon case series. (10.1302/0301-620x.107b1.bjj-2024-0597.r2)
  • [L3] The procedure resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula, with no infections or neuromuscular complications. (10.2106/00004623-199802000-00010)
  • [L4] There is little histopathologic evidence to support an inflammatory etiology to the posterior tibial tendons in acquired-adult flatfoot deformity. (10.1097/01.blo.0000218759.42805.43)
  • [L4] The free TDAP flap, with five types of advanced applications, makes it versatile for reconstructing different kinds of soft tissue defects of the extremities that can be used to achieve individualized defect reconstruction, minimize donor site morbidities, and an aesthetic appearance. (10.1186/s13018-023-04480-3)
  • [L5] Early recurrence of disease is most common in individuals with Dupuytren's diathesis, and the use of full-thickness skin grafts may be helpful in this setting. (10.5435/00124635-199801000-00003)
  • [L5] This brief review summarizes the characteristics of commonly used suture and needle types to better understand the rationale behind preferred surgical choices, noting that ideal sutures should exhibit high tensile strength, ease of handling, and minimal tissue reaction. (10.1016/j.jhsa.2009.10.036)
  • [L5] Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint, often associated with mechanical block from periarticular osteophytes. (10.2106/00004623-199806000-00015)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L4] The study reports on a novel arthroscopic excision technique for symptomatic os trigonum, hypothesizing it will demonstrate safety and efficacy comparable to other arthroscopic methods with less recovery than open procedures. (10.1016/j.arthro.2014.04.063)
  • [L4] However, loss of stability of the plantar arch must be strictly avoided, requiring careful management of early weight bearing. (10.1007/s00167-004-0496-6)
  • [Letter] Navicular stress fractures are difficult injuries requiring assessment and classification via CT; treatment should be individualized based on severity, previous treatment, and the athlete's sport, with surgery recommended for type II, III, or fractures with sclerosis, cysts, or avascular necrosis. (10.1177/0363546510379341)
  • [L4] The combination of these two technologies performed well in the repair and reconstruction of the complex wounds of the extremities, possessing potential for broader clinical application. (10.1186/s13018-020-01914-0)
  • [L4] The medial force ratio depends on both the tibiofemoral alignment and the nature of the activity involved and cannot be generalised to a single value. (10.1302/0301-620x.99b6.bjj-2016-0713.r1)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [Case_report] The authors suggest this approach may serve as a valuable resource for clinicians managing similar rare cases, though the patient ultimately developed metastatic disease. (10.1016/j.jseint.2023.10.003)
  • [L3] Patients with a Hylamer liner should be monitored frequently for signs of wear and osteolytic changes. (10.2106/00004623-199710000-00010)
  • [L4] A numeric distance scale for use in all different foot morphologies could not be constructed, but portal location is significantly more proximal in flat feet (15 mm) compared with cavus feet (22 mm). (10.1016/j.arthro.2011.02.030)
  • [L4] These findings focused the importance of causal factors of plantar fasciitis to achieve sustained pain relief and functional improvement. (10.1186/s13018-024-05132-w)
  • [L3] The plantar approach is recommended if the patient needs a better appearance, as it had less influence on quality of life regarding foot appearance compared to the dorsal approach. (10.1186/s12891-022-05858-w)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L4] MRI demonstrated complete regeneration of subchondral bone and cartilage in all patients with significant improvement in functional scores. (10.1155/2017/6525373)
  • [L4] Ultrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal. (10.1186/s13018-021-02302-y)
  • [L4] The study proposes an inexpensive and versatile method for plantar plate repair via a dorsal approach that uses standard operative instruments. (10.1186/s12891-021-04951-w)
  • [L4] Pain may be relieved and the ability to stand on the toes may be restored in most patients, despite the fact that the position and appearance of the flat foot are unchanged. (10.2106/00004623-198668010-00012)
  • [L4] Single-stage orthoplastic management was associated with 77% eradication of infection and only one amputation in this complex and comorbid patient group. (10.1302/0301-620x.106b12.bjj-2024-0219.r1)
  • [L3] This study suggested that the progression of the Hamada classification and condition of the subscapularis tendon affect the occurrence of osteolyses. (10.1016/j.jse.2021.12.019)
  • [L4] EPFR yielded good to excellent outcomes in 85% of 17 patients with plantar fasciitis resistant to treatment by ESWT after 2 years' follow-up. (10.1016/j.arthro.2010.01.026)
  • [L1] Clinical outcomes assessed 2 years postoperatively were superior in patients who underwent arthroscopic microfracture with atelocollagen augmentation compared to those who underwent arthroscopic microfracture alone, although the differences were not statistically significant. (10.1186/s12891-020-03730-3)
  • [L4] Free groin flaps are especially adaptable to the needs of amputees and are often the best alternative when local tissue cannot be transferred or cross-leg flaps are precluded. (10.2106/00004623-197860080-00006)
  • [L4] Of 17 thumbs, 16 had satisfactory subjective and functional stability at a minimum 2 years' follow-up. (10.1016/j.arthro.2008.10.001)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L1] This randomized controlled trial found significant and clinically relevant superior results for the operative treatment of plantar fasciitis as measured by Foot Function Index at 1 year and by VAS activity at 2-year follow-up when compared to the results of a supervised rehabilitation program. (10.1007/s00167-020-05855-3)
  • [L4] This technique could be a good form of treatment for patients with this condition who have an osteochondral fragment. (10.1302/0301-620x.102b10.bjj-2020-0527.r1)
  • [L4] The experience suggests that direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used. (10.2106/00004623-199807000-00004)
  • [L4] These results suggest that this could be a safe and effective surgical procedure to be considered for metatarsalgias of the lesser rays. (10.1186/s13018-019-1159-0)
  • [L4] This intervention showed no midterm progression to advanced arthritis in this cohort. (10.1177/15589447211017221)
  • [L4] The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. (10.1007/s001670050076)
  • [L4] Percutaneous needle fasciotomy can be applied effectively for recurrent disease; 50% of patients remain free of recurrence for a mean of 4.4 years. (10.1016/j.jhsa.2012.05.022)
  • [L4] Subtalar arthroereisis combined with medial soft tissue reconstruction significantly alleviated pain and improved the functions in pediatric and adolescent flexible flatfoot patients with accessory navicular; also, the radiological manifestations and functions improved. (10.1186/s13018-023-03542-w)

See Also

References

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[2] Pes cavovarus. Review of a surgical approach using selective soft-tissue procedures.. The Journal of Bone & Joint Surgery. 1980. DOI: 10.2106/00004623-198062060-00010

[3] Chapter 116 Heel Pain. 2019.

[4] Split-Thickness Skin Grafting: A Primer for Orthopaedic Surgeons. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-01389

[5] Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-020-03894-y

[6] Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-02021-w

[7] Coxa Vara in Childhood: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00003

[8] Total clavicle reconstruction with free peroneal graft for the surgical management of chronic nonbacterial osteomyelitis of the clavicle: a case report. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2588-y

[9] Current concepts of fourth-generation minimally invasive and open hallux valgus surgery. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b1.bjj-2024-0597.r2

[10] Contracture of the Deltoid Muscle. The Journal of Bone and Joint Surgery (American Volume). 1998. DOI: 10.2106/00004623-199802000-00010

[11] Neovascularity in Chronic Posterior Tibial Tendon Insufficiency. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000218759.42805.43

[12] The versatile thoracodorsal artery perforator flap for extremity reconstruction: from simple to five types of advanced applications and clinical outcomes. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04480-3

[13] Dupuytren’s Contracture. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199801000-00003

[14] Fibromatosis of the Plantar Fascia: SURGICAL TECHNIQUE AND DESIGN OF SKIN INCISION.. The Journal of Bone and Joint Surgery. American Volume. 1965.

[15] Chemistry and Mechanics of Commonly Used Sutures and Needles. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.10.036

[16] Chapter 3 Emerging Technologies in Orthopaedic Trauma. 2021.

[17] Current Concepts Review - Hallux Rigidus and Osteoarthrosis of the First Metatarsophalangeal Joint. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199806000-00015

[18] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[19] An Arthroscopic Technique for the Excision of a Symptomatic Os Trigonum. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.04.063

[20] Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF). Knee Surgery, Sports Traumatology, Arthroscopy. 2004. DOI: 10.1007/s00167-004-0496-6

[21] Letter to the Editor. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546510379341

[22] A neglected problem in the utilization of free anterolateral thigh flap toward reconstructing complicated wounds of extremities: the obliteration of deep dead space. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01914-0

[23] 8. Foot and Ankle Surgery. 2013.

[24] Mediolateral force distribution at the knee joint shifts across activities and is driven by tibiofemoral alignment. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b6.bjj-2016-0713.r1

[25] Hallux valgus deformity and postural sway: a cross-sectional study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04385-4

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