MRI of Pediatric Foot and Ankle Conditions.

The increase in competitive sports practice among children and lack of ionizing radiation have resulted in a higher demand for MRI examinations. MRI of the children skeleton has some particularities that can lead orthopedists, pediatricians, and radiologists to diagnostic errors. The foot and ankle have several bones with abundant radiolucent and high signal intensity cartilage in several ossification centers, apophysis and physis, that can make this interpretation even harder. The present revision aims to show, how to differentiate between normal developmental findings and anatomic variants from pathologic conditions, whether mechanical, inflammatory, infectious, or neoplastic.

Tumoral Calcinosis with an Atypical Presentation in the Foot: A Case Report.

Tumoral calcinosis is a rare disorder defined as the development of periarticular calcified masses, typically surrounding large joints, although they may occur in the foot. We present a case of a patient with systemic tumoral calcinosis with lesions in both shoulders and wrists and a relatively large lesion in the right foot presenting with foot pain.

EFFECT OF SUBSTRATE AND WALKING SURFACES ON CENTRAL METATARSAL FOOT PAD WEIGHT LOADING IN MAGELLANIC PENGUINS (SPHENISCUS MAGELLANICUS) WITH AND WITHOUT PODODERMATITIS: AN EX VIVO STUDY.

Pododermatitis is common in penguins kept under human care. Substrate optimization plays an important role in prevention and treatment; however, there is limited information on biomechanical properties of commonly used substrates on penguin feet. The objectives were to test the ability of different substrates to decrease weight loading on the central metatarsal pad of penguin feet in an ex vivo model using feet with and without bumblefoot harvested from two Magellanic penguin (Spheniscus magellanicus) cadavers. Penguin feet were attached to a digital force gauge mounted onto a stand for compression testing at 2.5 and 5 kg. Forces at the central metatarsal pad were measured in triplicate using small force sensors. Tested substrates included five granular surfaces (sand, wet sand, pea gravel, wet pea gravel, and crushed ice), three compliant surfaces (short-leaf Astroturf, long-leaf Astroturf, and neoprene), and three firm surfaces (tile, rubber drainage mat, and 3M Safety-Walk Wet Area Matting). Data were analyzed using linear mixed models. There were multifaceted effects of applied pressures, substrate surfaces, and pododermatitis on central metatarsal measured pressures. In general, doubling compression forces resulted in higher measured pressures in all firm and compliant surfaces but not in granular surfaces. Firm surfaces were associated with higher recorded plantar pressures at 2.5 kg, but different significance groupings emerged at 5 kg with a high-, medium-, and low-pressure cluster of surfaces. Pododermatitis lesions resulted in significant alterations in statistical significance clustering among substrate surfaces and unique substrate behaviors. The results of this study could help in making recommendations pertaining to foot health for penguin exhibits.

Investigation of Spatiotemporal Gait Characteristics, Balance, and Pain in Forefoot and Rearfoot Problems: Preliminary Results.

BACKGROUND: Foot problems are common in the general adult population. Whereas older people experience foot problems because of multiple chronic diseases, younger people often have musculoskeletal foot problems related to overuse. Symptoms and severity may differ depending on the anatomical location of the problem, such as forefoot and rearfoot problems. We aimed to compare the differences in spatiotemporal gait characteristics, balance, and pain in musculoskeletal forefoot and rearfoot problems. METHODS: Twenty-six patients with forefoot (14 participants) and rearfoot (12 participants) problems participated in this prospective study. Spatiotemporal gait characteristics (velocity, cadence, step time, step length, step-extremity ratio, stride length, base support, percentage of swing phase, percentage of stance phase, swing time, and stance time) were evaluated using an electronic walkway, and balance assessment was made using a balance check screener and trainer. The visual analog scale foot and ankle was used to determine patient pain levels. The Mann-Whitney U test was used to determine differences between groups. RESULTS: There were no significant differences between groups regarding spatiotemporal gait characteristics (P > .05). The eyes closed normal stability and eyes open perturbed stability scores were lower in patients with rearfoot problems (P < .05). Pain intensity evaluated with the visual analog scale foot and ankle was higher in patients with rearfoot problems (P < .05). CONCLUSIONS: Pain levels and balance deficits in this study were higher in patients with rearfoot problems. The balance evaluation and possible effects of pain management on balance should be considered, especially in patients with rearfoot problems, in aspects of treatment.

[The Swiss Claw Health Project - an interim assessment after 5 years]. / Das Schweizer Klauengesundheitsprojekt ­ eine Zwischenbilanz nach 5 Jahren.

SUBJECT AND AIMS: The Swiss Claw Health Project (SCHP) started on 1 January 2019 and will last a total of 8 years. The main goals of the SCHP are (a) digital recording of claw health data of cattle in Switzerland by 100 professional claw trimmers, (b) development of claw health programs, (c) improvement of cattle claw health in Switzerland, (d) development of breeding values for claw health and (e) reduction of antibiotic use to control claw health problems. MATERIAL AND METHODS: Data was collected digitally by 45 hoof trimmers who had previously successfully completed the training program for diagnosis and digital documentation in accordance with the ICAR Claw Health Atlas. The national animal health database was further developed for data storage. Livestock farms with unfavorable claw health were offered an on farm analysis with subsequent annual support visits. RESULTS: A total of 1155 cattle owners joined the project by the end of the 5th project year. The claw health data of 149753 claw trimmings at cow-level was recorded, and 176 individual visits and analyses of farms with claw health issues were carried out. A health program for mechanical and metabolism-related claw disorders was developed and successfully established. Biosecurity measures during claw trimming were analyzed, and a brochure with recommendations for claw trimmers was developed. Risk factors for the occurrence of digital dermatitis in dairy herds were identified. The prevalence of alarm lesions (painful lesions) decreased significantly and continuously in the participating farms over the project years 2 to 4. CONCLUSIONS: The scientific project support proved to be extremely useful, as the progress of the project was continuously monitored, and new issues could be addressed promptly. Digitally recorded findings during herd hoof trimming are essential for monitoring and improving claw health. CLINICAL RELEVANCE: This description and critical assessment of the SKGP procedure can be used by other consortia planning a similar project.

Common foot and ankle disorders in pregnancy: the role of diagnostic ultrasound.

Foot and ankle disorders are common during pregnancy, driven by significant physiological changes including weight distribution, hormonal fluctuations, and fluid balance. These changes often result in conditions such as varicose veins, thrombophlebitis, deep vein thrombosis (DVT), edema, overpronation, ankle sprains, metatarsalgia, stress fractures, ligament tears, synovitis, tendon tears, tenosynovitis, paratenonitis, plantar fasciitis, and Morton's neuroma. This paper emphasizes the diagnostic utility of ultrasound for these conditions, given its safety, non-invasiveness, and real-time imaging capabilities without ionizing radiation. Ultrasound is particularly effective for diagnosing venous disorders like varicose veins and thrombophlebitis, leveraging Doppler ultrasound to assess vein structure and function. It is also instrumental in identifying DVT, detecting vein dilation, reflux, and thrombosis. For conditions such as edema, ultrasound helps differentiate physiological from pathological causes, ensuring accurate diagnosis and management. In cases of musculoskeletal issues like overpronation, ankle sprains, ligament tears, and tendon pathologies, ultrasound provides detailed images of soft tissues, allowing for precise diagnosis and effective treatment planning. It is equally useful for detecting metatarsalgia, plantar fasciitis, and Morton's neuroma, offering insights into soft tissue abnormalities and guiding therapeutic interventions. Ultrasound's role extends to diagnosing foreign bodies in the foot and ankle, where it demonstrates high sensitivity and specificity. The accessibility and cost-effectiveness of ultrasound make it an invaluable tool in various healthcare settings, ensuring timely and accurate diagnosis and management of foot and ankle disorders during pregnancy, ultimately enhancing patient outcomes and quality of life.

The prevalence and anatomy of accessory navicular bone: a meta-analysis.

PURPOSE: There have been over 40 descriptions of the common developmental variants of the accessory ossicles of the feet. Although predominantly asymptomatic, they sometimes may be linked to painful conditions. One of the most common accessory ossicles in the foot is the accessory navicular bone (AN), located on the medial side of the foot. Our research provides a first meta-analysis on this topic that establishes its frequency by contrasting 39 studies from across the globe. METHODS: Up to February 2024, PubMed and Embase databases were thoroughly searched for research on the AN. Eligible data regarding AN prevalence was extracted. This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 39 studies, 11,015 patients, and 36,837 feet were analyzed in our study. The pooled prevalence estimate (PPE) of AN was found to be 17.5% (95%CI: 11.5-25.7) and 12.6% (95%CI: 10.1-15.5) in patients and feet analyses, respectively. Accessory navicular occurred bilaterally in 50.0% of patients, with similar distribution in gender-based groups (21.1% of males and 22.0% of females were confirmed with AN). Accessory navicular was most prevalent in the East Asian population (38.4%) and least prevalent in North Americans (8.0%). No significant differences in AN prevalence were found when comparing different imaging modalities (X-ray and cadaver dissection). CONCLUSION: Accessory navicular is a common finding in imaging studies. Its prevalence depends on the population covered by the study but is not affected by the patient's gender or the imaging modality utilized for AN assessment.

Verrucous Carcinoma of the Foot: A Single Canadian Center Experience on Diagnosis, Management, and Outcomes.

INTRODUCTION: Verrucous carcinoma (VC) was first described in 1948 by Dr. Ackerman. It is a low-grade cutaneous squamous carcinoma that usually develops in the oral cavity, the anogenital region, and the plantar surface of the foot. Clinically, there is low suspicion for malignancy given the slow growth of VC lesions and their wart-like appearance. Diagnosis can be difficult because of the benign histological appearance with well-differentiated cells and absence of dysplasia. Surgical excision is the only satisfactory form of treatment for plantar VC; however, this becomes difficult given its benign clinical appearance and the pathologic misinterpretation of the lesion as a benign hyperplasia. While there are case reports and retrospective studies of patients with plantar VC in the literature, we present the largest case series of plantar VC within North America, with recurrence despite negative margins. METHODS: We report on all the plantar VC excised between 2014-2023. We report six cases of VC, their treatment, and their outcomes. RESULTS: Six patients obtained a diagnosis of plantar VC by incisional biopsy. All patients underwent excision of their lesions and had negative margins reported on the final pathology. All patients developed nonhealing wounds at the site of their lesion excision; therefore, biopsies were performed to confirm a recurrence. All patients had a recurrence of VC at the initial site. All patients underwent re-excision of the lesions. Despite negative margins again on final pathology, all patients had a subsequent second recurrence. Ultimately, all patients underwent an amputation as definitive management. Each patient had an average of 3 operations. There were 4 different surgeons and different pathologists reporting their findings. CONCLUSIONS: Our experience with plantar VC suggests that an aggressive approach to surgical management is needed. Furthermore, management is optimized with the combined expertise of an experienced dermatopathologist and surgeon. Despite negative margins and repeated excisions, VC lesions recur and invade local tissues to the extent that only amputation of the involved foot has resulted in cure.

The experiences of podiatrists prescribing custom foot orthoses and patients using custom foot orthoses for foot pain management in the United Kingdom: A focus group study.

INTRODUCTION: Foot pain can be a significant burden for patients. Custom foot orthoses (CFOs) have been a mainstay in podiatry treatment for foot pain management and improving foot function. However, little is known about podiatrists' experience of prescribing CFOs or patient experience of using foot orthoses (FOs), including CFOs, for foot pain. METHODS: A focus group (FG) discussion with three FOs users (Female = 2 and Male = 1) was conducted in November 2022 within a private podiatry practice. This group represented non-experts from the general local population of individuals with existing or previous foot pain who have personally experienced using either over-the-counter FOs or CFOs. An online FG discussion with five musculoskeletal (MSK) specialist podiatrists (Female = 2 and Male = 3) was also conducted in December 2022. This group represented podiatrists with specialist knowledge in foot biomechanics and clinical experience in CFO provision. The FG discussions were recorded and lasted 49 and 57 min respectively. Transcribed data was manually coded, and a thematic analysis was undertaken to identify patterns within the collected data. RESULTS: The participants in the patient FG detailed mixed experiences of the prescription process and CFOs received, with reports of limited involvement/input in their prescription, the need for frequent adjustments and high costs. The impact on footwear choices, replicability and transferability of CFOs into different types of shoes and technologies to aid design were also highlighted. In the podiatrist FG, lack of confidence in design and manufacture processes, prescription form language, relationship and communication building with manufacturers, variability in the CFOs issued and the need for better student education in CFO provision emerged as key themes. CONCLUSION: Patients and podiatrists shared similar views on CFO provision, namely poor communication with manufacturers leading to dissatisfaction with the CFOs prescribed causing negative impacts on patient experiences. Podiatrists called for greater education at registration level to increase new graduate podiatrist knowledge in CFO design and manufacture and better collaboration with manufacturing companies.

Survey assessing foot trimmer involvement in managing lameness in UK beef cattle.

BACKGROUND: Cattle lameness is a significant welfare and economic problem facing the livestock industry. Published research has investigated foot trimming practices in dairy herds, but little is known about the practices in beef herds. Therefore, the objective of this study was to obtain information about the current practices of professional cattle foot trimmers concerning beef cattle within the UK. METHODS: An online survey comprising 16 questions was created using the Joint Information Systems Committee platform. The survey was open for 3 months. RESULTS: There was a significant difference (p < 0.05) between the proportions of dairy cattle and beef cattle receiving preventative foot trims. Digital dermatitis was the most commonly recorded cause of lameness when a lame beef animal was trimmed by the respondents, followed by white line disease. A thematic analysis of foot trimmers' opinions of barriers to engagement on beef farms is presented, in addition to their opinions on veterinary involvement with beef lameness. LIMITATIONS: Distribution bias may have affected the results, as the survey was distributed online with support from the Cattle Hoof Care Standards Board and the National Association of Cattle Hoof Trimmers. The percentage of foot trimmers not affiliated with either professional body is not known. CONCLUSION: Further research on the impact of lameness on suckler and finishing cattle, including investigations into preventative actions to reduce lameness in beef systems, is warranted.

Multifocal Bizarre Parosteal Osteocartilaginous Proliferation of the Foot: A Case Report.

CASE: Bizarre parosteal osteocartilaginous proliferation (BPOP) is rare, especially in the foot. To the best of our knowledge, multifocal BPOP has yet to be reported. We are reporting a case of a 40-year-old woman who presented with 4 bumps over her midfoot and toes. After staging studies, we excised the lesions, and histopathology confirmed BPOP. No local recurrence was observed at the end of the 2-year follow-up. CONCLUSION: BPOP should be considered in the differential diagnosis of multiple foot bumps, whether synchronous or metachronous, which may present multifocally in the foot.

Navigating the integration of knowledge and research evidence in clinical practice for children's foot health: A multi-professional survey.

BACKGROUND: Access to clinical services for children with foot and ankle problems are important, but unravelling the complexity of practice and service delivery can be challenging. The pursuit and implementation of research evidence is critical for driving positive change in practice, but little is understood about the approaches to knowledge and research acquisition in children foot health. AIM: The aim of the study was to: (1) explore multi-professional habits of knowledge and research evidence acquisition in children's foot health; and (2) understand how clinicians integrate information for children and their families into their practice. METHODS: This was a descriptive, cross-sectional online survey. Participants were included if they worked in the UK and had experience of working within paediatric services. RESULTS: There were complete responses from 247 health professionals, representing physiotherapists (n = 160), podiatrists (n = 50), orthotists (n = 25), nurses and specialists in community public health nurses (health visitors) (n = 12). Three main themes were generated from the data: (1) Factors that influence knowledge and inform clinical practice. (2) The role of Professional Bodies in informing professional knowledge. (3) Health Professionals' views on managing health information for parents and caregivers. CONCLUSIONS: This work advances understanding of the value health professionals' place in the development of materials for informing professional knowledge, as well as highlighting some of the challenges with translation of knowledge into clinical practice. The findings offer a national perspective of health professionals working on children's foot health and have highlighted that some of the most valued influences on clinical practice come from peer-to-peer networking.

Accessory foot bones in a Portuguese identified skeletal collection.

Data from dry bone samples, collected from anatomical or archaeological collections, can improve the knowledge regarding accessory foot bones, including prevalence, size, shape and laterality, that can be useful in disparate fields of research, from medicine to bioarcheology. In the present study, the prevalence of six accessory foot bones (os trigonum, calcaneus secundarium, accessory navicular bone, os vesalianum, os sustentaculum and os intermetatarseum) was assessed in a sample of 486 individuals (226 females, 260 males) from the Coimbra Identified Skeletal Collection (CISC). The most frequent accessory bones are os trigonum (9.9%; 48/485) and calcaneus secundarium (6.0%; 29/486), while the most uncommon is os sustentaculum (0.4%; 2/486). No sex differences were observed. All accessory bones occur more often unilaterally, with the exception of the accessory navicular bone that, in the majority of cases, occurs bilaterally. The unilateral expression of os trigonum, calcaneus secundarium and os vesalianum was mostly in the right foot. The co-occurrence of accessory foot bones was recorded in 1.7% of the individuals (8/486), and the combinations of os trigonum and calcaneus secundarium were the most frequently observed. This research emphasizes the relevance of conducting studies on reference skeletal collections in order to gain a comprehensive understanding of anatomical variations in the foot. This understanding is crucial for accurate diagnoses and successful treatment in clinical settings, as well as for establishing population comparison standards in the fields of bioarchaeology and forensic anthropology.

Resistance of zebu cattle (Bos indicus) to colonization by major ruminant hoof pathogens.

Zebu cattle (Bos indicus) is reported to be more resistant towards harmful environmental factors than taurine cattle (Bos taurus). A few hundred zebu cattle are kept in Switzerland and in contrast to the Swiss indigenous breeds, infectious hoof disease in zebu is not observed. Therefore, we compared the prevalence of three ruminant hoof pathogens in zebu and taurine cattle. These included Treponema spp., Fusobacterium necrophorum and Dichelobacter nodosus which are associated with bovine digital dermatitis (BDD), different bovine hoof diseases and ovine footrot, respectively. Interdigital swabs and punch biopsies from hind feet of slaughter animals were tested for the three pathogens by PCR. Sixty zebu from eight farms were compared to a convenience sample of 20 taurine cattle from 17 farms. Treponema spp. associated with BDD were not detected in zebu while 23 % of animals and 50 % of farms were positive for benign D. nodosus, with results indicating environmental contamination rather than colonization. Taurine cattle showed 35 % of animals and 41 % of farms positive for T. phagedenis while 90 % of animals and 94 % of farms were colonized by D. nodosus as indicated by a 500-fold higher bacterial load than in zebu. The difference in prevalence of the two pathogens between zebu and taurine cattle was highly significant. F. necrophorum was as well only detected in taurine cattle with values of 15 % of animals and 17.7 % of farms, being significantly different at the animal level. Furthermore, genetic analysis of Swiss zebu indicates high genomic diversity and clear separation from taurine cattle. This is the first evidence that zebu show resistance towards colonization by bacterial hoof pathogens in contrast to taurine cattle.

Angioleiomyoma of the Foot: Clinical and Functional Outcomes of Surgical Treatment in a Case Series.

BACKGROUND: Angioleiomyoma is a benign soft-tissue tumor that arises from the smooth muscle cells in the tunica media of the blood vessels. Although the most common location for these neoplasms is the uterine wall, they can also originate from lower limbs. Altogether, these neoplasms account for 0.2% of all those located in the foot and ankle region. Signs and symptoms of foot angioleiomyoma can be a localized pain, swelling, and functional impairment. To date, only case reports and case series with small populations have been reported in the literature to describe the clinical picture of these neoplasms and the effectiveness of surgical treatment. In this study, we report our results of surgical treatment for angioleiomyomas of the foot. METHODS: Thirteen cases suffering from angioleiomyoma of the foot underwent surgical resection in our institution between January of 2017 and January of 2022. For each case, we recorded preoperative and postoperative symptoms, and their preoperative and postoperative functional status according to both Musculoskeletal Tumor Society Score (MSTS) and American Orthopedic Foot and Ankle Society Score (AOFAS). Eventual complications and local recurrence were reported. RESULTS: Each patient had at least mild pain before surgical treatment. The mean preoperative MSTS and AOFAS were 22.1 and 76.8, respectively. The mean tumor size was 17.7mm. Preoperatively, each patient underwent resection with wide margins. None had local recurrences or major complications at their latest follow-up. After surgery, the mean postoperative MSTS and AOFAS increased to 29.5 and 98.8, respectively. Each case had a marked increment of their functionality and a reduction of their pain after surgery. CONCLUSIONS: Our results suggest that surgical approach with tumor resection should be considered a safe and reliable treatment for foot angioleiomyomas in light of the extremely low risk of local recurrence and because of the good postoperative pain relief and functional restoration that can be obtained after the treatment.

Selenium deposition in an atypically disintegrated hoof wall in a Thoroughbred racehorse with alkali disease: Proof by energy-dispersive X-ray fluorescence analysis.

From summer 2018 to summer 2019, several Thoroughbred racehorses held at the Miho Training Centre of the Japan Racing Association inadvertently ingested excessive amounts of sodium selenite, resulting in typical chronic selenium (Se) poisoning - the so-called alkali disease. The typical abnormality was a hoof wall disorder with a circumferentially deep ring and/or transverse hoof wall cracks parallel to the coronet on all feet and appearing after excessive ingestion. One affected Thoroughbred male was unique in that all the hooves had a rough surface with a very fragile hoof wall, but no wall rings or transverse cracking. This horse was euthanized because of dysstasia due to the permanent foot pain associated with hoof wall deformities in the front feet. To detect Se deposition in the hooves, we used energy-dispersive X-ray fluorescence (EDXRF) analysis to measure the Se signal intensity of each lesion. Characteristic Se-kα signals were emitted from the areas of histologically damaged hoof wall at 33.76 ± 11.78 (mean ± SD) counts per second (cps)/mm2. In contrast, the signal from the uninjured proximal hoof wall was 1.43 ± 0.14 cps/mm2 and that from the uninjured distal hoof wall was 1.51 ± 0.23 cps/mm2. The much greater Se deposition in the injured hoof walls suggests that their disintegration was caused by alkali disease. These results indicate that atypical hoof wall abnormalities due to alkali disease can be diagnosed by EDXRF analysis.

Plasma concentration of serum amyloid A and lipopolysaccharide binding protein in horses with laminitis resulted from hindgut acidosis.

Many studies have shown a strong correlation between Hindgut Acidosis (HGA) and the occurrence of laminitis in horses; therefore, the early diagnosis of HGA is essential. In this study, we investigated changes in the plasma concentrations of lipopolysaccharide-binding protein (LBP) and serum amyloid A (SAA) as inflammatory markers in horses with laminitis. Sixteen healthy male Arabian horses that had cecal cannulation without visible laminitis or general symptoms were randomly divided into two groups. The horses were fed two different diets in a forage-to-concentrate ratio. Blood samples were collected on Days 1, 10, and 20. The primary objective of this study was to analyze plasma levels of LBP and SAA. Cecal specimens were obtained from each equine subject on three designated days: days 1, 10, and 20. The second objective was to assess the levels of pH and volatile fatty acids (VFA) in the samples. Throughout the study period, horses fed a high-concentrate diet exhibited a significantly elevated average lameness grade on days 10 and 20 compared to the initial stage (P < 0.001). On day 20, a significant increase in the concentration of SAA was observed in horses fed a high-concentrate diet, in contrast to the initial stage of the study. LBP levels in the plasma were significantly elevated on days 10 and 20 in horses fed a high-concentrate diet. Based on our findings, it is recommended that the evaluation of plasma LBP concentrations is more effective than SAA for the early identification of HGA in horses fed a high-grain diet.

The minimal important change is not a universal fixed value across diagnoses when using the FAOS and FAAM in patients undergoing elective foot and ankle surgery.

PURPOSE: This study aimed to calculate region and diagnosis-specific minimal important changes (MICs) of the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) in patients requiring foot and ankle surgery and to assess their variability across different foot and ankle diagnoses. METHODS: The study used routinely collected data from patients undergoing elective foot and ankle surgery. Patients had been invited to complete the FAOS and FAAM preoperatively and at 3-6 months after surgery, along with two anchor questions encompassing change in pain and daily function. Patients were categorised according to region of pathology and subsequent diagnoses. MICs were calculated using predictive modelling (MICPRED) and receiver operating characteristic curve (MICROC) method and evaluated according to strict credibility criteria. RESULTS: Substantial variability of the MICs between forefoot and ankle/hindfoot region was observed, as well as among specific foot and ankle diagnoses, with MICPRED and MICROC values ranging from 7.8 to 25.5 points and 9.4 to 27.8, respectively. Despite differences between MICROC and MICPRED estimates, both calculation methods exhibited largely consistent patterns of variation across subgroups, with forefoot conditions systematically showing smaller MICs than ankle/hindfoot conditions. Most MICs demonstrated high credibility; however, the majority of the MICs for the FAOS symptoms subscale and forefoot conditions exhibited insufficient or low credibility. CONCLUSION: The MICs of the FAOS and FAAM vary across foot and ankle diagnoses in patients undergoing elective foot and ankle surgery and should not be used as a universal fixed value, but recognised as contextual parameters. This can help clinicians and researchers in more accurate interpretation of the FAOS and FAAM change scores. LEVEL OF EVIDENCE: Level IV.

Hazard of Failed Nonoperative Management for Symptomatic Accessory Navicular in Children and Adolescents: A Population-Based Case-Cohort Study.

BACKGROUND: The accessory navicular (AN) is an idiopathic condition of the foot present in 4% to 21% of the population. Most ANs remain asymptomatic, but children and adolescents who develop symptoms can have remarkably reduced quality of life. Although many respond to conservative measures, surgery is occasionally needed. Our purpose was to determine factors associated with the failure of nonoperative management. METHODS: This single-institution retrospective case-cohort study included patients up to age 19 years presenting between 2000 and 2021 with symptomatic AN and treated with standard-of-care. All 298 surgical cases, indicating failed nonoperative treatment, were included. For the subcohort, 299 patients were randomly sampled from all eligible patients, regardless of treatment. Baseline characteristics were summarized for the surgical cases and subcohort. Proportional hazards assumptions were checked and stratification implemented when necessary. Marginal structural proportional hazard modeling was used to estimate hazard ratios with 95% confidence intervals via inverse probability and LinYing weighting methods. RESULTS: The 298 surgical cases failed nonoperative management at a median of 5.2 months (IQR, 2.0-11.6 mo). In the subcohort, 86 failures of nonoperative management and 213 nonfailures constituted a 28.8% surgery rate. In both cohorts, nearly all patients played sports. Univariate proportional hazard modeling found older age ( P =0.02) and activity limitation ( P <0.001) at presentation, female sex ( P =0.002), higher BMI ( P =0.01), AN on the right ( P <0.001), and bone marrow edema of the AN ( P <0.001) and navicular body ( P <0.001) on MRI were associated with increased hazard of nonoperative failure. Nearly all of the surgical cohort reported improvement in pain (278/296, 94%) and returned to their primary sport (236/253, 93%) after surgery. Most also experienced full resolution of symptoms (187/281, 67%). CONCLUSIONS: Symptomatic AN predominantly affects female athletes, leading to surgery in 28.8% of our subcohort. Conservative treatment may be less successful-and therefore surgery could be more strongly considered-in older age, activity limitation at presentation, female sex, higher BMI, right-sided AN, and bone marrow edema on MRI. Surgery is effective for symptomatic and functional improvement. LEVEL OF EVIDENCE: Case-cohort-Level III.