Diagnostics & Outcomes

Foot & ankle diagnostics and outcome assessment: validated scores, disparities in research, and diabetic foot/Charcot neuroarthropathy focus.

Overview

Surgical repair of zones 2 and 3 fifth metatarsal fractures yields satisfactory patient-reported and radiographic outcomes when performed according to established guidelines [1]. In contrast, for thumb basilar joint osteoarthritis, radiographic stage does not correlate with symptom severity, suggesting that metrics linking radiographic and subjective components may improve both surgical decision-making and the monitoring of treatment response [3]. Similarly, future outcome metrics for articular cartilage defects of the knee should prioritize patient-centered factors to enhance accuracy and standardization [4].

Management of osteochondral lesions of the talus presents a dichotomy where surgical treatment demonstrates superior results compared to conservative care, yet conservative treatment remains an acceptable first option [25]. Arthroscopic debridement and microfracture as primary treatment for talar dome lesions consistently achieve good to excellent outcomes in over 80% of patients [18]. However, reported complication and revision rates for matrix-associated autologous chondrocyte implantation vary widely, ranging from 0% to 59% and 0% to 45%, respectively [12]. While platelet-derived growth factor shows potential, high-quality studies are required to confirm its safety and analyze long-term effects [27].

In foot and ankle surgery, depression and anxiety significantly influence patient expectations and satisfaction, underscoring the necessity for careful patient selection and preoperative expectation management [47]. The field of ankle fracture trials currently utilizes a wide variety of outcome measures without a consensus on a core set of primary outcomes [6]. Finally, understanding current evidence and appropriate indications for emerging technologies in orthopaedic trauma remains critical for their successful utilization [15].

Anatomy & Pathophysiology

Diagnostic Imaging & Assessment: Stress fractures of the talus do not seem to seriously damage the foot [14]. Ultrasound appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle cross-sectional area [20]. A simple footprint assessment board can be potentially useful to detect flatfoot [64].

Pathophysiology & Risk Stratification: Modern approaches to the diabetic foot focus on pathophysiology, risk stratification using tools like the Wagner-Meggitt system, and proactive management including patient education, offloading, and appropriate footwear [29]. Walking with shoes did not attenuate vertical forces in participants with diabetic neuropathic or healthy controls [43]. Protected weightbearing in an orthopedic device can reduce the risk for complications in acute Charcot neuroarthropathy of the foot and ankle [68]. Subjects with concurrent neuropathy and claw toe deformity were associated with the smallest intrinsic foot muscle volumes and the thickest plantar aponeuroses [85].

Kinematics & Biomechanics: Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway [61]. Dysfunction of the windlass mechanism is associated with hallux rigidus, as evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet [65]. In female patients with a more severe anteroposterior talo-first metatarsal angle, an aggravation of symptoms with aging should be expected when managing pes planovalgus deformity [69].

Functional Outcomes & Patient-Reported Measures: The foot function sub-scale (items 1-9) of the Manchester foot pain and disability index is a reliable and valid sub-scale [52]. The SEFAS is designed for a range of foot disorders including ankle fractures and has the best measurement properties in this population [56]. The FFI-RSN has acceptable responsiveness and can be used to evaluate global foot health in clinical or research settings with Norwegian patients suffering from plantar fasciopathy [71]. The Simple Ankle Value is correlated with existing accepted ankle patient-reported outcome measures [82]. The Chinese version of the American orthopaedic foot and ankle society hallux metatarsophalangeal-interphalangeal scale (AOFAS-Hallux-MTP-IP) can be recommended for the comprehensive assessment of the clinical conditions of patients with hallux valgus deformity in Mainland China [83]. The FFI-Ar tool can be used in usual practice and research for analysing foot and ankle disorders in Arabic-speaking people [86].

Surgical Management: Surgical treatment involving deformity correction to recreate a plantigrade foot along with tendon transfers has been used with notable success to restore a near-normal gait in adult footdrop, though limitations and postoperative dorsiflexion weakness have prompted investigation in nerve transfer as a possible alternative surgical treatment [72].

Classification

Osteonecrosis of the knee: This condition is differentiated into primary (spontaneous) and secondary categories [2]. Early diagnosis via MRI or bone scan is essential [2]. Nonoperative treatment is indicated for early stages with a benign course [2], whereas advanced stages require surgical options based on patient factors and lesion severity [2].

Subchondral insufficiency fracture of the knee (SIFK): The SIFK score classifies patients into low-, medium-, and high-risk categories for arthroplasty progression after subchondral insufficiency fractures of the knee [73]. This model assists in patient treatment and counseling [73].

Osteochondral lesions of the talus: Higher preoperative range of motion is predictive of good mid-term results in surgical management [75]. A new algorithm for these lesions resulted in a postoperative AOFAS score of ≥ 80/100 in 65% of cases [75]. Reported complication rates for matrix-associated autologous chondrocyte implantation ranged from 0% to 59% [12], with revision rates ranging from 0% to 45% [12].

Displaced intra-articular calcaneal fractures: Prognostic correlation exists between radiographic classifications and clinical outcomes [8]. A risk prediction model for postoperative recovery of closed calcaneal fracture might be translated into clinical guidance and application [77].

Nail patella syndrome: Distinct malformations of the knee joint are easily recognizable on conventional radiographs [9]. These malformations lead to the correct interpretation of aberrant morphology essential in treatment for nail patella syndrome [9].

Diabetic foot: Modern approaches focus on pathophysiology and risk stratification using tools like the Wagner-Meggitt system [29]. Proactive management includes patient education, offloading, and appropriate footwear [29].

Other Considerations: Radiographic stage does not correlate with symptom severity in thumb basilar joint osteoarthritis [3]. Metrics linking radiographic and subjective components may improve surgical decision making and monitoring of treatment response [3]. Future outcome metrics for articular cartilage defects of the knee should focus on patient-centered factors to improve accuracy and standardization [4]. A wide variety of outcome measures are used in interventional trials for ankle fractures, with no consensus on a core set of primary outcomes [6]. Demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores in scoring systems for total knee arthroplasty [58]. The minimum clinically important difference (MCID) is heavily influenced by assessment time points, analytical method, treatment modality, and fracture classification [67]. Consideration of evidence, ICF domains, wrist diagnoses, and assessment design can help hand therapists select the measure most appropriate for use [84].

Clinical Presentation

History and physical examination remain the cornerstone of initial assessment across diverse pathologies. A thorough history and physical examination are crucial to ensure that any lesion not readily identified as benign is appropriately managed in pediatric foot masses [21]. In thumb basilar joint osteoarthritis, radiographic stage does not correlate with symptom severity [3], whereas metrics linking radiographic and subjective components may improve surgical decision making and monitoring of treatment response [3]. Similarly, radiographic knee osteoarthritis is an imprecise guide to the likelihood that knee pain or disability will be present [26]. For ankle fractures, the severity of trauma is the most important prognostic factor [11], though the period within which osteoarthritis develops or becomes symptomatic following ankle fractures could not be specified [11].

Acute Injury and Trauma

In acute settings, early diagnosis is critical for specific pathologies. Early diagnosis of osteonecrosis of the knee via MRI or bone scan is essential [2], and early diagnosis and treatment of cuboid osteomyelitis are essential for enhancing clinical awareness and preventing misdiagnosis [40]. For displaced intra-articular calcaneal fractures, a prognostic correlation exists between radiographic classifications and clinical outcomes [8]. In pediatric desmoplastic fibroma, close follow-up by experienced surgeons may be beneficial for prognosis [7]. Distinct malformations of the knee joint in nail patella syndrome are easily recognizable on conventional radiographs [9].

Osteochondral Lesions and Cartilage Defects

Clinical presentation in osteochondral lesions of the talus is heavily influenced by lesion characteristics and patient factors. Worse clinical outcomes were shown at postoperative 6 and 12 months in patients with a high preoperative bone marrow edema index (BMEI) following arthroscopic bone marrow stimulation [5]. Duration of symptoms before admission negatively affects results in arthroscopic treatment of talus osteochondral lesions [19], as do higher lesion stages [19]. Older patients, deep lesions, and medial lesions uncovered with the medial malleolus were associated with inferior clinical outcomes following arthroscopic bone marrow stimulation for osteochondral lesions of the talus [41]. For osteochondral lesions of the talus with cysts, specific cutoff values for area (90.91 mm2), depth (7.56 mm), and volume (428.13 mm3) were associated with poor outcomes following arthroscopic bone marrow stimulation [39]. Future outcome metrics for articular cartilage defects of the knee should focus on patient-centered factors to improve accuracy and standardization [4].

Osteonecrosis and Arthropathy Management

Osteonecrosis of the knee should be differentiated into primary (spontaneous) and secondary categories [2]. Nonoperative treatment is indicated for early-stage osteonecrosis of the knee with a benign course [2], while advanced stages of osteonecrosis of the knee require surgical options based on patient factors and lesion severity [2]. Patients treated according to guidelines for zones 2 and 3 fifth metatarsal fractures achieved satisfactory patient-reported and radiographic outcomes [1]. In distal radius fractures, clinical improvement is associated with smaller magnitudes of change on PROMIS Physical Function when patients present with better reported function [32]. Patients are expected to present similar performance at 1 year postoperatively following total knee replacement when preoperative strengthening plus balance training is used [48]. A distinct gene-expression profile may aid in blood-based diagnosis and treatment monitoring for spinal tuberculosis [16].

Outcome Measurement Variability

Standardization of outcome reporting remains inconsistent across fracture and joint trials. A wide variety of outcome measures are used in interventional trials for ankle fractures, with no consensus on a core set of primary outcomes [6].

Investigations

Plain radiography: Radiography serves as the first examination of choice for foot and ankle pain [44]. It effectively identifies distinct malformations of the knee joint in nail patella syndrome [9]. Radiographic classifications correlate with clinical outcomes in displaced intra-articular calcaneal fractures [8], and metrics linking radiographic and subjective components may improve surgical decision-making and monitoring of treatment response in thumb basilar joint osteoarthritis [3]. However, radiographic knee osteoarthritis is an imprecise guide to the likelihood that knee pain or disability will be present [26]. Furthermore, restoration of 'normal' radiographic parameters may not be necessary to achieve a satisfactory functional outcome for patients with fractures of the distal radius [54].

MRI: MRI provides useful diagnostic assessment by directly visualizing soft-tissue structures and bone marrow to enable accurate diagnosis and grading of pathologies in the foot and ankle [44]. It is indispensable for evaluating deeper complex structures, such as the SDM and fracture lesions, in ankle injuries [45]. Early diagnosis of osteonecrosis of the knee via MRI is essential [2]. MRI showed abnormalities, particularly at the subchondral bone level, in patients treated with a cell-free biomimetic osteochondral scaffold for knee osteochondritis dissecans, with an overall improvement of MRI features over time [31]. Pre-operative evaluation with MRI made an important contribution to the diagnosis of localized pigmented villonodular synovitis of the knee [59]. A model combining MRI cartilage integrity, physeal status, and radiographic grade has the highest predictability of intra-operative cartilage integrity for osteochondral lesions of the talus [53]. Bone marrow lesions found in the first MRI examination were associated with 5-year incident joint surgery in patients with knee osteoarthritis, except for those allocated in lateral compartments [62].

Ultrasound: Ultrasound appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle cross-sectional area [20]. Ultrasound and MRI exhibit a complementary relationship in the evaluation of ankle injuries [45].

CT: Advanced CT and MRI examinations can significantly reduce the missed diagnosis rate of occult posterior malleolar fractures associated with tibial shaft fractures [57].

Bone scan: Early diagnosis of osteonecrosis of the knee via bone scan is essential [2]. 99mTc-HMPAO–WBC SPECT/CT provides additional clarity in the differential diagnosis between osteomyelitis and Charcot neuroarthropathy, especially in challenging cases or when metallic implants affect MRI accuracy [50].

Other Considerations: Patients treated according to guidelines for surgical repair of zones 2 and 3 fifth metatarsal fractures achieved satisfactory patient-reported and radiographic outcomes [1]. Osteonecrosis of the knee should be differentiated into primary (spontaneous) and secondary categories [2]. Nonoperative treatment is indicated for early-stage osteonecrosis of the knee with a benign course [2], while advanced stages require surgical options based on patient factors and lesion severity [2]. Long-term clinical outcomes following arthroscopic bone marrow stimulation for osteochondral lesions of the talus can be considered satisfactory, though one in three patients show progression of degenerative changes from a radiological perspective [13]. Stress fractures of the talus do not seem to seriously damage the foot [14]. Primary autologous osteochondral transplantation shows better functional outcomes compared with secondary autologous osteochondral transplantation after failed microfracture in patients with similar characteristics and lesion size [55].

Treatment

Non-Operative

Conservative management is the preferred initial strategy for acute zone 1 fifth metatarsal fractures, as union rates are similar to surgical management [79]. Nonoperative treatment is indicated for early-stage osteonecrosis of the knee with a benign course [2] and is recommended for the natural course of intra-articular shifting bone marrow edema syndrome of the knee [46]. For osteochondral lesions of the talus, conservative treatment presents acceptable results and should always be considered as the first option, despite surgical treatment yielding better results [25]. Nonoperative treatment of adult patients with a distal radial fracture through a virtual fracture care (VFC) protocol reduced secondary healthcare utilization and demonstrated similar reported complication and ED reattendance rates compared with treatment without VFC [76]. In patients older than 60 years with extra-articular distal radius fractures treated conservatively, there was no significant correlation between acceptable alignment according to radiological parameters and short- or medium-term functional outcome [78].

Operative

Indications: Surgical repair is indicated for zones 2 and 3 fifth metatarsal fractures to achieve satisfactory patient-reported and radiographic outcomes [1]. Advanced stages of osteonecrosis of the knee require surgical options based on patient factors and lesion severity [2]. Early detection of atraumatic osteonecrosis of the talus may allow the ankle to be treated non-operatively or with core decompression, thus reducing the need for arthrodesis [74]. A specific indication for arthroscopic drilling for osteochondral lesions of the talus is an early lesion with only mild osteosclerosis, continuity of the cartilaginous surface, and stability of the osteochondral fragment [36]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [66].

Surgical Approach / Technique: Arthroscopic debridement and microfracture for osteochondral lesions of the talar dome can consistently achieve good to excellent outcomes in greater than 80% of patients [18]. Arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus yields satisfactory clinical outcomes at a mean follow-up of 13.9 years [35]. Precise anatomic reduction enhances short-term functional outcomes in distal radius fracture treatment [17]. Understanding current evidence and appropriate indications is of critical importance for the utilization of emerging technologies in orthopaedic trauma [15].

Implant Selection: Graft non-union is associated with inferior clinical results following the modified Bankart and Bristow procedure [63].

Adjuncts: Bone marrow stimulation (BMS) combined with hyaluronic acid (HA) or bone marrow concentrate (CBMA) can provide superior outcomes for osteochondral lesions of the talus, albeit with currently limited evidence [34]. There is insufficient evidence to support a positive effect on clinical outcomes of bone marrow aspirate concentrate as an additive to surgical treatment of osteochondral lesions of the talus [33]. Further studies are warranted to determine the long-term efficacy of platelet-rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus [10].

Other Considerations: Osteonecrosis of the knee should be differentiated into primary (spontaneous) and secondary categories, with early diagnosis via MRI or bone scan being essential [2]. Worse clinical outcomes were shown at postoperative 6 and 12 months in patients with a high preoperative bone marrow edema index (BMEI) following arthroscopic bone marrow stimulation for osteochondral lesions of the talus [5]. At a minimum follow-up of 10 years, the survival rate of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) was 82%, with survival appearing stable at 15 and 20 years [24]. Future outcome metrics for articular cartilage defects of the knee should focus on patient-centered factors to improve accuracy and standardization [4]. In distal radius fracture treatment, both the Michigan Hand Outcomes Questionnaire (MHQ) and physical tests are responsive in measuring outcomes and should be reported for outcomes studies [37]. The Normal Hand Score analysis supports its use as an adjunct to patient-reported outcome measures after carpal tunnel decompression [81]. Skin temperature monitoring offers a direct and reliable indication of microcirculatory blood perfusion in the management of patients with diabetic foot undergoing microcirculation reconstruction [42]. More attention should be paid to appropriate patient selection and intraoperative judgment when using a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds to ensure wound closure and avoid undue complications [51]. The treatment of chronic, nonradicular, discogenic low back pain remains controversial, with intradiskal electrothermal therapy showing reported therapeutic success rates of 60% to 80%, though a more precise quantification of clinical benefits remains to be proved in randomized prospective trials [38].

Complications

Other Considerations: Outcomes for fifth metatarsal fractures in zones 2 and 3 are generally satisfactory regarding patient-reported and radiographic measures [1]. In pediatric foot masses, a thorough history and physical examination are crucial to ensure lesions not readily identified as benign are appropriately managed [21]. Stress fractures of the talus do not appear to cause serious damage to the foot [14]. Transient phalangeal osteolysis (microgeodic disease) is self-limiting, regressing rapidly both clinically and radiographically without residual deformity or sequelae [87].

Regarding osteochondral lesions of the talus, long-term clinical outcomes following arthroscopic bone marrow stimulation are considered satisfactory, though one in three patients show progression of degenerative changes from a radiological perspective [13]. Worse clinical outcomes at postoperative 6 and 12 months are associated with a high preoperative bone marrow edema index (BMEI) [5]. The degree of subchondral bone marrow edema at midterm follow-up correlates with clinical outcomes after microfracture, yet no significant differences in short-term clinical outcomes were found regarding the degree of edema [28]. Reported complication rates for matrix-associated autologous chondrocyte implantation range from 0% to 59%, with revision rates ranging from 0% to 45% [12]. Further studies are warranted to determine the long-term efficacy of platelet-rich plasma (PRP) as an adjunct to microfracture [10], and further high-quality studies are needed to confirm results and analyze the long-term effects of platelet-derived growth factor for treatment of osteochondral defects of the talus [27].

For ankle fractures, the severity of trauma is the most important prognostic factor, though the period within which osteoarthritis develops or becomes symptomatic could not be specified [11]. Isolated, displaced, closed talar neck and body fractures treated by ORIF achieve satisfactory clinical results despite a high rate of long-term complications [22]. In pediatric desmoplastic fibroma, close follow-up by experienced surgeons may be beneficial for prognosis [7].

Regarding knee pathology, osteonecrosis is differentiated into primary (spontaneous) and secondary categories, requiring early diagnosis via MRI or bone scan [2]. Nonoperative treatment is indicated for early-stage osteonecrosis with a benign course, while advanced stages require surgical options based on patient factors and lesion severity [2]. The technique of internal fixation for osteochondritis dissecans provides satisfactory results at a mean follow-up of 5 years with minimal complications such as synovitis [89]. For focal cartilage defects in the knee treated with autologous matrix-induced chondrogenesis, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity [23]. A decade after a distal radius fracture, range of motion, grip strength, and QuickDASH recover to population normal regardless of radiological outcomes [80].

In upper extremity and tumor resection contexts, Judet's bipolar prosthesis for bipolar radial head arthroplasty achieves mainly good clinical results despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years [70]. Functional results for three-dimensional printed, custom-made prostheses in patients undergoing resection of hand and foot tumors generally appear good to excellent, yet complications and reoperations are frequent [88].

Recovery

Light activity (weeks): Specific timelines for light activity such as desk work or driving are not explicitly defined in the provided evidence base. However, simultaneous bilateral endoscopic carpal tunnel release is associated with shorter recovery times than previously reported [92].

Full activity (months): The duration required to achieve full activity varies by pathology. For distal radius fractures, precise anatomic reduction enhances short-term functional outcomes [17]. In cases of isolated, displaced, closed talar neck and body fractures treated by open reduction and internal fixation, satisfactory clinical results are achieved despite a high rate of long-term complications [22]. For osteochondral lesions of the talus treated with arthroscopic bone marrow stimulation, long-term clinical outcomes are considered satisfactory even if one in three patients show radiological progression of degenerative changes [13].

Complete recovery / outcome plateau (months): Recovery trajectories and outcome plateaus are defined by specific follow-up intervals and prognostic factors. For osteochondral lesions of the talus treated with arthroscopic bone marrow stimulation, the survival rate is 82% at a minimum follow-up of 10 years, with stability appearing at 15 and 20 years [24]. The degree of subchondral bone marrow edema at midterm follow-up correlates with clinical outcomes after microfracture, whereas no significant differences are found at short-term follow-up [28]. Worse clinical outcomes are observed at postoperative 6 and 12 months in patients with a high preoperative bone marrow edema index (BMEI) following arthroscopic bone marrow stimulation for osteochondral lesions of the talus [5]. Duration of symptoms before admission and higher lesion stages negatively affect results after arthroscopic treatment of talus osteochondral lesions [19]. For ankle fractures, the severity of trauma is the most important prognostic factor, though the specific period for osteoarthritis development remains unspecified [11]. In spinal tuberculosis, a distinct gene-expression profile may lead to earlier diagnosis and treatment monitoring [16]. For osteochondritis dissecans of the knee, juvenile cases have a much better long-term prognosis than adult cases, with age and epiphyseal plate stage being the most important prognostic factors [90].

Rehabilitation protocol: Evidence regarding specific rehabilitation protocols, such as PT phasing or immobilisation duration, is limited in the provided text. Close follow-up by experienced surgeons may be beneficial for prognosis in cases of desmoplastic fibroma in children [7]. Greater Achilles tendon cross-sectional area seen on ultrasound 6 weeks after surgical repair predicts long-term functional outcome [49]. Further studies are warranted to determine the long-term efficacy of platelet-rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus [10]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis for focal cartilage defects in the knee will maintain structural and functional integrity over time [23].

Functional milestones: Patients treated according to guidelines for surgical repair of zones 2 and 3 fifth metatarsal fractures achieved satisfactory patient-reported and radiographic outcomes [1]. The Musculoskeletal Function Assessment Questionnaire was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values [60]. Mobile and fixed-bearing all-polyethylene tibial component total knee arthroplasty designs functioned equivalently at the time of early follow-up in a low-to-moderate-demand patient group [91].

Other Considerations: Predictors of recovery success include the severity of trauma for ankle fractures [11], preoperative BMEI for talus osteochondral lesions [5], duration of symptoms and lesion stage for talus osteochondral lesions [19], and age and epiphyseal plate stage for osteochondritis dissecans of the knee [90]. Precise anatomic reduction is critical for short-term functional outcomes in distal radius fractures [17].

Key Evidence

• [L4] Patients treated according to guidelines from our prior study achieved satisfactory patient reported and radiographic outcomes. (10.1186/s13018-021-02331-7)
• [L5] Osteonecrosis of the knee should be differentiated into primary (spontaneous) and secondary categories; early diagnosis via MRI or bone scan is essential as nonoperative treatment is indicated in early stages with a benign course, while advanced stages require surgical options based on patient factors and lesion severity. (10.1007/s001670050064)
• [L2] Metrics that link radiographic and subjective components may improve surgical decision making and monitoring of treatment response. (10.5435/jaaos-d-15-00329)
• [L4] Future outcome metrics should focus on patient-centered factors to improve accuracy and standardization. (10.1016/j.arthro.2016.04.009)
• [L3] Worse clinical outcomes were shown at postoperative 6 and 12 months in patients with a high preoperative BMEI. (10.1002/ksa.12355)
• [L2] The review identified a wide variety of outcome measures used in interventional trials for ankle fractures, with no consensus on a core set of primary outcomes. (10.1186/s12891-019-2770-2)
• [Case_report] Close follow-up by experienced surgeons may be beneficial for prognosis. (10.1186/s12891-024-07454-6)
• [L3] Finally, our data confirmed the prognostic correlation between the two radiographic classifications used and the clinical outcomes. (10.1186/s13018-016-0426-6)
• [L4] These distinct malformations are easily recognisable on conventional radiographs and lead to the correct interpretation of the aberrant morphology essential in treatment. (10.1302/0301-620x.98b4.37025)
• [L2] Further studies to determine the longterm efficacy of this approach were warranted. (10.1007/s00167-013-2784-5)
• [L1] The severity of the trauma was the most important prognostic factor, but the period within which osteoarthritis develops or becomes symptomatic could not be specified. (10.1530/eor-22-0065)
• [L5] Reported complication and revision rates ranged from 0% to 59% and 0% to 45%, respectively. (10.1016/j.arthro.2025.07.045)
• [L4] Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. (10.1007/s00167-021-06630-8)
• [L4] Stress fractures of the talus do not seem to seriously damage the foot. (10.1177/0363546506291405)
• [L2] If successful, a distinct gene-expression profile will aid in blood-based diagnosis and treatment monitoring, leading to earlier diagnosis of this devastating disease. (10.1186/s13018-024-04840-7)
• [L1] Precise anatomic reduction enhances short-term functional outcomes in DRF treatment. (10.1016/j.jhsa.2006.10.010)
• [L4] Good to excellent outcomes can be consistently reached in greater than 80% of patients with arthroscopic debridement and microfracture. (10.1016/j.arthro.2012.04.055)
• [L4] Duration of symptoms before admission and higher lesion stages were the most important factors negatively affecting results. (10.1177/2325967114s00203)
• [L3] US appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle CSA. (10.1186/s12891-022-05090-6)
• [L5] A thorough history and physical examination are crucial to ensure that any lesion not readily identified as benign is appropriately managed. (10.5435/jaaos-d-15-00397)
• [L4] Despite a high rate of long-term complications, satisfactory clinical results were achieved. (10.1186/s12891-019-2738-2)
• [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] At a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%, with survival appearing stable at 15 and 20 years. (10.2106/jbjs.23.01186)
• [L4] Although surgical treatment has better results, conservative treatment presents acceptable results and should always be considered as the first option. (10.1177/2325967114s00247)
• [L1] Radiographic knee osteoarthritis is likewise an imprecise guide to the likelihood that knee pain or disability will be present. (10.1186/1471-2474-9-116)
• [L4] Further high-quality studies are needed to confirm these results and to analyse the long-term effects of the procedure. (10.1007/s00167-015-3549-0)
• [L3] The degree of subchondral bone marrow edema at midterm follow-up was correlated with clinical outcomes, whereas no significant differences were found at short-term follow-up. (10.1177/0363546518782701)
• [L4] MRI showed abnormalities, in particular at the subchondral bone level, but there was an overall improvement of features over time. (10.1177/0363546517737763)
• [L4] Clinical improvement is associated with smaller magnitudes of change on PROMIS Physical Function when patients present with better reported function. (10.1016/j.jhsa.2019.02.015)
• [L1] There is insufficient evidence to support a positive effect on clinical outcomes of bone marrow aspirate concentrate as an additive to surgical treatment of osteochondral lesions of the talus. (10.1007/s00167-023-07651-1)
• [L2] BMS + HA and BMS + CBMA can provide superior outcomes, albeit the currently limited evidence. (10.1007/s00167-022-07130-z)
• [L4] BMS for OLT yields satisfactory clinical outcomes at a mean follow-up of 13.9 years. (10.1177/0363546521992471)
• [L4] A specific indication for the procedure is an early lesion with only mild osteosclerosis, continuity of the cartilaginous surface, and stability of the osteochondral fragment. (10.2106/00004623-199909000-00004)
• [L4] Unlike other conditions such as carpal tunnel syndrome, for which the outcomes questionnaire is the most responsive measure, in DRF treatment both the MHQ and physical tests are responsive in measuring outcomes and should be reported for outcomes studies of DRFs. (10.1016/j.jhsa.2006.10.003)
• [L5] The treatment of chronic, nonradicular, discogenic low back pain remains controversial, and while intradiskal electrothermal therapy shows reported therapeutic success rates of 60% to 80%, a more precise quantification of clinical benefits remains to be proved in randomized prospective trials. (10.5435/00124635-200301000-00003)
• [L3] For lesions with cysts, specific cutoff values for area (90.91 mm2), depth (7.56 mm), and volume (428.13 mm3) were associated with poor outcomes. (10.1016/j.arthro.2023.03.029)
• [Case_report] Early diagnosis and treatment of cuboid osteomyelitis are essential for enhancing clinical awareness and preventing misdiagnosis. (10.1186/s12891-025-08929-w)
• [L4] However, older patients, deep lesions, and medial lesions uncovered with the medial malleolus were associated with inferior clinical outcomes. (10.1177/0363546512472979)
• [L4] Skin temperature monitoring offers a direct and reliable indication of microcirculatory blood perfusion. (10.1186/s13018-024-05278-7)
• [L4] Walking with shoes did not attenuate vertical forces in either group. (10.1186/1471-2474-11-24)
• [L3] In contrast, MRI is indispensable for evaluating deeper complex structures, such as the SDM and fracture lesions, with both modalities exhibiting a complementary relationship. (10.1186/s12891-026-09662-8)
• [L4] We therefore recommend conservative therapy. (10.1186/1471-2474-9-45)
• [L3] These findings emphasize the importance of careful patient selection and preoperative expectation management rather than dissuading surgical treatment. (10.5435/jaaos-d-20-01394)
• [L2] Patients are expected to present similar performance at 1 year postoperatively. (10.1007/s00167-020-06029-x)
• [L2] Greater Achilles tendon cross-sectional area seen on ultrasound 6 weeks after surgical repair had good clinical prediction for long-term functional outcome. (10.1177/23259671231205326)
• [L4] While MRI is valuable, 99mTc-HMPAO–WBC SPECT/CT provides additional clarity, especially in challenging cases or when metallic implants affect MRI accuracy. (10.3390/tomography10080098)
• [L4] More attention should be paid to appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications. (10.1186/s13018-021-02405-6)
• [L4] The foot function sub-scale (items 1-9) is a reliable and valid sub-scale. (10.1186/1471-2474-15-276)
• [L3] A model combining MRI cartilage integrity, physeal status, and radiographic grade has the highest predictability of intra‐operative cartilage integrity. (10.1177/2325967121s00219)
• [L2] Restoration of 'normal' radiographic parameters may not be necessary to achieve a satisfactory functional outcome for the patient. (10.1302/0301-620x.99b3.35819)
• [L3] Primary AOT shows better functional outcomes compared with secondary AOT after failed microfracture in patients with similar characteristics and lesion size. (10.1016/j.arthro.2016.01.036)
• [L3] The SEFAS is designed for a range of foot disorders including ankle fractures and has the best measurement properties in this population. (10.1186/s12891-018-2051-5)
• [L4] Advanced CT and MRI examinations can significantly reduce the missed diagnosis rate of occult PMFs. (10.1186/s13018-021-02502-6)
• [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
• [L4] Pre-operative evaluation with MRI made an important contribution to the diagnosis of LPNS. (10.1007/s00167-002-0318-7)
• [L3] It was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values. (10.2106/00004623-199709000-00006)
• [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
• [L3] Bone marrow lesions found in the first MRI examination were associated with 5-year incident joint surgery, except for those allocated in lateral compartments. (10.1186/s13018-024-04705-z)
• [L4] Graft non-union is associated with inferior clinical results. (10.1186/s13018-019-1129-6)
• [L2] The findings of this study suggest that a simple footprint assessment board can be potentially useful to detect flatfoot. (10.1186/s12891-021-04154-3)
• [L3] Dysfunction of the windlass mechanism is associated with hallux rigidus, as evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet. (10.2106/jbjs.24.00437)
• [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
• [L3] The study found the MCID was heavily influenced by assessment time points, analytical method, treatment modality, and fracture classification. (10.1177/1558944718812180)
• [L3] Protected weightbearing in an orthopedic device can reduce the risk for complications in acute CN of the foot and ankle. (10.1186/s12891-016-1357-4)
• [L4] In female patients with a more severe anteroposterior talo-first metatarsal angle, an aggravation of symptoms with aging should be expected when managing pes planovalgus deformity. (10.2106/jbjs.19.01504)
• [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)
• [L4] The FFI-RSN has acceptable responsiveness and can be used to evaluate global foot health in clinical or research settings with Norwegian patients suffering from plantar fasciopathy. (10.1186/s12891-022-05374-x)
• [L5] Surgical treatment involving deformity correction to recreate a plantigrade foot along with tendon transfers has been used with notable success to restore a near-normal gait, though limitations and postoperative dorsiflexion weakness have prompted investigation in nerve transfer as a possible alternative surgical treatment. (10.5435/jaaos-d-21-00717)
• [L3] This model assists in patient treatment and counseling by classifying patients into low-, medium-, and high-risk categories. (10.1007/s00167-019-05792-w)
• [L4] Early detection of atraumatic osteonecrosis of the talus may allow the ankle to be treated non-operatively or with core decompression, thus reducing the need for arthrodesis. (10.2106/00004623-199804000-00009)
• [L2] The new algorithm for OLT resulted in a postoperative AOFAS score of ≥ 80/100 in 65% of cases. (10.1007/s00167-022-06876-w)
• [L3] Non-operative treatment of adult patients with a distal radial fracture through VFC reduced secondary healthcare utilization, with similar reported complication and ED reattendance rates compared with treatment without VFC. (10.1177/17531934231187830)
• [L3] The risk prediction model might be translated into clinical guidance and application. (10.1186/s13018-023-04087-8)
• [L3] There was no significant correlation between acceptable alignment according to radiological parameters and short- or medium-term functional outcome in patients older than 60 years with extra-articular DRF treated conservatively. (10.1177/1558944718770203)
• [L4] Acute zone 1 fractures are preferably treated conservatively as similar union rates were found after both conservative and surgical management. (10.1007/s00167-020-06072-8)
• [L2] A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes. (10.1177/17531934231194682)
• [L2] This analysis supports its use as an adjunct to patient-reported outcome measures after carpal tunnel decompression. (10.1177/17531934231226170)
• [L2] The study suggests that the Simple Ankle Value is correlated with existing accepted ankle patient-reported outcome measures. (10.1177/23259671231200498)
• [L4] It can be recommended for the comprehensive assessment of the clinical conditions of patients with hallux valgus (HV) deformity in Mainland China. (10.1186/s13018-025-06196-y)
• [L2] Consideration of the evidence, ICF domains, wrist diagnoses, and assessment design can help hand therapists select the measure most appropriate for use. (10.1016/j.jht.2016.03.001)
• [L4] Subjects with concurrent neuropathy and claw toe deformity were associated with the smallest intrinsic foot muscle volumes and the thickest plantar aponeuroses. (10.1186/s12891-020-03503-y)
• [L4] This tool can be used in usual practice and research for analysing foot and ankle disorders in Arabic-speaking people. (10.1186/s13018-022-03092-7)
• [L4] The condition appears to be self-limiting and to regress fairly rapidly both clinically and radiographically without residual deformity or sequelae. (10.2106/00004623-199512000-00014)
• [L4] Although the functional results generally appeared to be good to excellent, complications and reoperations were frequent; thus, this approach could be considered when patients have few or no alternatives other than amputation. (10.1097/corr.0000000000002730)
• [L4] The technique provides satisfactory results at a mean follow-up of 5 years with minimal complications such as synovitis. (10.1007/s00167-004-0521-9)
• [L5] The age of the patients and the stage of the epiphyseal plate were the most important prognostic factors, with juvenile cases having a much better long-term prognosis than adult cases. (10.1007/s00167-008-0540-z)
• [L1] The two designs functioned equivalently at the time of early follow-up in this low-to-moderate-demand patient group. (10.2106/jbjs.j.00157)
• [L4] Simultaneous bilateral ECTR is a successful procedure with shorter recovery times than reported previously. (10.1177/1558944720940061)

See Also

• Surgical Management

References

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[92] Return to Activities After Simultaneous Bilateral Endoscopic Carpal Tunnel Release. HAND. 2020. DOI: 10.1177/1558944720940061