What's New — Foot — September 2026¶
10 new articles published this month.
Themes: Talar osteochondral lesion management · Minimally invasive and technical innovations · Hallux and forefoot surgery · Infection and osteomyelitis · Ligamentous instability and tendon considerations
Digest generated 2026-10-04 16:27:53+00:00.
Highlights¶
Talar osteochondral lesion management¶
Two articles address osteochondral lesions of the talus. Xu et al. report ≥10-year outcomes after bone marrow stimulation, showing that age >45, longer preoperative symptom duration, and deeper bone marrow edema negatively impact long-term clinical and radiological results [5]. Chen et al. describe two novel assistive devices, a sizing template and an impactor rod, for autologous osteochondral transplantation in large talar lesions, demonstrating improved surgical accuracy and good mid-term outcomes in 34 patients [10]. Together, these studies refine both first-line arthroscopic treatment and advanced cartilage restoration strategies for this challenging pathology.
Minimally invasive and technical innovations¶
This theme covers novel or refined surgical techniques across the foot and ankle. Pan et al. describe endoscopic resection of a sinus tarsi ganglion extending to the anterolateral ankle, combining ganglionectomy and sinus tarsi debridement through one portal set for faster recovery and lower recurrence [1]. Keith et al. quantify cartilage disruption from retrograde intramedullary screw fixation of metatarsal fractures in a cadaveric model, showing progressively greater articular damage from the 2nd to 5th metatarsals [8]. Testa et al. evaluate the calcaneo-stop arthroereisis with FIT-CS for juvenile flexible flatfoot, reporting favorable medium-term clinical and radiographic outcomes [6].
Hallux and forefoot surgery¶
Two studies focus on the first ray. Wang et al. use a cadaveric model to demonstrate that the plantar fascia, flexor hallucis longus, and the fibro-osseous tunnel contribute to functional hallux rigidus by limiting first MTP dorsiflexion during weight bearing [3]. Partio et al. present a pilot randomized controlled trial comparing bioabsorbable versus titanium screw fixation in first MTP joint arthrodesis, finding equivalent functional improvement, union rates, and complications at 2 years [7]. These papers advance both the biomechanical understanding and fixation options in hallux surgery.
Infection and osteomyelitis¶
Kundakci et al. retrospectively compare 202 surgically treated osteomyelitis patients, contrasting foot versus non-foot locations. Foot osteomyelitis was more often linked to diabetic foot infections and contiguous spread, whereas non-foot cases more frequently arose from post-traumatic, hematogenous, or postoperative sources, with distinct microbiological profiles. These findings underscore the need for location-specific diagnostic and treatment pathways in osteomyelitis management.
Ligamentous instability and tendon considerations¶
Fleury et al. offer an expert opinion reframing the deltoid ligament as a tri-articular stabilizer of the tibio-talar, subtalar, and talo-navicular joints, warning that neglecting its broader role can lead to post-traumatic plano-valgus deformities [9]. Okutan et al. review the peroneus longus tendon as an ACL reconstruction autograft, addressing concerns about donor-site foot biomechanics and summarizing evidence supporting comparable outcomes to established grafts with generally favorable donor-site function [4]. Both papers highlight the foot's role in broader lower-limb stability and graft harvesting decisions.
Articles by Theme¶
Talar osteochondral lesion management (2)¶
5. Xu L, Cheng X, Li J, et al. Age Greater Than 45, Preop Symptom Duration, and Bone Marrow Edema Depth Negatively Impact Long‐Term Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus. Arthroscopy 2026. doi:10.1002/arj.70562
In 103 patients with small osteochondral lesions of the talus (<150 mm²) treated with bone marrow stimulation and followed at least 10 years (mean 11.8), all age groups improved significantly in pain, function, quality of life, and MOCART-assessed cartilage repair. Patients younger than 30 achieved the best outcomes, while age >45, longer preoperative symptom duration, and greater bone marrow oedema depth negatively affected long-term results. These findings support early BMS treatment and suggest older patients with adverse prognostic factors may warrant alternative or adjunctive cartilage repair strategies.
10. Chen Y, Li M, Fang Z, et al. Design and Application of Two Novel Assistive Devices in Autologous Osteochondral Transplantation for Talar Osteochondral Lesions: A Technical Note. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104875
The authors designed two assistive devices, a sizing template for graft orientation and an impactor rod for graft insertion, to improve autologous osteochondral transplantation for large talar osteochondral lesions, and evaluated them in a retrospective series of 34 patients. At a mean follow-up of 69 months, pain and function scores improved significantly with good MRI-based MOCART scores. These devices may facilitate surgical accuracy and support favourable clinical outcomes in AOT for talar osteochondral lesions.
Minimally invasive and technical innovations (3)¶
1. Pan X, Lui TH, Hong J, et al. Endoscopic Resection of Sinus Tarsi Ganglion Extended to the Anterolateral Ankle. Arthroscopy Techniques 2026. doi:10.1002/atn2.70307
The authors describe a minimally invasive endoscopic technique for resecting a sinus tarsi ganglion that extends into the anterolateral ankle, combining ganglionectomy with sinus tarsi debridement through the same set of portals. The technical note details portal placement and operative steps for this approach. By avoiding open excision, the technique is proposed to offer faster recovery and reduced recurrence for symptomatic ganglia refractory to conservative treatment.
6. Testa G, Sapienza M, Marchetti M, et al. Evaluation of the calcaneo-stop procedure with FIT-CS for the surgical treatment of juvenile flatfoot. International Orthopaedics 2026. doi:10.1007/s00264-026-07030-8
This retrospective study of prospectively collected data evaluated 121 children (218 feet) undergoing Calcaneo-stop arthroereisis with FIT-CS for symptomatic flexible flatfoot, with 3-year follow-up using AOFAS, OxAFQ-C, and Catania scores plus radiographic angles. Clinical and functional scores improved markedly (e.g., AOFAS from ~45 to ~92), with corresponding radiographic correction of Kite's and Costa-Bertani angles. The calcaneo-stop procedure appears to provide durable medium-term correction and functional improvement in juvenile flexible flatfoot.
8. Keith B, Burke J, Hynes K, et al. Cartilage disruption patterns associated with percutaneous intramedullary screw fixation for metatarsal fractures: a cadaveric study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06457-3
In 14 fresh-frozen cadaveric feet (56 lesser metatarsals), standardised retrograde intramedullary screw fixation (3.6 mm) produced mean articular cartilage disruption that increased from the 2nd to 5th metatarsal (10.17%, 17.43%), with screws consistently in the middle third medially-laterally and mostly in the 2nd, 3rd dorsal-to-plantar quadrants. The study quantifies and maps the iatrogenic cartilage injury inherent to this technique. Surgeons should weigh the progressive articular damage, greatest in the 4th and 5th metatarsals, when selecting intramedullary screw fixation for metatarsal fractures.
Hallux and forefoot surgery (2)¶
3. Wang M, Hunter Aitchison A, Orriols AM, et al. The role of the plantar fascia, flexor hallucis longus, and fibro-osseous tunnel in functional hallux rigidus. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06489-9
In 14 cadaveric lower limbs, the authors manipulated the plantar fascia (shortened/lengthened), flexor hallucis longus (shortened), and fibro-osseous tunnel (released) and measured first MTP dorsiflexion using the Dananberg technique. Shortening the plantar fascia or FHL did not significantly reduce dorsiflexion beyond the baseline of about 23.8°, while lengthening the plantar fascia increased dorsiflexion by roughly 6.7°. The results question the primacy of plantar fascia and FHL tension in functional hallux rigidus and suggest other structures, such as the fibro-osseous tunnel, may contribute to weight-bearing limitation.
7. Partio N, Mattila V, Waris V, et al. Bioabsorbable vs. titanium screws in first metatarsophalangeal joint arthrodesis: a pilot randomized controlled trial with 2-year follow-up. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06501-2
In a 30-patient pilot randomised controlled trial, first MTP joint arthrodesis with bioabsorbable cannulated lag screws was compared with titanium screws using a cup-and-cone technique, with follow-up at 3-24 months. Both groups improved substantially with no significant between-group differences in AOFAS or FA-VAS scores; union was 90% overall with three nonunions (one titanium, two bioabsorbable) requiring revision and no implant-related complications. Bioabsorbable fixation appears feasible with comparable preliminary outcomes, warranting larger trials to confirm equivalence.
Infection and osteomyelitis (1)¶
2. Kundakci B, Dalgic Y, Dalkir KA, et al. Clinical, etiological, and microbiological differences between foot and non-foot osteomyelitis. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06486-y
This retrospective study compared clinical, etiological, and microbiological features of 202 surgically treated adult osteomyelitis patients, divided into foot (n=89) and non-foot (n=113) groups using only intraoperative deep tissue/bone cultures. Foot osteomyelitis was predominantly linked to diabetic foot infections and contiguous spread, whereas non-foot cases more often arose from post-traumatic, hematogenous, or postoperative sources, with differing microbiological profiles. The findings support tailoring empirical antibiotic therapy and surgical strategy to the anatomic site and underlying etiology of osteomyelitis.
Ligamentous instability and tendon considerations (2)¶
4. Okutan AE, Budhiparama N, Herbort M, et al. Peroneus longus tendon autograft for anterior cruciate ligament reconstruction: Current evidence, donor‐site complications and patient selection. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70616
This narrative review synthesizes anatomical, biomechanical, and clinical evidence on the peroneus longus tendon as an autograft for ACL reconstruction, including donor-site morbidity and patient selection considerations. Available comparative studies show broadly similar short- to mid-term outcomes to established autografts with generally favourable donor-site function, but the evidence is largely retrospective and heterogeneous, so equivalence or noninferiority is not established. Clinicians may consider PLT grafts, particularly when avoiding additional knee morbidity, but questions remain regarding ankle performance in high-demand athletes and long-term donor-site consequences.
9. Fleury C, Acker A, Dubois-Ferrière V, et al. Deltoid ligament injury: thinking beyond the ankle – an expert opinion. EFORT Open Reviews 2026. doi:10.1530/eor-2025-0268
This expert opinion synthesizes anatomical, biomechanical, and clinical evidence to reframe the deltoid ligament as a tri-articular stabilizer of the tibio-talar, subtalar, and talo-navicular joints rather than an isolated ankle structure. The authors argue that neglecting this broader role can lead to irreversible post-traumatic plano-valgus or plano-abductus deformities. Clinically, deltoid ligament injuries should be systematically assessed in both acute and chronic settings, regardless of whether treatment is conservative or surgical.