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What's New — Foot — October 2026

12 new articles published this month.

Themes: Calcaneal Fracture Management · Minimally Invasive Forefoot Techniques · Osteochondral Lesions of the Talus · Ankle Ligament and Sports Injuries

Digest generated 2026-11-04 16:22:51+00:00.

Highlights

Calcaneal Fracture Management

This month's digest features a strong focus on calcaneal fractures, spanning historical context to contemporary techniques. A comprehensive review traces the evolution of primary subtalar arthrodesis for displaced intra-articular fractures from 1911 to present day [8], while a current-concepts article outlines anatomical assessment, imaging, and the shift toward minimally invasive approaches like the sinus tarsi technique [11]. A case series supports external fixation via a minimally invasive sinus tarsi approach, reporting acceptable AOFAS scores and low wound-complication rates [9]. Complementing these, an endoscopic posterolateral subtalar release addresses subtalar stiffness, a common late complication of calcaneal fractures, allowing early vigorous mobilization through smaller incisions [1].

Minimally Invasive Forefoot Techniques

Minimally invasive and endoscopic techniques for forefoot and midfoot pathology are highlighted. A historical review charts the evolution of minimally invasive surgery (MIS) for forefoot deformity correction, from early high-complication enthusiasm in the United States to a European-led renaissance with refined instrumentation [3]. For postoperative complications, an endoscopic plantar partial sesamoidectomy offers a direct approach to manage first metatarsal head metatarsalgia following first metatarsophalangeal joint arthrodesis, eliminating plantar pressure points through an all-endoscopic technique [6]. Additionally, an arthroscopic technique using suture tape augmentation addresses anterior calcaneal process avulsion fractures with bifurcate ligament injuries, combining fragment excision with internal brace augmentation to restore midfoot stability [2].

Osteochondral Lesions of the Talus

Two articles address osteochondral lesions of the talus (OLT). A state-of-the-art review summarizes evolving management strategies, emphasizing that surgical outcomes depend on lesion size, morphology, cartilage integrity, and subchondral bone involvement; it covers fragment fixation, bone marrow stimulation, and replacement procedures [5]. Complementing this, a retrospective study of autologous osteoperiosteal transplantation (AOPT) for cystic (Hepple V) lesions defines maximal outcome improvement thresholds for patient-reported measures and identifies BMI and plug number as predictors of achieving clinically meaningful satisfaction after surgery [4]. Together, these papers provide both strategic guidance and patient-specific outcome benchmarks for OLT treatment.

Ankle Ligament and Sports Injuries

Sports-related foot and ankle topics round out this month's digest. A letter to the editor discusses the efficacy of inferior extensor retinaculum reinforcement during arthroscopic lateral ligament repair, citing prior studies showing only modest early advantages without sustained superiority at final follow-up [10]. A methodological critique of the 2025 International Foot and Ankle Sports Consensus on navicular fractures in elite athletes identifies a data extraction error, recalculating mean return-to-sport time at approximately 19.7 weeks rather than 8.2 weeks, aligning with expert recommendations of 4-6 months postoperatively [7]. Finally, a mid-term observational study of 130 patients found no significant flatfoot deformity incidence following peroneus longus autograft harvest for ACL reconstruction, addressing donor-site morbidity concerns [12].

Articles by Theme

Calcaneal Fracture Management (4)

1. Pan X, Lui TH, Pan Y, et al. Endoscopic Posterolateral Subtalar Release. Arthroscopy Techniques 2026. doi:10.1002/atn2.70377

The authors describe an endoscopic posterolateral subtalar release technique for subtalar stiffness after joint-depression calcaneal fractures, combining resection of the posterior calcaneal spur with soft-tissue release of the posterior and lateral aspects of the posterior subtalar joint. The minimally invasive approach permits immediate vigorous postoperative mobilization, which open release with its large wounds would preclude. This offers a viable option for patients with subtalar stiffness whose symptoms limit walking on uneven surfaces.

8. Schepers T. The evolution of primary subtalar arthrodesis for displaced intra-articular calcaneal fractures: A historical review. Injury 2026. doi:10.1016/j.injury.2026.113549

This historical review traces primary subtalar arthrodesis for displaced intra-articular calcaneal fractures from its introduction by Van Stockum in 1911 to contemporary practice, grouping publications into four eras based on volume, treatment philosophy, and technical developments. It documents how indications, operative techniques, timing, and reported outcomes have evolved over more than a century. The review contextualizes the procedure's enduring role as a valuable option in carefully selected patients with severe calcaneal fractures.

9. Morelli F, Caperna L, Pepino M, et al. External fixation for displaced intra-articular calcaneal fractures: A case series. Injury 2026. doi:10.1016/j.injury.2026.113633

Thirty-two patients (35 displaced intra-articular calcaneal fractures) underwent minimally invasive sinus tarsi approach fixation with an external fixator in a retrospective case series. At mean 22-month follow-up, the mean AOFAS score was 75.4, with only two superficial pin-tract infections and no deep infections or wound complications. External fixation appears a valid alternative to ORIF, offering adequate reduction, early weight-bearing, and low soft-tissue morbidity.

11. Lucas y Hernandez J. Acute intra-articular calcaneal fractures: currents concepts. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104916

This narrative review summarizes current concepts in acute intra-articular calcaneal fractures, covering anatomy, imaging (CT as reference standard), and the evolving surgical-versus-conservative debate. Minimally invasive techniques such as the sinus tarsi approach, percutaneous screw fixation, and intramedullary nailing reduce soft-tissue morbidity while restoring hindfoot alignment and joint congruence. Displaced Sanders II-III fractures are the main indication for osteosynthesis, while Sanders IV fractures warrant discussion between ORIF and primary subtalar arthrodesis.

Minimally Invasive Forefoot Techniques (3)

2. Díaz‐Fernández R. Arthroscopic Technique for Anterior Calcaneal Process Avulsion Fractures and Bifurcate Ligament Injuries Using Suture Tape Augmentation. Arthroscopy Techniques 2026. doi:10.1002/atn2.70330

This technical note presents an arthroscopic management strategy for anterior calcaneal process avulsion fractures with associated bifurcate ligament injury, combining endoscopic excision of intra-articular fragments with suture tape internal brace augmentation of both limbs of the bifurcate ligament while preserving native fibres. The technique restores ligamentous stability and joint function in a minimally invasive fashion. It avoids the morbidity of open surgery and rigid across-joint fixation, potentially reducing persistent lateral midfoot pain and instability.

3. Tan CY, Thevendran G. Evolution of minimally invasive surgery (MIS) techniques in forefoot deformity corrections. International Orthopaedics 2026. doi:10.1007/s00264-026-07060-2

This historical review traces the evolution of minimally invasive surgery (MIS) for forefoot deformity correction from early general surgical concepts to modern foot and ankle applications, drawing on electronic and manual literature searches. The trajectory parallels that of laparoscopic surgery: initial enthusiasm with high complication rates in the United States, followed by a European-led renaissance based on strict anatomical landmarks and technologies such as the Shannon burr and image intensifiers. Hallux valgus MIS has progressed through four distinct generations, illustrating continuous conceptual and technical refinement.

6. Pan X, Lui TH, Li CCH, et al. Endoscopic Plantar Partial Sesamoidectomy for the Management of Metatarsalgia of the First Metatarsal Head After Arthrodesis of the First Metatarsophalangeal Joint. Arthroscopy Techniques 2026. doi:10.1002/atn2.70308

The authors describe an all-endoscopic plantar partial sesamoidectomy for first metatarsal head metatarsalgia occurring after first metatarsophalangeal joint arthrodesis, indicated when isolated excessive plantar pressure persists without significant sagittal deformity. The plantar-to-dorsal approach more directly eliminates the plantar pressure point than arthroscopic sesamoidectomy, and the extent of ostectomy can be titrated intraoperatively based on plantar pressure distribution. This offers a minimally invasive surgical option when conservative measures fail.

Osteochondral Lesions of the Talus (2)

4. Hu F, Yang S, Shao Q, et al. Maximal Outcome Improvements Predict Patient Satisfaction After Autologous Osteoperiosteal Transplantation for Cystic Osteochondral Lesions of the Talus, With Body Mass Index and Plug Number Associated With Threshold Achievement. Arthroscopy 2026. doi:10.1002/arj.70651

In a retrospective study of patients with Hepple V cystic osteochondral lesions of the talus treated with autologous osteoperiosteal transplantation (AOPT), the authors determined maximal outcome improvement (MOI) thresholds for patient-reported outcome measures that predict satisfaction, using distribution- and anchor-based methods with ROC curve analysis. Higher BMI and greater plug number were associated with failure to achieve these thresholds. Clinicians can use MOI thresholds as benchmarks for counseling patients and monitoring recovery after AOPT for cystic talar lesions.

5. Rubin J, Tham A, Gauthier P, et al. Evolving Management Strategies for Osteochondral Lesions of the Talus. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01591

This review summarizes evolving management strategies for osteochondral lesions of the talus (OLT), emphasizing that treatment selection should account for lesion size and morphology, cartilage integrity, subchondral bone involvement, and ankle stability. Fragment fixation (including lift-drill-fill-fix) suits viable fragments, bone marrow stimulation remains appropriate for small contained lesions despite variable long-term durability of fibrocartilage, and replacement procedures such as autologous or allograft osteochondral transplantation are favored for larger or complex lesions. The work provides a framework for individualized operative decision-making in this challenging injury.

Ankle Ligament and Sports Injuries (3)

7. Zimmermann FJ, Amling M, Simon A. Navicular fractures in elite athletes: Clarifying the evidence base of the 2025 International Foot and Ankle Sports Consensus. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70632

This letter critiques the 2025 International Foot and Ankle Sports Consensus systematic review on navicular fractures in elite athletes, identifying methodological and reporting errors that affect return-to-sport (RTS) guidance. Recalculation shows the mean RTS after operative treatment of navicular stress fractures is approximately 19.7 weeks (4.5 months), not the reported 8.2 weeks, consistent with the consensus recommendation of 4-6 months; additional concerns include inclusion of studies outside the eligibility window and paediatric cohorts. These clarifications matter for evidence-based RTS decision-making.

10. Maffulli N, Spiezia F, Oliva F, et al. Efficacy of Inferior Extensor Retinaculum Reinforcement in Arthroscopic Ankle Lateral Ligament Repair: Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261470347

In this letter, the authors respond to a randomised trial on arthroscopic lateral ankle ligament repair with or without inferior extensor retinaculum (IER) reinforcement, citing two prior studies from their group. Those studies found equivalent 24-month functional outcomes with or without IER augmentation, with only a modest early advantage at 3-6 months. The clinical implication is that routine IER reinforcement may not provide durable added benefit over isolated arthroscopic Broström repair.

12. Pontoh LA, Dilogo IH, Lubis AMT, et al. Incidence of Flatfoot Deformity After Anterior Cruciate Ligament Reconstruction Using Peroneus Longus Autograft: A Mid-Term Observational Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261487856

This prospective case series of 130 patients evaluated the incidence of flatfoot deformity after ACL reconstruction using peroneus longus autograft, using weightbearing podograms and the Arch Index as the primary criterion. The study assessed whether medial longitudinal arch collapse occurs following tendon harvest and its relationship with generalized joint laxity (Beighton score). The findings inform graft selection by clarifying donor-site morbidity risk when harvesting the peroneus longus tendon.

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