At last week’s AOFAS Annual Meeting in Seattle in Seattle, researchers presented the first data on robot-assisted total ankle replacement (TAR). The technology in question, TiRobot, is an orthopedic surgical robot whose robotic arm guides K-wire and screw placement using 2D or 3D imaging, with claimed sub-millimeter precision. It’s currently used mainly in spine and trauma surgery. The study The retrospective review of 113 Infinity ankle replacements performed between 20

by Vince Vacketta, DPM Can surgeons predict which patients will remain stiff after TAA, and can adjunctive soft-tissue procedures meaningfully change that? In a recent retrospective review of 175 primary TAAs performed by a single surgeon from 2013–2023, Thomas et al. addressed this question by measuring postoperative motion on weight-bearing radiographs, defining dorsiflexion (DF) under 20° as limited. The mean follow-up was 3.3 years. Key finding Postoperative DF was limit

Joint preservation has traditionally focused on cartilage restoration, but with mixed results. One example is a meta-analysis by Rikken et al. reporting “satisfactory” results with microfracture, despite a third of patients showing progressive cartilage and subchondral deterioration. Many in the cartilage space believe the missing link for joint preservation is a treatment strategy for the subchondral bone. Symptoms correlate with subchondral changes Edema is a signal of

Fifth metatarsal fractures are traditionally divided into three zones: Zone I (tuberosity avulsions), Zone II (Jones fractures) and Zone III (diaphyseal stress fractures). Based on a recent diagnostic study, a new two-part system refines Zone 1 injuries by splitting them into two distinct patterns: Avulsion – stable, pulled off by the peroneus brevis tendon Indirect – unstable, caused by a bending force that extends beyond the tendon's footprint Reading the x-rays The dividi

by Vince Vacketta, DPM My Gospel: Open debridement of diseased tendon, resection of the osseous deformity, and reanchoring of the Achilles with tendon transfer when needed. ​ The heterodoxy ​ More developing literature refutes the significance of the Achilles tendon and instead treats insertional disease as little more than “bump pain”: ​ Open vs. MIS repair: Minimally invasive tendon debridement and reinsertion achieves excellent outcomes comparable to open surgery, with les

From 2012 to 2023, overall U.S. applicants to American Orthopaedic Foot & Anke Society fellowship slots declined, with the steepest drop among male MD applicants; female applicants remained stable. In the 2026 SF Match, 88 applicants competed for 79 positions – 46 matched, with one additional position filled post-match, for fellowship match rate of 59%. The hard reality: Most orthopaedic fellowships don't pay off financially A 2025 career-long financial model finds that for m

At its June 2026 meeting, the AAOS Board of Directors approved its first-ever clinical practice guideline for ankle arthritis. Key recommendations Strongly recommends against intra-articular hyaluronic acid alone, which demonstrated no benefit. However, when combined with corticosteroid, it may offer short-term pain relief. Moderate recommendation against intra-articular platelet-rich plasma, as current evidence shows no benefit compared to placebo for ankle osteoarthritis.

by Vince Vacketta, DPM One of the long-proposed advantages of TAA over ankle arthrodesis (AA) has been the preservation of adjacent-joint motion and protection of the subtalar joint. But does that theoretical benefit hold up in practice? Examining the evidence In a recent Level III retrospective matched cohort analysis, researchers examined data from 4,210 patients to compare rates of progression to subtalar arthrodesis after TAA versus AA. The two groups were matched for age

HbA1c is widely used as a gatekeeping tool to delay or deny elective surgery in diabetic patients. Two new studies suggest it may be a poor indicator of actual surgical outcomes. Study 1: Cervical spine surgery (ACDF) In a study of 75 diabetic and prediabetic patients, HbA1c category had no significant impact on complication or revision rates at 30, 90, or 180 days postoperatively. Study 2: Foot and ankle surgery (the more striking finding) A second study examined 106 diabeti

A systematic review of nine randomized controlled trials (14 comparisons) examined how MRI-measured articular cartilage responds to exercise in people with knee osteoarthritis (OA). Key findings The review found that exercise did not harm cartilage in the following OA groups: At-risk populations: No effect on cartilage defects was observed. One comparison showed improved glycosaminoglycan (GAG) content. Established OA: Most comparisons showed no effect on cartilage thickness

by Vince Vacketta, DPM A new longitudinal study, Stable Long-term PROMIS Outcomes After Deep Peroneal Nerve Neurectomy for Midfoot Arthritis, found that deep peroneal nerve (DPN) neurectomy provided durable pain relief at six-year follow-up. These results support it as a viable motion-preserving alternative to midfoot arthrodesis in carefully selected patients. Key findings Nearly half of patients (47%) achieved clinically meaningful pain improvement. Pain relief was maintain

Three notable foot and ankle injuries struck during the 2026 FIFA World Cup tournament, each with real consequences. Nico Schlotterbeck (Germany) suffered a high-ankle sprain in the group stage and didn't play another minute, a significant blow to Germany's defensive core. Jurrien Timber (Netherlands) went down mid-tournament and was confirmed out, further depleting a Dutch backline already stretched thin. Kylian Mbappé (France) rolled his ankle in the quarterfinal against M

by Vince Vacketta, DPM ​ Yes, I’m back on this topic again. Study questions need for deltoid repair A study published early this month provides compelling evidence that omitting deltoid repair does not worsen short-term outcomes. Researchers analyzed 132 SER-IV (AO/OTA 44-B2) ankle fractures: 89 bimalleolar fractures. 43 deltoid-variant. No deltoid ligament repairs were performed. Patients requiring posterior malleolar fixation or syndesmotic fixation were excluded. After a

Blood Flow Restriction Training (BFRT) and Achilles Tendinopathy BFRT is a lower-load path to recovery when heavy resistance training is too painful or when progress has plateaued. The study that tested BFRT A 2021 study investigated the effects of BFRT on Achilles tendon thickness by comparing exercise protocols. 52 participants were split into three groups: low-intensity resistance exercise (LI), high-intensity resistance exercise (HI), and low-intensity resistance with BFR

Antigravity treadmills, popularized by the leading AlterG brand, use pressurized air to reduce effective body weight by up to 80%. Long employed by high-profile athletes, the technology now raises the question of whether it can help everyday fracture patients. Testing antigravity therapy A recent trial examined whether antigravity treadmill therapy improves recovery after lower extremity fractures compared to standard care. 78 patients with knee and distal tibia fractures we

Adjacent joint arthritis is a big problem with ankle fusion, so why not with first MTP fusion? The study: Radiographic changes vs. patient outcomes In an exploratory study published last month, 77 patients were followed for nearly nine years. Radiographic arthritis progression was significant in all adjacent joints, most notably the interphalangeal joint (66 of the 77 cases). The tarsometatarsal, naviculocuneiform, and talonavicular joints also showed measurable degenerative

MA is the second most common site of arthritis in the foot. Inconsistent treatment approaches and limited academic focus create the opportunity for new avenues of research. Weight-bearing CT (WBCT) now offers a way to study associated risk factors for MA. WBCT analysis reveals MA risk factors Researchers analyzed 606 cases (out of 1,316 total) from a single hospital’s WBCT database. They divided cases by the presence of MA and examined 25 potential risk factors. MA affected

by Vince Vacketta, DPM Orthopedic surgeons have long debated the effect of NSAIDs on bone healing. The spine literature, in particular, shows an increased risk of pseudarthrosis following prolonged or high-dose postoperative use. But NSAIDs may not be the only commonly prescribed medications that deserve our attention. ​​ Retrospective review of hindfoot and ankle arthrodesis ​ A new study suggests chronic PPI therapy may also negatively impact fusion healing following hindf

Subchondral insufficiency (SI) of the knee manifests as pain, with imaging showing edema in the femur or tibia. SI represents bone failure beneath cartilage in early to moderate osteoarthritis, and current surgical options are limited short of joint replacement. A February 2025 study introduces a novel structural solution adapted from construction engineering: a "rafter" arrangement of biointegrative, fiber-reinforced nails designed to internally support the failing bone. Raf

by Vince Vacketta, DPM A national database study published last month compared outcomes between two surgical treatments for end-stage ankle arthritis: primary TAA and AA. The analysis included 69,627 propensity-matched patients in each group. The study found that TAA was associated with better outcomes and lower healthcare costs compared with arthrodesis: Reoperations, Revisions, and Reoperations: The overall reoperation rate was 3.1% after TAA compared with 7.7% after arthr

We all want an effective approach to improve outcomes with osteochondral lesions of the talus. CBMA, rich in stem cells and cartilage-promoting factors, has emerged as a potential solution, but clinical evidence remains limited. A systematic review of 15 studies (PubMed, Scopus, Cochrane) examining functional and pain outcomes after CBMA-assisted surgical treatment of osteochondral talus lesions in adults. CBMA improved pain and function across multiple applications – standa

Since infection is a common indication for TMA, patients undergoing this procedure face a high risk of developing surgical site infections. Study design and scope A systematic review of global databases identified five studies (two clinical trials, three observational) covering 378 procedures and four interventions to reduce surgical site infections following TMA. Key outcomes Antibiotic beads embedded in tissue before closure reduced infection rates. Negative Pressure Woun

Surgeons drop implants more often than you'd think. When this happens, it’s not just embarrassing, it’s a genuine safety risk. The uncomfortable truth is that operating room floors are microbial party venues. Pathogens readily colonize these surfaces, so a dropped implant is a potential post-op surgical infection waiting to happen. What surgeons do when an implant is dropped Most delay surgery over using a contaminated implant. Some soak the implant in antiseptic solution to

by Vince Vacketta, DPM Does the time of day a cervical spinal fusion begins, or whether the surgery crosses an operating room shift change, affect patient outcomes? Researchers conducted a study examining three timing factors – case start time, operating room shift changes, and case order – to determine whether scheduling and workflow influence outcomes after cervical spinal fusion in patients with similar demographics and comorbidities. Key study findings Intraoperative shif