Strict BMI cutoffs for total ankle arthroplasty (TAA) may unintentionally restrict who gets surgery.  A recent  study  of 1,215 TAA patients from the   ACS-NSQIP database (2011–2020) found that applying common BMI eligibility cutoffs (<50, <45, <40, <35) disproportionately affected certain racial, ethnic, sex, and age groups.  What they found The analysis revealed notable disparities in eligibility across these demographic groups: The tighter the BMI cutoff, the bigger the di

by Vince Vacketta, DPM As winter sets in, for many of us, both snow and your patients may be falling. ‘Tis the season to review some recent literature on ankle fractures.  Center-center clamp placement  study : CT quality reduction without the hassle? The study was a cadaveric investigation designed to identify the optimal position for clamp placement on fluoroscopy. It found that a fluoroscopic “center-center” view for clamp placement accurately aligns with established CT-b

While genomics studies the full set of genes, proteomics studies the proteins those genes produce, which can more directly reflect a cell’s physiologic state.  In this  study , using proteomics, authors asked: Why do treatment responses differ between traditional tenopathy and tenopathy associated with diabetes? The study Researchers analyzed Achilles tendon tissue using mass spectrometry to quantify thousands of proteins, comparing patterns from three groups: Tendinopathy (n

In the spirit of Thanksgiving, when many of us add a little extra to our plates, a new  study  looked at how body mass index (BMI) influences recovery after lower-extremity fracture surgery. Using a 20-year national dataset, adults with BMI ≥30 were compared to those with BMI <30, all followed for two years. Short-term risks (first 90 days)  Obesity increased complications across the board:  Pulmonary embolism: +55% Deep vein thrombosis: +30% Renal failure: +22% Wound disrup

by Vince Vacketta, DPM To examine whether adding a second metatarsal shortening (Weil) osteotomy is truly needed to address transfer metatarsalgia in patients undergoing first MTPJ arthrodesis, a new study compared outcomes between patients who had first MTPJ fusions alone and those who received the fusion combined with a second metatarsal Weil osteotomy. Study results A second metatarsal Weil osteotomy is not needed Pain and functional outcomes were similar between both gro

For surgeons and patients with end-stage arthritis, the choice between joint replacement and fusion isn’t always clear. A new study offers direct comparison by analyzing 100 INFINITY ®  total ankle arthroplasty (TAA) patients (2008-2021) and 200 fusion patients (2013-2021), all with at least one year of follow up. Adults ≥19 years reported outcomes using the Ankle Osteoarthritis Scale, MODEMS, and SF-36, providing a head-to-head look at pain relief and long-term function.  R

The insurance side of AI   Centers for Medicare and Medicaid Services (CMS) does not require insurers to disclose how they make authorization decisions or how predictive technologies factor into the process. A 2025  survey  found that most insurers are now using AI, with 68% using it for prior authorization reviews. The battle lines are drawn when decisions to deny care are made without human oversight. In this same survey, only 12% of insurers said they used or were consider

by Vince Vacketta, DPM   PNBs have become a popular tool for managing pain after orthopedic surgery, but a new look at nearly 23,000 patients at Massachusetts General Hospital suggests the story is more nuanced.   This single-center retrospective  study  compared patients who received single-injection PNBs with those who did not. In the recovery room, the benefits were clear: patients with PNBs reported lower peak pain scores and required fewer opioids. But once the block wor

Ligament augmentation in lateral ankle reconstructions got a big boost with the publication of a Level 1  paper  showing superior two- and five-year outcomes when using a ligament augment. Since then, the market has expanded with offerings from  Stryker  ( Artelon ), Arthrex  (Internal Brace),  Conmed  (BioRez), and  Medline  (ForceWeb). Augment use in ortho foot and ankle In an online  survey  of American Orthopaedic Foot & Ankle Society (AOFAS), 85.7% reported using ligamen

Metal hypersensitivity affects 10-15% of foot and ankle patients, usually presenting with an eczematous-type rash overlying metallic implants and representing a type IV delayed hypersensitivity reaction.  Relevance of jewelry allergy A history of jewelry or contact allergy is an important clue. Research shows that 60% of patients with prosthesis-related hypersensitivity (PRH) patients had a known contact allergy – 25.7% to metals and 34.6% to other substances. In a patch test

The peroneus longus (PL) tendon is often used an autograft source with the belief that donor-site morbidity is minimal. However, this new  study  challenges that belief and causes us to pause before sacrificing the PL tendon. Study design The study is a retrospective review of 35 patients (mean age 43) who underwent PL autograft harvest between 2021–2023, with an average 22.5-month follow-up. Pre- and postoperative assessments included SANE, AOFAS, FAOS, CAIT scores, and ankl

by Vince Vacketta, DPM Two recent studies shed light on early weightbearing and mobilization following ankle fracture ORIF:  Study 1  – Hybrid cast and brace vs. traditional cast This study compared a hybrid approach (short cast followed by a functional brace) with the traditional six-week cast, evaluating function, pain, complications over two years. It found that rigid, long-duration immobilization is not necessarily superior. More flexible or functional approaches can matc

PCFD involves progressive ligamentous and bone changes. While osseous deformities are well described, ligament orientation is the focus...

by Vince Vacketta, DPM AA has long been regarded as the gold standard procedure for end-stage ankle arthritis (ESAA). But in 2025, with...

GLP-1 receptor agonists (GLP-1 RAs), commonly prescribed for type 2 diabetes (T2DM) and obesity, may affect orthopedic outcomes beyond...

First metatarsophalangeal (MTP) joint arthrodesis is traditionally fixed using plates and screws. Nitinol, a superelastic alloy, offers...

by Vince Vacketta, DPM Medial malleolar fractures (MMF) remain a significant and well-recognized complication of total ankle arthroplasty...

Platelet-rich plasma (PRP) therapy is increasingly recognized as a promising treatment for musculoskeletal disorders, including...

Each surgeon has their own method for applying post-operative splints, but even the most careful ones with high volumes can encounter...

The  AOFAS Annual Meeting , taking place September 10-13 in Savannah, will feature a few big product releases, including:    Stryker’s ...

by Vince Vacketta, DPM Is direct deltoid ligament repair necessary for BEF, and does such a repair improve patient outcomes?  This...

by Vince Vacketta, DPM A short course of ketorolac doesn’t impair bone healing after first metatarsophalangeal joint (MTPJ) fusion, with...

The knee lies midway along the mechanical axis between the hip and the foot, so it’s unsurprising that TKA alignment can impact foot and...

Large scale scientific fraud is real. Some publishers report that up to one in seven of their submissions likely originate from “paper...