What's New — Foot — August 2026

19 new articles published this month.

Themes: Hallux valgus and MTP1 surgery · Calcaneal fracture management · Midfoot trauma and classification · Athletic performance and injury screening · Reconstruction and salvage procedures · Clubfoot and humanities

Digest generated 2026-09-14 08:31:52+00:00.

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Highlights

Hallux valgus and MTP1 surgery

This month's hallux valgus literature spans deformity quantification, joint-preserving versus joint-sacrificing correction, and adjacent midfoot implications. A new articular dislocation angle quantifies first MTP subluxation and delineates the contributions of HVA, DMAA, and DASA to the deformity [2]. In severe hallux valgus, retrospective comparison of Scarf osteotomy against first MTP arthrodesis addresses satisfaction, footwear needs, residual pain, and complications [19]. Concomitant second tarsometatarsal arthrodesis during hallux valgus correction produced distinct radiographic midfoot and transverse arch changes versus isolated correction [5], while long-term data on first MTP total arthroplasty for hallux rigidus report implant retention and revision outcomes beyond ten years [1].

Calcaneal fracture management

Three studies address operative treatment and its complications in the calcaneus. Comparing robot-assisted percutaneous screw fixation, sinus tarsi approach, and extended lateral approach for displaced intra-articular fractures, all achieved similar radiographic and functional results, but the minimally invasive option reduced blood loss and accelerated early recovery while the extended lateral approach carried the highest wound complication rate [18]. For fracture-related infection with soft-tissue defects, bone cement with local flap transfer suited smaller defects and free myocutaneous flaps larger ones, with outcomes stratified by FRI classification [16]. Additionally, subtalar arthrodesis showed no union-rate differences between graft choices, informing salvage fusion decisions [15].

Midfoot trauma and classification

Lisfranc injuries take center stage with a newly proposed Suthersan classification developed from a large single-surgeon series, designed to capture force propagation through the midfoot and improve on the limited outcome correlation of Myerson-Hardcastle and Nunley-Vertullo systems [17]. Complementing this, anchor-based thresholds for minimal clinically important difference were found to better define meaningful six-month recovery after Jones fracture open reduction and internal fixation than distribution-based methods, offering more clinically applicable recovery benchmarks for midfoot-adjacent forefoot trauma care [9].

Athletic performance and injury screening

Sports-focused foot and ankle research this month emphasizes screening and return-to-play. A systematic review of hallux sesamoidectomy in active patients found high return-to-sport rates around 92% with defined time frames and complications [8]. Countermovement jump force-plate metrics were linked to traditional performance measures in youth female soccer athletes, clarifying field applicability [11]. A multimodal 3D running assessment combining markerless motion capture, ground reaction forces, and surface EMG identified biomechanical asymmetries tied to running-related injury risk [14]. In professional baseball, lower-extremity injury in MLB pitchers was associated with increased subsequent upper-extremity injury risk, underscoring kinetic-chain vulnerability [12].

Reconstruction and salvage procedures

Complex reconstructive scenarios are covered across several reports. Hexapod-assisted tibiocalcaneal arthrodesis after talectomy using the TL-HEX system achieved limb salvage in high-risk patients with talar destruction from infection, avascular necrosis, trauma, or neuroarthropathy [4]. For Freiberg's disease, meta-analysis compared autologous osteochondral transplantation with dorsiflexion closing wedge metatarsal osteotomy on functional, radiographic, and complication outcomes [13]. Accelerated rehabilitation after suture-tape-augmented modified-Brostrom reconstruction permitted immediate weight bearing without increased failure rates [10]. A case report also described extension-type hallux checkrein deformity after fibular osteotomy during high tibial osteotomy, highlighting EHL tethering as a rare complication [7].

Clubfoot and humanities

Two remaining articles round out the digest. A prospective observational study correlated serial foot anthropometric measurements with the Modified Pirani score during Ponseti correction of idiopathic congenital talipes equinovarus, adding objective morphological monitoring to clinical scoring [3]. Separately, an arts and humanities piece, 'Dorsiflex,' reflects on anatomy, movement, and the human body through pastel artwork created during a neurology clerkship [6].

Articles by Theme

Hallux valgus and MTP1 surgery (4)

1. Gulhan DA, Ergin M, Erkoçak ÖF, et al. Long-term clinical, functional and radiological outcomes after total arthroplasty of the first metatarsophalangeal joint in the treatment of hallux rigidus. International Orthopaedics 2026. doi:10.1007/s00264-026-07008-6

This retrospective single-center study evaluated 41 patients who underwent first metatarsophalangeal joint total arthroplasty for hallux rigidus with a minimum ten-year follow-up, comparing clinical, functional, and radiological outcomes between one and ten years postoperatively. Among the 35 patients with retained implants, VAS and AOFAS Hallux-MTP-IP scores and dorsiflexion range of motion remained improved at long-term follow-up, though implant retention and revision requirements were assessed across the full cohort. The findings provide long-term data to inform surgical decision-making and patient counseling regarding implant survival and the durability of pain relief and function after first MTP joint arthroplasty.

2. Guo M, Liu F, Gan Y, et al. The Articular Dislocation Angle of the First Metatarsophalangeal Joint. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.00955

This radiographic study introduced the articular dislocation angle (ADA), defined as the angle between lines perpendicular to the proximal articular surface of the proximal phalanx and the distal articular surface of the first metatarsal, to quantify subluxation or dislocation of the first metatarsophalangeal joint in hallux valgus. Measurement of HVA, DMAA, DASA, and ADA on weight-bearing radiographs of 70 feet revealed quantitative relationships among these parameters, delineating the relative contributions of each deformity component to hallux valgus pathology. The ADA offers surgeons a reproducible preoperative measurement to characterize joint dislocation and plan corrective osteotomies tailored to the specific deformity components present.

5. Kim J, Kyung MG, An Y, et al. Radiographic changes in midfoot alignment after hallux valgus correction with and without concomitant second tarsometatarsal arthrodesis: a comparative study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06471-5

This retrospective matched comparative study of 73 feet with hallux valgus and medial column malalignment compared radiographic arch changes after hallux valgus correction with (n=37) versus without (n=36) concomitant second tarsometatarsal arthrodesis at a minimum one-year follow-up. The TMT arthrodesis group demonstrated greater correction of transverse arch parameters (M2-M5 angle, C1-M2 distance) than isolated hallux valgus correction, with medial column alignment (lateral Meary's angle) also assessed. These findings suggest that adding second TMT arthrodesis in selected patients with symptomatic arthritis and medial column malalignment provides additional midfoot alignment correction beyond that achieved with hallux valgus correction alone.

19. Mahieu A, Mouton A, Graff W. Scarf osteotomy versus first metatarsophalangeal arthrodesis for severe hallux valgus: a retrospective comparative study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104810

In a single-surgeon retrospective series of 61 feet with severe hallux valgus (lateral sesamoid displacement >75% of the intermetatarsal space), first MTP arthrodesis (25 feet) was compared with Scarf osteotomy (36 feet) at minimum one-year follow-up. The study tested whether arthrodesis yields more very satisfied patients, less footwear adaptation, less residual pain, and different complication rates than the joint-preserving Scarf osteotomy. Results inform procedure selection for severe deformity, though the retrospective single-centre design limits generalizability.

Calcaneal fracture management (3)

15. Munoz M, Khvesyuk M, Leroux V, et al. No differences in union rates between grafts for subtalar arthrodesis. EFORT Open Reviews 2026. doi:10.1530/eor-2024-0202

This EFORT Open Reviews article compared union rates across different graft options for subtalar arthrodesis. The analysis found no significant differences in fusion success between graft types. Surgeons can therefore select graft material based on other considerations such as cost, availability, or donor-site morbidity rather than expected union rate.

16. Zhou F, Liu H, Zhang Y, et al. Surgical treatment of fracture-related infections of the calcaneus with relevant soft-tissue defects. Injury 2026. doi:10.1016/j.injury.2026.113398

This retrospective study of 43 patients compared bone cement with local flap transfer (for defects ≤3 cm) versus free myocutaneous flap reconstruction (for defects >3 cm) in treating calcaneal fracture-related infection with soft-tissue defects after ORIF. Both techniques produced significant improvements in AOFAS hindfoot and VAS pain scores with comparable complication rates, though free flaps required longer operative time and greater blood loss. Defect size can guide selection between these two reconstruction strategies for this challenging condition.

18. Zhao B, Ma C, Liu Q, et al. Comparison of three surgical methods in the treatment of displaced intra-articular calcaneal fractures: A retrospective study. Injury 2026. doi:10.1016/j.injury.2026.113468

This retrospective cohort of 190 patients (202 feet) with Sanders II/III displaced intra-articular calcaneal fractures compared robot-assisted percutaneous screw fixation, sinus tarsi approach open reduction, and extended lateral approach plating. Radiographic and final AOFAS/VAS outcomes were similar across groups, but robot-assisted fixation reduced blood loss and weight-bearing time with faster early function, while the extended lateral approach carried the highest wound complication rate (12.2% vs 0% and 1.8%). Robot-assisted percutaneous fixation may be preferable when available, though longer-term follow-up is needed to confirm equivalence in final function.

Midfoot trauma and classification (2)

9. Olawin A, Saggar R, Mozzocio J, et al. Paper 59. Anchor-Based Thresholds May Better Define Meaningful 6-Month Recovery Than Distribution Methods Following Jones Fracture Open Reduction and Internal Fixation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00316

This retrospective study compared anchor-based versus distribution-based methods for calculating minimal clinically important difference (MCID) thresholds for FAAM-ADL, FAAM-Sport, and VAS pain scores after ORIF of Jones fractures. Anchor-based thresholds derived from sensitivity/specificity analyses better identified patients achieving meaningful 6-month functional recovery than the one-half standard deviation distribution method. Clinically, MCID thresholds for this procedure should be anchor-derived rather than distribution-derived to accurately benchmark recovery.

17. Cawley WC, Hwang P, Mittal R, et al. Rethinking the Lisfranc injury: Rationale for and development of a new classification system for Lisfranc injuries. Injury 2026. doi:10.1016/j.injury.2026.113422

The authors developed the Suthersan classification for Lisfranc injuries from a large single-surgeon case series at an Australian tertiary trauma centre, excluding direct crush injuries, with inter- and intra-observer reliability as primary outcomes. The system was designed to address limitations of the Myerson-Hardcastle and Nunley & Vertullo classifications by accounting for force propagation through the midfoot to identify structures requiring stabilisation. If reliability proves adequate, it could standardize management and improve prognostication for these frequently missed injuries.

Athletic performance and injury screening (4)

8. Bouzid N, Johri M, Simpson C, et al. Return to Athletic Activity Following Sesamoidectomy: A Systematic Review of Time Frames and Clinical Outcomes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261477555

This systematic review of six studies comprising 193 athletically active patients (72.2% female) evaluated return to sport and complications after partial or complete hallux sesamoidectomy for refractory sesamoid pathology. The weighted mean return-to-sport rate was 91.9% at a mean of 12.2 weeks, with 83.6% returning to preoperative performance levels and complication rates ranging from 0% to 29.2%. These findings provide evidence-based expectations for counseling athletic patients that sesamoidectomy reliably permits return to sport within approximately three months, albeit with a notable risk of complications.

11. Lambert BS, Momin S, Rivera A, et al. Poster 164. Translating Force Plate Data: Linking Countermovement Jump Metrics to Traditional Performance Measures in Youth Female Soccer Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00462

This study linked countermovement jump (CMJ) force plate metrics, such as peak force, rate of force development, and asymmetry indices, to traditional field-based performance tests in youth female soccer athletes, a population at elevated lower extremity injury risk. The analysis clarified how portable force plate outputs correspond to conventional measures familiar to coaches and clinicians. This translation enhances the practical utility of CMJ testing for interpreting neuromuscular status and guiding training and rehabilitation in youth sports.

12. Menta S, Locascio L, Sciascia A, et al. Poster 173. Leg Up or Letdown? Exploring the Link Between Lower-Body Injury and Upper Extremity Injury in MLB Pitchers. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00471

This retrospective cohort study of MLB pitchers (2017-2024) used public injury and Statcast data with multivariable logistic regression to test whether prior lower extremity injury predicts subsequent upper extremity injury, adjusting for age, workload, fastball velocity, and a novel pitch-mix entropy metric. It provides large-scale epidemiologic evidence on the kinetic chain hypothesis linking lower-body injury to upper-body injury in professional pitchers. Results inform injury-prevention efforts by clarifying whether protecting or rehabilitating the lower extremity may reduce upper extremity injury risk in pitchers.

14. Haddas R, Salazar BP, Shu Y, et al. Poster 184. Running Smarter: Clinically Relevant 3D Biomechanical Insights to Identify and Prevent Injury Risk in Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00482

This retrospective study of 20 runners developed and demonstrated a clinically feasible multimodal running assessment combining 3D markerless motion capture, ground reaction force analysis, and surface electromyography. The protocol identified biomechanical and neuromuscular asymmetries and joint-specific loading patterns linked to running-related injuries that 2D gait evaluation cannot capture. Clinically, it enables targeted, personalized injury-prevention and treatment strategies for youth and adult runners.

Reconstruction and salvage procedures (4)

4. Guerrero Serrano JA, Sánchez Morata E, García López JM, et al. Hexapod-assisted limb salvage after talectomy: outcomes of tibiocalcaneal arthrodesis using the TL-hex system. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06379-0

This retrospective observational study evaluated talectomy followed by tibiocalcaneal arthrodesis using the TL-HEX hexapod external fixator in high-risk patients with severe talar destruction from infection, avascular necrosis, trauma, Charcot neuroarthropathy, or failed ankle arthroplasty between 2020 and 2024. Radiographic fusion and hindfoot alignment were assessed as primary outcomes, with functional scores, pain relief, complications, and satisfaction as secondary measures. The results support hexapod-assisted tibiocalcaneal arthrodesis as a viable limb-salvage strategy, offering computer-assisted multiplanar correction for complex hindfoot reconstruction when arthroplasty or joint preservation is not feasible.

7. Takada S, Okada Y, Suzuki H, et al. A Rare But Important Complication After Fibular Osteotomy During Lateral Closing-Wedge High Tibial Osteotomy: Extension-Type Checkrein Deformity of the Hallux: A case report. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101197

This case report describes a man in his 40s who developed an extension-type checkrein deformity of the hallux six months after lateral closing-wedge high tibial osteotomy with fibular osteotomy, caused by presumed tethering of the extensor hallucis longus at the osteotomy site with hypertrophic callus formation. Because proximal EHL excursion was markedly restricted despite preserved distal gliding, an EHL-to-extensor digitorum longus tendon transfer was performed rather than local release, resulting in full hallux motion recovery without recurrence. Surgeons performing LCW-HTO with fibular osteotomy should recognize this rare tendon-related complication, and the report highlights that tendon transfer may be required when tethering prevents adequate proximal tendon excursion.

10. Curatolo C, Martin K, Anand S. Paper 61. Immediate Weight Bearing after Modified-Brostrom Reconstruction: A Retrospective Review of an Accelerated Rehab Protocol. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00318

This retrospective review of 119 patients evaluated a suture-tape-augmented modified-Bröström reconstruction combined with an accelerated rehabilitation protocol allowing immediate weight bearing as tolerated. Early functional testing (heel-rise and hop tests at six weeks) showed good recovery without increased failure or complication rates, supporting the authors' hypothesis. The findings suggest immediate weight bearing after augmented lateral ankle ligament reconstruction is safe and permits early return to activity.

13. Tham A, Rubin J, Lowton E, et al. Poster 106. Autologous Osteochondral Transplantation Versus Dorsiflexion Closing Wedge Metatarsal Osteotomy for Freiberg’s Disease: A Systematic Review and Meta-Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00410

This systematic review and meta-analysis (PRISMA-guided search through August 2025) compared autologous osteochondral transplantation (AOT) with dorsiflexion closing wedge metatarsal osteotomy (DCWMO) for advanced Freiberg's disease, pooling AOFAS scores, VAS pain, range of motion, and complications. It is the first meta-analysis to directly compare these joint-preserving procedures. The results guide surgical decision-making by clarifying which approach offers superior functional, radiographic, and safety outcomes.

Clubfoot and humanities (2)

3. Suresh M, Pinto DJV, Rajasekharan P. Relationship of foot anthropometry with Modified Pirani score during Ponseti correction of idiopathic congenital talipes equinovarus: a prospective observational study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06467-1

This prospective observational study of 30 children with idiopathic unilateral clubfoot undergoing Ponseti correction measured five foot anthropometric parameters weekly over eight weeks and correlated them with simultaneously assessed Modified Pirani scores. Anthropometric measurements, particularly toe-to-midheel distances, showed significant correlations with Pirani scores, with good inter-observer reliability, providing objective morphological evidence of deformity correction. These findings suggest that simple anthropometric measurements can complement the clinical Pirani score as quantitative, objective tools for monitoring clubfoot correction during Ponseti treatment.

6. Singh A. Dorsiflex. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00832

This is an arts and humanities perspective piece featuring 'Dorsiflex,' a soft pastel drawing created by a medical student during a neurology clerkship, accompanied by an artist statement. The work depicts feet demonstrating dorsiflexion at the center of the composition with minimally rendered, intentionally unfinished hands, reflecting the artist's evolving professional identity and growing awareness of how movement is examined, lost, or altered in clinical practice. The piece illustrates the intersection of anatomical art and clinical medicine, highlighting how artistic study of movement deepens understanding of the musculoskeletal and neurologic examination.