Background. The goal of this systematic review is to determine the most commonly used outcome measurement tools used by foot and ankle specialists and determine their limitations, such as whether they are validated, have floor/ceiling effects, and so on. Methods. A literature search was conducted to identify primary publications between January 1, 2012 and July 1, 2017 that concern care of the foot and ankle and use any established grading criteria to evaluate patients. Results. In 669 publications, 76 scoring systems were used. The 10 most common were American Orthopaedic Foot and Ankle Score (AOFAS), visual analog scale (VAS), Short Form–36 (SF-36), Foot Function Index (FFI), Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), SF-12, Short Musculoskeletal Function Assessment (SMFA), Ankle Osteoarthritis Scale (AOS), and Foot and Ankle Disability Index (FADI). AOFAS was used in 393 articles, VAS in 308, and SF-36 in 133 publications. AOFAS, VAS, and SF-36 were used to evaluate 23,352, 20,759, and 13,184 patients respectively. AOFAS and VAS were used simultaneously in 172 publications. Conclusion. While there are many different scoring systems available for foot and ankle specialists to use to assess or demonstrate the effectiveness of treatments, the AOFAS, while it is an unvalidated scoring system, is the most commonly used scoring system in this review. Clinical Relevance. This review presents data about commonly used patient reported outcomes systems in foot and ankle surgery. Levels of Evidence: Level III: Systematic review.

Level IV.

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Insertional Achilles tendinopathy is a common condition that can lead to chronic, debilitating heel pain in athletes and nonathletes alike. Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy. When nonsurgical treatment fails, surgical treatment is recommended. Although there are options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, others are aimed at detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment. Additional or alternate procedures may include a calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer. Recent advances in suture anchor techniques further add to the complexity of available options. This review discusses the relevant anatomy, biomechanics, and pathophysiology as well as the recent available evidence for nonsurgical and surgical management of this condition to guide surgeons in selecting the most appropriate treatment for their patients.

Background: Hallux valgus has been associated with a widened forefoot. Most surgical procedures for the correction of hallux valgus have the potential to reduce forefoot width. Success after hallux valgus surgery is correlated with relief of toe pain in conventional shoes and improvement in the appearance of the foot. Therefore, reduction in forefoot width, referred to as metatarsal span (MS), likely correlates with both criteria and may be a reliable radiographic indicator of success after hallux valgus surgery. Methods: Preoperative and postoperative radiographs of 52 patients who underwent correction of hallux valgus with a distal Chevron osteotomy and Akin osteotomy were evaluated by 4 observers. The observers measured the hallux valgus angle (HVA), the intermetatarsal first and second angle (IMA), and the MS. Results: Preoperative HVA ranged from 14° to 48°, IMA ranged from 6° to 25°, and MS ranged from 74.2 to 110.6 mm. The average HVA improvement was 19.4°, IMA improvement was 6.7°, and MS reduction was 8.7 mm. No correlation was identified with regard to correction of the HVA or IMA to MS. Conclusion: Digital radiographic linear measurements were easily and reliably made. Therefore, linear measurements as described in this article can be used as a tool to evaluate if clinical outcomes correlate with reduction of MS. A distal Chevron with an Akin osteotomy has the potential to reduce forefoot width. Levels of Evidence: Level IV: Case series

Category: Ethics Introduction/Purpose: The objective of our study was to analyze COI nondisclosure for US based research articles that were published to three prevalent orthopaedic journals from the beginning of 2014 to the end of 2016. Methods: All US-based research articles published to FAI, JBJS, and JOA from the beginning of 2014 to the end of 2016 were reviewed. COI disclosure sections were analyzed to determine if a disclosure was made for first and/or last authors. Authors disclosing any financial relationship involving employment, royalties/licensing, speaking, and consulting fees were recorded as having disclosed a potential COI. First and last authors were then searched for using CMS Open Payments search tool to determine if they had received any of the aforementioned payment types. To determine if a COI nondisclosure (disclosure discrepancy) was present, an author’s disclosure statement for a published article was compared to CMS Open Payments data from the year prior to publication of the article. We used CMS data from the year prior to a publication to account for the time it takes to construct a paper and have it published. Results: Across all journals and years, we obtained disclosure accuracy data for 3,465 total first and last authors publishing 1,770 research articles. Within this sample, 7.1% (245/3,465) of the authors had a recorded undisclosed conflict-of-interest and 13.2% (233/1,770) of articles had a first and/or last author with an undisclosed potential conflict-of-interest. When looking at each journal individually over the three-year period, FAI contained the highest percentage of authors with undisclosed COI’s (42.3%), JBJS contained the lowest percent of authors with an undisclosed COI (4.6%), and JOA had an intermediate amount of authors with an undisclosed COI (7.0%). Conclusion: Discrepancies between payment disclosures made by authors and those published in the CMS database were present in all three journals reviewed in this study. The percentage of articles containing an author with a disclosure discrepancy varies widely between these journals. However, when analyzing the percentage of disclosure discrepancies by year, no trend was found.

Vitamin D is critically important to numerous physiologic functions, including bone health. Poor vitamin D status is a common but underrecognized problem that predisposes the military population to stress fracture and completed fracture. This has significant implications for force health protection, warfighter readiness, attrition, and cost. Despite this, vitamin D deficiency is still underdiagnosed and undertreated in the military. This is a major hindrance to military readiness and one that could easily be modified with awareness, prevention, and early treatment. In this commentary, we review the literature on vitamin D deficiency and critically examine the current status of policies and clinical practice related to vitamin D in the military health system. We offer several practical recommendations to increase awareness and readiness while decreasing musculoskeletal injury and the associated costs.

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