Diabetes Mellitus is a metabolic disease characterized by hyperglycaemia due to defective insulin secretion or action. Abnormalities in insulin regulation leads to imbalances in essential vitamins and minerals like Vitamin C (Vit C) and Vitamin D (Vit D) may play a role in the progression of this disease and defect in collagen formation.
Study Design & Methods
A cross-sectional study was conducted. The study included 60 cases of type 2 diabetes mellitus (T2DM) patients who were divided into 2 groups (controlled uncomplicated / Uncontrolled surgical) and 30 healthy controls of meditarenean origin. Serum levels of copper and zinc as well as serum levels of Vitamin C and Vitamin D were measured.
Results
Serum zinc levels were observed to be lower in T2DM cases with complications (83.65 ± 4.21) compared to healthy controls (95.40 ± 3.90). In contrast, serum copper levels were highest among cases with complications (178.05 ± 8.62) compared healthy controls (128.85 ± 8.76). Furthermore, the study found that Vitamin C and Vitamin D levels were significantly lower in T2DM cases and healthy controls.
Conclusions
The altered levels of trace elements zinc and copper, along with deficiencies in Vitamin C and Vitamin D, appear to be important predisposing factors for diabetic patients in developing complications. These findings suggest that monitoring and correcting these nutritional imbalances may have a significant impact on the management and prevention of surgical complications in individuals with type 2 diabetes mellitus.

Introduction: calcaneal lengthening osteotomy of is one of the most popular procedures in the flatfoot correction. It is believed that calcaneal lengthening osteotomy corrects all components of the deformity.
Methods: we evaluated the treatment outcomes of 35 children (44 feet) with calcaneal lengthening osteotomy (follow-up period 3-5 years). In all patients angles and indices of the degree of deformity were measured in clinical evaluation and on radiographs. To assess the impact of the studied parameters, a correlation analysis was carried out.
Results: In determining the effect of the "Evaluation Time" parameter on the main angles and indices, there was an improvement after surgery. The exceptions to these parameters were: AP and lateral Kite angle and hindfoot valgus. An increase in the AP Kite angle and hindfoot valgus after surgery had no statistical significance, and a worsening of the lateral Kite angle had statistical significance (p=0.021).
Conclusion: calcaneal lengthening osteotomy biomechanically increases the eversion of the subtalar joint. To lengthen the lateral column during calcaneus osteotomy distraction, the subtalar joint must be fixed in a rigid position. This position is obtained by subtalar joint eversion. Based on this, the correction of hindfoot valgus after calcaneal lengthening osteotomy is ineffective.

CARTIVA is a synthetic silicon based implant utilised in the treatment of first MTP osteoarthritis. This study assessed the clinical outcomes of this novel intervention in the management of first MTPJ arthritis. Methods: 64 patients who underwent a total of 67 CARTIVA procedures between May 2016 and June 2020 were included in the study. Minimum follow up was 12 months. Validated outcome measures, EQ-5D-3L and MOX-FQ were prospectively collected pre and post operatively at 12 months as the primary end point. AAOS-FAM was recorded post op. Secondary outcomes included complication and revision surgery. All cases were performed by the senior author. Results: The Average age was 54 (19 to 77) with 42 females 22 males. Radiological Grade 2 OA was present in 46 cases with Grade 3 in 21 (KL scale). There was statistical improvement in EQ-5D-3 (0.69 to 0.85 p<0.05) and MOXFQ scores (42.5 to 15.4(p<0.05)) when pre- and post-operative scores were compared. AAOS-FAM mean core score was 89.01. Multivariate analysis by grade of OA indicated that patients with Grade 2 OA did better than those with grade 3 OA although this did not reach statistical significance. 3 of the 67 CARTIVA implants required revision procedures one patient developed an implant related infection. Conclusions: All validated outcome measures demonstrated statistically significant improvement at 12 months post op. CARTIVA is a safe and efficacious surgical intervention in the management of moderate 1st MTPJ OA.

This study investigates the outcomes of silastic joint replacement arthroplasty in a low-physical-demand population with hallux rigidus. The aim is to assess the efficacy and suitability of this surgical procedure in addressing the deformity and improving joint function in individuals who have not responded to conservative treatments. The study includes a detailed examination of radiological alignment, functional outcomes, and patient satisfaction with a minimum of 10 years follow-up period
The results demonstrate high patient satisfaction, and reduced reliance on additional interventions in more than 78% of cases with less reported readiological findings the previously mentioned in litrature.The study contrib insights into the outcomes and benefits of silastic joint replacement arthroplasty in low physical demand patients, aiding in appropriate patient selection and treatment decision-making.

Unstable ankle fractures are common in the elderly after low energy injury. Post-fixation rehabilitation and return to function are often limited by associated fragility. Fibular pro-tibia fixation allows immediate weight bearing on the injured limbs and early return of mobility. Fibular protibia fixation is performed by passing long screws which also engage the tibia cortices through a lateral fibular plate. Fixing the fibula to the tibia provides much-enhanced rigidity to allow immediate weight bearing. It required no new approach but using long anatomical locking plates and anteverted pro-tibia screws compared with the traditional open reduction and internal fixation. Methods: This is a retrospective study on 18 elderly patients with ages ranging from 63 to 95 (average age 75) who suffer from bimalleolar or trimalleolar ankle fracture after low energy injury. The primary outcome is the time to independent ambulation. Secondary outcomes are major complications and length of stay. Result: 16 out of 18 patients were able to regain independent ambulation within a month, while two patients with severe cardiovascular diseases suffered from a deep infection requiring implant removal. There is no mechanical failure. The average length of stay is 12.7 days. Conclusion: Fibular pro-tibia fixation provides rigid fixation for unstable ankle fractures in the elderly, allows a faster return to independent ambulation, and reduces prolonged immobilization.

One of the recognized surgical methods for the treatment of planovalgus deformity of the feet in children over 12 years of age is the Evans calcaneal osteotomy. This operation, described in 1975, was modified: various levels of osteotomy, as well as forms of diastasis (wedge-form osteotomy, lengthening osteotomy) were suggested. Problem of choosing the parameters of the formed diastasis in the preoperative stage in order to reduce the number of cases of hypo- and hypercorrection of deformity remains a pressing issue to this day.
A retrospective study was performed in which 64 children aged 12-17 years with symptomatic flatfoot (53 patients with flat-valgus deformity of the feet and 11 patients with flat feet without a valgus position of the calcaneus) were included. All patients in this group underwent an elongating wedge-form osteotomy of the calcaneus. A dynamic assessment of radiometric parameters and the results of the AOFAS questionnaire was performed before and after surgery (after 6 months and 1 year).
In 9 patients (81.8%) with flat feet without a hallux valgus position of the calcaneus at 6 months, X-ray hypercorrection was confirmed (varus position of the calcaneus 6-14°). In the group with flat-valgus deformity, hypercorrection was confirmed radiologically in 7 patients (13.2%).
The results of the study showed the importance of choosing the form of diastasis at the preoperative stage in the treatment of flexible flatfoot in adolescents.

Objectives : To compare our results of the use of fibula rod system versus the literature available.Designs & Methods : Retrospective study. We looked at Ankle fractures treated by the fibula rod system from the period of 2017 to 2020. Data collected from the Theatre Operating Management System (TOMS) , Clinical Notes and Synapse(r) ( FujiFilm ) viewer . Patient Related Outcome Measures were obtained using FAOS ( Foot and Ankle Outcome Scores ) via telephone ,email and letters.Results : 26 female and 17 male,average age 60.7 years (range 20-97 ). Pattern:Bimalleolar 5 / BM +Subluxed 7 / Trimalleolar 15 / TM + Subluxed 12 / Pilon 4
Indications :Swelling 19 / Swelling + Blisters 15 / poor skin 7 / Other 4 .Co morbidities- Diabetes 3 / Vascular Insufficiency 2 / Osteopenia 9 / Other 4 (Psoriasis, B12 deficiency ) .18 needed stabilisation with external fixator for swelling/blisters,dislocations .
Average time : frame to fixation was 9.2 days ( Range 5-18 days ) .Average time to discharge- 12.6 weeks .Clinical Outcomes: Excellent - 24 .Fair - 17
Poor - 2 .Radiological Outcomes :Excellent - 18 Fair - 25
Poor - 2
PROMS with FAOS : 40 responses at an average of 2 years since injury ( Range 13 -38 months ) Average score 73.18%
Complications-syndesmotic screw snapped, non union persistent pain and stiffness.Conclusion :Our Experience vs Literature, Complication rate <1% vs 7-13%, Excellent to fair results 99% vs 73-100%. Union rate 99 % vs 99%

Introduction: The objective of this study was to evaluate the effects of minimally invasive chevron and Akin (MICA) procedures on the plantar pressure distribution of the lesser metatarsals (MTs) in patients with hallux valgus (HV), focusing on whether correction of HV influences lesser metatarsal pressure and, consequently, transfer metatarsalgia. Methods: This prospective study was conducted from January 29, 2019, to July 18, 2023. Thirty feet from twenty-six patients with moderate hallux valgus, symptomatic enough to warrant surgery, were included. The fourth generation MICA was the sole procedure performed, without any additional interventions on soft tissues or lesser toes. Radiographic parameters (HVA, IMA, DMAA, 1st metatarsal length, and Meary's angle) and pedographic outcomes (using RSscan International, Olen, Belgium) were measured preoperatively and three months postoperatively. Results: Postoperative radiographic analysis showed significant improvements in HVA, IMA, DMAA, and an average 2.3mm shortening of 1st metatarsal length (all p < 0.01). However, the pedographic analysis revealed no significant change in the maximum force, maximum pressure, or cumulative load on lesser MTs three months postoperatively. The maximum force and pressure on the big toe and first MT significantly decreased. Conclusion: The MICA procedure for hallux valgus results in significant radiographic corrections but does not decrease maximum force, maximum pressure, or cumulative load on lesser metatarsals at three months post-operation. This result may be relative to the inevitable shortening of 1st metatarsal after surgery. This suggests that MICA alone may not adequately address lesser metatarsal pressures in patients with HV and transfer metatarsalgia.

This study aimed to evaluate the outcomes of TTCA with a retrograde intramedullary nail regarding open and arthroscopic joint preparation. A retrospective and comparative analysis of 62 patients (68 ankles) who underwent TTCA with a retrograde intramedullary nail was performed. They were divided into two groups: Open and Arthroscopy. Patient demographics, hospital stay, fusion, and complications were recorded. For radiographic evaluation, the coronal tibiotalar (CTT) angle was measured. Data analysis revealed that 34 ankles of 32 patients underwent Arthroscopic and 34 ankles of 30 underwent Open TTCA. There was no difference in age, sex, smoking, peripheral neuropathy, and diabetes mellitus between the two groups (p=0.1667/0.652/0.456/1.000/0.485). The Arthroscopy group had a shorter hospital stay (mean 1.35 ± 0.88 nights) compared to the Open (p<0.001). The follow-up period was comparable (mean 63.49 ± 26.08 months, p=0.458). Union rates were 85.29% for Arthroscopy and 94.12% for Open TTCA (p=0.231). Postoperative CTT angle improved similarly in both groups (p=0.700). Rates of early (13.24%) and late (7.35%) complications did not significantly differ between the groups (p=0.341 and p=0.642, respectively). The use of retrograde intramedullary nails in TTCA with open and arthroscopic joint preparation has yielded similar rates of bone healing with acceptable complication rates and satisfactory radiological recovery in both groups. Despite the conventional preference for the open approach, the arthroscopic method emerges as a valid, efficient, and reliable alternative for appropriate cases.

Background: Ankle fracture is a debilitating injury and imposes a substantial burden to the healthcare system encompassing direct medical costs, rehabilitation expenses and the potential long-term care. The surgical fixation methods for treating ankle fractures with syndesmotic injury remains a subject of ongoing debate. Objectives:To analyse and compare the cost-effectiveness between TightRope and syndesmotic screws in syndesmotic fixation to elucidate the economic implications and facilitate informed resource allocation. Study Design:Case series. Level of evidence: 4. Methods: Data for a consecutive series of patients who underwent syndesmotic fixation between June 2020-2023 in our institution was collected retrospectively. Post-operative images and operative indications was reviewed and collected using electronic records and PACS systems. Results:Over the 3-year period, 213/504 patients who underwent ankle surgeries also had syndesmosis fixation. Clinical and radiological follow-up was obtained for all 213 patients. 27/213 (12.7%) patients had TightRope fixation whereas the remaining patients all had syndesmotic screws fixation. Among the patients who had TightRope fixation, 3/27 (11%) required removal at a further date. In comparison, 50/186 (27%) patients had their syndesmotic screws removed with the commonest indications being patients’ preferences and broken screws. Eventhough a TightRope System (stainless steel; £177.9 each) is relatively more expensive than syndesmotic screws (stainless steel; £4.47/screw), TightRope is proven to be more cost-effective as fewer cases require removal (theatre cost; approximately £1,200/hour) and lower risks to patients due to fewer needs for further surgery. Conclusions: Our study found that TightRope system is more cost-effective than syndesmotic screws in the management of syndesmotic injury.

Introduction
The occurrence of both hallux valgus (bunion) and bunionette (tailor's bunion) in the same foot is relatively uncommon. When both conditions are present, it is sometimes referred to as a "combination bunion." However, the prevalence of this condition is not well-documented in the medical literature.
Materials & Methods
We retrospective collected 74 cases who was diagnosed of combination bunion in our hospital during 2016-2022. All cases received minimal invasive osteotomy. Clinical assessment included American Orthopaedic Foot and Ankle Society (AOFAS) scrore, visual analog scale, shoe selectivity, patient satisfaction. Radiographic assessment including 5th MP angle, 4th-5th IM angle,Hallux valgus angle, 1st-2nd Intermetatarsal angle (IMA)
Results
We achieved good and excellent results in 74 cases with a very high satisfaction. Sufficient correction of 5th MP angle, 4th-5th IM angle, Hallux valgus angle, 1st-2nd Intermetatarsal angle (IMA)without radiological recurrence. A substantially shorter operating time and a reduced risk of complications related to surgical exposure.
Conclusion
Combination bunion actually is not so rare and the prevalence might be underestimated.Minimal invasive osteotomy has some advantages : less skin and soft tissue damage, Simple technique with K-wire fixation.Percutaneous distal metatarsal osteotomy is an alternatively safe and reliable technique combination bunion.