Hallux valgus deformity (HVD) involves subluxation of the first metatarsophalangeal joint. While HVD is primarily considered a forefoot condition, midfoot instability may play a significant role in its development and severity. However, very few studies have placed a heavy emphasis on studying this phenomenon. Therefore, this review had a particular focus on understanding midfoot instability based on weightbearing imaging assessments of the TMT joint. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched five databases for studies on midfoot instability in HVD patients. The severity of HVD was defined by hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA). Data was extracted, and articles were graded using the Methodological Index for Non-Randomized Studies (MINORS). Of 547 initially retrieved articles, 23 met the inclusion criteria. Patients with HVD showed higher HVA and DMAA on weightbearing radiographs (WBRG) and weightbearing computed tomography (WBCT) compared to healthy individuals. Midfoot instability was assessed through intermetatarsal angle (IMA) and tarsometatarsal angle (TMT angle). Patients with HVD exhibited greater IMA and TMT angles on both WBRG and WBCT. This review highlights the importance of weightbearing imaging assessments for midfoot instability in HVD. IMA and TMT angles can differentiate between healthy individuals and HVD patients, emphasizing the significance of midfoot assessment in understanding HVD pathology. These findings validate the limited evidence thus far in the literature pertaining to consistent midfoot instability in HVD patients and are able to provide ample reasoning for physicians to place a larger emphasis on midfoot imaging when assessing HVD in its entirety.

Background/Objectives: Triplane ankle fractures represent a complex fracture type in pediatric patients. These fractures can prove challenging due to the involvement of multiple fracture planes and variations in segment fragmentation. With increasing literature pertaining to the treatment of triplane fractures and the limitations of previous systematic reviews, the aim of this review is to summarize recent data on the diagnosis, treatment, and complications of pediatric triplane ankle fractures. Methods: This systematic review was conducted following PRISMA guidelines and searched five major databases up to July 2024. The inclusion criteria focused on observational studies and randomized controlled trials in pediatric triplane fractures. Case reports, cadaveric studies, and systematic reviews were excluded. Articles were screened and graded using the MINORS tool for quality assessment. Data were extracted on demographics, fracture types, treatment approaches, and outcomes. Results: A total of 34 studies met the inclusion criteria. The use of CT scans in combination with radiographs was common, and two-part fractures were the most frequently observed type. Surgical treatment, particularly open reduction with internal fixation, was preferred, while conservative surgical treatment remains under-reported. Complications were minimal, with limb length discrepancy being the most common. Conclusions: This review highlights the increased use of CT for diagnosing triplane fractures and the preference of certain surgical interventions. Conservative treatment approaches, though less studied, may offer alternatives in moderate cases. This review emphasizes the need for further research on conservative treatment outcomes, longer follow-ups, and randomized controlled trials to refine treatment strategies for this complex fracture pattern.

Tibial shaft fractures are among the most common pediatric long bone fractures. These fractures have significant implications for growth, function and alignment, often requiring precise management to prevent complications such as limb length discrepancies and angular deformities. This review focuses on the classification, etiology and management of pediatric tibial shaft fractures, emphasizing recent advancements and remaining challenges. A comprehensive literature review was conducted in November 2024 using PubMed, Medline and Scopus. Articles were selected based on relevance to etiology, classification and management strategies. Both recent and foundational studies were included to provide a comprehensive perspective. The review explores the major types of tibial shaft fractures in children, including Toddler’s fractures (and spiral fractures), transverse fractures, greenstick fractures, stress fractures, segmental fractures and comminuted fractures, focusing on their etiology, age-specific prevalence, clinical presentation, imaging findings, management strategies and potential complications. Younger children typically experience fractures due to low-energy mechanisms, such as twisting injuries, resulting in spiral or greenstick fractures. Older children and adolescents are more prone to high-energy trauma, causing transverse, comminuted or segmental fractures, often associated with fibular involvement. Most fractures are treated non-operatively using casting techniques tailored to fracture stability, angulation and age. Surgical interventions, including flexible intramedullary nailing, external fixation and plating, are reserved for complex or unstable fractures, open injuries or cases involving neurovascular compromise. Advances in classification systems, imaging modalities and surgical techniques have improved outcomes, yet opportunities exist to develop growth-preserving methods and improve long-term functional recovery. Future research should prioritize optimizing individualized management strategies and exploring innovative technologies to enhance diagnostic accuracy and treatment efficacy.

The use of midfoot wedges for the correction of flatfeet disorders, such as progressive collapsing foot disorder, has increased greatly in recent years. However, the wedge material/composition has yet to be standardized. Metallic wedges offer advantages such as comparable elasticity to bone, reduced infection risk, and minimized osseous resorption, but a comprehensive review is lacking in the literature. Therefore, the objective of this systematic review was to organize all studies pertaining to the use of metallic wedges for flatfoot correction to better understand their efficacy and safety. This systematic review adhered to PRISMA guidelines, and articles were searched in multiple databases (PubMED, SPORTDiscus, CINAHL, MEDLINE, and Web of Science) until August 2023 using a defined algorithm. Inclusion criteria encompassed midfoot surgeries using metallic wedges, observational studies, and English-language full-text articles. Data extraction, article quality assessment, and statistical analyses were performed. Among 11 included articles, a total of 444 patients were assessed. The average follow-up duration was 18 months. Radiographic outcomes demonstrated that patients who received metallic wedges experienced improvements in lateral calcaneal pitch angle and Meary’s angle, with an enhancement of up to 15.9 degrees reported in the latter. Success rates indicated superior outcomes for metallic wedges (99.3%) compared to bone allograft wedges (89.9%), while complications were generally minor, including hardware pain and misplacement. Notably, there were no infection complications due to the inert nature of the metallic elements. This review summarizes the effectiveness, success rates, and safety of metallic wedges for flatfoot correction. Radiographic improvements and high success rates highlight their efficacy. Minor complications, including pain and mispositioning, were reported, but the infection risk remained low. Our results demonstrate that metallic midfoot wedges may be a viable option over allograft wedges with proper planning. Future research should prioritize long-term studies and standardized measures.

Hallux valgus deformity (HVD) involves subluxation of the first metatarsophalangeal joint. While HVD is primarily considered a forefoot condition, midfoot instability may play a significant role in its development and severity. Therefore, this review had a particular focus on understanding midfoot instability based upon weightbearing imaging assessments of the TMT joint. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched five databases for studies on midfoot instability in HVD patients. Severity of HVD was defined by hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA). Data was extracted, and articles were graded using the Methodological Index for Non-Randomized Studies (MINORS). Of 547 initially retrieved articles, 23 met inclusion criteria. Patients with HVD showed higher HVA and DMAA on weight-bearing radiographs (WBRG) and weight-bearing computed tomography (WBCT) compared to healthy individuals. Midfoot instability was assessed through intermetatarsal angle (IMA) and tarsometatarsal angle (TMT angle). Patients with HVD exhibited greater IMA and TMT angles on both WBRG and WBCT. This review highlights the importance of weight-bearing imaging assessments for midfoot instability in HVD. IMA and TMT angles can differentiate between healthy individuals and HVD patients, emphasizing the significance of midfoot assessment in understanding HVD pathology.