Background: There was an increasing requirement for novel treatments of osteoarthritis (OA). The aim was to compare the efficacy of intraarticular Botulinum toxin type A (BoNT‐A) and intraarticular hyaluronate plus rehabilitation exercise in patients with ankle OA.Methods: This was a prospective, randomized, assessor‐blinded study with a 6‐month follow‐up period, conducted in the outpatient rehabilitation department at a university‐affiliated tertiary care medical center. Seventy‐five patients with symptomatic ankle OA (Kellgren‐Lawrence grade 2) were randomized to receive either a single 100‐unit BoNT‐A injection into the target ankle (n = 38) or a single hyaluronate injection plus 12 sessions of rehabilitation exercise (30 minutes/day, 3 times/week for 4 weeks) (n = 37). The primary outcome measure was the Ankle Osteoarthritis Scale (AOS). Secondary outcome measures included American Orthopedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score, visual analog scale (VAS) for ankle pain, single leg stance test (SLS), Timed “Up‐and‐Go” test (TUG), consumption of rescue analgesics and global patient satisfaction.Results: There were no significant between‐group differences in total AOS scores, pain subscale and disability subscale scores (adjusted mean difference AMD = ‐0.2, 95% CI = (‐0.5, 0.2), p = 0.39; AMD = ‐0.1, 95% CI = (‐0.5, 0.3), p = 0.57; AMD = ‐0.2, 95% CI = (‐0.6, 0.2), p = 0.36). The 2 groups showed no significant differences in AOFAS, VAS, SLS, TUG scores and consumption of rescue analgesics at each follow‐up visit, except that the hyaluronate group improved more in SLS than the BoNT‐A group at 1‐month follow‐up. Patients' satisfaction rate was high, with no serious adverse events. There was no difference in adverse events between the two groups (p = 1.00).Conclusions: Treatment with intraarticular BoNT‐A or hyaluronate injection plus rehabilitation exercise was associated with improvements in pain, physical function and balance in patients with ankle OA. These effects were rapid at 2 weeks and might last for at least 6 months. There was no difference in effectiveness between the two interventions.Trial registration: The trial was registered at clinical trials.gov (Registry numberNCT01760577).

Background/Objective: The recurrence of hallux valgus (HV) after primary surgical correction remains a clinical challenge, often requiring combined approaches to address both bony realignment and soft tissue imbalance. While locking plates have shown some biomechanical advantages in HV correction, evidence regarding their application in revision procedures is limited. This study presents a retrospective single-surgeon experience with a small cohort, aiming to describe radiographic and functional outcomes and to share practical insights rather than provide definitive conclusions. Methods: In this retrospective case series, patients undergoing revision surgery for failed HV correction over the past ten years at a single tertiary institution were analyzed. Radiographic parameters—hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and sesamoid position—were assessed. Functional outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale for pain. Surgical strategies were tailored according to recurrence mechanisms, and some cases involved Wilson osteotomy with intramedullary plate fixation. The Mann–Whitney U test and the Wilcoxon signed-rank test were applied to assess efficacy. Results: A total of 11 feet treated by one surgeon were included. Both soft tissue procedures and combined osteotomy with intramedullary plate fixation led to statistically significant but preliminary improvements in HVA, IMA, DMAA, and sesamoid alignment. Functional scores improved, and the complication rate was within the range reported in the previous literature. Conclusions: This retrospective single-surgeon study with a limited sample size suggests that Wilson osteotomy combined with intramedullary plate fixation may represent a joint-preserving and biomechanically supportive option for recurrent HV, particularly in cases with large DMAAs and severe sesamoid displacement. However, the findings should be interpreted cautiously given the small cohort, retrospective design, and absence of multi-angle radiographic visualization. The results highlight a potential approach in specific clinical settings rather than a definitive solution. Larger, prospective, multi-center studies are required to confirm long-term utility.

This retrospective observational study aimed to evaluate the outcomes of subcapital osteotomy using an intramedullary locking plate for the treatment of hallux valgus (HV) deformity. We hypothesized that plate fixation would provide superior angular correction and lower recurrence compared to screw fixation. Between January 2018 and July 2023, a total of 49 feet underwent corrective osteotomy for HV. Of these, 36 feet were treated with headless screws and 13 with intramedullary locking plates. All cases had a minimum follow-up duration of 12 months. Radiographic outcomes were assessed using weight-bearing radiographs obtained preoperatively and at 1, 6, and 12 months postoperatively. The mean follow-up duration was 24.64 ± 14.34 months in the screw group and 18.23 ± 8.47 months in the plate group. HV recurrence was observed in 9 feet – 7 (77.78%) in the screw group and 2 (22.22%) in the plate group ( P = 1.000). The findings demonstrate that subcapital osteotomy with an intramedullary locking plate is effective in correcting the intermetatarsal angle, particularly when compared to the use of headless screws in modified Mitchell osteotomy. Furthermore, precise adjustment of the plate tip position allowed for effective correction of significant deviations in the distal metatarsal articular angle. Three cases of loss of reduction were observed in the screw group, while the plate group experienced minimal complications. Longer-term follow-up data are required to provide a more accurate and comprehensive assessment of clinical outcomes.