Background: Total ankle replacement (TAR) has emerged as a valuable alternative to ankle arthrodesis for the treatment of end-stage ankle osteoarthritis, offering pain relief while preserving joint motion and improving quality of life. Despite advances in implant design and surgical techniques, complications remain common, and tibial component malalignment has been increasingly recognized as a major contributor to implant failure and revision surgery. Purpose: To provide a comprehensive overview of the current evidence regarding tibial component malalignment in TAR, focusing on its etiology, radiographic assessment, biomechanical implications, clinical consequences, and available treatment strategies. Methods: A narrative review of the literature was conducted using PubMed, Scopus, and Web of Science. English-language studies published up to 2026 investigating tibial component positioning, malalignment, associated complications, and revision strategies in TAR were included and qualitatively analyzed. Results: Tibial component malalignment is a multifactorial condition influenced by preoperative deformities, patient-specific anatomy, surgical technique, instrumentation, and surgeon experience. Malposition in the coronal, sagittal, or axial planes alters ankle biomechanics, resulting in abnormal load distribution, altered kinematics, polyethylene wear, instability, and increased stress at the bone–implant interface. These changes may lead to pain, aseptic loosening, subsidence, osteolysis, and ultimately prosthetic failure. Weight-bearing radiographs remain the standard imaging modality for postoperative assessment, while weight-bearing computed tomography provides complementary three-dimensional evaluation, particularly in complex cases. Management should be individualized according to implant stability, degree of deformity, and symptom severity, ranging from supramalleolar osteotomy and isolated polyethylene insert exchange to partial or complete revision arthroplasty, including the use of custom implants in cases of substantial bone loss. Conclusions: Tibial component malalignment represents a critical determinant of functional outcomes and implant survivorship following TAR. Early recognition through standardized imaging and a thorough understanding of its biomechanical and clinical implications are essential to optimize treatment strategies, minimize revision rates, and improve long-term outcomes after total ankle replacement.

Talocalcaneal coalition is a frequent cause of painful rigid flatfoot in adolescents and young adults, resulting from congenital failure of segmentation with fibrous, cartilaginous, or osseous bridging of the subtalar joint. Clinical presentation typically coincides with skeletal maturation and includes hindfoot pain, recurrent ankle sprains, progressive stiffness, and characteristic planovalgus deformity. Although prevalence is likely underestimated, advances in imaging have improved recognition and characterization. Diagnosis relies on the integration of clinical findings with imaging, where computed tomography (CT) remains the reference standard, while magnetic resonance imaging (MRI) enables accurate detection of both osseous and non-osseous coalitions and associated soft-tissue changes. This narrative review aims to provide a comprehensive and updated synthesis of current concepts in talocalcaneal coalition, with specific focus on its clinical implications and contemporary management strategies. We critically analyze diagnostic pathways, including emerging modalities such as weight-bearing CT, and discuss evidence-based indications for conservative treatment, coalition resection, and arthrodesis. Particular attention is devoted to patient selection, prognostic factors, and evolving minimally invasive techniques. Current limitations and areas of controversy are highlighted, emphasizing the need for standardized imaging criteria and optimized treatment algorithms to improve long-term functional outcomes.

Background: Fibular nonunion is an uncommon but clinically relevant complication following fractures or surgical procedures, often resulting in persistent pain and functional impairment. Due to its rarity, current evidence remains limited and no standardized treatment guidelines are available. Purpose: To systematically review the literature on fibular nonunion, focusing on clinical presentation, diagnostic approaches, and treatment outcomes. Methods: A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE, Scopus, and Web of Science were searched up to July 2025. Studies including adult patients (≥18 years) with fibular nonunion treated either conservatively or surgically were included. Data regarding demographics, clinical presentation, and treatment outcomes were extracted and analyzed descriptively. Results: Nineteen studies comprising 183 patients were included. The mean patient age was 45.7 years, with a predominance of males (58.4%). The distal third of the fibula was the most frequently involved site (75.9%). The mean time to diagnosis was 28.6 weeks. Surgical treatment was performed in 65.6% of cases, most commonly using open reduction and internal fixation. Among studies reporting union outcomes, favorable radiographic healing rates were observed following surgical treatment. Conservative treatment was primarily reserved for asymptomatic or minimally symptomatic patients. The overall complication rate was low (3.8%), mainly consisting of minor infections and hardware-related issues. Conclusions: Fibular nonunion is an uncommon but clinically significant condition. Available evidence suggests that surgical management may represent the most consistently successful treatment strategy in symptomatic and mechanically unstable cases, while nonoperative treatment may remain appropriate in carefully selected asymptomatic or minimally symptomatic patients. However, the available literature is limited by retrospective study designs, heterogeneous populations, inconsistent outcome reporting, and variable definitions of nonunion, highlighting the need for prospective multicenter studies and standardized treatment protocols.