A Rehabilitation Algorithm After Lateral Ankle Sprains in Professional Football (Soccer): An Approach Based on Clinical Practice Guidelines.

Lateral ankle sprain (LAS) is one of the most common types of injury in professional football (soccer) players with high risk of recurrence. The rehabilitation after LAS in professional football players is often still time-based and relies on anecdotal experience of clinicans. There is still a lack of utilization of criteria-based rehabilitation concepts after LAS in professional football. The aims of this clinical commentary are (1) to critically discuss the need for criteria-based rehabilitation concepts after LAS in professional football players, (2) to highlight the current lack of these approaches and (3) to present a novel clinical guideline-based rehabilitation algorithm. Short time-loss (15 days) and high recurrence rate (17%) raise the question of trivialization of LAS in professional football. Despite consequences for many stakeholders involved (players, teams, clubs, insurers), there is still a lack of of criteria-based, step-by-step approaches. The use of a criteria-based rehabilitation approach might reduce the high recurrence rate after LAS in professional football players and will lead, in turn, to increased long-term player availability. Practical experiences of he authors demonstrate the feasibility of such an approach. The effectiveness of this novel rehabilitation algorithm remains to be evaluated in future studies. Level of Evidence: 5.

Accuracy to identify young adults with chronic ankle instability using a virtual reality - Balance error scoring system: A cross-sectional study.

INTRODUCTION: The Balance Error Scoring System (BESS) assesses the ability to control postural stability by performing 3 different stances on two-type surfaces during closed eyes. Virtual reality technology combined with the BESS test (VR-BESS) may be used to disrupt visual inputs instead of closing the eyes, which may improve the sensitivity of diagnosing patients with chronic ankle instability (CAI). OBJECTIVE: This study aimed to evaluate the accuracy to identify individuals with CAI of the VR-BESS test comparing with the original BESS test. METHODS: The BESS and VR-BESS tests were administered to 68 young adults (34 participants with CAI and 34 without CAI). Frontal and lateral video views were used to measure the participant's performance errors. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was computed to determine the diagnostic test's overall accuracy. RESULTS: The total score of the BESS test and the VR-BESS test were statistically significant in comparison to the AUC of no discrimination at 0.5, with AUC values of 0.63 and 0.64, respectively. The cut-off scores for the BESS and VR-BESS tests were 12 and 15, respectively. There was no significant difference between the ROC curves of the BESS and the VR-BESS test for identifying individuals with CAI. CONCLUSION: The BESS and VR-BESS tests may be utilized interchangeably to identify individuals with CAI.

Can Arthrogenic Muscle Inhibition Exist in Peroneal Muscles Among People with Chronic Ankle Instability? A Cross-sectional Study.

BACKGROUND: Ankle sprains lead to an unexplained reduction of ankle eversion strength, and arthrogenic muscle inhibition (AMI) in peroneal muscles is considered one of the underlying causes. This study aimed to observe the presence of AMI in peroneal muscles among people with chronic ankle instability (CAI). METHODS: Sixty-three people with CAI and another sixty-three without CAI conducted maximal voluntary isometric contraction (MVIC) and superimposed burst (SIB) tests during ankle eversion, then fifteen people with CAI and fifteen without CAI were randomly invited to repeat the same tests to calculate the test-retest reliability. Electrical stimulation was applied to the peroneal muscles while the participants were performing MVIC, and the central activation ratio (CAR) was obtained by dividing MVIC torque by the sum of MVIC and SIB torques, representing the degree of AMI. RESULTS: The intra-class correlation coefficients were 0.77 (0.45-0.92) and 0.92 (0.79-0.97) for the affected and unaffected limbs among people with CAI, and 0.97 (0.91-0.99) and 0.93 (0.82-0.97) for the controlled affected and unaffected limbs among people without CAI; Significant group × limb interaction was detected in the peroneal CAR (p = 0.008). The CARs were lower among people with CAI in the affected and unaffected limbs, compared with those without CAI (affected limb = 82.54 ± 9.46%, controlled affected limb = 94.64 ± 6.37%, p < 0.001; unaffected limb = 89.21 ± 8.04%, controlled unaffected limb = 94.93 ± 6.01%, p = 0.016). The CARs in the affected limbs were lower than those in the unaffected limbs among people with CAI (p = 0.023). No differences between limbs were found for CAR in the people without CAI (p = 0.10). CONCLUSIONS: Bilateral AMI of peroneal muscles is observed among people with CAI. Their affected limbs have higher levels of AMI than the unaffected limbs.

Intraosseous myolipoma of the calcaneus.

A man in his 40s presented with an incidental finding of an osteolytic bone lesion. He sustained an ankle injury while inline skating, fracturing his lateral malleolus. Besides the fracture, radiographic imaging on the day of the injury incidentally revealed a well-defined solitary osteolytic lesion with a sclerotic rim within the right calcaneus. MRI showed an intraosseous, fat-containing lesion with focal contrast enhancement, assessed as an intraosseous lipoma with central necrosis. In the pathological analysis of a sample of the lesion an intraosseous myolipoma of the calcaneus was found-an unexpected and extraordinary finding. To prevent pathological fracturing, curettage and bone grafting were performed using autologous iliac crest bone in combination with allogenous bone chips.

Lateral Ankle Ligaments: An Insight Into Their Functional Anatomy, Variations, and Surgical Importance.

BACKGROUND: Ankle sprains are prevalent injuries leading to functional impairment. The lateral ankle ligament complex (LLC), comprising the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL), is weak and prone to injury. The morphometric data of these ligaments are essential for orthopedic practices, including techniques like direct repair or ATFL reconstruction with autograft/allograft, which are limited in the literature. The present study aims to document the anatomy and morphometry of the LLC. METHODS: Fifteen adult Indian-origin embalmed cadavers were selected for the study. Ankles with antemortem or postmortem injuries or previous surgical interventions were excluded from the study. After precise dissection of the ankle's anterior and lateral aspects as per Cunningham's dissection manual, ligaments were exposed. Length and width were measured using a digital vernier caliper. Morphological attributes such as shape, orientation, and inter-fiber angles were documented. RESULTS: The most common shape in ATFL was a single band (53.33%). Inner ATFL fibers merged with the ankle joint capsule in 73.33%. ATFL mean length and width were 14 ± 2.4 mm and 7.6 ± 2.0 mm. The angle between the fibula's long axis and ATFL fibers was 107 ± 22°, and the angle between tibiotalar joint lines and parallel ATFL fibers was 30 ± 9.5°. A single band of CFL was predominant (73.33%). The mean length and width of CFL were 18.4 ± 3.9 mm and 5.2 ± 1.3 mm; the angle between the anterior fibula border's long axes and parallel CFL line was 131°. PTFL length was 20.9 ± 3.3 mm and width was 6.2 ± 1.4 mm. The mean length and width of the anterior inferior talofibular ligament (AiTFL) were 11.7 ± 2.6 mm and 9.5 ± 1.6 mm, and of the posterior inferior talofibular ligament (PiTFL) were 12.8 ± 2.1 mm and 10.4 ± 2 mm. CONCLUSION: Comprehensive knowledge of these ligaments' anatomy and relationships is vital for clinical examination and ultrasonography. Understanding LLC details aids radiologists and orthopedic surgeons in graft selection, sizing, and precise anatomical structure placement during surgical reconstruction.

Imaging of soccer injuries in adolescent female athletes.

Soccer participation is increasing among female adolescents with a concomitant rise of injuries in this group. Age- and sex-related factors, such as the transition from skeletal immaturity to skeletal maturity as well as anatomic, physiologic, neuromuscular, and behavioral differences between females and males, all play a role in injury patterns for these athletes. Anterior cruciate ligament (ACL) tears in this group have received a great deal of attention in the medical literature and the media in recent years with increasing knowledge about causative factors, surgical management, and injury prevention. There have been fewer studies specifically focused on female adolescent soccer players in relation to other types of injuries, such as patellar dislocation/instability; other knee and ankle ligament tears; hip labral tears; muscle strains and tears; and overuse injuries such as apophysitis, patellofemoral pain syndrome, and bone stress injuries. Because imaging plays a critical role in diagnosis of soccer-related injuries in female adolescents, knowledge of the mechanisms of injury, imaging findings, and clinical considerations are essential for radiologists involved in the care of these patients.

Understanding the effects of a sudden directional shift in somatosensory feedback and increasing task complexity on postural adaptation in individuals with and without chronic ankle instability.

BACKGROUND: Individuals with chronic ankle instability (CAI) present somatosensory dysfunction following an initial ankle sprain. However, little is known about how individuals with CAI adapt to a sudden sensory perturbation of instability with increasing task and environmental constraints to maintain postural stability. METHODS: Forty-four individuals with and without unilateral CAI performed the Adaptation Test to a sudden somatosensory inversion and plantarflexion perturbations (environment) in double-, injured-, and uninjured- limbs. Mean sway energy scores were analyzed using 2 (group) × 2 (somatosensory perturbations) × 3 (task) repeated measures analysis of variance. RESULTS: There were significant interactions between the group, environment, and task (P=.025). The CAI group adapted faster than healthy controls to a sudden somatosensory inversion perturbation in the uninjured- (P=.002) and injured- (P<.001) limbs, as well as a sudden somatosensory plantarflexion perturbation in the double- (P=.033) and uninjured- (P=.035) limbs. The CAI and healthy groups presented slower postural adaptation to a sudden inversion perturbation than a sudden somatosensory plantarflexion perturbation in double-limb (P<.001). Whereas both groups demonstrated faster postural adaptation to a sudden somatosensory inversion perturbation compared to somatosensory plantarflexion perturbation while maintaining posture in the injured- (P<.001) and uninjured- (P<.001) limbs. The CAI and healthy groups adapted faster to a sudden somatosensory inversion perturbation in the injured- (P<.001) and uninjured- (P<.001) limbs than in double-limb, respectively. DISCUSSION: Postural adaptation in individuals with and without CAI depended on environmental (somatosensory perturbations) and task constraints. The CAI group displayed comparable and faster postural adaptation to a sudden somatosensory inversion and plantarflexion in double-, injured-, and uninjured- limbs, which may reflect a centrally mediated alteration in neuromuscular control in CAI.

Absorption function loss due to the history of previous ankle sprain explored by unsupervised machine learning.

BACKGROUND: Ankle sprains are common and cause persistent ankle function reduction. To biomechanically evaluate the ankle function after ankle sprains, the ground reaction force (GRF) measurement during the single-legged landing had been used. However, previous studies focused on discrete features of vertical GRF (vGRF), which largely ignored vGRF waveform features that could better identify the ankle function. PURPOSE: To identify how the history of ankle sprain affect the vGRF waveform during the single-legged landing with unsupervised machine learning considering the time-series information of vGRF. METHODS: Eighty-seven currently healthy basketball athletes (12 athletes without ankle sprain, 49 athletes with bilateral, and 26 athletes with unilateral ankle sprain more than 6 months before the test day) performed single-legged landings from a 20 centimeters (cm) high box onto the force platform. Totally 518 trials vGRF data were collected from 87 athletes of 174 ankles, including 259 ankle sprain trials (from previous sprain ankles) and 259 non-ankle sprain trials (from without sprain ankles). The first 100 milliseconds (ms) vGRF waveforms after landing were extracted. Principal component analysis (PCA) was applied to the vGRF data, selecting 8 principal components (PCs) representing 96% of the information. Based on these 8 PCs, k-means method (k = 3) clustered the 518 trials into three clusters. Chi-square test assessed significant differences (p < 0.01) in the distribution of ankle sprain and non-ankle sprain trials among clusters. FINDINGS: The ankle sprain trials accounted for a significantly larger percentage (63.9%) in Cluster 3, which exhibited rapidly increased impulse vGRF waveforms with larger peaks in a short time. SIGNIFICANCE: PCA and k-means method for vGRF waveforms during single-legged landing identified that the history of previous ankle sprains caused a loss of ankle absorption ability lasting at least 6 months from an ankle sprain.

Comparison of Direct Repair Versus Anatomic Graft Reconstruction of the Anterior Talofibular Ligament: A Biomechanical Cadaveric Study.

The goal of our study is to compare the stability of the anatomic reconstruction of the anterior talofibular ligament (ATFL) with direct repair of the ATFL, in a cadaver model. We performed the following techniques in 18 cadaveric ankles: the intact ATFL was cut, after which a direct repair using 2 anchors was performed. The repair was sectioned, and anatomic reconstruction was then performed with a tendon autograft. We measured angular displacement in 3 anatomic planes (axial, coronal, sagittal) for each situation in response to the anterior drawer test (ADT), talar tilt test (TTT) and pivot test (PT), using a specifically constructed arthrometer. The sectioned ATFL was inferior to the intact ATFL in the axial plane with the ADT (p = .012), in the axial plane with the PT (p = .001) and in the axial and coronal planes with the TTT (p = .013 and p = .016, respectively). Direct anatomic repair was inferior to the intact ATFL in the axial plane upon the PT (p = .009). No differences could be found between anatomic graft reconstructions and the intact ATFL with any manoeuver, nor when comparing anatomic graft reconstruction and direct repair with 2 anchors. We were able to conclude that anatomic graft reconstruction of the ATFL reproduces angular stability of the native ligament in a cadaver model. While we could not detect if anatomic graft reconstruction was superior to direct repair, the latter proved to be less stable in the axial plane upon internal rotation (pivot test) versus the intact ATFL.

E-health intervention for preventing recurrent ankle sprains: a randomised controlled trial in general practice.

BACKGROUND: Ankle sprains are frequent injuries in general practice. However, no effective treatment is available yet. AIM: To examine the effectiveness of an unsupervised e-health-supported neuromuscular training programme in combination with usual care compared with usual care alone in patients with acute lateral ankle sprains in general practice. DESIGN AND SETTING: Randomised controlled trial with 1-year follow-up among patients (14-65 years) who visited the GP with an acute lateral ankle sprain within 3 weeks of injury. METHOD: The intervention group received, in addition to usual care, an unsupervised e-health-supported neuromuscular training programme and the control group received usual care alone. The primary outcome was self-reported re-sprains during 52 weeks of follow-up. Secondary outcomes were ankle function, pain in rest and during activity, subjective recovery, and return to the same type and level of sport. RESULTS: In total, 165 participants (mean age 38.3 years and 69 [41.8%] male) were included. No statistically significant difference in the occurrence of a re-sprain were found between the intervention 20.7% (17/82) and control group 24.1% (20/83) (hazard ratio 1.14, 95% confidence interval = 0.59 to 2.21). Also, no statistically significant differences in secondary outcomes were found between groups. The adherence rate to the programme was low (6.1%, 5/82). CONCLUSION: The rate of re-sprains was relatively high and an unsupervised e-health-supported neuromuscular training programme does not yield meaningful effects and does not encourage adherence in preventing re-sprains in patients in general practice. More research is necessary to indicate the best treatment modality and way of delivery for these patients.

Visual Disruption Influences Neuromechanics during Landing Cutting in Individuals with Chronic Ankle Instability.

CONTEXT: Individuals with chronic ankle instability (CAI) appear to demonstrate altered movement patterns when their vision is disturbed during simple tasks such as single-leg standing and walking. However, it remains unclear whether visual disruption by stroboscopic glasses alters movement patterns during landing cutting movements, considered highly demanding sports maneuvers that mimic a typical athletic movement. OBJECTIVE: This study aimed to identify altered lower extremity kinematics and muscle activation when participants' vision was disrupted by stroboscopic glasses during landing cutting tasks in CAI patients. DESIGN: A case control design. SETTING: A controlled laboratory setting. PATIENTS OR OTHER PARTICIPANTS: Eighteen CAI patients and 18 matched healthy controls volunteered to participate in the study. All participants performed 5 trials of landing cutting with (SV) and without (NSV) stroboscopic glasses. MAIN OUTCOME MEASURES: Frontal and sagittal lower extremity kinematics, and 6 lower extremity muscle activations during the stance phase of landing cutting tasks with (SV) and without stroboscopic glasses (NSV). RESULTS: CAI patients demonstrated more inversion angle from 18% to 22% and from 60% to 100% of the stance phase and more peroneal longus activation from initial contact to 18% of the stance phase under the SV condition compared to the NSV condition. There were no differences in knee and hip joint angles between the visual conditions for both groups. CONCLUSIONS: When wearing stroboscopic glasses, CAI patients showed altered movement patterns, including increased inversion angle and peroneus longus activation during the stance phase of landing cutting. The results suggest that CAI patients may lack the ability to reweight sensory information to adapt their movement to visual disruption.

Is Subtle Cavovarus a Problem for Athletes?

Cavovarus or high-arched foot is a common foot deformity that occurs due to the disruption of the foot-driven equilibrium between the first metatarsal, fifth metatarsal, and the heel. This imbalance leads to an increase in the foot's normal plantar concavity. Cavovarus deformity ranges from a mild and flexible malalignment to a fixed, complex, and severe deformation. Subtle cavovarus foot, the mild form of the cavus foot, was first described by Manoli and colleagues.

Modified Stabilization Test to Diagnose Chronic Syndesmotic Injuries Based on Posture Control.

BACKGROUND: To propose and validate a modified noninvasive method for the diagnosis of chronic syndesmotic injuries. METHODS: This study included 16 patients with chronic ankle instability. Herein, we propose the Modified Stabilization Test, a new measurement for use in the diagnosis of chronic syndesmotic injury, as determined by wearing a 60-kPa pneumatic brace. The test combines the center of pressure and sensory organization test to measure postural control. For comparison, we also measured the tibiofibular clear space, tibiofibular overlap, and medial clear space using anteroposterior radiograph; a line marked horizontally above the tibial plaque using computed tomography (CT) to measure the syndesmotic gap and fibular rotation angle; and magnetic resonance imaging (MRI) scans to determine the presence of the λ sign. The distance of syndesmosis was confirmed in 16 individuals through arthroscopy, and the results of the examination were used to determine the diagnostic efficacy of each index. RESULTS: Receiver operating characteristic curve analysis revealed that the optimal cut-off value, sensitivity, and specificity of the Modified Stabilization Test for the diagnosis of chronic syndesmotic injuries were 0.80, 100%, and 87.5%, respectively. The area under the curve (AUC) of the Modified Stabilization Test was 0.906 (95% CI 0.656, 0.993; P < .001), which was superior to imaging indices such as radiography, CT, and MRI (AUC = 0.516-0.891). CONCLUSION: We developed the Modified Stabilization Test-a noninvasive diagnostic tool for the screening of chronic syndesmotic injuries. The test showed high sensitivity and specificity for the identification of chronic syndesmotic injuries and is helpful in the identification of chronic syndesmotic injuries. LEVEL OF EVIDENCE: Level II, diagnostic-investigating a diagnostic test.

Effects of A Single Balance Training Session on Neural Excitability in Individuals With Chronic Ankle Instability.

CONTEXT: Individuals with chronic ankle instability (CAI) demonstrate reduced spinal reflex modulation and corticospinal excitability of the soleus, which may contribute to decreased balance performance. OBJECTIVE: To determine the effects of a single session of balance training on Spinal-reflexive excitability modulation and corticospinal excitability in those with CAI. DESIGN: Randomized controlled trials. SETTING: Research laboratory. PARTICIPANTS: Thirty participants with CAI were randomly assigned to the balance training (BAL) or control (CON) group. MAIN OUTCOME MEASURES: Modulation of soleus spinal-reflexive excitability was measured by calculating relative change in normalized Hoffmann reflexes (ratio of the H-reflex to the M-wave) from prone to single-leg standing. Corticospinal excitability was assessed during single-leg stance using transcranial magnetic stimulation, outcomes of which included active motor threshold (AMT), motor evoked potential, and cortical silent period (CSP). Balance performance was measured with center of pressure velocity in anterior to posterior and medial to lateral directions. Separate 2 × 2 repeated-measures analyses of variance were employed to determine the effect of group (BAL and CON) and time (baseline and posttraining) on each dependent variable. RESULTS: There were significant group by time interactions in the modulation of soleus spinal-reflexive excitability (F1,27 = 4.763, P = .04); CSP at 100% AMT (F1,27 = 4.727, P = .04); and CSP at 120% AMT (F1,27 = 16.057, P < .01). A large effect size suggests increased modulation of spinal-reflexive excitability (d = 0.81 [0.03 to 1.54]) of the soleus in BAL compared with CON at posttest, while CSP at 100% (d = 0.95 [0.17 to 1.70]) and 120% AMT (d = 1.10 [0.29 to 1.84]) was reduced in BAL when compared with CON at posttest. CONCLUSION: After a single session of balance training, individuals with CAI initiated increases in spinal reflex modulation and corticospinal excitability of the soleus. Thus, individuals with CAI who undergo balance training exhibit positive neural adaptations that are linked to improvements in balance performance.

Challenges in Diagnosing Juxt-Articular Osteoid Osteoma of the Talus: A Case Report.

Osteoid osteomas of the talus are rarely seen. They can easily be misdiagnosed. In this case report, we present a 21-year-old man with an osteoid osteoma in the talar neck whose pain onset coincided with an ankle injury. The latter was deemed a misleading factor when making a diagnosis. Eventually, the patient was treated with surgical excision of the osteoid osteoma. The gap that resulted after the excision was filled with an autologous bone graft. A year after his operation, the patient returned to his daily activities and remained pain-free. A high index of suspicion and an appropriate imaging examination are mandated for the early diagnosis of such entities.

The Burden of the "Simple Ankle Sprains": A Review of the Epidemiology and Long-Term Impact.

Lateral ankle sprain (LAS) is not as simple as it was believed to be as it has substantial negative impacts on the active sporting population. The negative impact on physical function, quality of life (QoL) and economic burden is significant with increased risk of reinjury, development of chronic lateral ankle instability and posttraumatic ankle osteoarthritis resulting in functional deficits, decreased QoL and chronic disabilities. Economic burden from a societal perspective demonstrated notably higher indirect costs from productivity loss. Preventative interventions with early surgery for a selective cohort of active sporting population may be considered to mitigate morbidities associated with LAS.

Chronic Lateral Ankle Instability: Can We Get Even Better with Surgical Treatment?

Lateral ligament attenuation may occur after repetitive ankle sprains, creating instability. Management of chronic ankle instability requires a comprehensive approach to mechanical and functional instability. Surgical treatment, however, is indicated when conservative treatment is not effective. Ankle ligament reconstruction is the most common surgical procedure to resolve mechanical instability. Anatomic open Broström-Gould reconstruction is the gold standard for repairing affected lateral ligaments and returning athletes to sports. Arthroscopy may also be beneficial for identifying associated injuries. In severe and long-standing instability, reconstruction with tendon augmentation could be necessary.

The effect of thickness and elastic modulus of the anterior talofibular ligament on anterior ankle joint stiffness: A subject-specific finite element study.

Ankle sprain is a frequent type of sports injury leading to lateral ligament injury. The anterior talofibular ligament (ATFL) is a primary ligamentous stabilizer of the ankle joint and typically the most vulnerable ligament injured in a lateral ankle sprain (LAS). This study aimed to quantitively investigate the effect of the thickness and elastic modulus of ATFL on anterior ankle joint stiffness (AAJS) by developing nine subject-specific finite element (FE) models under acute injury, chronic injury, and control conditions of ATFL. A 120 N forward force was applied at the posterior calcaneus leading to an anterior translation of the calcaneus and talus to simulate the anterior drawer test (ADT). In the results, the ratio of the forward force to the talar displacement was used to assess the AAJS, which increased by 5.85% in the acute group and decreased by 19.78% in the chronic group, compared to those of the control group. An empirical equation described the relationship between AAJS, thickness, and elastic modulus (R-square 0.98). The equation proposed in this study provided an approach to quantify AAJS and revealed the effect of the thickness and the elastic modulus of ATFL on ankle stability, which may shed light on the potential diagnosis of lateral ligament injury.

Evaluation of surgical outcomes of calcaneonavicular coalition and too-long anterior process in children: A prospective study.

INTRODUCTION: Calcaneonavicular coalitions (CC) affect approximately 1% of the general population. CC or Too-long anterior process (TLAP) result in "repeated sprains" that can be associated with foot and/or ankle chronic pain. The main objective of this study was to analyze the effectiveness of surgery using the AOFAS score. HYPOTHESIS: Functional results after surgical treatment of CC or TLAP are not as good as expected. MATERIALS AND METHODS: A single-center prospective study was carried out at our University Hospital from 01/01/2019 to 06/01/2021. The patients included were operated on in the pediatric surgery department for CC or TLAP resection by direct approach after MRI confirmation and failure of non-operative treatment. A survey evaluating the AOFAS score as well as the number of ankle sprains and the intensity of pain was undertaken at the preoperative consultation and then at three and twelve months postoperatively. RESULTS: A total of 17 feet in 16 patients (14 girls and 2 boys) comprising 12 TLAP and 5 CC were included. The AOFAS score was statistically significantly increased (58.6 vs. 82.9; p<0.001) postoperatively. No statistical difference was noted between the follow-up visits at three and twelve months. At the twelve-month follow-up, 9 out of 16 patients (56.2%) still reported activity restrictions; mainly linked to the persistence of chronic pain, and 10 out of 16 patients (62.5%) reported a feeling of instability. DISCUSSION: CC and TLAP surgery rapidly improves function but it does not dramatically reduce foot pain and activity restrictions. A dedicated score would be useful to identify patients who will benefit the most from surgery. LEVEL OF EVIDENCE: IV; prospective study.