{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:02:21Z","timestamp":1777615341167,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T00:00:00Z","timestamp":1598227200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Passively correctible, adult-acquired flatfoot deformities (AAFD) are treated with joint-sparing procedures. Questions remain as to the efficacy of such procedures when clinical deformities are severe. In severe deformities, a primary fusion may lead to predictable outcomes, but risks nonunion. We evaluated pre- and postsurgical flexible AAFD patients undergoing joint-sparing or fusion procedures, comparing reoperation and complication rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified patients with flexible AAFD between January 1, 2001 and 2016. Exclusion criteria were incomplete medical record, rigid AAFD, and prior flatfoot surgery. Patient demographics, pre- and postsurgical radiographic measurements, surgery performed, and postoperative complications were evaluated by bivariate analysis, comparing joint-sparing versus fusion procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 239 patients (255 feet) (mean follow-up 62 \u00b1 50 months), 209 (87%) underwent joint-sparing reconstructions, 30 (12.6%) underwent fusions. Fifty-four (24.1%) feet underwent joint-sparing reconstruction with reoperation versus 11 (35.5%) in fusion patients ( P = .17). Radiographic improvement in talonavicular angle, talar first-metatarsal (anteroposterior view), and Meary\u2019s angle was higher in fusion patients ( P &lt; .001, P &lt; .001, and P = .003, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>More nonunion reoperations among fusion patients were offset by reoperations in joint-sparing patients. Fusion uniquely corrected Meary\u2019s angle. Nonunion is of less concern for joint-sparing versus fusion for patients with severe flexible AAFD. Degree of deformity versus advantage of joint motion should improve decision making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Levels of Evidence:<\/jats:title>\n                    <jats:p>Level IV: Retrospective case series<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1938640020950552","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T05:48:25Z","timestamp":1598248105000},"page":"150-157","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9724-6263","authenticated-orcid":false,"given":"Kathryn","family":"Whitelaw","sequence":"first","affiliation":[{"name":"School of Medicine, Georgetown University, Washington, DC (KW)"},{"name":"Massachusetts General Hospital, Boston, Massachusetts (KW, SS, NCH, DG, CWD)"},{"name":"Hospital for Special Surgery, New York, New York (AHJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivesh","family":"Shah","sequence":"additional","affiliation":[{"name":"School of Medicine, Georgetown University, Washington, DC (KW)"},{"name":"Massachusetts General Hospital, Boston, Massachusetts (KW, SS, NCH, DG, CWD)"},{"name":"Hospital for Special Surgery, New York, New York (AHJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noortje C.","family":"Hagemeijer","sequence":"additional","affiliation":[{"name":"School of Medicine, Georgetown University, Washington, DC (KW)"},{"name":"Massachusetts General Hospital, Boston, Massachusetts (KW, SS, NCH, DG, CWD)"},{"name":"Hospital for Special Surgery, New York, New York (AHJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Guss","sequence":"additional","affiliation":[{"name":"School of Medicine, Georgetown University, Washington, DC (KW)"},{"name":"Massachusetts General Hospital, Boston, Massachusetts (KW, SS, NCH, DG, CWD)"},{"name":"Hospital for Special Surgery, New York, New York (AHJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne H.","family":"Johnson","sequence":"additional","affiliation":[{"name":"School of Medicine, Georgetown University, Washington, DC (KW)"},{"name":"Massachusetts General Hospital, Boston, Massachusetts (KW, SS, NCH, DG, CWD)"},{"name":"Hospital for Special Surgery, New York, New York (AHJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher W.","family":"DiGiovanni","sequence":"additional","affiliation":[{"name":"School of Medicine, Georgetown University, Washington, DC (KW)"},{"name":"Massachusetts General Hospital, Boston, Massachusetts (KW, SS, NCH, DG, CWD)"},{"name":"Hospital for Special Surgery, New York, New York (AHJ)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,8,24]]},"reference":[{"key":"bibr1-1938640020950552","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-017-1945-5"},{"key":"bibr2-1938640020950552","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2012.03.007"},{"key":"bibr3-1938640020950552","doi-asserted-by":"publisher","DOI":"10.1177\/1938640018796618"},{"key":"bibr4-1938640020950552","doi-asserted-by":"publisher","DOI":"10.1177\/2473011418S00102"},{"key":"bibr5-1938640020950552","doi-asserted-by":"publisher","DOI":"10.1177\/2473011418S00117"},{"key":"bibr6-1938640020950552","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199908000-00007"},{"key":"bibr7-1938640020950552","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2006.06.008"},{"key":"bibr8-1938640020950552","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200807000-00005"},{"issue":"239","key":"bibr9-1938640020950552","first-page":"196","author":"Johnson 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