Identification of radiographic characteristics associated with pain in hallux valgus patients: A preliminary machine learning study

The impact of corrective exercises, kinesiology taping, and mechanical correction on pain and foot shape in women with hallux valgus

Background

This study aimed to assess the effect of corrective exercises and exercises supplemented by kinesiology taping or an orthosis on pain and foot alignment in women with hallux valgus (HV).

Methods

Eighty-two women with HV were randomly divided into groups: E (n = 24) who exercised for 12 weeks; EKT (n = 18) who exercised and used kinesiology taping on HV; EMC (n = 15) who performed exercise and used an orthosis to correct their big toe position; and CHV (25 women with HV without therapy). Additional control group C: (n = 31) women with normal hallux. The Wejsflog index, Clarke's angle, alpha and beta angles, and pain intensity in the big toe area were assessed at the beginning and after therapy.

Results

The Wejsflog index was significantly lower in women with HV and increased significantly after therapy in the E and EKT groups. Clarke's angle did not differ between women with and without HV, and Clarke's angle did not change after therapy. The HV angle decreased significantly in groups E and EKT but was still significantly greater than that in group C. The fifth toe varus angle did not differ between women with and without HV and decreased significantly in the right foot after therapy in group E. Pain in the HV area decreased significantly in all groups undergoing therapy.

Conclusion

Women with HV have a greater forefoot width, but their longitudinal arch and fifth toe position do not differ. Exercises significantly reduce pain and improve hallux alignment. Combining exercises with kinesiology taping or an orthosis does not increase the therapeutic effect. Although the observed effects of conservative therapy are promising, it should be remembered that long-term effects have not been studied.

Trial registration

The Australian New Zealand Clinical Trials Registry (ACTRN12621000902897).

Assessing ChatGPT responses to common patient questions regarding total ankle arthroplasty

Purpose

Artificial Intelligence is becoming increasingly integrated into healthcare, making it essential to assess its potential as a reliable information source for patient queries in the ambit of orthopaedic surgery. In literature, it is being employed in foot and ankle surgery and total hip arthroplasty. The aim of the present study was to evaluate the ability of Chat Generative Pretrained Transformer (ChatGPT) version 3.5 to give accurate, complete and comprehensive responses to the most common questions which are usually asked by the patient to the surgeon regarding total ankle arthroplasty.

Methods

Ten most common questions were selected by two ankle surgeons and then ChatGPT was used to answer these questions. The responses were analyzed using an accuracy score and the modified DISCERN score to assess clarity. WordCalc software package (educational-level indices) was used to assess the readability of the responses.

Results

Most of ChatGPT's responses were considered excellent not requiring clarification or satisfactory requiring minimal clarification. Indeed, the accuracy score was 2, suggesting that the overall responses were satisfactory requiring minimal clarification, and DISCERN score mean was 51, which is considered good-fair.

Conclusions

ChatGPT demonstrates potential as a tool for responding to common patient questions related to total ankle arthroplasty, offering clear and mostly accurate information. While its current performance is based on the available literature, ongoing advancements in artificial intelligence may further enhance its utility in healthcare communication. However, further studies are required to evaluate its role more precisely in patient information and clinical settings.

Levels of Evidence

Not applicable.

Radiographic characteristics-based classification system for percutaneous endoscopic lumbar discectomy surgical approach selection in patients with L5-S1 disc herniation: a hierarchical clustering analysis

Background

No classification system exists for aiding the selection of surgical approaches in L5-S1 disc herniation when undergoing percutaneous endoscopic lumbar discectomy (PELD). We aimed to identify radiographic subtypes to aid the selection of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in patients with L5-S1 disc herniation via unsupervised hierarchical clustering analysis.

Methods

In this retrospective case-control study, we gathered 296 anteroposterior and lateral lumbar spine radiographs (dataset 1) from Tianjin Hospital between January 2016 and October 2021 for clustering analyses. Additionally, we analyzed 111 patients who underwent PEID or PETD for L5-S1 disc herniation at Tianjin Hospital from January 2016 to August 2022. We included patients with radicular leg pain or back pain associated with intra-canal disc herniation who failed in conservative treatments over 6 weeks. First, pair-wise Spearman correlation coefficients were calculated among plain radiographic metrics in dataset 1 to reveal the association among these radiographic metrics. Second, hierarchical clustering analysis was conducted to unsupervised cluster the plain films into several subtypes. Last, for each radiographic subtype, the intraoperative blood loss (IBL), operation time (OT), total operating room time (TORT) along with visual analogue scale (VAS) and Oswestry Disability Index (ODI) were compared between patients underwent PETD or PEID with age as covariates.

Results

This study yielded 3 main findings: (I) iliac height (IH) was negatively correlated with intervertebral foramen width (IFW), intervertebral foramen height (IFH), and intertransverse height (ITH) (R=-0.50, -0.42, and -0.46, all P<0.001), ITH was positively correlated with IFW and IFH (R=0.40 and 0.53, all P<0.001); (II) 2 lumbosacral radiographic subtypes were identified via hierarchical clustering analysis; (III) relative to subtype 1, the patients identified as subtype 2 exhibited lesser IBL, shorter OT, and shorter TORT following PETD (t=2.92, P=0.006; t=2.65, P=0.012; t=3.17, P=0.003).

Conclusions

The morphology pattern of the lumbosacral region affect the ease of different PELD procedures when performing percutaneous discectomy at the segment of L5-S1. Without considering the type of disc herniation, this classification system might aid spine surgeons in the selection of an appropriate surgical approach.

Evaluating the Quality and Usability of Artificial Intelligence-Generated Responses to Common Patient Questions in Foot and Ankle Surgery

Background

Artificial intelligence (AI) platforms, such as ChatGPT, have become increasingly popular outlets for the consumption and distribution of health care-related advice. Because of a lack of regulation and oversight, the reliability of health care-related responses has become a topic of controversy in the medical community. To date, no study has explored the quality of AI-derived information as it relates to common foot and ankle pathologies. This study aims to assess the quality and educational benefit of ChatGPT responses to common foot and ankle-related questions.

Methods

ChatGPT was asked a series of 5 questions, including "What is the optimal treatment for ankle arthritis?" "How should I decide on ankle arthroplasty versus ankle arthrodesis?" "Do I need surgery for Jones fracture?" "How can I prevent Charcot arthropathy?" and "Do I need to see a doctor for my ankle sprain?" Five responses (1 per each question) were included after applying the exclusion criteria. The content was graded using DISCERN (a well-validated informational analysis tool) and AIRM (a self-designed tool for exercise evaluation).

Results

Health care professionals graded the ChatGPT-generated responses as bottom tier 4.5% of the time, middle tier 27.3% of the time, and top tier 68.2% of the time.

Conclusion

Although ChatGPT and other related AI platforms have become a popular means for medical information distribution, the educational value of the AI-generated responses related to foot and ankle pathologies was variable. With 4.5% of responses receiving a bottom-tier rating, 27.3% of responses receiving a middle-tier rating, and 68.2% of responses receiving a top-tier rating, health care professionals should be aware of the high viewership of variable-quality content easily accessible on ChatGPT.

Level of Evidence

Level III, cross sectional study.

Advancements in Artificial Intelligence for Foot and Ankle Surgery: A Systematic Review

Background

There has been a rapid increase in research applying artificial intelligence (AI) to various subspecialties of orthopaedic surgery, including foot and ankle surgery. The purpose of this systematic review is to (1) characterize the topics and objectives of studies using AI in foot and ankle surgery, (2) evaluate the performance of their models, and (3) evaluate their validity (internal or external validation).

Methods

A systematic literature review was conducted using PubMed/MEDLINE and Embase databases in December 2022. All studies that used AI or its subsets machine learning (ML) and deep learning (DL) in the setting of foot and ankle surgery relevant to orthopaedic surgeons were included. Studies were evaluated for their demographics, subject area, outcomes of interest, model(s) tested, model(s)' performance, and validity (internal or external).

Results

A total of 31 studies met inclusion criteria: 14 studies investigated AI for image interpretation, 13 studies investigated AI for clinical predictions, and 4 studies were grouped as "other." Studies commonly explored AI for ankle fractures, calcaneus fractures, hallux valgus, Achilles tendon pathologies, plantar fasciitis, and sports injuries. For studies reporting the area under the receiver operating characteristic curve (AUC), AUCs ranged from 0.64 (poor) to 0.99 (excellent). Two studies (6.45%) reported external validation.

Conclusion

Applications of AI in the field of foot and ankle surgery are expanding, particularly for image interpretation and clinical predictions. Current model performances range from poor to excellent, and most studies lack external validation, demonstrating a need for further research prior to deploying AI-based clinical applications.

Level of Evidence

Level III, retrospective cohort study.