J Am Podiatr Med Assoc. 2019 Oct 7. doi: 10.7547/18-087
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Baggott PJ1, Malhotra K2, Livingstone J3.
1 Barnet & Chase Farm Hospitals. Royal Free London NHS Foundation Trust Foot & Ankle Unit.
2 Barnet & Chase Farm Hospitals, Royal Free London NHS Foundation Trust Foot & Ankle Unit.
3 Barnet Hospital, Royal Free London NHS Foundation Trust Foot and Ankle Unit.
This manuscript reviews the role of Vitamin D and its deficiency in pathology of the foot and ankle. Vitamin D is an essential vitamin which targets a number of tissues and organs, and plays an important role in calcium homeostasis. Vitamin D deficiency is common, particularly at higher latitudes where there is reduced exposure to ultraviolet B radiation. The effects of Vitamin D deficiency have been extensively studied but only a small portion of the literature has focused on the foot and ankle. Most of the evidence regarding the foot and ankle consists of retrospective studies which cannot determine whether Vitamin D deficiency is in fact the cause for the pathologies being investigated. The available evidence suggests that insufficient levels of Vitamin D may result in an increased incidence of foot and ankle fractures. The effects of Vitamin D deficiency on fracture healing, bone marrow edema syndrome, osteochondral lesions of the talus, strength around the foot and ankle, tendon disorders, elective foot and ankle surgery, and other foot and ankle conditions are less clear. Based on the available evidence, we are unable to recommend routine testing or supplementation of Vitamin D in patients presenting with foot and ankle pathology. However, Vitamin D supplementation is cheap, safe and may be of benefit in patients at high risk of deficiency. When it is supplemented the evidence suggests calcium should be co-supplemented. Further high-quality research is needed into the effect of Vitamin D in the foot and ankle. Cost-benefit analyses of routine testing and / or supplementation of Vitamin D for foot and ankle pathology are also required.
The musculoskeletal system
Diabetes and the diabetic foot
Fractures around the foot and ankle
Osteochondral lesions of the talus
Strength around the foot and ankle
Tendons and soft tissues around the foot and ankle
Outcome of foot and ankle surgery
Other foot and ankle pathology
Bone Marrow Edema Syndrome
Foot Ankle Int . 2022 Jan 11;10711007211068785. doi: 10.1177/10711007211068785
Deepak Ramanathan 1, Ahmed K Emara 1, Stephen Pinney 1, Andrea Bell 2, Sara Lyn Miniaci-Coxhead 1
Background: Vitamin D deficiency has been postulated as a cause for impaired bone healing and remodeling. The purpose of this study was to assess the potential association between low vitamin D levels and reoperation for nonunion following ankle fusion surgery.
Methods: All adult patients (aged ≥18 years) who underwent ankle fusion procedures at a tertiary referral center from January 2010 to January 2019 with available vitamin D levels within 12 months preoperatively were retrospectively reviewed (n = 47). Patients were categorized as vitamin D deficient (<30 ng/mL) vs normal (31-80 ng/mL). The primary outcome was the incidence of reoperation secondary to nonunion. Secondary outcomes included incidence of reoperation not related to nonunion and the need for repeat reoperation.
Results: The average level in the vitamin D-deficient group (n = 17; 36.2%) was 16.9 vs 46.4 ng/mL in the normal group (n = 30; 63.8%).
All recorded reoperations for nonunion occurred exclusively in the vitamin D-deficient cohort (4/17 [23.5%]; P = .013).
There were similar reoperation rates for causes other than nonunion (2/17 [11.8%] vs 4/30 [13.3%]; P > .99) and repeat reoperation rates (3/17 [17.6%] vs 1/30 [3.3%]; P = .128) among vitamin D-deficient vs normal patients.
Conclusion: Vitamin D deficiency may be associated with an increased risk of reoperation for nonunion after ankle fusion.
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