Journal of the International Foot & Ankle Foundation <p>The Journal of the International Foot &amp; Ankle Foundation (JIFAF) is an open-access peer-reviewed international journal with a focus on foot and ankle medicine and surgery. It is the official publication of the <strong><a href="">International Foot &amp; Ankle Foundation</a></strong>. Established in 2022, the journal is the continuation of the <strong><a href="" target="_blank" rel="noopener">Foot and Ankle Online Journal (FAOJ)</a></strong>, which ran from 2008 through 2020. JIFAF is the ideal platform for practitioners, residents and students to publish case related material quickly and easily for distribution online absolutely free of charge. Its purpose is to provide a quality journal to further promote education and research in foot and ankle medicine and surgery.</p> International Foot & Ankle Foundation en-US Journal of the International Foot & Ankle Foundation 2832-0158 Nicotine Products Consideration in the Perioperative Setting: A Narrative Review <p><span style="font-weight: 400;">Nicotine-containing products, including combustible tobacco, smokeless tobacco, electronic cigarettes (e-cigarettes), and nicotine replacement therapies (NRT), are widely used and have significant implications in the perioperative setting for orthopedic surgery. Smoking has been linked to numerous surgical complications such as delayed wound healing, infection, cardiovascular and pulmonary complications and impaired bone healing. This narrative review aims to provide an overview of the different nicotine-containing products, their nicotine content, and the potential effects observed with their use in orthopedic surgery. A comprehensive literature search was conducted to identify studies reporting on dosage, health effects, and perioperative outcomes associated with various forms of tobacco and nicotine products. The findings reveal that combustible tobacco products contain varying levels of nicotine, ranging from 7.2 to 26.3 mg per gram of tobacco. Smokeless tobacco products have nicotine contents ranging from 7.1 to 23.1 mg per gram. Smokeless tobacco users exhibit better surgical outcomes in terms of bone healing compared to smokers. Nicotine content in e-cigarette liquids varies widely, from 0 to 134.7 mg per milliliter. Limited evidence exists regarding the effects of e-cigarettes on surgical outcomes, but animal studies suggest similar soft tissue healing rates compared to combustible cigarettes due to comparable nicotine levels. NRT, available as gum, nasal spray, lozenges, patches, and inhalers, aims to replace tobacco use and gradually reduce nicotine intake. Dosages range from 0.5 mg per spray to 42 mg in high-dose patches. Understanding the nicotine content, absorption, and route of administration of NRT products is crucial for perioperative management. In conclusion, different nicotine-containing products have varying nicotine levels and potential implications for surgical outcomes. Further research is needed to elucidate the specific effects of e-cigarettes and NRT on bone healing and to establish optimal perioperative management strategies for nicotine users undergoing orthopedic surgery.</span></p> Ross Groeschl Robert Mendicino Copyright (c) 2023 Journal of the International Foot & Ankle Foundation 2023-08-01 2023-08-01 2 8 10.55067/jifaf.v2i8.64 Formation of intermetatarsal syndesmosis and maintenance of deformity correction following syndesmosis bunionectomy: A case study <p><span style="font-weight: 400;">Hallux Valgus is a common foot deformity with a main surgical objective of correcting the deformity in all three planes, typically using screws, wires, and other hardware to correct the deformity. The deformity often involves normal bones or variations of normal bones that have migrated out of their normal anatomical position. The syndesmosis bunionectomy can be used to correct these deformities without relying on hardware for adequate correction, omitting osteotomies, and instead forming a syndesmosis between the first and second metatarsals. The initial correction of the bunion involves the usage of strong, non-absorbable suture, followed by long-term correction by the formation of an intermetatarsal syndesmosis. This article presents a case of significant hallux valgus previously treated surgically with a syndesmosis bunionectomy, now presenting for hardware removal 30 months later and histological examination to evaluate true formation of an anatomical syndesmosis following bunion correction as well as maintenance of intermetatarsal angle correction.</span></p> Matthew Novak Doug Ichikawa Copyright (c) 2023 Journal of the International Foot & Ankle Foundation 2023-08-01 2023-08-01 2 8 10.55067/jifaf.v2i8.65