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Vitamin D in the Foot and Ankle: A Review of the Literature

Karan Malhotra MBChB (Hons), MRCS, FRCS (Tr&Orth), Paul J. Baggott MBBS, and Julian Livingstone BSc, FCPM, FFPM, RCPSG (Glasg)
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Background

Vitamin D is an essential vitamin that targets several 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. We reviewed the role of vitamin D and its deficiency in foot and ankle pathology.

Methods

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 evidence regarding the foot and ankle consists of retrospective studies, which cannot determine whether vitamin D deficiency is, in fact, the cause of the pathologies being investigated.

Results

The available evidence suggests that insufficient vitamin D levels 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.

Conclusions

Based on the available evidence, we cannot recommend routine testing or supplementation of vitamin D in patients with foot and ankle pathology. However, supplementation is cheap, safe, and may be of benefit in patients at high risk for deficiency. When vitamin D is supplemented, the evidence suggests that 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 supplementation of vitamin D for foot and ankle pathology are also required.

Foot and Ankle Unit, Barnet and Chase Farm Hospitals, Royal Free London NHS Foundation Trust, Barnet, United Kingdom. Dr. Malhotra is now with Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.

Corresponding author: Karan Malhotra, MBChB (Hons), MRCS, FRCS (Tr&Orth), Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, United Kingdom. (E-mail: karan@doctors.org.uk)