Embargoed for release until 5:00 p.m. ET on Monday 10 August 2026
Follow @Annalsofim on X , Facebook , Instagram , Bluesky , and Linkedin
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine . The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
----------------------------
1. Joint fusion surgery reduced walking pain in patients with foot arthritis compared with watchful waiting
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00710
Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00710-PS
URL goes live when the embargo lifts
A randomized controlled trial compared first metatarsophalangeal joint (MTPJ) arthrodesis, a joint fusion surgery for painful hallux rigidus (arthritis of the big toe joint), with watchful waiting in reducing walking pain. The study found that first MTPJ arthrodesis resulted in clinically significant improvement in walking-related pain compared with watchful waiting, reinforcing arthrodesis as the preferred treatment for some patients with painful hallux rigidus. The findings are published in Annals of Internal Medicine .
Despite being widely regarded as the gold standard of surgical treatment for hallux rigidus, arthrodesis has not previously been evaluated against the natural course of the disease or nonsurgical care in a randomized trial. Researchers from the University of Helsinki and Helsinki University Hospital and colleagues randomly assigned 90 adults aged 40 years or older with chronic, symptomatic hallux rigidus to either undergo first MTPJ arthrodesis or continue with observation alone. After 12 months, patients who underwent surgery reported an average walking-pain score of 1.3 compared with 5.7 among those in the watchful waiting group. Benefits were also observed among patients undergoing surgery for secondary outcomes measuring pain, function, satisfaction, quality of life, and use of analgesics. The findings suggest arthrodesis provides a significantly greater reduction in walking-related pain and may be a more effective treatment option for some patients with painful hallux rigidus.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Mikko Miettinen, MD, please email mikko.miettinen@hus.fi.
----------------------------
2. Experts discuss assessing cardiovascular risk before noncardiac surgery in a patient with complex medical conditions
This “Beyond the Guidelines” feature is based on a presentation at the American College of Physicians Internal Medicine Meeting on 18 April 2026.
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02584
In a new Annals “Beyond the Guidelines” feature, a general internal medicine physician and a cardiologist discuss how to evaluate and manage perioperative cardiovascular risk in an older patient with multiple chronic conditions who is preparing for noncardiac surgery. Using the 2024 American Heart Association/American College of Cardiology guideline that emphasizes a stepwise patient-centered and team-based approach to preoperative cardiac assessment, the experts explore how clinicians can balance the need for preoperative testing with the risks of unnecessary procedures and surgical delays.
The discussion centers on Mr. S, an 80-year-old man scheduled for outpatient surgery to remove several skin cancers. His medical history includes coronary artery disease, pulmonary hypertension, diabetes, chronic obstructive pulmonary disease (COPD), cirrhosis, hemophilia, and prior lung and prostate cancers. Although he reports chronic shortness of breath and a recent productive cough, he remains functionally independent and has no chest pain.
The first discussant, Avital Y. O’Glasser, MD, is a Professor of Medicine in the Division of Hospital Medicine and a Professor of Anesthesiology and Perioperative Medicine in the Department of Anesthesiology and Perioperative Medicine at Oregon Health & Science University. Dr. O’Glasser recommends a structured evaluation that considers both cardiac and noncardiac conditions, use of validated risk calculators, and targeted testing only when results would meaningfully change management. For Mr. S, she recommends a formal preoperative risk assessment for his multiple chronic medical issues in a dedicated preoperative clinic or with his primary care practitioner. This includes obtaining an updated electrocardiogram and considering ischemic testing and echocardiography based on his symptoms and cardiovascular history.
The second discussant, Kirsten E. Fleischmann, MD, MPH, is a Professor of Clinical Medicine, Walter H. Shorenstein Endowed Chair in Cardiology, an Assistant Chair in the Department of Medicine, and an Associate Chief of the Division of Cardiology at the University of California, San Francisco. Dr. Fleischmann emphasizes that preoperative assessment should focus on identifying and reducing risk rather than “clearing” a patient for surgery. She recommends evaluating functional status, considering cardiac biomarkers such as B-type natriuretic peptide (BNP), and tailoring additional testing to the patient's overall clinical picture. Dr. Fleischmann also highlights the need for careful medication management before surgery.
Both experts agree that clinicians should take a team-based approach to perioperative care, using risk stratification tools and selective testing to guide decision making while avoiding unnecessary interventions. They emphasize that preoperative consultations should focus on optimizing patient health, communicating risks clearly, and preparing for potential postoperative cardiovascular complications.
All “Beyond the Guidelines” features are based on selected clinical conferences at Beth Israel Deaconess Medical Center (BIDMC) and include multimedia components published in Annals of Internal Medicine .
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact one of the discussants, please email Kendra McKinnon at kmckinn1@bidmc.harvard.edu.
Also in this issue:
Securing Patient-Centered Decision Making With Adults With Intellectual and Developmental Disabilities
Isaac Baldwin, MD; and Allison M. McCarthy, PhD
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01293
Beyond “Provider”: Recommendations to Turn Consensus Into Action
Michael Suk, MD, JD, MPH, MBA
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01556
Inflammatory Bowel Disease
Soo-kyung Park, MD, and Siddharth Singh, MBBS
In the Clinic
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02511
Annals of Internal Medicine
News article
People
Surgery Versus Watchful Waiting for First Metatarsophalangeal Joint Osteoarthritis: A Randomized Controlled Trial
11-Aug-2026