This case study investigates a pes anserinus anomaly in a male in his seventies who held an occupation in installation, maintenance, or repair. Using whole-body dissection, we found abnormal deposits and synovial tissue in the region of the pes anserinus, possibly suggestive of chronic overuse or injury which would fit with the patient’s occupation. This study could aid healthcare providers in understanding and diagnosing variations and in managing lower limb pathologies, particularly in patients with occupational or repetitive stress-related injuries.
Freiberg’s disease is a rare condition involving osteochondrosis and collapse of the metatarsal head, often leading to chronic pain and impaired mobility. Traditional surgical treatments such as osteotomies, autografts, and joint replacements can relieve symptoms but may compromise joint mechanics or cause donor-site complications. In this case, a 23-year-old woman with Smillie stage 3–4 disease underwent a Valenti-type resectional arthroplasty combined with a folded, decellularized dermal graft spacer to preserve joint function. The procedure resulted in rapid recovery, with pain-free motion and restored within weeks. Radiographs showed remodeling of the metatarsal head, and the patient remained fully ambulatory without complications. This technique offers a promising joint-preserving alternative for young, active patients, although further research is needed to confirm its long-term efficacy.
Background: Adult acquired flat foot deformity (AAFD) is a triplanar deformity characterised by collapse of the medial longitudinal arch. The most frequently used surgical method is the Evans calcaneal osteotomy. It is usually used in the paediatric age group and there are very few studies related to the use of the modified calcaneal osteotomy procedure in adults. The aim of this study was to evaluate the radiographic improvements after this procedure in the adult age group and to investigate whether or not there was real probability of increased arthritis in the STJ and CCJ. Methods: The study included 20 patients who presented at our clinic between January 2020 and June 2022 with the complaint of foot pain and were diagnosed with Grade 2 AAFD. This retrospective study was based on the data in the hospital records system and the patient follow-up forms. Preoperatively and at 1, 6, 12, and 24 months postoperatively, a record was made of calcaneus length, calcaneal slope angle, talocalcaneal angle, medial longitudinal arch angle, and the time to removal of the Kirschner wire. The presence of arthritis in the joint regions was calculated according to the Kellgren–Lawrence classification. Results: According to the data recorded preoperatively and at the postoperative follow-up examinations (mean 1–6–12–24 months), the difference in calcaneal length, calcaneal slope angle, and change in medial longitudinal arch angle were statistically significant (p < 0.001). No statistical significance was found in respect of the development of arthritis according to the preoperative and postoperative measurements for the CCJ and STJ (p = 1.00). Conclusions: The Modified Evans Osteotomy procedure is beneficial and effective in the correction of pes planovalgus. The surgeon must have a good knowledge of anatomy and it must not be forgotten that there could be variations. The probability of arthritis is not as high as has been assumed.
Pincer nail is a severe variant of nail deformity characterized by excessive transverse curvature of the nail, impinging on both lateral nail folds. The distal end is the most curved and grows inward, squeezing both lateral nail folds, resulting in varying degrees of pain and discomfort, making it difficult for patients to wear shoes, hindering walking, and severely impacting the quality of life. Although most previous nail surgical procedures have demonstrated good outcomes, these complicated operations result in a long recovery period and painful nail extraction. Here we present a tissue-preserving combination therapy of nail grinding followed by limited nail fold resection without nail plate extraction. By preserving the integrity of the nail bed and matrix, this approach avoids the extensive dissection and avulsion trauma inherent in conventional procedures, offering reduced postoperative pain, faster recovery, and minimal cosmetic alteration.
Calcaneal stress fracture is an uncommon osseous cause of heel and hindfoot pain. A 33-year-old woman with chronic underweight status (body mass index, 16.59 kg/m2) presented with a 2- to 3-week history of right lateral hindfoot pain that reportedly began during treadmill walking in association with a perceived twisting event. The medical record documented tenderness in the region of the calcaneofibular ligament and a negative talar tilt test, but heel-specific examination was incompletely documented. Magnetic resonance imaging (MRI) obtained at the initial evaluation was formally interpreted as showing a calcaneal tuberosity stress fracture and quadratus plantae strain, with no abnormality reported in the ankle ligament complexes. On retrospective MRI review, an incomplete, vertically oriented fracture line extending to the cortex without articular extension or osseous displacement was identified, with surrounding marrow signal abnormality meeting the imaging criteria for Nattiv grade 4. Weight-bearing radiographs obtained 4 days later showed a corresponding sclerotic band. This case illustrates MRI–radiographic correlation in a calcaneal tuberosity stress fracture presenting with lateral hindfoot pain and supports inclusion of osseous injury in the differential diagnosis.
Angioleiomyoma is a benign soft tissue tumor originating from the smooth muscle of vascular structures. Though relatively uncommon, it frequently occurs in the lower extremities and is often misdiagnosed due to its nonspecific clinical presentation. We report the case of a 54-year-old female with chronic posterolateral heel pain initially attributed to insertional Achilles tendinopathy and Haglund’s deformity. After failure of conservative management, MRI revealed a well-circumscribed subcutaneous lesion with signal characteristics concerning for a soft tissue neoplasm. Surgical excision was performed, and histopathologic analysis confirmed a venous-type angioleiomyoma, characterized by thick-walled vascular channels and smooth muscle proliferation without atypia. Immunohistochemistry was positive for SMA, weakly positive for desmin, and ERG-positive in the vascular endothelium. The patient experienced complete symptom resolution postoperatively. Although not exceedingly rare, angioleiomyomas remain underrecognized in clinical practice, particularly in the foot and ankle, resulting in diagnostic delays averaging over five years. MRI demonstrated characteristic features described in recent literature, validating its utility in preoperative assessment. This case reinforces the importance of maintaining a broad differential when evaluating chronic, focal heel pain and supports the use of advanced imaging and histopathologic confirmation in atypical cases. Greater awareness of angioleiomyomas can help reduce diagnostic delays and improve outcomes in patients with chronic, unexplained soft tissue pain in the foot and ankle.
Extracorporeal magnetotransduction therapy (EMTT) is a high-energy electromagnetic modality that delivers field strengths of 80-150 mT, effective transduction power > 60 kT/s, and dual-frequency architecture with pulse repetition near 8 Hz and oscillations of 100-300 kHz. This prospective pilot study evaluated pain and functional outcomes in patients with symptomatic midfoot osteoarthritis (OA). Eight patients (13 feet; five bilateral and three unilateral cases) with radiographic Kellgren-Lawrence (KL) grade 3 or 4 midfoot OA received eight EMTT sessions over four weeks. Outcomes were measured at baseline, after the eighth treatment at four weeks, and at 3-month and 6-month follow-up using the 0-10 Visual Analog Scale (VAS) and Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-ADL). VAS demonstrated a significant overall effect of time (F(3,36) = 3.93, p = 0.016), with mean scores decreasing from 4.15 ± 1.63 at baseline to 2.62 ± 1.98 at 3 months and 3.00 ± 2.08 at 6 months. Bonferroni-adjusted baseline-to-follow-up contrasts approached significance at 3 months (p = 0.067) and were not significant at 6 months (p = 0.150). FAAM-ADL improved significantly over time (F(3,30) = 13.76, p < 0.001), increasing from 61.7% ± 9.9% at baseline to 81.8% ± 11.1% at 6 months. No treatment-related adverse events were observed; one participant proceeded to surgery by 6 months and was classified as a treatment failure. These preliminary findings suggest that EMTT is safe and may provide clinically meaningful functional improvement in selected patients with midfoot OA; larger sham-controlled trials are needed.
Post-surgical pyoderma gangrenosum (PSPG) is a challenging diagnosis associated with significant morbidity, often misidentified as postoperative infections, leading to inappropriate management. This systematic review aims to elucidate the characteristics, management strategies, and outcomes of PSPG in the context of foot and ankle surgery to improve diagnostic accuracy and patient care. A systematic literature search was conducted across multiple databases, including PubMed, Scopus, and Embase, for cases of PSPG following foot and ankle surgery published up to January 2023. Data on demographics, clinical presentation, management, and outcomes were extracted and analyzed. Ten cases met the inclusion criteria, predominantly females presenting with rapidly worsening and painful postoperative ulcers. A high rate of negative cultures was observed during the patients' treatment period. Dermatology consults initially suspected 83.33% of the cases. Notably, 30% of patients underwent amputation of various parts of the lower extremity, all diagnosed more than 35 days after symptom onset, and were female. The mainstream treatment for PSPG involved systemic immunosuppressants, with corticosteroids being the most common, effectively resolving symptoms in the majority of instances. PSPG should be suspected in patients with unexplained, worsening postoperative wounds. Early recognition and appropriate treatment with immunosuppressants are crucial to prevent severe outcomes. Multidisciplinary management involving dermatologists and surgeons is recommended to optimize patient outcomes. Further research is needed to establish robust diagnostic and management protocols for PSPG in the surgical context.
Background: Diabetes mellitus (DM) is a metabolic disease with an increasing global prevalence. It is characterized by chronic and systemic complications. Due to these complications, DM significantly impacts patients' health-related quality of life (HRQoL). One of the most critical complications of DM is diabetic foot ulcers (DFUs), which have serious consequences for patients and healthcare systems. Objective: This study aimed to investigate variables potentially associated with HRQoL in patients with DFUs presenting to our wound care unit. Methods: This prospective cross-sectional study was conducted from February to May of 2023 at the Wound Care Unit of the General Surgery Department at Eskişehir City Hospital. A total of 209 patients who agreed to participate were included in the study. Data were collected via a structured questionnaire developed based on the literature, which included the Diabetic Foot Ulcer Scale-Short Form (DFS-SF). We used the Kolmogorov-Smirnov test, univariate analyses (Mann-Whitney U and Kruskal-Wallis tests), and multiple linear regression. Results: In the multivariate analysis, receipt of foot care education (p < 0.001), frequency of hospital applications due to DFU (p = 0.008), and Wagner classification (p = 0.012) were found to be predictors of HRQoL for DFUs (Adjusted R2 = 0.206, F = 4.365, p < 0.001). Conclusions: To maintain a high HRQoL among DFU patients, they should immediately apply to specialized Wound Care Units, receive education, especially regarding early diagnosis and treatment, and receive multidisciplinary management for DFU.
Background: Pes planus is a common foot deformity that may lead to both structural and functional consequences. This alteration in foot morphology has been associated with changes in neurosensory mechanisms such as proprioception and balance. This study aims to evaluate proprioception and balance parameters in young adults with pes planus by comparing them with healthy individuals. Methods: This case-control study, which had a quantitative and cross-sectional design, included a total of 90 volunteer university students aged 18-30. The presence of pes planus was assessed using the Navicular Drop Test. Proprioception assessment was performed using a digital goniometer to measure active and passive joint position sense, while balance assessment was performed using the Y Balance Test. Results: The groups were similar in terms of demographic and anthropometric characteristics (p > 0.05). In the proprioception assessment, a significant difference was observed in active joint position sense scores in individuals with pes planus (p = 0.032). In contrast, no significant difference was found between the two groups in terms of passive joint position sense (p = 0.769). According to the Y Balance Test results, no difference was observed in the anterior and posteromedial directions (p = 0.690 and p = 0.806). At the same time, the balance performance of individuals with pes planus was significantly lower in the posterolateral direction (p = 0.045). Conclusions: Young individuals with flexible pes planus showed differences in active joint position sense and balance performance in the posterolateral direction. This situation shows that pes planus may be associated with not only structural but also neurosensory functions. The findings highlight the importance of planning protective interventions early. In the future, there is a need for longitudinal studies conducted with larger and more heterogeneous samples, including rigid type pes planus.
BACKGROUND:Diabetic foot osteomyelitis (DFO) poses significant challenges due to its high morbidity and recurring nature. Current treatments involve prolonged antibiotics and often surgical intervention; however, the optimal route of antibiotic administration is unknown. This study evaluated the effect of route of antibiotic administration on treatment failure among patients with diabetic foot osteomyelitis. METHODS:The authors conducted a retrospective cohort study among patients with unresected diabetic foot osteomyelitis. A propensity score was used to match the treatment exposure groups. The primary outcome was treatment failure, defined as either (1) treatment with additional antibiotic course or (2) additional surgical debridement/amputation at the original site of infection within 1 year of initial treatment. Secondary outcomes included the impacts of hemoglobin A1c, peripheral arterial disease, obesity, and infection severity on treatment failure. RESULTS:Among 152 patients meeting criteria, 49 matched pairs were analyzed. Treatment failure rates did not significantly differ between oral and intravenous groups (OR 0.98, 95% CI 0.30-3.19, p > 0.9). A time-to-event analysis similarly found no significant outcome disparities between groups (p = 0.3). CONCLUSIONS:The study results support the previously published literature that demonstrates comparable treatment outcomes between routes of antibiotic administration when treating diabetic foot osteomyelitis.
Daptomycin is widely used for serious methicillin-resistant Staphylococcus aureus (MRSA) infections, but it can cause eosinophilic pneumonia, an uncommon and potentially severe adverse drug reaction. We report probable daptomycin-induced eosinophilic pneumonia (DIEP) in a 77-year-old woman receiving intravenous daptomycin with rifampin for a postoperative MRSA foot infection with concern for orthopedic-device involvement and osteomyelitis. Daptomycin had been initiated 10 days before admission, when she developed acute hypoxemic respiratory failure with bilateral ground-glass and consolidative opacities on chest computed tomography and a negative evaluation for infection. Daptomycin was discontinued on the day of admission, yet respiratory failure progressed, requiring mechanical ventilation. Bronchoalveolar lavage performed after corticosteroid exposure demonstrated eosinophilia (9%), and she improved with systemic corticosteroids and supportive care. Although she did not meet strict FDA "most likely/definite" criteria, the temporal association, compatible imaging, exclusion of alternative etiologies, abnormal lavage eosinophilia, and clinical response following drug withdrawal support "probable" DIEP criteria. Clinicians managing complex foot infections should consider DIEP when new respiratory symptoms and infiltrates develop during daptomycin therapy, even early in the treatment course and even when peripheral eosinophilia is absent or minimal.
Chronic limb-threatening ischemia (CLTI) in patients with no conventional targets for revascularization presents a formidable challenge in limb salvage. Deep venous arterialization (DVA) is an emerging endovascular approach that redirects arterial blood flow into the venous system to perfuse the ischemic foot. Despite early promising results, appropriate wound management of the ischemic foot following a DVA procedure has been described in the literature, albeit infrequently and with limited standardization. Here, we present a case of an 85-year-old male with multiple comorbidities, including peripheral artery disease and a prior right above-knee amputation (AKA), who underwent a successful left-sided DVA following an open transmetatarsal amputation (TMA) for infection. A staged wound care approach with guillotine amputation, delayed revision and skin grafting ultimately preserved his only remaining limb and allowed for ambulation. This case underscores the potential of DVA as a limb-saving option in complex "no-option" patients when paired with multidisciplinary care and tailored wound management.
BACKGROUND:Minimally invasive surgery (MIS) for hallux valgus (HAV) correction may benefit from using the medial eminence to enhance lateral capital fragment translation. This study investigates whether osteotomy placement through the medial eminence correlates with improved HAV and forefoot width (FW) correction. A retrospective analysis of 20 patients who underwent MIS bunion correction was performed. Pre- and postoperative radiographs were reviewed to assess hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, osteotomy location, osteotomy angle, capital fragment shift, and forefoot width. Pearson correlation and multivariable linear regression were used to identify associations. Chart review was performed at the one-year mark for complications (recurrence, infection, non-union, hardware failure). Significant correlations were found between DMAA and HVA (r = 0.883, p < 0.001), DMAA and IMA (r = 0.573, p = 0.008), and HVA and capital fragment shift (r = 0.541, p = 0.014). Osteotomy location and angle were not significantly associated with correction. Multivariable analysis showed DMAA was independently associated with HVA correction (β = 0.679, p < 0.001), and both capital fragment shift and metatarsal head angulation were associated with FW narrowing. Additionally, no patients in this cohort experienced complications. Use of the medial eminence in MIS osteotomy was not associated with improved HAV or FW correction. Angular deformity parameters and lateral fragment shift were more predictive of radiographic outcomes.
Lateral column lengthening (LCL) calcaneal osteotomy is a well-established surgical procedure used in flexible flatfoot reconstructive surgery. The effects of LCL on subtalar joint (STJ) range of motion (ROM) have not been thoroughly explored in the literature. Our study aimed to objectively measure the average decrease in the total ROM of the STJ following LCL. A retrospective cohort study was conducted on 15 patients (20 feet) who underwent LCL for various indications. Data for STJ ROM was collected from both the preoperative and postoperative periods. Mean follow-up for the cohort was 12 weeks postoperatively. The mean total preoperative STJ ROM was 39.65 ± 2.52 degrees, while the mean total postoperative STJ ROM was 19.17 ± 2.62 degrees (p < 0.001). This represents a statistically significant reduction of 20.48 degrees (48% decrease) in STJ ROM from preoperative to postoperative measurements. This study provides the first objective measurement of the STJ ROM decrease following LCL calcaneal osteotomy on patients in vivo. The findings highlight the substantial impact of the procedure on the ROM in the STJ. These results have important implications for patient management and should be considered when evaluating the outcomes of LCL procedures. Further research is warranted to explore the functional consequences and long-term effects of the reduced STJ ROM and to develop strategies for optimizing foot function in patients undergoing this procedure.
Plantar load distribution and postural stability are key functional domains in diabetic foot assessment, yet their association in early-stage disease remains poorly characterized. This study aimed to investigate the association between static plantar load distribution and postural stability parameters in 31 patients with early-stage diabetic foot (Meggitt-Wagner grade 0-1). A cross-sectional study was conducted with 31 participants (mean age 58.48 ± 9.53 years; 51.6% with loss of protective sensation). Static plantar load distribution was assessed using the Tekscan Pressure Measurement System (Presto-Scan DB software) and postural stability was assessed using the Nintendo Wii Balance Board® under bipedal eyes-open, bipedal eyes-closed, and single-leg stance conditions. Spearman correlation analyses with Benjamini-Hochberg false discovery rate (FDR) correction were performed. A rearfoot-dominant loading pattern was observed bilaterally (right: 61.5 ± 8.2%; left: 61.8 ± 7.9%). Mean CoP sway velocity was 4.78 ± 1.98 mm/s (eyes open) and 5.76 ± 1.88 mm/s (eyes closed) in bipedal stance. No statistically significant associations between plantar load distribution and CoP parameters were found after FDR correction (all q > 0.05). Adults with early-stage diabetic foot exhibit a rearfoot-dominant loading pattern and sensory-dependent postural control behavior. The absence of significant cross-domain associations suggests that static plantar load distribution and postural stability represent complementary assessment targets. Future controlled studies with matched healthy comparators are needed to determine clinical significance.
Background: Changes in the rearfoot calcaneal position affect the foot "arch structure" during the stance phase of gait and hence influence reactions in the plantar fascia thickness and stiffness during weight bearing. However, previous research has focused on the non-weight-bearing assessment of plantar fascia thickness (PFT) and stiffness (PFS) and has not linked these measurements to rearfoot position. Methods: This study aims to investigate if a change in the weight-bearing rearfoot position influences the PFT and PFS. A linear actuator-driven 3D-printed platform was utilised to reliably move the rearfoot through a range of frontal (F (4,12) = 19,585.8, p = 0.00) and sagittal plane angles (F (2,6) = 11,751.32, p = 0.00) whilst weight bearing. An ultrasound probe capable of shear wave elastography was incorporated into the platform for the closed-chain weight-bearing assessment of the PF. The PFT and PFS were collected for 13 (26 feet) participants (11 male, two female; age 35.62 ± 15.04; BMI: 30.31± 6.22 Kg/m2) from a convenience sample who met the inclusion criteria. Results: The data were subject to appropriate statistical, collective and cluster analysis. Individual participant data analysis showed a strong nonlinear correlation between PFT and PFS in the relaxed calcaneal position. The rearfoot sagittal plane cluster demonstrated an auxetic property in 54.3% of the group, where both the PFT and PFS increased. The frontal plane cluster demonstrated an auxetic property in 76% of the group, where the PFT increased as the PFS increased. Conclusions: The results suggest that the PF does have a specific response to changes in the rearfoot position for individuals, which, in some, can show an auxetic property.
Introduction: Offloading adherence (OA) is critical for diabetic foot ulcer (DFU) healing. This report investigated whether DFU patients with low overall OA (<20%) limit offloading device usage to days they come to the clinic. Methods: Activity monitors measured OA 24 h/day. Daily walking and standing OA were calculated for up to four weeks, and participants self-reported their cumulative adherence. Each day was classified as to whether a DFU-related clinic visit occurred. Results: Four participants from an ongoing RCT were identified with <20% overall adherence, despite self-reporting 65-80% adherence. Most days they did not wear their devices at all, while the majority of wear-days coincided with footcare visits. Conclusions: This report describes a cohort that had low daily OA yet consistently wore their devices to the clinic and self-reported inflated OA. To improve OA and DFU healing, more research is needed to understand this phenomenon and help clinicians ascertain adherence during patient encounters.
Patients with diabetes and/or peripheral artery disease (PAD) are at risk for lower limb amputation and a subsequently higher mortality risk. Peer support interventions have been shown to increase diabetes self-management and glycemic control. This scoping review aims to synthesize the current literature on peer support interventions in reducing lower limb amputations. A PubMed search was conducted in June of 2023, excluding publications prior to 2000, focusing on two themes: (1) peer support and (2) the patient population of interest (i.e., individuals with diabetic foot disease and/or PAD). Studies were included if they addressed the population of interest, involved a peer support intervention to improve lower extremity health, and had outcomes pertaining to the health of the lower extremities or programmatic metrics such as participant satisfaction or program adherence. Out of 1730 publications initially identified, six met the inclusion criteria. These six studies were categorized as group foot care education studies (n = 4) or group cognitive behavioral studies (n = 2). The group foot care education studies showed mixed results, which varied from no effect to significant improvements in foot care, self-management, and complications. There was a trend of improvement in self-management behaviors and physical activity in cognitive behavioral interventions. Despite showing promise in other settings, there have been limited investigations of peer support interventions to improve lower extremity outcomes and avert amputations in persons with diabetes and/or PAD. Further studies are required to conclusively determine the efficacy of peer support interventions to reduce lower extremity amputation rates.
