Search Results (186)

Objective: This study aimed to compare the clinical and radiological outcomes of dynamic rod stabilization with and without transforaminal lumbar interbody fusion (TLIF) in patients undergoing surgery for degenerative lumbar instability. Specifically, we evaluated the prognostic value of hybrid systems in reducing adjacent segment disease (ASD), enhancing fusion rates, and improving functional outcomes. Methods: A retrospective analysis was conducted on 62 patients treated between 2019 and 2022. Group 1 (n = 34) underwent dynamic rod stabilization alone, while Group 2 (n = 28) received dynamic stabilization combined with TLIF. Radiological assessments included disk height index (DHI) and fusion rates. Clinical outcomes were measured using the Visual Analog Scale (VAS) for back and leg pain at baseline, 12, and 24 months. Statistical analysis was performed using Jamovi^® software (version 2.4.1). Results: The hybrid group (dynamic + TLIF) demonstrated significantly higher anterior fusion rates (p < 0.001) and greater improvement in VAS scores for back (p = 0.005) and leg pain (p < 0.001) at 12 months. Although operative time was longer (p = 0.002), there was no significant difference in hospital stay (p = 0.635). No significant differences were observed in ASD development (p = 0.11) or pseudoarthrosis (p = 0.396). The hybrid group maintained better lumbar lordosis and higher adjacent segment DHI. Conclusions: Hybrid dynamic stabilization combined with TLIF provides superior clinical outcomes and fusion rates compared to dynamic stabilization alone, without significantly increasing the risk of ASD. These findings support the use of hybrid constructs as a balanced strategy for treating degenerative lumbar instability. Full article

Background and Objectives: Although the use of allografts in revision anterior cruciate ligament reconstruction is associated with theoretical advantages, it has historically led to poorer clinical results and lower survival rates. However, the heterogeneity of the available literature makes it difficult to elucidate the effectiveness of allographs, as most of the studies published do not make any reference to some of the key aspects related to the processing of the allograft employed. The present study analyzed the clinical results and the survival of allografts in patients undergoing revision anterior cruciate ligament reconstruction with a well-characterized, single type of allograft. Materials and Methods: This was a retrospective observational study analyzing a series of patients undergoing revision anterior cruciate ligament reconstruction with an Achilles tendon allograft with a bone block (FlexiGraft, LifeNet Health), subjected to low-dose irradiation at dry ice temperatures. Preoperative and follow-up clinical variables (IKDC, pain, hop test, and YBT scores) were recorded. Survival was analyzed using the Kaplan–Meier methodology. Results: A total of 39 patients (34 male, 5 female) were included in the study. The mean patient age was 37.3 years and mean postoperative follow-up was 78.7 months. Forty-one percent of patients were competitive athletes, and all of the patients in the sample exhibited preoperative instability. The mean allograft thickness was 9.2 mm. During surgery, 51.3% of patients required meniscus repair and 20.5% had to be treated for chondral defects. At the last follow-up visit, 92.3% of the subjects presented with IKDC grade A and 7.7% with IKDC grade B. The mean subjective IKDC score was 0.79 and mean pain intensity was 1.15 according to the VAS scale. Limb symmetry, as measured by the various hop tests and the Y balance test, were within the safety range, with 74.4% of patients succeeding in returning to their previous level of sport. Ten-year survival was estimated at 97.4%. Conclusions: Allografts obtained and processed following the current regulations governing patient selection and graft harvesting, which are additionally processed without recourse to chemical procedures and sterilized at less than 2 MRad in dry ice conditions, represent an effective and safe alternative in revision anterior cruciate ligament reconstruction. Full article

Background: Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate the clinical outcome and glenohumeral arthritis progression in patients with recurrent anterior shoulder instability and significant bone loss treated by a modified Latarjet procedure. Methods: From July 2018 to November 2021, a prospective observational case series was carried out on 21 patients with recurrent anterior shoulder instability associated with significant bone defects treated by a modified Latarjet procedure in which the coracoid process was rotated 90° on its longitudinal axis and the subscapularis muscle was horizontally split. Patients with a glenoid defect of more than 21% were included. Post-operatively, the patients were clinically assessed using modified Rowe scoring. Glenohumeral arthritis, graft position, union, and resorption were radiologically evaluated. Results: The mean age at the time of surgery was 28.52 ± 8.0 (range: 19–45) years. The mean number of dislocations was 18.33 ± 8.67 (range: 6–35) times. The mean glenoid defect size was 26.19 ± 4.85 (range: 21–37) % and Hill–Sachs lesions were off-track in 19 cases. The mean follow-up period was 30.67 ± 7.53 (range: 16–40) months. Eighteen patients (85.7%) showed good to excellent results. The mean modified Rowe score was 85.00 ± 18.77 (range: 30–100) points. The mean external rotation loss was 8.09 ± 5.11° (range: 0–20°). No cases of recurrent instability were observed, and there was no progression of glenohumeral arthritis. Conclusions: The modified Latarjet is an effective and reliable surgical option to treat traumatic anterior shoulder instability with significant bone loss. Most of the reported complications associated with this procedure did not affect the functional outcome. Full article

Borderline personality disorder (BPD) is a complex and heterogeneous condition characterized by emotional instability, impulsivity, and impaired regulation of interpersonal relationships. This narrative review integrates findings from recent neuroimaging, neurochemical, and treatment studies to identify core neurobiological mechanisms and highlight translational potential. Evidence from 112 studies published up to 2025 is synthesized, encompassing structural MRI, resting-state and task-based functional MRI, EEG, PET, and emerging machine learning applications. Consistent disruptions are observed across the prefrontal–amygdala circuitry, the default mode network (DMN), and mentalization-related regions. BPD shows a dominant and stable pattern of hyperconnectivity in the precuneus. Transdiagnostic comparisons with PTSD and cocaine use disorder (CUD) suggest partial overlap in DMN dysregulation, though BPD-specific traits emerge in network topology. Machine learning models achieve a classification accuracy of 70–88% and may support the tracking of early treatment responses. Longitudinal fMRI studies indicate that psychodynamic therapy facilitates the progressive normalization of dorsal anterior cingulate cortex (dACC) activity and reductions in alexithymia. We discuss the role of phenotypic heterogeneity (internalizing versus externalizing profiles), the potential of neuromodulation guided by biomarkers, and the need for standardized imaging protocols. Limitations include small sample sizes, a lack of effective connectivity analyses, and minimal multicenter cohort representation. Future research should focus on constructing multimodal biomarker panels that integrate functional connectivity, epigenetics, and computational phenotyping. This review supports the use of a precision psychiatry approach for BPD by aligning neuroscience with scalable clinical tools. Full article

Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article

Background/Objectives: Anorectal and retroperitoneal abscesses, although differing in frequency and presentation, present significant diagnostic and therapeutic challenges, especially when interconnected through complex fascial planes. Rare cases such as horseshoe ischiorectal phlegmons with extraperitoneal spread are particularly difficult to manage due to limited literature and the absence of standardized protocols. This article presents a rare case alongside a narrative review of similar cases, aiming to highlight key diagnostic pitfalls and therapeutic strategies. Methods: We conducted a narrative literature review using PubMed, Embase, Scopus, and Web of Science to identify reports on horseshoe ischiorectal phlegmons with extraperitoneal or retroperitoneal extension. Relevant studies were compared with the present case. Results: We describe a 59-year-old male who presented with severe sepsis, diffuse abdominal pain, and hemodynamic instability. Imaging and surgery revealed extensive necrotizing spread to the anterior abdominal wall, peritoneum, and retroperitoneal space, despite absent local perianal signs. Emergency midline laparotomy, wide debridement, and drainage were performed. Despite intensive care, the patient suffered rapid clinical deterioration and died within six hours postoperatively. Conclusions: This case and literature review highlight how a clinically silent ischiorectal phlegmon can progress to extensive extraperitoneal involvement and fatal sepsis. This underscores the need for early recognition, advanced imaging, and aggressive multidisciplinary management. Further studies are needed to develop evidence-based guidelines for complex anorectal abscesses with deep fascial extension. Full article

Background/Objectives: Patellar instability in adolescents is a significant cause of short- and long-term morbidity and disability. Traditionally, patients with first-time patellar dislocation are managed nonoperatively, although most studies are not focusing on the adolescent athletic population. The primary objective of the current study was to compare patient-reported outcomes and complications in adolescent athletes who underwent surgery either after the first patellar dislocation or after the recurrence of the dislocation with a minimum postoperative follow-up of 48 months (48–75 months). Methods: A total of 39 adolescent athletes who underwent medial patellofemoral ligament (MPFL) reconstruction (Group A, after the first dislocation, and Group B, recurrent patella dislocation) were included in this study. In all the patients, the same MPFL reconstruction technique was applied using a semitendinosus autograft. The graft was fixed on the patella using a transverse tunnel and adjustable loop button fixation and, in the femur, using a tunnel and absorbable screw fixation. The tunnel was drilled obliquely to prevent penetration of the distal femoral physis. The preoperative and postoperative clinical and functional evaluations of the patients were conducted via the visual analog scale (VAS), the Lysholm Knee Scoring System, the Kujala Anterior Knee Pain Scale, and the Pediatric International Knee Documentation Committee (Pedi-IKDC), and the return to sports score was assessed via the Tegner Activity Scale (TAS). Results: At the latest follow-up, both groups demonstrated significant improvement in the Lysholm scores, with Group A achieving a mean of 92.57 ± 6.21 and Group B achieving a mean of 90.53 ± 8.21 (p = 0.062). Postoperatively, Group A achieved a mean Kujala score of 94.21 ± 9.23, whereas Group B reached 92.76 ± 12.39, with no statistically significant difference (p = 0.08). The Pedi-IKDC score improved postoperatively in both groups. In Group A, it increased from 67.98 ± 12.29 to 93.65 ± 4.1, and in Group B, from 56.21 ± 13.6 to 91.67 ± 6.21 (p = 0.067). The preoperative visual analog scale (VAS) score for pain was significantly lower in Group A (3.1 ± 1.13) than in Group B (4.2 ± 3.01, p < 0.01). At the latest follow-up, the VAS scores improved in both groups, with Group A reporting a mean score of 0.47 ± 1.01 and Group B 0.97 ± 1.32 (p = 0.083). The Tegner activity scores were similar between the groups preoperatively, with Group A at 7.72 ± 1.65 and Group B at 7.45 ± 2.09 (p = 0.076). Postoperatively, Group A had a mean score of 7.28 ± 2.15, whereas Group B had a mean score of 6.79 ± 3.70 (p = 0.065). The mean time to return to sports was significantly shorter in Group A (5.1 ± 1.3 months) than in Group B (7.6 ± 2.1 months) (p < 0.01). Overall, 84.61% of the patients returned to their previous activity level. Specifically, 95.2% (20/21) of patients in Group A achieved this outcome, whereas 72.22% (13/18) achieved it in Group B. Patient satisfaction was generally high, with 76% (16/21) of patients in Group A reporting being satisfied or very satisfied, compared with 77% (14/18) in Group B. Conclusions: MPFL reconstruction is a safe and effective procedure for both acute and recurrent patellar dislocation in adolescent athletes. While patients who underwent acute reconstruction returned to sport more quickly and showed higher absolute postoperative scores, the greatest overall improvement from preoperative to final follow-up was observed in those treated for recurrent instability. Both surgical approaches demonstrated high satisfaction rates and minimal complications, supporting MPFL reconstruction as a reliable option in both acute and recurrent cases. Full article

Hallux valgus (HV) is described as a lateral deviation of the great toe at the first metatarsophalangeal joint (MTP), which is a very common foot deformity in the clinic. This deformity extends beyond localized foot mechanics to affect the entire lower extremity kinetic chain, potentially increasing dynamic instability during locomotion. This study aimed to characterize the kinematics of ankle and knee joints during walking in HV patients compared to controls. In total, 23 patients with bilateral HV and matched healthy controls were recruited. The 6-DOF kinematics data of ankles and knees were collected using a joint motion function analysis system while level walking at adaptive speed. HV patients demonstrated significant kinematic alterations in the ankle joint at IC, including decreased varus by 2.87° (p < 0.001), decreased internal rotation by 1.77° (p = 0.035), and decreased plantarflexion by 4.39° (p < 0.001) compared with healthy subjects. Concurrent compensatory changes in the knee joint included increased varus rotation by 1.41° (p = 0.023), reduced anterior translation by 0.84 mm (p < 0.001), and increased lateral translation by 0.26 mm (p = 0.036). HV patients showed increased ankle dorsiflexion of 3.61° (p = 0.06) and decreased ankle internal rotation of 2.69° (p = 0.043), with concurrent increased knee internal rotation of 2.59° (p = 0.009) at SPF. The ripple effect during walking in the HV population may elevate the risk of knee pathologies. These findings may inform both conservative management strategies and post-surgical rehabilitation regimens. Full article

Background: Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb, and it is characterized by ulnar nerve compression at the elbow. Traditional surgical options, including simple decompression and anterior transposition, have limitations in addressing ulnar nerve instability. This study introduces and evaluates the short-term outcomes of a novel surgical technique, the fascio-aponeurotic epicondylar flap (FAEF), for stabilizing the ulnar nerve and managing its instability. Materials and methods: A retrospective study was conducted on ten patients with longstanding cubital tunnel syndrome and confirmed ulnar nerve dislocation or instability. All patients underwent surgical intervention using the FAEF technique, which involves creating a quadrangular fascial flap from the epicondylar fascia to stabilize the ulnar nerve within the retrocondylar groove. Outcomes were assessed using clinical follow-ups, the Michigan Hand Outcomes Questionnaire (MHQ), VAS, and qDASH scores over a 90-day postoperative period. Results: All ten patients experienced complete resolution of neurological symptoms, including paresthesia, pain, and nerve clicking, by the final follow-up. Postoperative recovery was uneventful, with no complications such as infections or hematomas. Grip strength and hand functionality were fully restored, with significant improvements in MHQ scores (mean: 94). Dynamic elbow mobilization initiated on the first postoperative day resulted in full recovery of elbow range of motion. No recurrence of ulnar nerve dislocation was observed. Discussion: The FAEF technique effectively stabilizes the ulnar nerve, alleviates symptoms, and restores function while minimizing risks associated with traditional procedures, such as nerve trauma and elbow instability. By preserving the anatomical integrity of the medial epicondyle and enhancing nerve mobility, this approach represents a less invasive alternative to anterior transposition and medial epicondylectomy. Conclusions: The FAEF technique is a viable and effective surgical option for managing ulnar nerve instability in cubital tunnel syndrome. It offers a less invasive solution with excellent short-term outcomes, making it a promising addition to the surgical armamentarium for this condition. Further studies are warranted to evaluate long-term efficacy and broader applicability. Full article

Background: This study investigated syndesmotic stability after transection and the effects of stabilization using rigid and dynamic reconstruction techniques. Methods: Syndesmotic stability was analyzed using a six-degree-of-freedom robotic arm on 14 human specimens. Stability was analyzed in the neutral position and during dorsiflexion and plantar flexion using an external rotation stress test under an axial load of 200 Newtons. The examination was performed on intact and sequentially transected syndesmosis in the following order: (1) anterior inferior tibiofibular ligament (AITFL); (2) interosseous ligament (IOL); and (3) posterior inferior tibiofibular ligament (PITFL). Then, reconstruction was performed using different syndesmotic screw techniques or a dynamic Suture Button system (Arthrex TightRope; n = 7). Results: A syndesmotic transection mainly caused sagittal instability of the fibula. While both static and dynamic reconstruction provided stabilization, screw fixation, particularly with two screws and a plate, demonstrated superior control of the fibular movement, especially in the sagittal and transverse planes, compared to one Suture Button. Conclusions: The results suggest that syndesmotic stabilization with one Suture Button may be insufficient for cases involving three-ligamentous injuries, whereas two Suture Buttons may offer comparable biomechanical stability to syndesmotic screws. Additionally, the study suggests that lateral radiographs may provide additional clinical value in assessing syndesmotic stability. Full article

Background: A pseudotumor adjacent to the odontoid has been reported to be a non-neoplastic mass that is mainly associated with atlantoaxial instability. Methods: Case report. Results: A 72-year-old woman presented to our clinic with a chief complaint of bilateral fine motor dysfunction and gait disturbance. She had rheumatoid arthritis as a comorbidity. Physical examination revealed bilateral hand fine motor dysfunction and signs of myelopathy, including hyperreflexia of the deep tendon reflexes in the lower extremities. Magnetic resonance imaging (MRI) showed a retro-odontoid pseudotumor. Surgery was proposed to the patient, but she did not wish to undergo surgery at this time. At a follow-up visit approximately one year after the initial visit, she complained of the progression of the bilateral hand fine motor dysfunction and gait disturbance. MRI demonstrated a pseudotumor in the space anterior to the odontoid process, indicating that the localization of the pseudotumor around the odontoid process changed from the posterior space to the anterior space in its natural course. Conclusions: The speculated sequential mechanism of the change in the location of the pseudotumor from the posterior space to anterior space to the odontoid process in the natural course is as follows: As the rheumatoid arthritis progressed, the C1-2 joint was immobilized in the dislocated position, and as a result, the retro-odontoid pseudotumor disappeared due to immobilization of the C1-2 joint. Following the disappearance of the retro-odontoid pseudotumor, the odontoid process shifted backward owing to rupture of the transverse annular ligament. Consequently, a new space appeared in front of the odontoid process. Subsequently, damage to the apical and alar ligaments resulted in pseudotumor formation in the new space. Considering our case, the formation of an antero-odontoid pseudotumor occurs only in limited cases, with extreme progression of the pathology. Most cases of retro-odontoid pseudotumors are treated by surgery before such a progression; therefore, we consider that such a case has not yet been reported in the literature. Full article

Objectives: Some following up patients have poor clinical outcomes when they experience anterior cruciate ligament reconstruction. The patient will undergo progression of knee joint osteoarthritis or several secondary knee procedures such as high tibial osteotomy, total knee arthroplasty, menisectomy, meniscus repair, or meniscus transplantation on their knees after anterior cruciate ligament reconstruction. This may be related to the remaining instability of the knee joint, changes in the knee joint biomechanics, and progression of osteoarthritis. This study aims to determine which secondary knee procedures are performed over time after anterior cruciate ligament reconstruction. Methods: The National Health Insurance Service-Health Screening database analyzed 146,122 patients who underwent ACL reconstruction surgery between 1 January 2002 and 31 December 2021. Secondary knee procedures were investigated by categorizing them into revisional reconstruction, high tibial osteotomy, total knee arthroplasty, menisectomy, meniscus repair, and meniscus transplantation, respectively. Multivariable Cox Proportional Hazard model analysis was used. The significant predictors for complications (p < 0.05) were as follows. Results: Among a total of 146,122 patients with anterior cruciate ligament reconstruction, 1073 (0.7%) patients underwent HTO, 908 (0.6%) patients underwent TKA, 15,218 (10.4%) patients underwent meniscectomy, 7169 (4.9%) patients underwent meniscus repair, and 938 (0.6%) patients underwent meniscus transplantation. The hazard ratio differed according to graft type, gender, and age group. Conclusions: Patients who undergo ACL reconstruction may experience poor clinical outcomes, such as progression of osteoarthritis and undergoing secondary knee procedures several years after ACL reconstruction. It is important for decision-making, ongoing monitoring, and follow-up care for patients undergoing ACL reconstruction. Full article

Background and Objectives: The anterior cruciate ligament (ACL) is crucial for knee stability, preventing anterior displacement of the tibia and rotation relative to the femur. Despite ACL reconstruction (ACLR), residual instability is common, affecting knee function. Anterolateral ligament reconstruction (ALLR) alongside ACLR improves outcomes, as the ALL plays a significant role in rotational stability. This study aims to assess the clinical and functional outcomes of the ACLR+ALLR combination using biomechanical testing in patients with at least ten months of follow-up. Materials and Methods: This cross-sectional comparative cohort study involves patients with ACLR. Inclusion criteria were adult patients who underwent ACLR within the last 3 years, with the same surgical technique performed by a single operator. Patients underwent anamnestic and clinical evaluation and completed Lysholm and KOOS questionnaires. Biomechanical tests included a Unilateral Drop Jump, a Countermovement Jump with knee rotation, and a five-repetition Sit-To-Stand. Force platforms, a camera, and surface electromyography were used to assess biomechanical stability and joint function. Results: This study included 18 subjects, 5 with ACLR and ALLR, and 13 with ACLR alone. The groups showed no significant differences in the KOOS and Lysholm scales and clinical outcomes. Muscle trophism reduction compared to the contralateral limb was noted in both groups. Biomechanical evaluations showed no difference in Quadriceps muscle activity during the landing phase of the Drop Jump. However, the ACL-ALL group exhibited fewer spikes and fewer knee joint angular excursions during ground impact stabilization. In the 5-STS task, a significant difference was observed in the vertical force peak. Differences in muscle activity during foot rotation and force components during the jumping phase were noted in the Countermovement Jump. Conclusions: ACLR combined with ALLR shows similar perceived joint function but improved biomechanical joint stability. Further studies with larger samples and longer follow-ups are needed for validation. Full article

Background and Objectives: Gait and posture alterations are reported in patients with diabetic foot. We evaluated whether gait and postural parameters are associated with a well-known parameter, e.g., glycated hemoglobin levels in blood, and the salivary markers 1,5-anhydro-D-glucitol (1,5-AG) and Advanced Glycation End-Products (AGEs) measured in saliva samples. Materials and Methods: Gait and postural impairment was assessed using a wearable inertial sensor, and the evaluation of balance/gait and risk of fall was determined by the Tinetti Scale and Downton Index, respectively. Glycemic control was measured by glycated hemoglobin concentration and fasting glycemia. The salivary concentration of 1,5-AG and AGEs was measured using an enzyme-linked immunosorbent assay. Results: Eighty-five patients were evaluated, revealing significant associations (p < 0.05) between salivary 1,5-AG and sway path displacement along the medio-lateral axis (rho = 0.365, p = 0.017) and sway area (rho = 0.334, p = 0.031) during tandem position tests with eyes closed. Salivary AGEs were significantly associated with sway path displacement along the anterior–posterior axis (rho = 0.419, p = 0.004) and medio-lateral axis (rho = 0.436, p = 0.002) in the tests performed with eyes closed, feet close together, and foam pads, as well as with sway area (rho = 0.387, p = 0.007). The concentration of HbA1c was significantly correlated with sway path displacement along the anterior–posterior axis in the tests performed with eyes closed, feet close together, and foam pads (rho = 0.236, p = 0.043), as well as with sway area (rho = −0.236, p = 0.043). A significant difference was observed in the salivary AGE concentration between patients with previous ulcers versus those without (p = 0.035). By applying Bonferroni correction for multiple comparisons, the associations remained significant (p < 0.05) for AGE concentration in saliva and postural instability parameters. Conclusions: The results suggest a link between salivary glycemic control biomarkers, in particular AGEs and postural changes in patients with diabetic foot, indicating a new interesting filed for further studies on fall risk. Full article

Alterations in static plantar pressure distribution serve as important indicators of gait and balance impairments in individuals with Multiple Sclerosis (MS). In addition, the identification of altered patterns of plantar load distribution, along with restricted ankle dorsiflexion, may serve as early markers of postural instability and gait dysfunction in women with MS. Objectives: To assess differences in static plantar pressure, load distribution, and ankle dorsiflexion range of motion between women diagnosed with MS and women without the condition. Methods: A cross-sectional observational study was conducted between April and December 2024. Women with MS were recruited from patient associations in the provinces of Alicante and Murcia, as well as from the neurology outpatient clinic at the Doctor Balmis University Hospital (Alicante, Spain). Static postural assessment was performed using the Neo-Plate^® pressure platform, which measured maximum and mean plantar pressure (kPa), load distribution (%), contact surface area (cm²), and anterior–posterior weight distribution between the forefoot and rearfoot. The ankle dorsiflexion range of motion was assessed with a universal two-arm goniometer. All parameters were compared with those of a group of women without a diagnosis of MS. Results: Compared to women without MS, participants with MS showed a significantly greater load on the right forefoot (25.75% vs. 23.41%, p = 0.021), and reduced load on the right (23.09% vs. 26.01%, p = 0.004) and left rearfoot (26.60% vs. 30.85%, p = 0.033). Total forefoot loading was significantly higher (52.33% vs. 46.40%, p < 0.001), and rearfoot loading was lower (47.64% vs. 52.42%, p = 0.006) in the MS group. Ankle dorsiflexion range of motion was also significantly reduced in women with MS, both with the knee flexed (5.95° ± 4.50 and 6.76° ± 4.69 vs. 15.45° ± 5.04 and 14.90° ± 5.43) and extended (2.69° ± 3.69 and 3.12° ± 3.83 vs. 8.17° ± 3.41 and 8.60° ± 3.31), with all differences reaching statistical significance (p < 0.001). Conclusions: Women with MS present significant alterations in static plantar load distribution, with increased forefoot and decreased rearfoot loading, as well as markedly reduced ankle dorsiflexion, in comparison to women without the disease. These findings suggest the presence of postural imbalances associated with MS, potentially affecting functional stability and mobility. Full article