Search Results (330)

This study addresses the limited adsorption efficiency of traditional vacuum suction cups used in applications such as unmanned aerial vehicles (UAVs) and robotic systems. Inspired by the adhesion mechanism of the abalone muscular foot, we propose a novel suction cup design. The design incorporates optimization of the groove geometry, groove distribution, and the positioning of the sealing ring. To assess the mechanical performance of these designs, finite element analysis (FEA) is employed. A prototype exhibiting the most promising simulation results is fabricated and subjected to tensile testing. The experimental results show strong agreement with the simulation outcomes, thereby validating the accuracy and reliability of the FEA. The biomimetic suction cup demonstrates superior adsorption performance compared to the baseline design. Specifically, the maximum von Mises stress is reduced by 5.9%, the maximum pressure is increased by 498%, and the maximum frictional stress rises by 498%. Moreover, the maximum sliding distance is reduced by 38%, while the maximum total circumferential deformation is increased by 21%. This innovative design enhances the stress distribution across the bottom surface of the suction cup, mitigates inward edge contraction, and delays the communication between the inner cavity and the external environment, thereby improving the overall adsorption efficiency of the suction cup. Full article

Cerebral palsy (CP) is a developmental disability caused by injury to the fetal or infant brain, affecting between 1.6 to 3.7 per 1000 live births worldwide. Ambulatory patients with cerebral palsy experience various gait problems, for which they seek treatment from medical professionals. Varus foot deformities are among the most problematic for patients. Varus foot deformity is characterized by the inner border of the foot being tilted upward and the hindfoot inward, increasing weightbearing on the lateral aspect of the foot. This positioning increases weight-bearing pressure under the lateral (outside) of the foot and often under the fifth metatarsal head when walking. As such, varus foot deformity can contribute to in-toeing, make shoe and brace-wearing difficult and painful, compromise gait stability, and sometimes lead to metatarsal fractures. Current knowledge of CP etiology and classifications, as well as principles and advances in assessment and treatment decision making for varus foot deformities, are outlined in this narrative review. In younger children with flexible deformities, non-operative interventions such as bracing, botulinum toxin injection, and serial casting are effective. The literature and expert consensus suggest that, if possible, surgery should be delayed until after the age of 8 years. When surgery is indicated, soft tissue procedures are used for flexible deformities. In addition to the soft tissue procedures, bone surgery is needed for rigid deformities. Careful pre-operative foot assessment is needed, including assessment of deformity flexibility and range of motion, X-rays, and computerized gait analysis if possible. Strategies are presented for thorough assessment when gait analysis is not available or feasible. Research reports of surgical outcomes for soft tissue and bony correction are positive, but should be interpreted with caution. The quality of evidence on surgical outcomes is compromised by use of varying research design methods and selection of outcome measures, with few including measures of function or patient-reported outcomes. It is recommended that surgical outcome be assessed using standardized assessment tools, such as the Foot Posture Index, which have had their validity and reliability established. Recent advances in 3D kinematic foot model development and musculoskeletal modeling have the potential to greatly improve surgical outcomes for patients with CP. Full article

Background: The PITX1 gene encodes a transcription factor that plays a crucial role in the development of the lower limbs, pelvis, and structures derived from the first branchial arch. Pathogenic variants in PITX1 are associated with a limited spectrum of rare disorders, including congenital talipes equinovarus with or without long bone anomalies and/or mirror-image polydactyly, and Liebenberg syndrome. In 2020, a novel clinical phenotype, Mandibular–Pelvic–Patellar (MPP) syndrome, resulting PITX1 missense variants, was proposed. Case presentation: We report the fourth documented case of MPP syndrome worldwide, identified in a 17-year-old female patient presenting with congenital lower limb deformities, patellar aplasia, and micrognathia. Whole-genome sequencing revealed a heterozygous PITX1 missense variant NM_002653.5: c.412A>C, p.(Lys138Gln). The clinical phenotype included knee flexion contractures and severe equinovarus and planovalgus foot deformities requiring multiple staged reconstructive surgical procedures. Conclusions: This case supports recognition of MPP syndrome as a clinically and genetically distinct PITX1-related disorder. Our findings expand the phenotypic spectrum of MPP syndrome and suggest that severe congenital foot deformities represent a consistent and clinically relevant feature of this condition. Full article

Background: Congenital split foot/hand is a rare limb anomaly. Although various surgical techniques have been described, detailed gross anatomical studies of soft tissue adaptation, particularly in the foot, are extremely rare. This study presents a detailed anatomical description of a case of severe bilateral split foot. Methods: A comprehensive dissection was performed on the lower limb of a 64-year-old male donor with bilateral split foot/hand. Results: Radiographic evaluation classified the deformity as Blauth type IV, characterized by the absence of the lateral cuneiform bone and severe hypoplasia/aplasia of the second and third metatarsals. Significant changes were revealed in the musculotendinous apparatus. The key finding was a unique tendon loop passing through the central cleft, formed by the tendon of the extensor digitorum longus and connecting with the tendons of the flexor digitorum longus and flexor hallucis longus. Conclusions: This study presents the first detailed macroscopic anatomical description of split foot, demonstrating that this congenital anomaly involves complex, structured tendon and muscle adaptations that extend beyond skeletal deficiencies alone. The discovery of a persistent tendon loop—previously reported only once in split hand—indicates asynchronous development of skeletal and soft tissue structures. These findings should be taken into account for surgical planning, emphasizing the need to identify and manage such abnormal soft tissue structures during reconstructive procedures. Full article

Background: Flexible flatfoot is a common pediatric condition. Surgical intervention is indicated for symptomatic cases unresponsive to conservative treatment. This study evaluates the outcomes of two established procedures, Grice extraarticular subtalar arthrodesis and subtalar arthroereisis, in children treated for symptomatic flatfoot. Methods: A retrospective analysis was conducted on 158 patients (286 feet) treated between 2013 and 2024. Among them, 34 underwent Grice arthrodesis and 124 underwent arthroereisis. Demographic and procedural data were collected, including age, sex, neurological impairment (cerebral palsy), laterality, and concurrent Achilles tendon lengthening. Radiographic parameters assessed pre- and postoperatively included Meary’s, Pitch, and Kite’s angles (frontal and sagittal view), uncovering of the talus, and Cyma line. Only patients with both pre- and postoperative measurements were included in paired analysis. Statistical tests included paired t-tests within groups and Welch’s t-tests for between-group comparisons. Results: Grice patients were younger (mean age 9.0 ± 3.1 years) and included all cerebral palsy cases (18/34; 52.9%), while arthroereisis patients were older (10.8 ± 2.6 years) and typically neurologically normal. Achilles tendon lengthening was performed in 100% of Grice and 48% of arthroereisis cases. Both groups showed significant radiographic improvement across all measured parameters (all p < 0.05). Grice arthrodesis produced greater reductions in Meary’s angle (right Δ = −19.8° ± 9.2 vs. −13.1° ± 7.5; p = 0.024), while arthroereisis yielded larger increases in Pitch angle (left Δ = +9.2° ± 7.2 vs. +5.5° ± 6.2; p = 0.055). Other angular improvements (Kite’s, uncovering, and Cyma line) were statistically significant within both groups but not between groups. Conclusions: Symptomatic flat-valgus foot in children remains a relevant public health issue. Treatment should be individualized, while cases secondary to unrecognized or untreated congenital conditions often require surgery to restore normal foot biomechanics. Full article

Working equids are at high risk of musculoskeletal disorders due to strenuous labor, repetitive tasks, and harsh environmental conditions. This retrospective study describes the distribution of radiographically detected musculoskeletal findings in working equids presented to four Society for the Protection of Animals Abroad (SPANA) centers in Morocco, based on 498 animals and 1125 radiographs collected between 2015 and 2022. The study population was mainly composed of horses (78.1%), followed by donkeys (15.3%) and mules (6.6%). Most were males (65.7%), and the majority were between 5 and 15 years old (60.4%). The distal limb (foot, pastern, and fetlock) was the most frequently examined region (62.7%). Among the animals reviewed, 381 (76.5%) exhibited at least one radiographically detected abnormality, while 117 (23.5%) showed no visible osseous change. The most frequent findings included foot-related changes (36.2%), defined as non-fracture podiatric abnormalities, fractures (29.7%), and periosteal new bone formation (22%). Less frequent findings were degenerative joint disease (8.1%), joint subluxation or luxation (1.6%), epiphyseal abnormalities (1.6%), and angular deformities (0.8%). These results provide an overview of radiographically detected osseous changes in working equids under field conditions. They highlight the diagnostic value of radiography in low-resource environments and provide a basis for future field-based studies. Full article

Charcot neuro-osteoarthropathy (CNO) is a devastating complication of peripheral neuropathy, characterized by progressive bone and joint destruction that leads to severe foot deformity, ulceration, and a high risk of amputation. The management of CNO is predicated on an accurate understanding of its biomechanical instability, yet conventional imaging modalities like non-weight-bearing computed tomography (CT) and magnetic resonance imaging (MRI) fail to capture the true, load-dependent nature of the deformity. This review elucidates the paradigm shift facilitated by weight-bearing computed tomography (WBCT) in the diagnosis and management of CNO. A comprehensive narrative review of the literature was conducted to synthesize the pathophysiology of CNO, the limitations of conventional imaging, and the technological principles, clinical applications, and future directions of WBCT in CNO management. The review integrates findings on CNO pathophysiology, radiological assessment, and the debate surrounding weight-bearing protocols in conservative management. WBCT provides a three-dimensional, functional assessment of the Charcot foot under true physiological load, overcoming the critical limitations of non-weight-bearing imaging. It reveals the full extent of osseous collapse, unmasking hidden instabilities and enabling the use of novel quantitative 3D metrics for deformity characterization and risk stratification. Clinically, WBCT enhances the entire management pathway, from improving early diagnostic accuracy and informing surgical strategy with patient-specific instrumentation to enabling objective postoperative evaluation of reconstructive outcomes. WBCT is a promising technology that redefines the assessment of CNO from a static, morphological description to a dynamic, quantitative biomechanical analysis. Its integration into clinical practice offers the potential to improve diagnostic precision, optimize surgical planning, and ultimately enhance patient outcomes. The future synergy of WBCT with artificial intelligence holds promise for further advancing patient care, moving towards a predictive and prescriptive model for managing this complex condition. Full article

Introduction: Medial compartment knee osteoarthritis (OA) is characterized by varus deformity. A medial open-wedge high tibial osteotomy (MOWHTO), frequently invoked in the treatment of this deformity, affects the knee as well as the ankle joints. This study aims to evaluate the radiological and clinical effects of a MOWHTO on the ankle joint. Materials and Methods: A retrospective analysis was conducted with data from 110 patients (mean age: 52 years; 74.5% female) who underwent a MOWHTO between 2020 and 2023. Radiographic assessments were conducted both preoperatively and one year after surgery using full-length weight-bearing radiographs. The measurements included several alignment parameters such as the hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral distal tibial angle (LDTA), and talar tilt. Clinical outcomes were assessed using the Lysholm knee score and the American Orthopedic Foot and Ankle Society (AOFAS) ankle score. Results: While changes in the LDTA demonstrated a small effect size (d = 0.225), moderate-to-large effect sizes were observed in key alignment parameters (MPTA (d = 0.838), the JLCA (d = 0.798), and talar tilt (d = 0.752)), all of which showed statistically significant differences indicative of a correction in the joint alignment of potential clinical significance. Median Lysholm and AOFAS scores at one year were 90 and 100, respectively, indicating favorable clinical outcomes. No significant difference in outcomes was observed based on the amount of correction. Conclusions: An MOWHTO not only restores knee alignment but also significantly improves ankle alignment in the coronal plane. These findings suggest that an MOWHTO is associated with the restoration of knee alignment and with improvements in ankle alignment in the coronal plane. Full article

Complex landslides have characteristics and parameters that are difficult to analyze. The landslide on 16 June 2024 in the rural community of Quilloturo (Tungurahua, Ecuador) caused severe damage (14 deaths, 24 injuries, and hundreds of affected families) related to the area’s geological, social, and anthropogenic conditions. Its location in the eastern foothills of Ecuador’s Cordillera Real exacerbated the effects of a landslide involving various processes (mud and debris flows, landslides, and rock falls). This event was preceded by intense rainfall lasting more than 10 h, which accumulated and caused natural damming of the streams prior to the event. The lithology of the investigated area includes deformed metamorphic and intrusive rocks overlain by superficial clayey colluvial deposits. The relationship between the geological structures found, such as fractures, joints, schistosity, and shear, favored the formation of blocks within the flow, making mass movement more complex. Geomorphologically, the area features a relief with steep slopes, where ancient landslides or material movements, composed of these colluvial deposits, have already occurred. At the foot of these steep slopes, on plains less than 300 m wide and bordered by the Pastaza River, there are human settlements with less than 60 years of emplacement and a complex history of territorial occupation, characterized by a lack of planning and organization. The memory of the inhabitants identified mass movements that have occurred since the mid-20th century, with the highest frequency of occurrence recorded in the last decade of the present century (2018, 2022, and 2024). Furthermore, it was possible to identify several factors within the knowledge of the inhabitants that can be considered premonitory of a mass movement, specifically a flood, and that must be incorporated as critical elements in decision-making, both individual and collective, for the evacuation of the area. Full article

Background/Objectives: Triple arthrodesis (TA) involves fusion of subtalar, talonavicular and calcaneocuboid joints. In the paediatric population, this procedure is used to correct foot deformities, augment stability and decrease pain, often in neuromuscular conditions. There is limited research into long-term outcomes of paediatric TA in regards to patient quality of life (QOL). This study aims to retrospectively evaluate the long-term patient-reported outcomes of the paediatric TA at a single centre. Methods: All paediatric patients who underwent TA at the Women’s and Children’s Hospital between 1998 and 2012 were identified from operative records and the patient and/or their carer were given the opportunity to be interviewed. Patient-reported outcomes were measured over the phone using the Foot and Ankle Ability Measure (FAAM) and Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) tools. Results: Eighteen patients were included in the study, with a total of 23 feet, with five patients having bilateral surgery in the one sitting. Follow-up was at a mean time of 17 years post-surgery, with a mode of 20 years. There were recurring themes of continued pain plus impaired function and mobility, especially in children who could not walk prior to surgery. Derived from the FAAM, the average Activities of Daily Living Scale was 39.81%, with four patients at 0%. The MOXFQ outcomes for walking, pain and social interaction domains were converted from the Likert scale into an average total score of 34.99/64. Over half of the patients continued to have pain after the surgery in adult life. Conclusions: This study highlights variable results post-paediatric triple arthrodesis, with concerning rates of limited improvement in functional outcomes, ongoing pain and negative psychosocial impact in adulthood, as reported by the patient or their carer. Full article

Critical transmission lines frequently traverse geologically complex mountainous regions, where harsh environments and variable climatic conditions pose significant geohazard risks. Utilizing 163 Sentinel-1A scenes (January 2018 to October 2023), we employed Multi-Temporal InSAR (MT-InSAR) to derive the deformation field along the transmission corridor. Time-series analysis of the Lingshao (LS) line towers, interpreted through the principles of mining subsidence, revealed the mechanisms behind their differential tilt. Simultaneously, time-series deformation at the tower footings was input to a deep learning model for 365-day prediction; the accuracy and practical applicability of which were rigorously assessed. The results demonstrate that (1) a unidirectional subsidence funnel within the transmission corridor deformation field, in the absence of zonal settlement features, strongly indicates the presence of a goaf beneath the line; (2) the integrated approach combining time-series InSAR with the settlement trough method proves feasible for monitoring transmission tower tilt, as validated through field verification; (3) the magnitude and direction of tower tilt correlate directly with their position in the mining-induced subsidence basin, showing convergent tilt in tensile zones, divergent tilt in compressive zones, and uniform settlement in neutral zones; (4) for the eight selected typical tower footings, predicted deformation values ranged from −284.6 mm to −186.3 mm, showing excellent agreement with measurements through correlation coefficients of 0.989–0.999 and Root Mean Square Error (RMSE) values of 0.54–2.17 mm. The framework enables proactive hazard avoidance during line routing and provides early warning for tower defects, significantly enhancing power infrastructure resilience in mining-affected regions. Full article

Background/Objectives: Charcot-Marie-Tooth (CMT) disease, the most common hereditary peripheral neuropathy, often causes cavovarus foot deformity in children. Surgical interventions to correct deformity or improve function can involve either primary fusion or reconstruction. However, the optimal surgical approach remains contested. This systematic review aims to present and evaluate existing data on both fusion and reconstruction surgical interventions in treating pediatric CMT cavus foot. Methods: A PRISMA-guided search of five electronic databases was conducted (from inception to 17 February 2025). Studies were eligible if they reported surgical outcomes for CMT pediatric patients ($\le$18 years) with cavovarus foot treated by primary fusion or reconstruction. Titles, abstracts and full texts were screened by four independent reviewers, and data were extracted on patient demographics, procedures, follow-up, functional scores, radiographic correction and complications. Results: Fourteen studies met inclusion criteria, encompassing 169 patients and 276 feet, with a mean age at surgery of ~13.5 years. Nine studies evaluated joint-sparing reconstruction, three assessed primary fusion, and two combined both reconstruction and fusion. Both interventions yielded improved outcomes post-operatively. Reconstruction generally produced high patient satisfaction and near-normal radiographic parameters but carried recurrence or reoperation rates of 10–40%. Fusion provided durable correction of rigid deformities but was associated with nonunion, adjacent joint arthritis and higher revision rates. Conclusions: Joint-sparing reconstruction is an effective first-line approach for flexible cavovarus deformities in pediatric CMT patients, while fusion should be reserved for severe, rigid or recurrent cases. A patient-specific staged approach is recommended, and higher-quality comparative studies are needed to refine surgical decision-making. Full article

Customized foot orthoses are widely used to manage plantar pressure and improve structural support in children with hereditary spastic paraparesis. However, the combined biomechanical effects of insole design parameters remain insufficiently quantified. This study employed a patient-specific three-dimensional finite element model to evaluate the influence of four design factors (arch height, heel cup depth, insole thickness, and material type, namely ethylene-vinyl acetate [EVA], thermoplastic polyurethane [TPU], and rubber) on four biomechanical metrics: plantar pressure distribution, von Mises stress, strain, and total deformation. Nine orthotic configurations, defined by a Taguchi L9 orthogonal array, were simulated under a vertical ground reaction force equal to 1.1× body weight. The configuration with an arch height of 42 mm, heel cup depth of 20 mm, thickness of 10 mm, and EVA material achieved the lowest peak plantar pressure (0.087 MPa). Arch height was the dominant factor for plantar pressure (79.4% of variance), deformation (68.1%), and strain (48.2%), while heel cup depth was most influential for stress (40.2%). Material type contributed minimally to plantar pressure and deformation but had a greater effect on stress (11.6%) and strain (15.0%). Thickness played a secondary role, particularly in deformation (19.9%) and strain (22.3%). These findings demonstrate the feasibility of using finite element modeling combined with the Taguchi method to systematically evaluate and optimize orthotic design parameters. Specifically, the study demonstrates that optimized personalized insoles can substantially reduce peak plantar pressure and improve load distribution in a pediatric patient with HSP, pes planovalgus, and flexed-knee gait, providing a potentially effective noninvasive intervention to prevent secondary complications and improve gait mechanics. Full article

Background: Achieving orthogonal coronal-plane alignment in total ankle arthroplasty (TAA) remains challenging in cases with severe varus deformity. We developed a novel tibial precutting technique for use in transfibular TAA to resolve intra-articular bony conflict and enable accurate implant placement without excessive medial soft tissue release. Methods: This technique involves a controlled resection of the lateral distal tibia to eliminate impingement between the tibial plafond and talar dome. From November 2019 to June 2022, 15 patients with coronal varus deformities >15° underwent transfibular TAA using this method. Twelve patients with ≥2 years of follow-up were retrospectively evaluated. Coronal alignment was assessed using the tibiotalar angle (TTA) on weight-bearing radiographs. Clinical outcomes were measured using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and ankle range of motion (ROM) before surgery and at final follow-up. Results: The median TTA significantly improved from 20.4° (IQR: 18.1–24.3) preoperatively to 1.8° (IQR: 0.9–3.6) at the latest follow-up (p < 0.01), indicating successful correction to neutral alignment. All SAFE-Q subscales showed statistically significant improvement (p < 0.05), and ankle ROM also increased significantly postoperatively (p < 0.05). No cases of talar subsidence, implant lucency, fibular non-union, or avascular necrosis were observed. Conclusions: These results indicate that the TIBIA #2 technique can broaden the indications for transfibular total ankle arthroplasty in severe varus deformity while delivering meaningful clinical benefit. Nevertheless, confirmation in larger, controlled, and multi-centre cohorts is required before widespread adoption. Full article

Background: Accurate sex estimation is crucial in forensic identification when DNA analysis is impractical or remains are fragmented. Traditional anthropometric approaches often rely on single bone measurements and yield moderate levels of accuracy. Objective: This study aimed to evaluate deep convolutional neural networks (CNNs) for automated sex estimation using entire foot radiographs, an approach rarely explored. Methods: Digital foot radiographs from 471 adults (238 men, 233 women, aged 18–65 years) without deformities or prior surgery were retrospectively collected at a single tertiary center. Six CNN architectures (AlexNet, ResNet-18, ResNet-50, ShuffleNet, GoogleNet, and InceptionV3) were trained using transfer learning (70/15/15 train–validation–test split, data augmentation). The model performance was assessed using accuracy, sensitivity, specificity, precision, and F1-score. Results: InceptionV3 achieved the highest accuracy (97.1%), surpassing previously reported methods (typically 72–89%), with balanced sensitivity (97.5%) and specificity (96.8%). ResNet-50 followed closely (95.7%), whereas simpler networks, such as AlexNet, underperformed (90%). Conclusions: Deep learning applied to whole-foot radiographs delivers state-of-the-art accuracy for sex estimation, enabling rapid, reproducible, and cost-effective forensic identification when DNA analysis is delayed or unavailable, such as in mass disasters or clinical emergency settings. Full article