Search Results (836)

Diabetic foot ulcers drive non-traumatic lower-limb amputation; limb salvage surgery is often pursued to preserve function and survival. Predictors of adverse outcomes remain incompletely defined, and evidence for multidisciplinary team (MDT) care is heterogeneous. We aimed to clarify risk factors for major amputation and death after diabetic limb salvage and evaluate MDT impact. We systematically reviewed 49 studies (2020–2025) reporting major amputation or mortality after limb salvage in diabetes (PROSPERO CRD420251044859). Risk factors spanned demographic, clinical, and surgical domains (e.g., older age, male sex, renal/cardiovascular disease, ischemia, osteomyelitis, advanced ulcer classification). MDT models generally showed lower amputation rates and improved wound healing, with occasional survival benefits; heterogeneity precluded meta-analysis. As a real-world comparator, the Mid Essex Diabetes Amputation Reduction Plan (MEDARP) treated 72 high-risk patients using a “toe and flow” MDT. Major amputation occurred in 6.9% and mortality in 12.5%, both at or below published ranges, with gains in patient-reported outcomes. Findings support MDT-based strategies, but conclusions should be interpreted cautiously given the predominantly observational evidence, and highlight the need for standardized outcome definitions and reporting. Full article

Hand–foot–mouth disease (HFMD), primarily caused by human enteroviruses (EVs), poses a public health challenge, particularly among infants, due to a lack of effective therapies. Elucidating the molecular interplay between EVs and the host immune response is crucial for developing antiviral treatments. Recent studies have highlighted the significance of long non-coding RNAs (lncRNAs) in regulating host–pathogen interactions; however, the mechanisms of lncRNAs in EV infection remain poorly unexplored. Here, we identified a highly inducible nuclear lncRNA, LINC1467, that is upregulated in response to HFMD-related EV infection. Functional analyses revealed that LINC1467 suppresses viral replication. Mechanistically, LINC1467 interacts with nuclear import receptor Importin 8 (IPO8) to form the LINC1467/IPO8/p65 complex, facilitating the phosphorylation and nuclear translocation of p65, thus promoting the expression of pro-inflammatory cytokines and activating the NF-κB pathway. The antiviral function of LINC1467 was further validated in a mouse model of viral infection. These findings uncover a novel lncRNA-mediated regulatory mechanism in the innate immune response and highlight LINC1467 as a promising target for future antiviral strategies against HFMD-related EVs. Full article

Background: This paper concerns the study of forces acting on the upper ankle joint of a human in static and quasi-dynamic positions. This paper aimed to determine the pressure forces on the axis of the upper ankle joint in the position of the body tilting forward and backward, as well as in a neutral position. Methods: A model with designated centres of gravity (including and excluding the weight of the platform imitating the foot) and the point of gravity imitating the proximal insertion of the triceps surae and tibialis anterior muscles was developed for this study. The forces and the weight of the tilted object were measured using dynamometers. A method for determining the arms of gravitational forces and the angle of inclination of an object is presented. The function describing the distribution of gravitational loading along its tilting part was described. Next, all measurements and calculations were referred to the human body. Results: Measurements of muscle force, body gravity, the arms of these forces, and the angles of the object’s inclination on the axis of rotation are presented. A methodology for determining the pressure force on the human upper ankle joint axis is presented. The distribution of the value of the pressure force and its components from the maximal forward, through the vertical body position, up to the maximal backward position of the body tilt, is provided. Conclusions: The ankle joint pressure force is the vector sum of the force of gravity and the force of the muscle counteracting the body tilt. This force is the smallest in the vertical body position and increases with the body tilt. It reaches 5.23 times the weight of the tilting part of the body when the body is tilted to its maximum forward position, and 3.57 times the weight when the body tilts backward. Regardless of the direction of the body tilt, the joint pressure vector always runs through the axis of the upper ankle joint. Full article

Background/Objectives: Juvenile hallux valgus (JHV) and flexible flatfoot (FFF) often coexist in children, yet their combined surgical management remains poorly explored. This study evaluates clinical and radiographic outcomes following a simultaneous approach using lateral hemiepiphysiodesis of the first metatarsal (LHFM) and calcaneal-stop (C-Stop) procedures in skeletally immature patients. Methods: A retrospective cohort of 24 bilateral patients (48 feet) aged 10–12 underwent LHFM and C-Stop between 2017 and 2023. Radiographic evaluation included Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Meary’s angle (MA), and transverse TaloCalcaneal (Kite’s) Angle (tTCA). The Foot and Ankle Disability Index (FADI) and the Tegner Activity Scale (TAS) were administered at the most recent follow-up and complications were recorded. Results: The mean follow-up was 3.7 years. Postoperative radiographs showed significant improvements in all parameters, with correction inversely correlated to baseline deformity severity. Full normalization of flatfoot parameters was achieved in 68.8% of feet, with mild residual deformity in the remainder. Males showed greater radiographic correction than females. IMA and HVA improved in most cases, reaching full normalization in 53.1% and 50% of feet, respectively. Clinically, all patients showed corrected hindfoot alignment and medial arch restoration; 90% achieved the maximum FADI score and 88% resumed recreational sports. Two cases of screw migration occurred, with one revision; no further complications were reported. Conclusions: Simultaneous correction of FFF and JHV using C-Stop and LHFM proved effective, yielding significant radiographic improvements and excellent functional outcomes in most cases, with minimal complications. However, full hallux alignment was achieved in only half of the cases, suggesting that additional distal metatarsal procedures may be needed for more severe deformities. Full article

Bit pressure and rein tension-induced mouth pain in horses have recently become a significant welfare concern, fueling debates within the equestrian community and beyond. Evidence indicates that bits can cause pain-related behaviors and even oral lesions. Although studying pressure-induced pain in animals is challenging, the similarities in the physiology of pain processing (nociception) across mammals suggest that it is reasonable to assume that pain perception in humans and horses is principally comparable. Therefore, we compared human pressure pain detection thresholds (PPDTs) to reported rein pressures in equestrian sports as reported in the scientific literature. Reported rein tensions (kPa) range from a minimum of 91.2–107.87 to a maximum of 1314.09–4285.51, while human PPDTs (in kPa) are 232.4 for the face, 445.3 for the hand, and 535.5 for the foot. These comparisons reveal that only the lowest reported bit pressures would be pain-free for humans. Average to maximum pressures would cause strong to severe pain sensations in humans. Furthermore, data on pressure pain-induced stimulus response functions suggest that bit pressures commonly encountered in equestrian sports could cause lesions in humans, making them unacceptable in human experimentation. In conclusion, bit pressures as reported in the scientific literature would cause significant pain if applied to humans, raising welfare concerns for horses. Full article

Background: Foot morphology plays a central role in musculoskeletal development during childhood. Variations in the medial longitudinal arch may influence walking mechanics, and excess body weight can further affect plantar structure and gait. Objective: This study examined the relationship between foot type, body mass index (BMI), and gait function in school-aged children, with particular focus on gait symmetry as a sensitive marker. Methods: Ninety-eight children aged 8–16 years were evaluated. Foot type was classified using a pressure platform, and gait was assessed with a wearable sensor. Outcomes included gait symmetry, walking speed, cadence, Timed Up and Go (TUG), and Six-Minute Walk Distance (6MWD). Results: Mixed bilateral foot patterns were observed in 46 of the 98 participants (47%). Significant associations were found between foot type, BMI, and gait symmetry (p < 0.01), while other mobility measures (speed, cadence, TUG, 6MWD) remained stable across groups. Children with normal bilateral feet showed the best gait symmetry, whereas mixed patterns had the lowest. Conclusions: Gait symmetry is a sensitive indicator of functional imbalance in schoolchildren and is strongly influenced by both foot morphology and body weight. Incorporating plantar assessment and BMI monitoring into routine pediatric evaluations may help clinicians identify children at risk for long-term musculoskeletal problems at an early stage. Full article

Background: The functional capacity of older adults is a critical determinant of autonomy and quality of life, particularly in low-income populations from remote regions with limited access to health services. This study aimed to characterize the functional fitness (FF) of community-dwelling older adults in the interior of Amazonas, Brazil, stratified by sex and age group. Methods: A cross-sectional study was conducted with 807 older adults (471 females), aged ≥ 60 years, from four municipalities in northern Brazil. The FF was assessed using the Senior Fitness Test (SFT), including measures of strength (30-s Chair Stand Test—CST; 30-s Arm Curl Test—ACT), flexibility (Chair Sit and Reach Test-CSAR, Back Scratch Test-BST), balance/agility (8-Foot Up-and-Go Test—FUG), and aerobic endurance (6-min walk test—6MWT). Descriptive statistics, confidence intervals, and age- and sex-specific percentiles were calculated. Results: Results indicated a progressive decline in FF with advancing age. Males outperformed females in strength and endurance tests, whereas females exhibited better flexibility. Notable reductions in performance were observed after age 75, particularly in CST, ACT, FUG, and 6MWT. Overall, the functional profiles of this population were below international norms, especially among females and individuals aged ≥ 80. The prevalence of overweight was 39.3%, with socioeconomic vulnerability affecting over 90% of participants. Conclusions: Older adults in low-income, remote Amazonian Brazilian communities demonstrate marked functional decline with ageing, influenced by socioeconomic and environmental constraints. These findings highlight the urgency of implementing accessible, community-based interventions focused on physical activity, strength, mobility, and endurance to support healthy ageing in underserved regions. Full article

Background/Objective: The recurrence of hallux valgus (HV) after primary surgical correction remains a clinical challenge, often requiring combined approaches to address both bony realignment and soft tissue imbalance. While locking plates have shown some biomechanical advantages in HV correction, evidence regarding their application in revision procedures is limited. This study presents a retrospective single-surgeon experience with a small cohort, aiming to describe radiographic and functional outcomes and to share practical insights rather than provide definitive conclusions. Methods: In this retrospective case series, patients undergoing revision surgery for failed HV correction over the past ten years at a single tertiary institution were analyzed. Radiographic parameters—hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and sesamoid position—were assessed. Functional outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale for pain. Surgical strategies were tailored according to recurrence mechanisms, and some cases involved Wilson osteotomy with intramedullary plate fixation. The Mann–Whitney U test and the Wilcoxon signed-rank test were applied to assess efficacy. Results: A total of 11 feet treated by one surgeon were included. Both soft tissue procedures and combined osteotomy with intramedullary plate fixation led to statistically significant but preliminary improvements in HVA, IMA, DMAA, and sesamoid alignment. Functional scores improved, and the complication rate was within the range reported in the previous literature. Conclusions: This retrospective single-surgeon study with a limited sample size suggests that Wilson osteotomy combined with intramedullary plate fixation may represent a joint-preserving and biomechanically supportive option for recurrent HV, particularly in cases with large DMAAs and severe sesamoid displacement. However, the findings should be interpreted cautiously given the small cohort, retrospective design, and absence of multi-angle radiographic visualization. The results highlight a potential approach in specific clinical settings rather than a definitive solution. Larger, prospective, multi-center studies are required to confirm long-term utility. Full article

Background and Objectives: This study aimed to investigate the effect of intraoperative hyaluronic acid (HA) application on short-term functional outcomes after open surgical repair of Achilles tendon rupture. Materials and Methods: This retrospective cohort study included 102 patients screened at three tertiary centers (January 2023–October 2024). After applying the exclusion criteria, 64 patients were analyzed (32 HA, 32 control), with group allocation based on the intraoperative use of HA. The primary outcomes were the American Orthopaedic Foot and Ankle Society (AOFAS) Score and the Achilles Tendon Total Rupture Score (ATRS), evaluated at 3, 6, and 12 months; the Short Form 36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, assessed at 6 and 12 months; and physical-performance tests (heel-rise endurance, single-leg hop distance, and calf muscle strength), performed at 6 and 12 months. Complications, including re-rupture, wound infection, and delayed wound healing, were also recorded. Results: At 6 months, the HA group had higher AOFAS scores (mean difference: 9.0, 95% CI: 6.3–11.7, p = 0.008) and ATRSs (mean difference: 7.0, 95% CI: 3.8–10.2, p = 0.008) than the controls. The differences were smaller but remained significant at 12 months (AOFAS mean difference: 5.0, 95% CI: 2.5–7.5, p = 0.034; ATRS mean difference: 4.0, 95% CI: 1.1–6.9, p = 0.034). The SF-36 PCS and MCS scores were also superior in the HA group at 6 and 12 months (all p < 0.05). The physical-performance tests (heel-rise endurance, single-leg hop, calf strength) showed significant mean differences, with the HA group scoring higher at both timepoints (all p < 0.05). Complication rates were low and not significantly different between groups (all p > 0.05). Conclusions: Intraoperative HA application during open Achilles tendon repair was associated with improvements in short-term functional recovery, general health status, and physical performance without increasing complication rates. These findings support the use of HA as a safe adjunct to optimize tendon gliding; however, prospective randomized controlled trials are needed to confirm these results. Full article

Background: This study investigated sex differences in foot arch structure and function, and their impact on postural control and energy flow during dynamic tasks. Findings aim to inform sex-specific training, movement assessment, and injury prevention strategies. Methods: A total of 108 participants (53 males and 55 females) underwent foot arch morphological assessments and performed a sit-to-stand (STS). Motion data were collected using an infrared motion capture system, three-dimensional force plates, and wireless surface electromyography. A rigid body model was constructed in Visual3D, and joint forces, segmental angular and linear velocities, center of pressure (COP), and center of mass (COM) were calculated using MATLAB. Segmental net energy was integrated to determine energy flow across different phases of the STS. Results: Arch stiffness was significantly higher in males. In terms of postural control, males exhibited significantly lower mediolateral COP frequency and anteroposterior COM peak velocity during the pre-seat-off phase, and lower COM displacement, peak velocity, and sample entropy during the post-seat-off phase compared to females. Conversely, males showed higher anteroposterior COM velocity before seat-off, and greater anteroposterior and vertical momentum after seat-off (p < 0.05). Regarding energy flow, males exhibited higher thigh muscle power, segmental net power during both phases, and greater shank joint power before seat-off. In contrast, females showed higher thigh joint power before seat-off and greater shank joint power after seat-off (p < 0.05). Conclusions: Significant sex differences in foot arch function influence postural control and energy transfer during STS. Compared to males, females rely on more frequent postural adjustments to compensate for lower arch stiffness, which may increase mechanical loading on the knee and ankle and elevate injury risk. Full article

Background/Objectives. Patient-Reported Outcome Measures (PROMs) capture patients’ perspectives about their health status, quality of life, and medical care outcomes. LIMB-Q Kids is a validated PROM designed to assess health-related quality of life (HRQL) in children with lower limb differences. It evaluates physical, social, and psychological function; symptoms related to the leg, hip, knee, foot and ankle; leg-related distress, appearance, and school-related concerns. It has now been translated and culturally adapted from English to other languages. The aim of this study was to translate and culturally adapt LIMB-Q Kids to Hebrew. Methods. Following international guidelines, two independent forward translations from English to Hebrew were produced and reconciled into a single version. A backward translation was then compared with the original to identify discrepancies. This draft underwent cognitive debriefing interviews (CDIs) with 11 children (ages 8–15) having lower limb differences to assess comprehension and cultural relevance. Results. CDIs revealed general issues including lengthy or unclear text, high-level language, cultural unfamiliarity and duplication of descriptors. Specific to Hebrew, issues included gender inflections and the need for vowel diacritics to support younger, less proficient readers. Revisions to 14 items were made. Conclusions. A translation and cultural adaption (TCA) process led to a linguistically validated and culturally adapted Hebrew version of LIMB-Q Kids. It can now be used for the clinical follow-up of children with lower limb differences including pre- and post-operatively, and as an aid to decision-making for surgery. Full article

Introduction: 3D-printing is an emerging technology in the field of prosthetics, offering advantages such as cost-effectiveness, ease of customization, and improved accessibility. While previous reviews have focused on limited aspects, the aim of this systematic review is to provide a comprehensive evaluation of the clinical outcomes of 3D-printed prostheses for both upper and lower limbs. Methods: A search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across six databases (PubMed, Web of Science, EBSCO, Scopus, Cochrane Library, and Sage). Studies on 3D-printed prostheses in human rehabilitation that focused on the clinical outcomes of the device were included, while studies lacking clinical data, 3D printing details, or focusing on traditional manufacturing methods were excluded. Finally, the risk of bias was assessed using the modified Downs & Black Checklist. Results: A total of 1420 studies were identified, with 11 meeting the inclusion criteria. The included studies assessed different 3D-printed prosthetic types and upper and lower limb prostheses. The main clinical outcomes analyzed were functional performance, design and material integrity, and overall effectiveness of 3D-printed prostheses. Studies on upper limb prostheses reported improved dexterity, range of motion (ROM), and user satisfaction, despite some durability limitations. Lower limb prostheses showed enhancements in comfort, gait parameters, and customization, particularly in amphibious and partial foot designs. Conclusions: 3D-printed prostheses show potential to improve functional performance, patient satisfaction, fit, and implementation feasibility compared to conventional methods. However, limitations such as small sample sizes, variability in assessment tools, and limited high-quality evidence highlight the need for further research to support broader clinical adoption. Full article

In this study, a novel compliant ankle structure with three passive degrees of freedom for quadruped robots is presented. First, this paper introduced the bionic principle and structural implementation method of the passively compliant ankle, with a particular focus on the configuration and working principle of the elastic adjustment element. Then, the kinematic model of the ankle and mathematic model of the elastic element, comprising mechanical and pneumatic model, was established by using appropriate theory. Finally, a test rig of the ankle was carried out to verify its actual function. The research results show that: (1) The ankle structure demonstrates excellent stability, maintaining its upright posture even under unreliable foot–ground interactions. (2) Compared to traditional structure, the single-leg module incorporating the proposed design exhibits smoother forward stepping under an appropriate pre-inflation pressure, with its actual motion trajectory showing closer agreement with the planned one; (3) The parallel topology enables a notable reduction in the driving torque of each joint in the leg during motion, thereby improving the energy efficiency of robots. Full article

To address the limited adaptability of traditional fixed-parameter strategies for hexapod robots operating in multi-material terrain environments, this study proposes a terrain-aware gait optimization method based on an improved particle swarm optimization algorithm that incorporates foot-end sinking perception. This method establishes a ground sinking detection mechanism based on foot-end position sensors, constructs a dynamic weight allocation strategy based on ground bearing capacity, and develops a Terrain-aware Ground Particle Swarm Optimization algorithm (TGPSO) that integrates Latin hypercube sampling, linearly decreasing inertia weights, and stagnation exploration mechanisms. Furthermore, it establishes a unified terrain-based reward function framework to achieve dynamic adjustment of weights for velocity, stability, and transportation efficiency. Simulink simulation verification demonstrates that TGPSO achieves superior optimization performance compared to traditional strategies across three typical terrain types, while exhibiting faster convergence speed and enhanced stability. The research findings provide theoretical foundations and technical support for intelligent motion control of hexapod robots across varying material properties, achieving targeted optimization of locomotion performance under diverse terrain conditions. Full article

Objectives: This study aimed to compare the clinical, functional, and radiological outcomes of three different fixation techniques—dorsal locking plate, crossed cortical screw, and a combination of both—used in first metatarsophalangeal (MTP) joint arthrodesis for advanced-stage hallux rigidus. The goal was to provide evidence-based guidance for surgical technique selection. Methods: This retrospective cohort study included 52 patients with advanced hallux rigidus (stage III–IV, Coughlin–Shurnas classification) who underwent surgical treatment between 2023 and 2025 at the Department of Orthopedics and Traumatology of Ankara Etlik City Hospital, with a minimum follow-up of one year. Patients were categorized into three groups according to the fixation technique used. Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot Function Index (FFI) were assessed using validated Turkish-language versions of the questionnaires. Radiological parameters included hallux valgus angle, first toe dorsiflexion angle, distal interphalangeal (DIP) arthritis, and radiographic union—defined as trabecular bridging across at least three cortices on weight-bearing anteroposterior and lateral radiographs. ANCOVA was performed with age as a covariate. Results: A total of 52 patients were included: Group 1 (dorsal plate fixation, n = 19), Group 2 (crossed cortical screw fixation, n = 16), and Group 3 (combined fixation, n = 17). Group 1 patients were significantly older (mean age: 64 ± 6 vs. 55 ± 6 and 59 ± 5 years; p < 0.001). After age adjustment, VAS pain scores were significantly higher in Group 1 compared to Group 3 (mean VAS: 2.8 ± 0.6 vs. 1.9 ± 0.5; p = 0.010). AOFAS scores did not differ significantly (p = 0.166), although Group 2 showed the highest median value (90 [70–93]). FFI scores differed significantly (p < 0.001), with Group 1 reporting worse outcomes (19 [17–31]) than Group 2 (15 [13–22], p = 0.03) and Group 3 (15 [11–16], p = 0.01). Dorsiflexion angle was significantly lower in Group 2 than Group 1 (median 19° vs. 27°; p = 0.04), though all remained within the physiological range. Radiographic union was achieved in 50/52 patients (96.2%), without significant intergroup differences (p = 0.612). Complications included two cases of wound dehiscence in Group 1; no infections, symptomatic non-union, malalignment, or hardware irritation were observed. Conclusions: Crossed cortical screw fixation yielded the most favorable functional outcomes, whereas the combined technique achieved the lowest postoperative pain scores. Dorsal plate fixation alone consistently underperformed. While outcomes were adjusted for age, residual confounding cannot be excluded. These results highlight the importance of tailoring fixation strategy to patient profile, with crossed screw and combined methods representing reliable choices for optimizing postoperative outcomes in advanced hallux rigidus. Full article