Search Results (79)

Background and Clinical Significance: Angioleiomyoma (ALM) is a benign tumor that generally presents as a single lesion and, according to the updated WHO classification, includes the following three histological subtypes: solid (or capillary), cavernous, and venous. Typically, ALMs are described as well-defined nodules in the lower extremities but are unusually located in the acral locations and toes. We summarize two cases of ALM and perform a systematic review to provide foot surgeons with the most up-to-date and useful information on the epidemiological aspects, anatomical distribution, and specific histological subtypes of ALM in the foot. Materials and Methods: A systematic review was carried out according to the criteria of a PICO framework, and a systematic search and data processing were carried out according to the PRISMA guidelines. We analyzed patient demographics, clinical characteristics, diagnostic workup, treatment, and clinical outcomes. Each one of the included articles was independently assessed for methodological quality and risk of bias by an independent evaluator. The risk of bias of the included studies was assessed based on their characteristics. Results: This systematic review included 14 case series with 172 reported cases of ALM. One hundred and seventy-two (18.57%) were cases of ALM located on foot, excluding the ankle region. The female-to-male ratio was 1.48. The most common location was the hindfoot (41.5%), followed by the forefoot (20.2%) and the midfoot (8.9%). In 29.4% of cases, the location of the lesions could not be determined. The most frequent location of the lesions was subcutaneous (69%), followed by subaponeurotic (16.5%) and skin (14.5%) locations. The most frequent histological presentation was the solid histologic subtype (65%), followed by the venous subtype (21%) and the cavernous subtype (14%), respectively. Of the total reported cases of ALM located in foot, 63.1% presented as solid painful lesions. Calcified presentations occurred in 7% of cases, with more than half of the cases located in the hindfoot. Surgical excision was the treatment of choice in the two herein reported cases of solid ALM located in the hindfoot, one of them with a calcified presentation. No recurrence was observed in either case after two and five years of follow-up, respectively. All cases reviewed after surgical excision showed a low recurrence rate with a favorable prognosis regardless of the histological subtype and a very rare tendency toward malignancy. Conclusions: ALMs of the foot present as well-defined, painful nodules in the subcutaneous tissue of middle-aged women. Solid histological subtypes are the most prevalent. Histopathological analysis is usually essential for confirmation. Treatment consists primarily of direct excision, with remarkably low recurrence rates. Full article

Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed long-term clinical and radiographic outcomes. Methods: This retrospective cohort study included 47 feet from children aged 8–13 years who underwent STA with adjunctive soft tissue procedures between 2014 and 2018, following ≥6 months of failed conservative treatment, with a minimum follow-up of 5 years. Exclusion criteria included neuromuscular or rigid flatfoot. Weight-bearing radiographs assessed anteroposterior (AP) and lateral Meary’s angles, reflecting forefoot-to-hindfoot alignment, and calcaneal pitch, indicative of longitudinal arch height. Implant migration was recorded and clinical outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) score. Measurements were recorded preoperatively, immediately postoperatively, and at 1 month, 3 months, 6 months, 1 year, and 5 years. Results: Radiographic correction was significant and sustained at 5 years. The AP Meary’s angle improved from 13.09° to 5.26° at 1 month and 6.69° at 5 years (p < 0.001); lateral Meary’s angle from 9.77° to 4.06° and 4.88° (p < 0.001); and calcaneal pitch from 14.52° to 16.87° and 16.89° (p < 0.001), respectively. AOFAS scores increased from 67.52 to 90.86 at 1 month and 96.33 at 5 years (p < 0.001). Implant migration peaked within the first postoperative month (mean: 3.2 mm on ankle AP view; 3.0 mm on foot AP view) and stabilized thereafter. Four cases of complications included implant dislodgement, subsidence, and persistent sinus tarsi tenderness, which were successfully resolved after appropriate management. No recurrence of deformity was observed. Conclusions: STA implant migration is most pronounced during the first month, likely due to physiological settling as the foot adapts to altered biomechanics. With appropriate implant selection, technique, and follow-up, migration does not compromise long-term correction or outcomes. In general, symptomatic cases can often be managed conservatively prior to implant removal. Full article

Background/Objectives: Soft-tissue defects surrounding the big toe can be a challenging problem for reconstructive surgeons. The first dorsal metatarsal artery (FDMtA) arises from the dorsalis pedis artery, which itself arises in front of the ankle joint from the anterior tibial artery. This study aimed to characterize the FDMtA cutaneous perforators (FDMtAPs) and evaluate the potential of a local pedicled perforator flap to cover a hallux soft-tissue defect. Methods: Nine feet from fresh cadavers were dissected to describe the FDMtAP anatomy. For each artery, we recorded the origin’s position from the FDMtA, the proximal and distal diameters, and the artery’s course, length, number, and type. We described the FDMtA perforator flap harvest and its application through a clinical case. Results: A mean of 3.67 ± 1.23 FDMtAPs were found from the nine dissected feet, with at least 2 perforators per foot. Around 88% were located between 0 and 4 cm along the axis at their origin from the FDMtA, with an area of around 8 cm² and a mean of 2.35 ± 0.36 cm long. The proximal diameter had a mean of 0.178 ± 0.037 mm and 0.110 ± 0.008 mm at the distal diameter. A pedicled flap was readily feasible for all dissections. The case described had satisfactory healing, correct functional, and aesthetic recovery at two months. Conclusions: The first dorsal metatarsal artery perforator flap seems to be a reliable and valuable solution for the hallux soft-tissue reconstruction, notably after the excision of acral melanoma. Full article

Diabetes, as one of the most common diseases of civilization, is a significant factor of mortality worldwide. Undiagnosed and improperly treated, it leads to the development of a number of complications, including diabetic foot syndrome (DFS) and Charcot neuroarthropathy (CN). Charcot neuroarthropathy is a complex and devastating disease characterized by the presence of neuropathy, progressive deformities, and joint destruction. Risk factors and epidemiological data emphasize the high prevalence of CN in the diabetic population, drawing attention to typical predisposing factors for the development of this disease. Serious complications, such as foot ulcers or amputations, show the scale of the negative impact of CN and DFS on the quality of life of patients. Background/Objectives: The aim of the study was to assess the treatment of foot ulcers in patients with DFS and CN using ozone therapy with simultaneous negative pressure wound therapy (NPWT). Methods: The study included 30 patients aged 39 to 87 years with DFS and 30 patients with CN. Ozone therapy and negative pressure wound therapy were used for the treatment of chronic wounds. Results: The analysis of the results showed a significant reduction in the wound size in both study groups; in patients with DFS, a reduction from 5 cm³ to 0.40 cm³ observed after 3 weeks and to 0.002 cm³ after 6 weeks of therapy, while in patients with CN, a reduction from 8 cm³ to 1.50 cm³ was observed after 3 weeks and to 0.004 cm³ after 6 weeks of therapy. No statistically significant differences were observed in median wound sizes between the DFS and CN groups. Ozone therapy with a value of 70 μg/mL is an effective method in the treatment of chronic diseases of soft tissue and the skeletal system. In combination with NPWT after cleansing the wound of bone sequestrum, the process increased the density of capillaries by accelerating the synthesis of proteins and collagen and reduced bacterial colonization in the wound. Conclusions: The use of ozone therapy procedures at 70 μg/mL with negative pressure therapy is effective in the prevention and treatment of infectious bone complications in diabetes, such as diabetic foot syndrome and Charcot neuroarthropathy. Full article

Understanding the viscoelastic properties of plantar soft tissue under dynamic conditions is crucial for assessing foot health and preventing injuries. In this work, we document an in vivo device, employing the principles of dynamic mechanical analysis (DMA), which, for the first time, enables in situ, real-time multidimensional mechanical characterization of plantar soft tissues. This device overcomes the limitations of conventional ex vivo and single-DOF testing methods by integrating three sinusoidal mechanism-based multi-DOF dynamic testing modules, providing measurements of tensile, compressive, shear, and torsional properties in a physiological setting. The innovative modular design integrates advanced sensors for precise force and displacement detection, allowing for comprehensive assessment under cyclic loading conditions. Validation tests on volunteers demonstrate the device’s reliability and highlight the significant viscoelastic characteristics of the plantar soft tissue. The example dataset was analyzed to calculate the storage modulus, loss modulus, loss factor, and energy dissipation. All design files, CAD models, and assembly instructions are made available as open-source resources, facilitating replication and further research. This work paves the way for enhanced diagnostics and personalized treatments in orthopedic and rehabilitative medicine. Full article

Background/Objectives: Traditional treatment for chronic osteomyelitis is temporary implantation of antibiotic-impregnated cement beads, followed by bone grafting after the infection is controlled. In this way, a staged operation is needed, and undergoing repetitive general anesthesia is a burden. Moreover, damage to the soft tissue at the surgical site due to several incisions is a concern. This study was conducted to investigate the outcomes of one-stage antibiotic-mixed cement blocks, instead of beads, used as a primary salvage procedure to treat chronic osteomyelitis of the foot, ankle, and lower leg. Methods: Twenty patients with chronic osteomyelitis of the leg and foot were included. They underwent complete debridement of the infected bone, and antibiotic-mixed cement fillings were placed into the defected bone space. Full-weight-bearing activities were allowed immediately after surgery. Results: For 16 of the 18 patients, infection was controlled after one-time surgery. Repeat antibiotic cement-filling surgery was necessary for two patients. Two-staged surgery with continuous irrigation and cement filling was necessary for one large tibial lesion. Conversion into arthrodesis of the metatarsophalangeal joint was necessary for metatarsal head infection. Conclusions: One-stage surgery with complete debridement and antibiotic-mixed cement filling is a simple and effective procedure for treating intractable chronic osteomyelitis, which makes full-weight-bearing walking possible immediately after surgery. Full article

Background: In 1927, Cochrane observed persistent elastic resistance to hallux dorsiflexion after cheilectomy for hallux rigidus, attributing it to soft tissue tightness beneath the first metatarsophalangeal (MTP) joint. An innovative surgery was introduced using a plantar approach, dividing the plantar tissues. This procedure achieved complete pain resolution and high satisfaction in 12 patients. Despite addressing the etiology of hallux rigidus, this approach has not been adopted in current surgeries. This report presents a case treated with the arthroscopic Cochrane procedure with a long-term follow-up. Methods: A 73-year-old male with hallux rigidus presented with limited dorsiflexion, a painful bony prominence, and pain during walking at the first MTP joint, treated with the arthroscopic Cochrane procedure. Results: During surgery, hallux dorsiflexion did not improve after resecting all spurs in the MTP joint, but the dorsiflexion angle immediately improved from 55° to 85°after releasing the flexor hallucis brevis tendon, plantar capsule, and plantar portion of the lateral ligament. Improvements in both visual analog scale scores (70–0) and Japanese Society for Surgery of the Foot scores (57–88) were noted from preoperatively to 9 years and 6 months postoperatively. No postoperative cockup deformity was observed. Conclusions: The arthroscopic Cochrane procedure can yield favorable long-term outcomes without postoperative cockup deformity. Full article

This study aimed to first investigate changes in electromyography (EMG) patterns after multilevel surgical treatment in patients with cerebral palsy (CP) and then to assess the connection between the measure of EMG and motor control indices and surgery outcomes. We analyzed retrospective EMG and gait data from 167 patients with CP before and after surgery and from 117 typically developed individuals as a reference group. The patients underwent at least one soft tissue surgery on their shank and foot muscles. Using Repeated Measures ANOVA, we examined the norm-distance (ND) of the kinematics, kinetics, and EMG patterns, in addition to the Kerpape-Rennes EMG-based Gait Index (EDI), EMG Profile Score (EPS), and Walking Dynamic Motor Control Index (DMC) before and after surgery. Participants were divided into different response groups (poor, mild, and good gait quality) according to their pre- and post-treatment Gait Deviation Index (GDI), using the K-means-PSO clustering algorithm. The gait and EMG indices were compared between the responders using the nonparametric Mann–Whitney test. The ND for all kinematics and kinetics parameters significantly improved (p-value < 0.05) after the surgery. Regarding EMG, a significant reduction was only observed in the ND of the rectus femoris (p-value < 0.001) and soleus (p-value = 0.006). Among the indices, DMC was not altered post-operatively (p-value = 0.88). Although EDI and EPS were consistent across responders with a similar pre-treatment gait, a higher DMC was significantly associated with a greater improvement, particularly in patients with poor gait (p-value < 0.05). These findings indicate systematic changes in the EMG of patients with CP following surgery, which can also be demonstrated through indices. DMC is a measure that can potentially serve as a partial predictor of outcomes, particularly in patients with poor pre-operative gait. Future research should investigate the effects of different surgical strategies on the improvement of these patients. Full article

Background: Hallux valgus is a prevalent foot deformity conventionally treated with open surgical techniques, which carry risk of complications due to extensive soft tissue dissection. Minimally invasive surgeries (MISs) as alternatives offer comparable outcomes, reduced pain, and faster recovery; however, their challenges include the risk of shortening of the first metatarsal. This study aimed to assess the efficacy of our modified MIS hallux valgus correction technique and investigate the factors that affect first metatarsal shortening. Methods: Twenty-nine feet treated with modified MIS hallux valgus surgery between 2017 and 2022 were included with an average follow-up of 29 months. Clinical outcomes were evaluated with the Manchester–Oxford Foot Questionnaire (MOXFQ), Foot Function Index (FFI), and visual analog scale for pain. Radiographic evaluations included the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsal length, and sesamoid grade. Results: Functional and radiographic outcomes were significantly improved (p < 0.0001 and p < 0.001, respectively). Significant correlations between patient satisfaction and the MOXFQ, FFI, and VAS scores were found, with no significant correlations between patient satisfaction and radiographic outcomes. Non-purchasing of the lateral cortex of the proximal osteotomy site was identified to increase risk of first metatarsal shortening (odds ratio [OR] = 22.09, p = 0.0064). Conclusions: Our modified MIS for hallux valgus correction showed favorable radiographic and functional outcomes. Proximal lateral cortex purchasing should be targeted to reduce postoperative shortening of the first metatarsal. Full article

Soft tissue reconstruction in the lower limbs presents a significant challenge, particularly when addressing defects in the distal third of the leg, ankle, and foot. The reverse sural flap reliant on the perforating branches of the peroneal artery has emerged as a versatile option, offering a solution for patients for whom microsurgical techniques are not feasible. Despite its advantages, the procedure carries inherent risks, especially in populations with underlying conditions, such as venous insufficiency, cardiovascular disease, and diabetes, as well as in elderly patients, where the likelihood of flap necrosis is elevated. This report details a case of reverse sural flap necrosis in a patient with lupus-like syndrome, a complex scenario that underscores the need for meticulous preoperative assessment and planning. The case illustrates not only the technical considerations and challenges associated with the reverse sural flap but also the broader implications of systemic autoimmune disorders on postoperative outcomes. Through a comprehensive review of the literature, we explore the relationship between vascularization, autoimmune profiles, and the success of reverse sural flap procedures. We highlight the critical need for surgeons to adopt a holistic approach to patient evaluation, considering both local and systemic factors that may influence the viability of the flap and the overall reconstructive success. Full article

Introduction: Despite the rising global awareness and improvement of socioeconomic and living standards, the prevalence of diabetic osteomyelitis (DOM) and its complications has been increasing rapidly. This study aims to investigate the long-term prognosis of DOM of the foot treated using antibiotic-impregnated cement spacer (ACS) and the contributing risk factors for reoperation. Methods and Materials: We retrospectively reviewed the data of 55 diabetic patients with Meggitt-Wagner Grade IIB wounds diagnosed with osteomyelitis of the foot, treated in our institution with excessive debridement, excision of the infected tissue, and implantation of antibiotic-impregnated cement spacer fixed with a Kirschner wire. Descriptive statistics, including patient demographics, were analyzed. Statistical analysis was performed using point-biserial correlation and a Chi-square test with Cramer’s V effect-size estimation to determine the relationship between reoperation and various parameters. Results: 55 patients (36 (65.45%) males and 19 (34.55%) females) with a median age of 64 (39–84) years were thoroughly analyzed throughout a median follow-up of 884 days (2–4671 days). Of the entire cohort, 29 (52.72%) patients achieved primary successful infection eradication without any further intervention, and 8 (14.54%) patients were successfully treated using a secondary procedure. More than half of the reoperated patients underwent the secondary intervention within less than a month after the primary ACS. When assessing correlation, age (r = 0.28, p = 0.04), gender (r = 0.31, p = 0.02), Staphylococcus aureus (r = −0.10, p = 0.04), and the use of gentamicin-only antibiotic cement spacer (r = 0.34, p = 0.01) demonstrated statistically significant correlation to reoperation. 89.18% of the patients who achieved infection eradication did not undergo cement removal. Conclusions: ACS has shown excellent results in eradicating bone infection with up to 7.23 years of follow-up, acting as a structural stabilizer, preventing soft tissue contractures, and delivering highly concentrated local antibiotic treatment both to soft tissue and bone. Regardless, specific factors should be thoroughly evaluated prior to surgery, as advancing age, gender, and the use of gentamicin-only antibiotics appear to be positively associated with a higher likelihood of reoperation. Conversely, infections caused by cultured Staphylococcus aureus seem to be inversely related to reoperation. Full article

Many patients with community-acquired diabetic foot infections (DFI) receive systemic (empirical) antibiotic treatments before surgical interventions, often by the general practitioner. Sometimes, hospital clinicians prescribe them before surgery to reduce the infection inoculum and preserve soft tissue for immediate wound closure in case of residual infection after surgery. In contrast, the international guidelines (IWGDF) advocate against presurgical antibiotic use in routine situations without severe progredient soft tissue infections and/or sepsis. We run several retrospective and prospective cohorts of DFI and retrospectively analyze the influence of presurgical antibiotic therapy (as binary (yes/no) or continuous (in days) variables) on failures after a combined surgical and medical treatment. In our large database, the presence, choice, administration routes, or duration of preoperative antibiotic therapy did not improve the postoperative outcomes of operated diabetic foot infections or prevent their failures. In turn, this lack of influence leaves space for enhanced antibiotic stewardship in the management of DFI. Full article

In contemporary times, a significant portion of the population experiences symptoms of temporomandibular joint (TMJ) dysfunction. The objective of this study was to evaluate the effects of a single-session TMJ soft tissue therapy on the TMJ and cervical spine mobility as well as on body balance and the foot load distribution. This study was a parallel-group, randomized, controlled trial with a 1:1 allocation ratio. Fifty women aged 20–30 years diagnosed with myofascial pain in the TMJ area were included in the study and divided into two groups. The experimental group received TMJ soft tissue therapy. The following research tools were used: a Hogetex electronic caliper, a CROM Deluxe, and a FreeMed Base pedobarographic platform. In the experimental group, an increase in mobility within all assessed jaw and cervical spine movements was observed. This change was statistically significant (p < 0.05) for lateral movement to the left, abduction, and protrusion of the jaw (an increase of 10.32%, 7.07%, and 20.92%, respectively) and for extension, lateral bending to the right and left, and rotation to the right and left, of the cervical spine (an increase of 7.05%, 7.89%, 10.44%, 4.65%, and 6.55%, respectively). In the control group, no significant differences were observed. No significant changes were observed in the load distribution and body balance assessment. A single session of TMJ soft tissue therapy increases jaw and cervical spine mobility but does not impact body balance or foot load distribution in static conditions in women diagnosed with myofascial pain in the TMJ area. Full article

Bivalve mollusks, comprising animals enclosed in two shell valves, are well-adapted to benthic life in many intertidal zones. Clams have evolved the buried lifestyle, which depends on their unique soft tissue structure and their wedge-shaped muscular foot and long extendible siphons. However, molecular mechanisms of adaptative phenotype evolution remain largely unknown. In the present study, we obtain the high-quality chromosome-level genome of Manila clam R. philippinarum, an economically important marine bivalve in many coastal areas. The genome is constructed by the Hi-C assisted assembly, which yields 19 chromosomes with a total of 1.17 Gb and BUSCO integrity of 92.23%. The de novo assembled genome has a contig N50 length of 307.7 kb and scaffold N50 of 59.5 Mb. Gene family expansion analysis reveals that a total of 24 single-copy gene families have undergone the significant expansion or contraction, including E3 ubiquitin ligase and dynein heavy chain. The significant expansion of transposable elements has been also identified, including long terminal repeats (LTR) and non-LTR retrotransposons. The comparative transcriptomics among different clam tissues reveals that extracellular matrix (ECM) receptors and neuroactive ligand receptors may play the important roles in tissue structural support and neurotransmission during their infaunal life. These findings of gene family expansion and tissue-specific expression may reflect the unique soft tissue structure of clams, suggesting the evolution of lineage-specific morphological novelties. The high-quality genome and transcriptome data of R. philippinarum will not only facilitate the genetic studies on clams but will also provide valuable information on morphological novelties in mollusks. Full article

Background/Objectives: Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon’s arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Methods: Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. Results: A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. Conclusions: The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology. Full article