Search Results (2,440)

Background: Although surgical digit amputations are common procedures in hand surgery, substantial differences in technical approaches have been reported, with the development of symptomatic neuromas posing a major challenge. Given the absence of a universally accepted technique, especially concerning painful neuroma prevention, this survey study’s rationale was to explore the preferred surgical approach for traumatic noninfected digital amputation injuries (excluding the thumb) at the interphalangeal (IP) joint levels. Methods: A 10-point online questionnaire was sent to ÖGH, DGH and SGH members. To provide a comprehensive overview of the preferred approach, descriptive statistics were performed, while examining differences based on years of surgical experience (≤20 years versus >20) and society affiliation (ÖGH vs. DGH vs. SGH) via inferential Pearson-chi square and Fisher’s exact tests were employed. Results: Of the 1670 experts contacted, 213 (12.8%) took part in the survey. Across different societies and years of surgical experience, there is a consensus on most aspects, including smoothing bony edges after transosseous resection (99.8%), removal of articular cartilage after disarticulation (78.9%), shortening flexor tendons (81.2%), and avoiding additional extensor tendon shortening (92.3%). No consensus was found on the technique of surgical bone transection, the reduction of the phalangeal head during disarticulation and the treatment of digital nerves including neuroma prevention. Conclusions: Although there is a broad consensus on most aspects of surgical digit amputation, the treatment of digital nerves and neuroma prevention remains an area with a lack of consensus. Future studies should focus on these aspects to uncover further benefits. Full article

Background: Post-COVID-19 syndrome or Long COVID (LC) is a multi-system condition characterised by persistent symptoms beyond three months following SARS-CoV-2 infection. Pain, particularly musculoskeletal and neuropathic pain, is commonly reported and may substantially affect functioning and health-related quality of life (HRQoL). However, there is limited detailed characterisation of pain phenotypes and their differential impact on outcomes in LC. This study aimed to (i) characterise pain associated with LC, (ii) identify factors associated with pain type and severity, and (iii) examine its impact on HRQoL, physical activity, and work. Methods: A cross-sectional survey was conducted among adults with clinician-diagnosed or self-reported LC who reported current or previous joint, muscle, or nerve pain. Participants completed validated patient-reported outcome measures including the C19-YRS, Nordic Musculoskeletal Questionnaire, Pain Detect Questionnaire (PD-Q), Musculoskeletal Health Questionnaire, and EQ-5D-5L. Participants were classified into neuropathic, nociceptive, or ambiguous pain groups based on PD-Q scores. Descriptive analyses, group comparisons, and backward stepwise ordinary least squares regression were used to examine factors associated with overall pain (PD-Q Total). Results: Among 198 participants (73% female; mean age 52 ± 12.7 years; mean LC duration 2.4 years), 96% reported new or worsened pain following COVID-19 infection, with muscle pain (87%), joint pain (84%), and nerve pain (66%) most frequently reported. PD-Q scores suggestive of neuropathic pain were identified in 28% of participants and were associated with significantly greater pain intensity, symptom burden, functional impairment, and lower HRQoL (p < 0.05). These participants reported higher average pain scores across all body regions and greater radiating pain (76%) compared to other groups. Functional disability and anxiety were significant factors associated with pain severity. Conclusions: Pain is highly prevalent in LC, with neuropathic pain representing a distinct and more severe phenotype associated with substantial functional and quality-of-life impacts. This study provides novel comparative evidence on pain phenotypes and their differential burden, highlighting the need for targeted pain assessment and management strategies in LC. Full article

Background/Objectives: Intra-articular injections are used for temporomandibular disorders (TMDs) resistant to conservative treatment. However, many reviews assess injectable agents combined with arthrocentesis or other co-interventions, limiting interpretation of their standalone effects. This overview aimed to summarize meta-analytic evidence on standalone intra-articular injections for temporomandibular joint disorders. Methods: MEDLINE, BASE, and Europe PMC were searched on 29 March 2026. Systematic reviews with quantitative meta-analyses evaluating standalone intra-articular TMJ injections were included. Data regarding injectable substances, clinical indications, and outcome domains were extracted and synthesized descriptively. Results: Three systematic reviews with meta-analyses were included. The evidence addressed platelet-rich plasma, corticosteroids, sodium hyaluronate, and physiological saline. Reported indications included degenerative joint disease, osteoarthritis, internal derangement, and arthritis. All included agents were reported to be associated with pain reduction. Conclusions: Meta-analytic evidence on standalone intra-articular injections for TMDs remains limited and heterogeneous. Available data suggest potential benefits, mainly for pain reduction, but do not establish clear superiority of any agent. The potential therapeutic activity of physiological saline should be considered when designing future injection trials. Full article

Introduction: Chronic sacroiliac joint (SIJ) pain is a frequent cause of low-back pain and remains challenging to diagnose and treat due to complex anatomy, overlapping clinical features, and limited long-term efficacy of conventional therapies. Case Presentation: We report the case of a 74-year-old woman with chronic right-sided sacroiliitis associated with spondyloarthritis, presenting with persistent gluteal pain refractory to nonsteroidal anti-inflammatory drugs, physiotherapy, and steroid injections. The patient underwent a dual imaging-guided intra-articular injection, consisting of pre-procedural ultrasound assessment and fluoroscopy-guided needle placement to confirm intra-articular access prior to injection. Autologous adipose tissue purified through mechanical filtration, without enzymatic manipulation, was administered. Pain intensity decreased from a visual analog scale (VAS) score of 8/10 at baseline to 2/10 at three months, with sustained improvement up to 12 months, functional recovery, and discontinuation of analgesic therapy, without procedure-related complications. Conclusions: This case suggests that dual imaging-guided intra-articular injection of mechanically filtered autologous adipose tissue may be feasible in selected patients with refractory SIJ pain. No causal inference can be drawn from a single case, and further studies are required to evaluate safety and clinical effectiveness. Full article

Background/Objectives: The aim of this study is to analyze outcomes in patients who underwent genicular artery embolization (GAE) with respect to pain, symptoms, physical activity, quality of life, and knee joint range of motion and muscle strength of the knee joint. The study will provide evidence of the treatment’s effectiveness using both subjective and objective measurements. In addition, the study will examine the impact of the severity of radiological changes in the knee joint and the number of embolized vessels on the extent of improvement in outcomes following the procedure. Methods: Patients eligible for GAE who exhibited symptoms of chronic exudative knee arthritis, confirmed by USG and MRI with contrast, did not have laboratory markers of inflammation, nor did they respond effectively to standard non-surgical treatments. The analysis included 34 patients. Subjective parameters were assessed using the VAS and KOOS scales. Knee range of motion and muscle strength were assessed using an electronic dynamometer and goniometer. Measurements were performed according to the same schedule before GAE, and at 1, 3 and 6 months after the procedure. The results were subjected to statistical analysis. Results: In the analysis up to 6 months, a significant time effect was demonstrated for the VAS and all KOOS subscales. The improvement was visible after 1 month and continued after 3 and 6 months. No significant changes over time were demonstrated for objective parameters. Exploratory analysis demonstrated a relationship between increased knee extensor strength and pain reduction up to 3 months and increased range of motion up to 6 months after the GAE. There was no significant association between radiological changes and the number of embolized vessels with improved outcomes after GAE. Conclusions: GAE appears to be a promising minimally invasive treatment option for patients with chronic knee synovitis. Clinically meaningful improvements were observed in patient-reported outcomes. Full article

Background/Objective: Hip osteoarthritis (HOA) is a major source of pain and disability worldwide. Although total hip arthroplasty (THA) provides substantial symptomatic improvement, a subgroup of patients remains ineligible because of severe comorbidities, frailty or elevated perioperative risk. Conservative treatments provide only temporary symptom control and transarterial periarticular embolization (TAPE) has emerged as a minimally invasive intervention targeting abnormal periarticular hypervascularity and inflammation. The aim was to compare clinical outcomes of TAPE and conservative care (CC) in patients with symptomatic HOA considered unsuitable for THA. Methods: A prospective non-randomized two-centre cohort study included consecutive adults aged ≥60 years with symptomatic HOA and baseline visual analogue scale (VAS) pain scores over 40. Patients were managed with either TAPE or structured CC. The primary endpoint was change in VAS pain score from baseline to 6 months. Secondary outcomes included Lower Extremity Functional Scale (LEFS), Timed Up-and-Go (TUG) and analgesic use. Patients were evaluated at baseline, 1, 3 and 6 months. Results: A total of 81 patients were screened, 69 were enrolled and 62 were included in the complete case longitudinal analysis. Baseline symptom severity was greater in the TAPE group, with higher VAS scores (73.6 ± 12.5 vs. 63.7 ± 14.1; p = 0.003) and lower-joint space width (1.37 ± 0.79 vs. 2.07 ± 0.89 mm; p < 0.001). The reduction in pain occurred during the first three months following embolization, after which symptom trajectories stabilized. Mean VAS pain in the TAPE group decreased from 73.6 ± 12.5 at baseline to 55.4 ± 13.0 at three months and 56.8 ± 13.6 at six months. LEFS improved in both groups throughout follow-up. Conclusions: TAPE was associated with symptom improvement and short-term safety in a small cohort of surgery-ineligible patients with HOA. The observed benefits appeared greatest within the first three months. Full article

Background: Knee osteoarthritis (KOA) is a degenerative joint disorder characterized by chronic pain, functional limitation, and low-grade inflammation. While platelet-rich plasma (PRP) has gained traction as a biologic therapy, the relationship between short-term clinical outcomes and systemic inflammatory biomarker dynamics remains poorly understood in routine clinical settings. Methods: This prospective observational study evaluated 40 patients with grade 2–3 KOA receiving a single ultrasound-guided intra-articular PRP injection. Clinical outcomes via the Visual Analog Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36), alongside serum inflammatory markers (IL-1β, IL-8, IL-18, TNF-α, erythrocyte sedimentation rate, and C-reactive protein), were assessed at baseline and 4 weeks post-injection using paired tests and multivariable regression. Results: At 4 weeks, clinical scores improved significantly (all p < 0.001). Circulating IL-8 and TNF-α levels decreased significantly (p = 0.009 and p = 0.014, respectively), whereas IL-1β and IL-18 variations were non-significant. Baseline cytokines did not predict clinical outcomes, but a significant association emerged between ΔIL-18 and ΔWOMAC (p = 0.032). Conclusions: A single intra-articular PRP injection was associated with short-term clinical improvements and selected reductions in circulating IL-8 and TNF-α, although the clinical significance of these biomarker changes remains uncertain. Given the observational design and short follow-up, these preliminary findings require confirmation in larger controlled trials. Full article

Argan tree (Argania spinosa L. Skeels), an endemic Moroccan species, is widely recognized for its traditional medicinal and nutritional uses. It has long been employed to promote skin and cardiovascular health, regulate blood glucose levels, and support overall wellbeing. Traditionally, different parts of the argan tree, including argan oil, leaves, and other plant-derived preparations, have been used to manage various health conditions such as diabetes, gastritis, gastric ulcers, rheumatism, joint and muscle pain, skin disorders including acne, eczema, and inflammation, as well as wound healing and dental problems. This narrative critical review compiles and evaluates current knowledge on the ethnobotany, phytochemistry, pharmacology, and toxicology of argan tree to support its evidence-based application. Relevant literature was collected from major English and French scientific databases, focusing on studies addressing the plant and its principal bioactive constituents. Ethnobotanical data indicate the extensive use of argan oil, leaves, and other plant parts in traditional remedies and dietary practices. Phytochemical investigations reveal a rich composition dominated by unsaturated fatty acids, tocopherols, phytosterols, and polyphenolic compounds. Experimental studies highlight a broad spectrum of biological activities, including antioxidant, antidiabetic, antibacterial, and anti-obesity effects, along with emerging applications in nanotechnology. Toxicological findings generally suggest low toxicity and good safety profiles under tested conditions. Overall, A. spinosa exhibits substantial ethnopharmacological relevance and diverse bioactivities, supporting its continued exploration for nutraceutical and therapeutic applications. Full article

Background/Objectives: Temporomandibular disorders may influence the perception of odontogenic pain through shared trigeminal pathways and referred pain mechanisms. This study compared postoperative pain following root canal treatment (RCT) between patients with anterior disc displacement with reduction (ADDwR) and individuals without temporomandibular disorders. Methods: The study was registered at ClinicalTrials.gov (NCT07329413; 8 January 2026). Individuals with irreversible pulpitis and symptomatic apical periodontitis in a vital mandibular molar, with or without ADDwR according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), were included. After exclusions and losses to follow-up, 70 patients (35 per group) were analyzed. All RCTs were performed by one clinician using a standardized protocol. Postoperative pain was assessed using the Numeric Rating Scale at 6 and 12 h and on postoperative days 1, 2, 3, 5, and 7. Joint pain and maximum mouth opening were recorded preoperatively and on postoperative day 7, and their associations with postoperative pain were analyzed. Results: Patients with ADDwR reported significantly higher pain scores at 6 and 12 h compared with the comparison group (p < 0.05). Multivariable analyses showed that ADDwR, female gender, and age were independently associated with postoperative pain at specific time points (p < 0.05). Additionally, procedure duration was significantly longer in the ADDwR group than in the comparison group (p < 0.05). Conclusions: Patients with ADDwR reported higher levels of early postoperative pain following RCT than individuals without temporomandibular disorders. These findings suggest that temporomandibular conditions may influence postoperative pain perception and should be considered when evaluating postoperative pain complaints. Full article

Objective: Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain and is associated with biomechanical, muscular, and functional impairments affecting the extensor mechanism of the knee. Quadriceps muscle dysfunction, altered tendon morphology, and impaired lower extremity biomechanics have been suggested to contribute to patellofemoral joint instability and pain development. The aim of this study was to evaluate the muscle and tendon thicknesses of the extensor mechanism using ultrasonography in individuals with PFPS and to investigate the relationship of these measurements with knee pain, knee function, and physical performance, with particular emphasis on the combined assessment of muscle morphology, tendon morphology, and functional performance parameters. Methods: This cross-sectional study was conducted between 5 November 2019 and 15 December 2019, including 80 individuals aged 18–45 years who presented with anterior knee pain and were clinically diagnosed with patellofemoral pain syndrome (PFPS). Demographic characteristics of the participants were collected. Pain severity was assessed using the Visual Analog Scale (VAS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Physical performance was assessed using the 6 m walk test and the five-repetition sit-to-stand test. Ultrasonographic examination was used to measure rectus femoris muscle thickness, vastus intermedius muscle thickness, quadriceps tendon thickness, and patellar tendon thickness using a high-frequency linear probe in a standardized supine position with the knee relaxed and the lower extremity muscles at rest. Results: The mean age of the participants was 32.11 ± 7.08 years, and the mean body mass index (BMI) was 25.05 ± 4.11 kg/m². Of the participants, 42 (52.5%) were male and 38 (47.5%) were female; 46 (57.5%) were smokers and 34 (42.5%) were non-smokers. Ultrasonographic measurements showed that rectus femoris muscle thickness was 1.98 ± 0.45 cm, vastus intermedius muscle thickness was 1.75 ± 0.53 cm, quadriceps tendon thickness was 0.54 ± 0.12 cm, and patellar tendon thickness was 0.35 ± 0.08 cm. Rectus femoris, vastus intermedius, and quadriceps tendon thicknesses were significantly higher in males compared to females (p = 0.001). Individuals with BMI > 25 had greater rectus femoris (p = 0.023) and vastus intermedius (p = 0.001) muscle thicknesses. A negative correlation was found between rectus femoris muscle thickness and WOMAC total (r = −0.227, p = 0.042) and WOMAC pain scores (r = −0.233, p = 0.028). Additionally, a significant relationship was observed between quadriceps tendon thickness and the five-repetition sit-to-stand test (r = −0.247, p = 0.044). Conclusions: In patients with PFPS, quadriceps muscle and tendon thicknesses were found to be associated with certain demographic and clinical parameters. Ultrasonographic evaluation of muscle and tendon structures may be a useful, non-invasive, dynamic, and radiation-free method for better understanding the clinical characteristics of PFPS and its relationship with physical performance. Ultrasonographic assessment may also provide complementary information for rehabilitation planning and functional evaluation in individuals with PFPS, although these findings should be interpreted cautiously because of the cross-sectional design and weak correlations observed. Full article

Background/Objectives: Patellofemoral joint (PFJ) replacement is a bone-preserving option for isolated patellofemoral osteoarthritis; however, reported survivorship and failure patterns remain variable. This study evaluated implant survivorship, functional outcomes, reoperations, and failure mechanisms following PFJ replacement using standard second-generation implant systems, with or without patellar resurfacing. Methods: We retrospectively reviewed a consecutive cohort of 39 patients (48 knees) who underwent PFJ replacement for isolated patellofemoral osteoarthritis between 2011 and 2021. Median age at surgery was 59 years, and median body mass index (BMI) was 31 kg/m². Median follow-up for clinical and revision surveillance was 9 years (IQR 8–10). Functional outcomes were assessed using the Oxford Knee Score (OKS) and SF-12 Physical and Mental Component Scores (PCS and MCS). Implant survivorship was analyzed using Kaplan–Meier methodology, with conversion to total knee arthroplasty (TKA) as the endpoint. Statistical analyses were primarily descriptive and exploratory because only five TKA revisions occurred. Results: Median OKS improved from 19 (IQR 16–24) preoperatively to 36 (IQR 24–42) at the latest follow-up, with a median paired improvement of 17 points. SF-12 PCS improved from 25 to 47, and SF-12 MCS from 36 to 55. Eight knees (16.7%) underwent non-revision reoperation, and five knees (10.4%) underwent conversion to TKA. All TKA revisions were performed for the progression of tibiofemoral osteoarthritis. Kaplan–Meier survivorship free from TKA revision was 89.6% at 9 years (95% CI 76.8–95.5). No clear difference in TKA-free survivorship was detected between resurfaced and non-resurfaced knees. Conclusions: PFJ replacement demonstrated substantial functional improvement and mid- to long-term survivorship comparable to published registry ranges in a selected cohort with isolated patellofemoral osteoarthritis. TKA revision was uncommon and was attributable to the progression of tibiofemoral osteoarthritis. Because of the retrospective design, small cohort size, bilateral cases, and limited number of revision events, subgroup and risk-factor analyses should be interpreted as exploratory. Full article

Calcific tendinitis (CT) is a condition that most commonly affects the rotator cuff tendons of the shoulder joint. Fundamental crystal morphology and composition underlying different radiological stages of CT remained insufficiently characterized. We collected human tendon samples from 33 patients with CT and 12 control patients. CT patients exhibited an increased incidence of comorbidities, especially high blood pressure and disorders of fat metabolism. Based on the Gärtner classification, calcific deposits were classified as type I in two patients, type II in 14 patients, and type III in 17 patients. Tendon calcification of the controls was significantly lower compared to the CT group. No differences in the amount of histological calcification between the Gärtner groups were observed. A correlation between the radiological size of calcification and the amount of calcification detected in histology was found. SEM-EDS and Raman identified basic calcium phosphate to be the predominant crystal type in tendons from CT patients, with only two calcium pyrophosphate detections. CT is mainly associated with BCP deposition. Calcified depot size was associated with pain intensity, while diabetes mellitus was observed more frequently in CT patients than in controls. BCP may be a focus of future mechanistic studies on CT. Full article

Background: Pain is a prominent and disabling manifestation of inflammatory bowel disease (IBD), including abdominal, pelvic, musculoskeletal, axial, and neuropathic pain phenotypes. Patients referred to pain clinics represent a selected subgroup with clinically meaningful, persistent, refractory, or diagnostically complex pain. Objective: To characterize pain phenotypes, treatment patterns, interventional pain-care exposure, and utilization burden among patients with IBD evaluated in tertiary pain-clinic settings and to explore differences between Crohn’s disease and ulcerative colitis patients. Methods: We performed a retrospective electronic medical-record cohort study of patients with documented IBD who were evaluated in pain-clinic settings between 24 October 2010 and 14 May 2026. Repeated clinical entries were aggregated into unique visit dates and patient-level variables. IBD diagnosis, pain phenotypes, treatment documentation, interventional procedures, and pain-clinic utilization were summarized descriptively using counts, percentages, means, medians, interquartile ranges, and ranges as appropriate. Crohn’s disease and ulcerative colitis subgroups were compared using univariable odds ratios with 95% confidence intervals and two-sided p-values. Because repeated clinical entries could belong to the same patient, the primary analytic unit was the patient rather than the individual note. Results: The source dataset included 19,615 clinical entries representing 7053 unique pain-clinic visits among 596 unique patients with IBD. The cohort included 314 patients with Crohn’s disease (52.7%), 247 with ulcerative colitis (41.4%), and 35 with IBD-unclassified (5.9%). The mean number of pain-clinic visits per patient was 11.8, with a median of four visits (interquartile range, 1–11). The dominant patient-level pain phenotypes were limb or peripheral joint pain (395/596, 66.3%), back or axial spine pain (358/596, 60.1%), and abdominal or pelvic pain (246/596, 41.3%). Overall, 437 patients (73.3%) had documentation of at least one interventional pain procedure. Compared with ulcerative colitis, Crohn’s disease was associated with higher documentation of abdominal or pelvic pain (148/314, 47.1% vs. 82/247, 33.2%; odds ratio, 1.79; 95% confidence interval, 1.27–2.53; p = 0.001) and fibromyalgia-like or widespread pain (83/314, 26.4% vs. 39/247, 15.8%; odds ratio, 1.92; 95% confidence interval, 1.25–2.93; p = 0.0027). In contrast, radiofrequency procedures (59/314, 18.8% vs. 78/247, 31.6%; odds ratio, 0.50; 95% confidence interval, 0.34–0.74; p = 0.0005) and facet or medial branch procedures (79/314, 25.2% vs. 87/247, 35.2%; odds ratio, 0.62; 95% confidence interval, 0.43–0.89; p = 0.012) were less frequently documented in Crohn’s disease than in ulcerative colitis. Conclusions: Among patients with IBD referred to tertiary pain-clinic evaluation, pain was heterogeneous and predominantly musculoskeletal, axial, neuropathic, and procedurally targetable rather than exclusively visceral. These findings support structured, mechanism-based pain assessment integrated with gastroenterology, rheumatology, and pain-medicine care. Full article

Background: The management of diabetic foot disease and knee osteoarthritis (OA) with smart orthotics holds significant importance during the early stages of these conditions, given their potential consequences, including functional impairment, chronic pain, and economic burden. Real-time monitoring of plantar foot pressure enables early detection of abnormal force distribution and gait biomechanics, allowing for the redirection of forces away from affected ulcers or arthritic joints. This is the first systematic review to synthesise clinical evidence for smart orthotics technology with real-time plantar pressure sensor biofeedback across both diabetic foot ulcer prevention and knee osteoarthritis management simultaneously. A search of the PROSPERO register confirmed no existing registration covers this specific combination. Objectives: To examine the clinical evidence for the use of standard and smart orthotics in the prevention and management of diabetic foot ulcers (DFUs) and knee OA, and to evaluate their impact on plantar pressure redistribution, ulcer recurrence, pain, biomechanics, and economic burden. Eligibility criteria: Studies published in English involving human adult participants (≥18 years) with a clinical diagnosis of diabetes mellitus (at risk of DFU or with peripheral neuropathy) or knee OA, where the intervention involved any orthotic device or smart/intelligent insole with clinical outcomes reported, were included. Studies on healthy individuals only, those not reporting participant age, and non-weight-bearing protocols not differentiated from weight-bearing were excluded. Information sources: Five databases were searched: CINAHL (EBSCO Information Services, Ipswich, MA, USA), PubMed Advanced (National Library of Medicine, Bethesda, MD, USA), Wiley Online Library (John Wiley & Sons, Hoboken, NJ, USA), Cochrane Library (Cochrane Collaboration, London, UK), and Google Scholar (Google LLC, Mountain View, CA, USA). Searches were completed in May 2026. Methods: We conducted a comprehensive literature review. This review was structured and reported with reference to the PRISMA 2020 statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis; University of Ottawa, Ottawa, ON, Canada) to guide transparency of reporting. It does not constitute a full Cochrane-style systematic review; risk of bias assessment was applied to key included studies and GRADE (Grading of Recommendations Assessment, Development and Evaluation; McMaster University, Hamilton, ON, Canada) certainty ratings were applied informally and narratively rather than as formal per-outcome evidence profiles. Five databases were searched yielding 92,637 records. After removal of 398 duplicates by Rayyan, 92,239 records remained. A subsequent automated keyword-based relevance filter applied within Rayyan (Rayyan AI, Doha, Qatar), prior to human screening, excluded 84,572 records that did not contain any terms related to orthotics, diabetic foot, or knee osteoarthritis, yielding 7667 records for human title/abstract screening. A narrative synthesis approach was adopted owing to the heterogeneity of study designs and outcome measures across included studies, which precluded meta-analysis. This review was not prospectively registered. A complete list of all 78 included studies, including those not individually discussed in the results and discussion. Results: The available clinical studies report promising findings for orthotics and smart orthotics in pain reduction, ulcer prevention, and potential reduction in economic burden, though conclusions are limited by small sample sizes, heterogeneity, and predominantly open-label designs. Recent research found that orthotics can be used to alter the gait pattern that influences knee OA by reducing excessive force on the affected joint. A randomised controlled trial demonstrated an 80% relative risk reduction in DFU recurrence (RR = 0.20; 95% CI: 0.06–0.79; p = 0.022), with absolute event rates of 6.3% in the intervention group versus 30.8% in controls (ARR = 24.5%); a second trial reported a 71% reduction in ulcer incidence over 18 months; and a third randomised controlled trial demonstrated statistically significant plantar pressure reduction (p < 0.01) in patients with diabetic neuropathy. Conclusions: The available evidence suggests that orthotics may be associated with improved pressure redistribution, reduced ulcer incidence, and benefit in the management of knee OA. Although the number of studies directly comparing smart orthotics with standard orthotics remains limited, the limited comparative studies suggested that smart orthotics showed promising results in reducing ulcer incidence, providing the patient with real-time feedback to offload via their electronic devices. These findings, while preliminary, highlight the potential of smart orthotic technology as an adjunct to standard orthotic care in reducing the overall burden of diabetic foot disease and knee osteoarthritis. Limitations: The primary methodological limitation of this review is the open-label design of all included smart orthotic trials, which precludes participant blinding and introduces performance bias. However, this limitation is structural and inherent to the wearable technology field—analogous to surgical trials—and is substantially mitigated by the use of objective primary outcome measures (plantar pressure and ulcer recurrence) across the three included RCTs, the consistency of effect direction across independent RCTs conducted in different countries, and a narrative sensitivity analysis confirming robustness of findings (Risk of Bias Across Studies Section). Formal per-outcome GRADE evidence profiles were not produced; overall certainty of evidence was assessed narratively with reference to GRADE domains and is judged to be low to moderate for smart orthotics in DFU prevention and low for knee OA management, consistent with the Level 2–3 evidence base and open-label study designs. Future adequately powered, multi-site RCTs with standardised outcome reporting, minimum 24-month follow-up, and integrated health economic modelling are the highest priority to extend these preliminary findings. Registration: This review was not prospectively registered. Full article

Laser acupuncture, defined as photobiomodulation or low-level laser therapy applied to specific acupuncture points, has been proposed as a non-invasive adjunctive strategy in oral and dental care. This umbrella review aimed to synthesize and critically appraise systematic reviews evaluating laser acupuncture in dental and orofacial conditions. The review followed PRISMA 2020 recommendations and was prospectively registered in PROSPERO. PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to 12 May 2026. Systematic reviews with or without meta-analysis were included. Methodological quality was assessed using AMSTAR 2, and findings were narratively synthesized considering methodological quality, overlap, consistency, dosimetric heterogeneity, and clinical applicability. From 263 records identified, six systematic reviews published between 2021 and 2024 met the eligibility criteria. The included reviews addressed three main domains: temporomandibular disorders, dental-related neuropathies, and pediatric dental outcomes. Laser acupuncture protocols used red to near-infrared wavelengths, mainly between 690 and 980 nm, but varied substantially in fluence, energy delivery, irradiation time, session frequency, and acupoint selection. The most consistent signal was observed for short-term pain reduction in temporomandibular disorders, although comparative evidence did not support laser acupuncture as superior to established conservative therapies. Evidence for dental-related neuropathies was associated with possible improvements in neurosensory and motor outcomes, while pediatric evidence suggested possible short-term changes in gag reflex, procedural pain, and bruxism-related outcomes; however, both domains were supported by only one systematic review each and should be considered preliminary and hypothesis-generating. No serious adverse events were reported, but harm reporting was limited. Overall, this umbrella review should be interpreted as an evidence map rather than as a source of high-certainty clinical recommendations. Laser acupuncture may represent an emerging adjunctive approach for selected dental and orofacial indications; however, current evidence remains limited and heterogeneous and does not support standardized protocols, stand-alone use, or definitive clinical recommendations. Full article