Background. The current ‘gold standard’ method for enabling weightbearing during non-invasive lower limb immobilisation is to use a Patella Tendon-Bearing (PTB) or Sarmiento cast. The Beagle Böhler Walker™ is a non-invasive frame that fits onto a standard below knee plaster cast. It is designed to achieve a reduction in force across the foot and ankle. Our objective was to measure loading forces through the foot to examine how different types of casts affect load distribution. We aimed to determine whether the Beagle Böhler Walker™ is as effective or better, at reducing load distribution during full weightbearing. Methods. We applied force sensors to the 1st and 5th metatarsal heads and the plantar surface of the calcaneum of 14 healthy volunteers. Force measurements were taken without a cast applied and then with a Sarmiento Cast, a below knee cast, and a below knee cast with Böhler Walker™ fitted. Results. Compared to a standard below knee cast, the Böhler Walker™ reduced the mean peak force through the first metatarsal head by 58.9% (p < .0001); 73.1% through the fifth metatarsal head (p < .0001); and by 32.2% (p < .0001) through the calcaneum. The Sarmiento cast demonstrated a mean percentage reduction in peak force of 8.6% (P = .39) and 4.4% (P = .87) through the 1st and 5th metatarsal heads respectively, but increased the mean peak force by 5.9% (P = .54) through the calcaneum. Conclusions. Using a Böhler Walker™ frame applied to a below knee cast significantly reduces loadbearing through the foot compared to a Sarmiento cast or a standard below knee cast. Implications. This could mean early weightbearing is safer and better tolerated in patients with a wide variety of foot and ankle pathologies, which can in turn improve quality of life and reduce the incidence of immobility dependent morbidity

In recent years, the plantaris tendon has been implicated in the development of chronic painful mid-portion Achilles tendinopathy. In some cases, a thickened plantaris tendon is closely associated with the Achilles tendon, and surgical excision of the plantaris tendon has been reported to be curative in patients who have not derived benefit following conservative treatment and surgical interventions.

The aim of this review is to outline the basic aspects of, and the recent research findings, related to the plantaris tendon, covering anatomical and clinical studies including those dealing with histology, imaging and treatment.

Cite this article: Bone Joint J 2016;98-B:1312–19.

Osteochondral lesions (OCLs) occur in up to 70% of sprains and fractures involving the ankle. Atraumatic aetiologies have also been described. Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Current literature suggests that microfracture is indicated for lesions up to 15 mm in diameter, with replacement strategies indicated for larger or cystic lesions. Short- and medium-term results have been reported, where concerns over potential deterioration of fibrocartilage leads to a need for long-term evaluation.

Biological augmentation may also be used in the treatment of OCLs, as they potentially enhance the biological environment for a natural healing response. Further research is required to establish the critical size of defect, beyond which replacement strategies should be used, as well as the most appropriate use of biological augmentation. This paper reviews the current evidence for surgical management and use of biological adjuncts for treatment of osteochondral lesions of the talus.

Cite this article: Bone Joint J 2014;96-B:164–71.