Introduction. The arch of the foot has been described as a truss where the plantar fascia (PF) acts as the tensile element. Its role in maintaining the arch has likely been underestimated because it only rarely torn in patients with progressive collapsing foot deformity (PCFD). We hypothesized that elongation of the plantar fascia would be a necessary and sufficient precursor of arch collapse. Method. We used a validated finite element model of the foot reconstructed from CT scan of a female cadaver. Isolated and combined simulated ligament transection models were created for each combination of the ligaments. A collapsed foot model was created by simulated transection of all the arch supporting ligaments and unloading of the posterior tibial tendon. Foot alignment angles, changes in force and displacement within each of the ligaments were compared between the intact, isolated ligament transection, and complete collapse conditions. Result. Isolated release of the PF did not cause deformity, but lead to increased force in the long (142%) and short plantar (156%), deltoid (45%), and spring ligaments (60%). The PF was the structure most able to prevent arch collapse and played a secondary role in preventing hindfoot valgus and forefoot abduction deformities. Arch collapse was associated with substantial attenuation of the spring (strain= 41%) and interosseous talocalcaneal ligaments (strain= 27%), but only a small amount in the plantar fascia (strain= 10%). Conclusion. Isolated PF release did not cause arch collapse, but arch collapse could not occur without at least 10% elongation of the PF. Simulated transection of the PF led to substantial increase in the force in the other arch supporting ligaments, putting the foot at risk of arch collapse over time. Chronic degeneration of the PF leading to plantar fasciitis may be an early sign of impending PCFD

Introduction. Plantar heel pain, or plantar fasciopathy (PF), is a common musculoskeletal complaint, affecting 39% of lower-extremity tendinopathies in general practice. Conservative management is recommended as the first-line treatment, yet many patients continue to experience symptoms even after ten years. There is a significant lack of high-quality evidence for the effectiveness of various treatments, highlighting the need for more research. Minimally invasive surgical options, such as endoscopic plantar fascia release and radiofrequency microtenotomy, have shown promise in reducing pain and improving outcomes. This systematic review aims to evaluate the effectiveness of these minimally invasive surgical treatments compared to non-surgical options in managing PF. Method. The systematic review, registered on PROSPERO (CRD42024490498) and adhering to PRISMA guidelines, searched databases including PubMed, Embase, Cochrane, and others for studies from January 1991 to May 2024. Keywords included plantar fasciitis, plantar fasciopathy, and heel pain. Limited to human trials, the search strategy was refined with an information specialist and found no protocol duplicates. Result. The systematic review identified eight studies involving 495 patients (56.2% women, average age 46.5 years). The studies compared various treatments, including endoscopic plantar fascia release (EPF), mini-scalpel needle (MSN) treatment, ultrasound-guided pulsed radiofrequency (UG-PRF), and needle electrolysis (NE), to non-surgical interventions and corticosteroid injections (CSI). Primary outcomes focused on pain reduction, with some needle treatments showing superior results (between-group diffence). No severe adverse events were reported. Conclusion. In conclusion, plantar fasciopathy (PF) remains a prevalent and challenging condition, that can be resistant to conservative treatments. This systematic review highlights the potential of minimally invasive surgical options, such as endoscopic plantar fascia release and needle treatments, in reducing pain and improving functional outcomes. Despite some needle treatments showing superior results, the overall lack of high-quality evidence underscores the need for further research to establish the most effective management strategies for PF

Plantar fasciitis (PF) is one of the widespread conditions causing hindfoot pain. The most common presenting symptoms are functional limitation and pain (first step and activity) on plantar surface of the foot. The non-operative treatments provide complete resolution of pain in 90% of patients, but functional limitation still remains as a risk factor for recurrency of PF. Although the number of non-operative treatment options showing efficacy on pain and functional limitation are excessive, the evidences are limited for functional limitation. Additionally, Mulligan mobilization with movement (MMWM) in Chronic Plantar Fasciitis has been poorly studied in the literature. According to these findings, the study was aimed to determine effectiveness of Mulligan mobilization with movement on Chronic Plantar Fasciitis. A total of 25 patients (40 feet) with chronic PF were included in the study. The patients were randomly divided into Mulligan concept rehabilitation group (PF-M, n=20 feet) and Home Rehabilitation group (PF-H, n=20 feet). (MMWM), Foot and ankle exercises program were applied to PF-M, twice a week totally 8 week (16 sessions) and foot- ankle exercises as a home program were given for PF-H, 8 weeks. The range of motion (ROM) for dorsiflexion and plantar flexion was measured by using a manual goniometer. Pain, disability and activity restriction were assessed by Foot Function Index (FFI) . The first step morning pain was evaluated by Visual Analogue Scale (VAS) and Kinesiophobia was also reported by using Tampa Scale (TSK). Patients were evaluated at baseline and 8 weeks. FFI, VAS, TSK, ROM values improved in all groups (intragroup variability) at 8th week (P < .05). The other result indicated that ROM values for DF and PF and TSK scores in PF-M had more significant improvement than PF-H (p<.05). To the best of our knowledge this is the first randomised controlled trial for investigating Mulligan Concept efficiancy on chronic PF. Both Mulligan mobilization with movement (MMWM) and exercise protocols are effective for chronic PF. Furthermore, The Mulligan concept seems more effective treatment option in reducing kinesiophobia and improving functional capacity

Introduction. We compared ultrasound guided methylprednizolone-lidacaine infiltrations around inflammatory area of plantar aponeurosis with systematic use of NSAID'S. Also, we investigated the reliability of the sonographic criteria (a. swelling of aponeurosis more than 20% in comparison to the healthy foot, b. effusion around aponeurosis, c. calcium deposits) most used to identify plantar fasciitis in clinically suspicious patients. Methods. A prospective randomised controlled clinical trial, including 28 patients (mean age: 47 years, range: 36–65 years, 85% females) with typical clinical symptoms of plantar fasciitis. All of these patients undertook a soft tissue ultrasonography of the plantar aponeurosis, without Doppler. Then, we randomly divided our sample in 2 groups, group A (14 patients) and group B (14 patients). In group A patients we performed an ultrasound guided injection –in transverse view- around the swollen part of aponeurosis, while we managed group B patients with per os NSAID's treatment (meloxicam 15 mg, once per day) for 2 weeks. Results. From the 28 suspicious patients we found 20 (71.4%) matching at least in one of our sonographic criteria. Swelling in comparison to the contralateral foot was the most usual found on these patients (14/20: 70% of the -ultrasound positive- patients). In group A patients the mean visual analogue scale (VAS) 100/100 after 1 month reduced –from 69/100 prior to injection- to 34/100, while 6 patients (42.85%) declared free of symptoms and 4 had poor or no improvement. In group B patients, the mean VAS decline was 21/100 (from 66/100 prior to injection, to 45/100 1 month later), but only 1 patient reported pain free. Conclusion. High frequency ultrasound of the foot is a good standing -but not excellent- diagnostic tool for plantar aponeurositis. Ultrasound guided methylprednisolone injections seems to have better short-term results than per os anti-inflammatory treatment on these patients

Introduction. Orthopaedic trauma surgery is characterised by repetitive, forceful tasks that are physically demanding, thus theoretically increasing the risk of musculoskeletal injuries in these surgeons. The aim of this study is to assess prevalence, characteristics and impact of musculoskeletal disorders among orthopaedic trauma surgeons. Methods. A modified version of the physical discomfort survey was sent to surgeon members of the Orthopaedics Trauma Association (OTA) via e-mail. For data analysis, one-way ANOVA and Fisher Exact test were performed to compare the variables where appropriate. P values<0.05 were considered statistically significant. Results. A total of 86 surgeons completed the survey during the period of data collection. Of the respondents 84.9% were males and more than half were aged between 30–45 years old. The majority of musculoskeletal complaints and disorders were low back pain (29.3%), wrist or forearm tendinitis (18.0%), elbow lateral epicondylitis (15.4%), plantar fasciitis (14.7%). When data was analysed according to number of years in practice the results yielded a significant difference between the groups in both number of regions involved (p<0.05) and number of musculoskeletal disorders (p<0.05), as a higher proportion of these were documented in surgeons practicing for 16–20 years and more than 30 years. Also surgeons working in a private setting (p<0.005), surgeons working in more than one institute (p<0.005), increased number of regions involved (p<0.001) and increased number of musculoskeletal disorders (p<0.001) were significantly more likely to require time-off work. Conclusion. To our knowledge, our study is the first of its kind that shows a high percentage of orthopaedic trauma surgeons sustain occupational injuries some time in their careers. Cost of management and rehabilitation of these injuries, in addition to the amount of missed workdays due to these injuries indicate that these injuries have a significant economic burden on the health-care system