Foot and ankle injuries are among the most common musculoskeletal conditions encountered in both athletic and general populations, accounting for a substantial proportion of emergency and sports medicine visits. These injuries encompass a wide spectrum, from acute ligamentous sprains to more subtle and frequently misdiagnosed conditions such as Lisfranc ligament injuries, tarsal coalitions, and posterior tibial tendon dislocations. The complex anatomy and biomechanics of the foot and ankle, combined with the high functional demands placed upon them during gait and athletic activity, underscore the importance of accurate diagnosis and appropriate management. This article reviews the relevant anatomy of the foot and ankle, discusses common and clinically significant injuries, and highlights key aspects of diagnosis, imaging, and treatment. Both nonoperative and operative treatment strategies are addressed, with consideration given to injury severity, stability, and patient-specific factors. Finally, the importance of rehabilitation and injury prevention in reducing recurrence and optimizing long-term outcomes is discussed.

Leriche syndrome (LS) is an aortoiliac occlusive disease (AIOD) characterized by claudication, decreased femoral pulses, and erectile dysfunction. We present an LS case with bilateral femoropopliteal occlusive disease (FPOD) considered untreatable with surgery or endovascular therapy alone but successfully revascularized via hybrid intervention (HI). An 84-year-old woman with a history of LS was admitted to our hospital with rest pain in the right leg, and coldness and numbness in the left leg. The ankle-brachial index (ABI) indicated severe bilateral amplitude reduction and pulse elongation. Computed tomography angiography revealed occlusion of the terminal aorta, bilateral common iliac artery to external iliac artery, common femoral artery to superficial femoral artery, and right popliteal artery with poor run-off. We initially decided to perform HI only on the right lower extremity. Easy guidewire passage through the occluded lesion suggested a primarily thrombotic nature. HI using Fogarty arterial thrombectomy was eventually performed for the bilateral lower extremities. Complete revascularization was achieved using covered and self-expanding stents for aortoiliac lesions, and drug-eluting stent deployment and drug-coated balloon angioplasty for FPOD. The post-operative ABI was elevated, and symptoms improved bilaterally. This HI is highly effective for treating AIOD combined with bilateral FPOD involving thrombotic lesions.

ObjectiveThis case report aimed to describe effects in balance, gait, and functional recovery observed during a multimodal technology-assisted rehabilitation program in a patient following total ankle and total talus replacement (TATTR).MethodsA 59-year-old man (history of ankle fracture-dislocation) developed persistent pain, progressive avascular necrosis of the talus, and advanced ankle osteoarthritis. He underwent TATTR on January 19th, 2025. Then, he underwent a rehabilitation program combined joint mobility recovery, progressive strengthening, proprioceptive training using the Pro-Kin 252 system, gait retraining on an antigravity treadmill, and visual-feedback gait optimization with the Walker View device. We assessed Berg Balance, Tinetti, Barthel Index, EQ-5D, stabilometric variables, gait parameters, and passive ankle range of motion at baseline (T0), 1 month (T1), 3 months (T2), and 5 months (T3).ResultsOverall, clinical outcomes improved from baseline to the 5-month follow-up; stabilometric analysis showed marked reductions in eyes-closed ellipse area and perimeter from T0 to T3 (Area T0: 318 mm[2]; T3: 77 mm[2]; Perimeter T0: 742.37 mm; T3: 555.27 mm). Berg Balance Scale increased from 30 to 56, Tinetti total score from 9 to 29, EQ-5D index from 0.169 to 1.0, and Barthel Index from 70 to 100. Gait parameters also improved, with left step length increasing from 39 cm to 50 cm and left contact time decreasing from 1.01 s to 0.84 s.ConclusionsThis case report suggested that a tailored multimodal rehabilitation program supported by advanced technologies might be associated with improvements in balance, gait, and functional independence after TATTR.

Haglund syndrome has become an important consideration in the differential diagnosis of posterior heel pain. It results from mechanical conflict between a prominent posterosuperior calcaneal tuberosity, the Achilles tendon, and the surrounding bursae. We report the case of a 45-year-old woman presenting with chronic posterior heel pain associated with a visible deformity of the posterior ankle. Imaging demonstrated a prominent calcaneal tuberosity, Achilles tendinopathy, and mild retrocalcaneal bursitis. The clinical presentation and imaging findings are discussed, highlighting the role of imaging techniques in evaluating posterior heel pain, confirming the diagnosis of Haglund syndrome, and excluding other causes of posterior heel pain, including inflammatory enthesitis associated with spondyloarthropathies.

Achilles tendon rupture is a common injury among active adults and frequently requires surgical repair in high-demand patients. Augmentation techniques have been developed to improve repair strength and reduce re-rupture risk, particularly in cases of degenerative tendon tissue. TeKBrace, a woven polyester mesh, provides mechanical reinforcement while allowing biologic integration. We present the case of a 36-year-old recreational athlete who underwent open Achilles tendon repair with TeKBrace augmentation following an acute rupture. Intraoperative findings of degenerative tendon tissue and mild gapping under tension supported the decision to augment the repair. At 6 months, the patient demonstrated symmetric ankle range of motion and approximately 90% restoration of plantarflexion strength compared with the contralateral limb. The patient demonstrated excellent functional recovery and returned to recreational basketball without pain or limitation at 9 months, and no complications or re-rupture were observed. This case highlights the biomechanical rationale and clinical utility of TeKBrace scaffold augmentation in selected patients, although larger studies with longer follow-up are needed to better define its clinical effectiveness.

Professional bus drivers are exposed to occupational hazards leading to chronic disease, including musculoskeletal disorders and joint pain. Here, we investigated factors associated with joint pain among Swiss bus drivers. We used data from the Transport Personnel Health Cohort (TRAPHEAC-N=549), a Swiss bus driver cohort, and the Swiss Health Study (SHeS-N=1,364), a population-based study. Joint pain was assessed using the Nordic questionnaire. Exposures included vibrations, ergonomics, work organization, stress, BMI, smoking, and physical activity. Associations were analyzed using logistic regression and random forest models. Joint pain was prevalent in TRAPHEAC, especially in the neck (67%), lower-back (59%), shoulders (54%), and upper-back (45%). Comparatively, back pain prevalence in SHeS was 11% (odds-ratios comparing TRAPHEAC with SHeS: 1.89). Logistic regression showed associations between seat and floor vibrations with neck, upper-back, and elbows (odds-ratios 1.1-1.5), while stress was associated with joint pain across all regions. BMI and ergonomics were associated with selected pain locations. Random forest models, using permutation importance, identified stress (shoulder, upper-back, lower-back, and knee pain) with seat vibrations and ergonomics (neck and ankle pain), as the most influential predictors of joint pain. Despite modern infrastructure, joint pain remains prevalent among Swiss bus drivers, supporting prevention targeting biomechanical and psychosocial factors.

We report the case of a 32-year-old male professional soccer player presenting with a one-year history of posterior ankle pain due to posterior ankle impingement syndrome secondary to an elongated Stieda process and loose bodies. Preoperative review of MRI revealed an anatomical variation of the posterior neurovascular bundle in relation to the flexor hallucis longus (FHL) tendon at the level of the ankle joint. In this case, the neurovascular bundle was situated posterior and lateral to the FHL tendon, as opposed to medial to the FHL tendon, as seen in typical anatomy. This finding is significant because posterior ankle arthroscopy relies on the FHL tendon as an anatomical landmark to protect the posterior neurovascular bundle by always working lateral and posterior to the tendon. An arthroscopic approach would have posed a high risk of iatrogenic injury to the tibial nerve and posterior tibial vessels. The originally planned arthroscopic ankle debridement was therefore changed to an open approach using a posteromedial incision. Postoperative recovery was uncomplicated, and the patient returned to soccer within seven weeks with little swelling and no pain.