Rheumatoid vasculitis (RV) is a rare, severe extra-articular manifestation of rheumatoid arthritis (RA), typically occurring after long-standing erosive disease. Advances in RA therapy have reduced its incidence; however, RV can occasionally present early in high-risk patients. We report a man in his thirties from Central India with a 3-year history of inadequately treated seropositive RA, who presented with progressive polyarthritis, neuropathy, and distal ischemic changes. Over five months, he developed worsening joint pain and swelling, followed by tingling, numbness, and subsequently dry gangrene of the 2nd-5th toes of the left foot. Examination revealed palpable peripheral pulses, normal ankle-brachial index, active synovitis in 24/28 joints, and sensorimotor deficits with weakness and absent ankle reflex. Laboratory evaluation showed anaemia, thrombocytosis, markedly elevated ESR and CRP, and high RF (288 U/mL) and ACPA (>300 U/mL). ANA and ANCA were negative. CT angiogram ruled out peripheral arterial occlusion, and echocardiography excluded cardiac emboli. Nerve conduction study demonstrated sensorimotor axonal neuropathy. Sural nerve biopsy confirmed vasculitis with axonal damage and perivascular inflammation. A diagnosis of rheumatoid vasculitis was made. Treatment with high-dose intravenous methylprednisolone, followed by oral prednisolone, rituximab, and methotrexate, led to rapid control of joint inflammation and halting of gangrene progression. At 6-month follow-up, the patient was asymptomatic on methotrexate 25 mg/week with steroids tapered off, and no further vascular events. This case highlights that RV may rarely occur early in seropositive RA with poorly controlled disease. Prompt recognition, biopsy confirmation, and aggressive immunosuppression are crucial for favourable outcomes.

Ankle distraction arthroplasty (ADA; also known as tibiotalar arthrodiastasis) is a less common alternative approach to managing ankle osteoarthritis and potentially delaying or avoiding total ankle arthroplasty and arthrodesis. In ADA, an external fixator is used to distract and offload the joint, potentially relieving pain and creating an environment to partially restore subchondral bone and cartilage. The method maintains the native joint. This review explores current evidence, indications, techniques, outcomes, and complications of ankle distraction arthroplasty.

Osteonecrosis of the femoral head (ONFH) remains a challenging condition in orthopaedics[1]. Free vascularized fibular grafting (FVFG) theoretically has the potential to restore blood supply to the femoral head and enhance mechanical stability within the femoral head. This method has shown promising clinical outcomes in hip preservation. Previous studies have utilized the anterolateral approach to the hip for this surgical procedure. Here, we report a minimally invasive technique utilizing the direct anterior approach for debridement and bone grafting, requiring a shorter fibular graft and simplifying the procedure. This method holds potential as an effective treatment option for early to mid-stage femoral head necrosis[2].

Distal tibial metaphyseal malunion is a challenging complication of lower-extremity trauma due to its effects on alignment, ankle mechanics, and long-term function. This narrative literature review synthesizes current evidence regarding the pathophysiology, evaluation, and management of distal tibial metaphyseal malunion. Since the ankle is a highly congruent joint, even small degrees of angular or rotational deformity can alter tibiotalar contact patterns, producing pain, instability, and progressive post-traumatic arthritis. Malunion typically arises from the interaction of fracture morphology, fixation challenges in the metaphyseal region, soft-tissue compromise, and associated fibular or syndesmotic injury. Accurate evaluation requires systematic assessment with weight-bearing radiographs and computed tomography to characterize deformity and joint congruity. Management is guided primarily by cartilage preservation and symptom severity, with treatment options ranging from corrective osteotomy to circular external fixation, intramedullary techniques, ankle arthrodesis, or total ankle replacement following deformity correction. Early recognition and individualized treatment are essential to optimize outcomes.

Transient osteoporosis of pregnancy (TOP) is a rare condition that typically presents during the third trimester as unexplained lower limb joint pain, most commonly involving the hip. We report an uncommon case of TOP affecting both ankles and provide a literature review of previously reported cases involving the ankle. A 31-year-old Japanese woman developed bilateral ankle pain in the second trimester of pregnancy without any history of trauma. She presented to the orthopedic outpatient clinic in the postpartum period, and her radiographs revealed bilateral diffuse osteopenia, which brought her to our rheumatologic department. Additional radiographic evaluation of the spine and hips showed no evidence of osteopenia. Magnetic resonance imaging of the right ankle, which was obtained for worsening pain, demonstrated bone marrow edema. Blood tests, which evaluated inflammatory markers and alkaline phosphatase, and a musculoskeletal ultrasound were unremarkable. The patient's symptoms gradually resolved with conservative management, including vitamin D supplementation, intermittent use of nonsteroidal anti-inflammatory drugs, and rest. At three months postpartum, radiographs showed partial improvement of osteopenia, whereas MRI still demonstrated bone marrow edema. Follow-up radiographs at eight months demonstrated resolution of the patient's osteopenia, which was consistent with a diagnosis of TOP. We also reviewed previously reported cases of TOP affecting the ankles, identifying eight cases in total. Clinicians should consider the possibility of TOP in pregnant or postpartum women presenting with unexplained joint pain in the lower limbs, including the ankles, even when the pain appears during the second trimester of pregnancy. TOP carries a risk of fracture, making timely and appropriate conservative management essential. Although based on a single case, these findings may indicate that radiographs could reflect recovery earlier than MRI, and may be useful as a follow-up imaging modality in TOP affecting the ankles.

Plantar fasciitis is the most common cause of heel pain in adults, affecting 10 percent of individuals over their lifetime. Therapeutic stretching remains a cornerstone of conservative management, particularly plantar fascia-specific stretching, combining dorsiflexion of the ankle and toes with targeted digital pressure along the plantar aponeurosis. However, many patients cannot perform these techniques effectively due to limited mobility, age-related restrictions, higher body mass, or improper application of the exercises. This study characterizes the mechanical environment created during plantar fascia-specific stretching and assesses whether a custom-built stretching device could replicate the strain generated by manual techniques. Twelve morphologically normal cadaveric feet were dissected, and the plantar fascia was exposed. Strain sensors were affixed along the fascia, and deformation was measured under various conditions: resting baseline, great toe and lesser toes dorsiflexion with and without direct manual pressure, and application of a custom device with incrementally increased weights to load the plantar fascia. The results demonstrated that dorsiflexion of the metatarsophalangeal joints combined with direct pressure to the plantar fascia reliably produced measurable strain, whereas dorsiflexion alone did not consistently generate adequate strain. Great toe dorsiflexion was not required to induce effective plantar fascia strain when direct pressure was applied. The custom device reproduced the strain levels achieved with manual stretching, but only when configured to deliver targeted pressure at the fascia. These findings suggest that plantar fascia stretch is influenced by both metatarsophalangeal dorsiflexion and direct aponeurosis pressure, and that a properly designed device can replicate clinically relevant strain patterns.

BackgroundMusculoskeletal disorders (MSDs), which impose significant economic and mental health burdens, are a major public health concerns among older population globally. However, evidence on the intersection between MSDs and depression among older adults in India remains limited.ObjectiveThe objective of the study is to investigate the association between musculoskeletal disorders and depression among older Indian adults using nationally representative data.MethodsCross-sectional data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018) were analyzed for 65,311 participants. Depression was measured by validated tool the Composite International Diagnostic Interview-Short Form (CIDI-SF). Binary logistic regression analysis was employed to examine the nexus between musculoskeletal disorders and depression in middle-aged and older adults.ResultsThe results indicate a significant association between musculoskeletal disorders (MSDs) and depression. After adjusting for covariates, the odds of experiencing depression among those who experienced joint pain or stiffness (aOR: 1.19, CI 1.11-1.29), foot or ankle pain/swelling (aOR: 1.55, CI 1.43-1.68), and back pain or problems (aOR: 1.28, CI 1.19-1.38) were higher compared with those reporting no such conditions. Similarly, individuals who experienced falls or injuries had 50% higher odds of depression (aOR: 1.50, CI 1.38-1.63) than those who didn't experienced falls or injuries.ConclusionAlthough causality cannot be established due to the cross-sectional nature of the study, findings highlight the strong association between MSDs and depression among older adults in India. These results underscore the need for physicians to address mental health alongside MSDs management and to promote preventive and educational programs.