BackgroundHyaluronic acid (HA) has emerged as a potential biologic adjunct in the management of various foot and ankle pathologies due to its viscoelastic, anti-inflammatory, and chondroprotective properties.MethodsA scoping review of the currently available literature evaluating HA use in foot and ankle pathology was performed, with emphasis on osteoarthritis (OA), osteochondral lesions of the talus (OLTs), and soft tissue disorders.ResultsCurrent evidence suggests that HA injections may provide pain relief and functional improvement across multiple foot and ankle conditions. The most consistent evidence supports potential HA use in soft tissue disorders, including Achilles tendinopathy, plantar fasciitis, and acute lateral ankle injuries. HA may be used as an adjunct in OLT and selected OA applications, although outcomes remain heterogeneous across studies.ConclusionAlthough HA demonstrates a favorable safety profile and potential clinical benefit in selected foot and ankle conditions, currently available evidence remains limited by heterogeneous study designs, inconsistent treatment protocols, and short-term follow-up. Additional high-quality, comparative, and long-term studies are warranted to better define the role of HA in foot and ankle pathology.Level of Evidence:Level V, Scoping Review.

Copers are individuals with a history of ankle sprain who return to daily and sports activities without recurrent instability. However, it is unclear whether copers can use movement strategies comparable to those of healthy individuals without a history of ankle sprain. Understanding these movement strategies may be important for designing effective training programs and avoiding unintended biomechanical adaptations. Therefore, we aimed to compare the kinematics and muscular activities of the lower limbs during half squats and gait between copers and healthy controls. Ten copers (3 females) and 10 controls (4 females) were included in this secondary cross-sectional study. All participants were young, physically active adults who engaged in recreational physical activities for more than 1.5 h per week. We compared mean and peak angles of the thigh, shank, and foot calculated from inertial measurement units, as well as muscle activities of the biceps femoris long head, rectus femoris, gastrocnemius, and tibialis anterior between copers and controls during half squats and gait. During the half squat, copers exhibited lower thigh rotational angles and lower activities of biceps femoris long head, rectus femoris and tibialis anterior across both the descending and ascending phases, accompanied by a higher mean foot angle. In contrast, gait-related group differences were limited to the mean shank angle during the stance phase, with no significant differences observed in other limb angles or muscle activities. These findings suggest that movement strategy alterations in copers are task-dependent and more evident during demanding exercises such as the half squat than during level walking. Identifying such movement characteristics may be important for designing efficient training or rehabilitation programs for individuals with a history of ankle sprain.

Chronic lateral ankle instability (CLAI) is a frequent sequela of acute lateral ligament injury, causing recurrent sprains, persistent pain, and functional limitations, particularly among athletes and active individuals. While most acute ankle sprains respond well to conservative treatment, approximately 20-30% of patients experience persistent mechanical or functional instability requiring surgical intervention. In recent years, arthroscopic techniques have grown in popularity due to their minimally invasive nature, ability to address concomitant intra-articular pathology, and favorable recovery profiles compared to open surgery. This clinical practice review integrates recent evidence from randomized controlled trials, comparative cohort studies, and technical reports with expert clinical experience to provide practical guidance on the arthroscopic management of CLAI. For patients with adequate ligament tissue quality, arthroscopic Broström repair remains the preferred first-line option, offering high return to sport (RTS) rates and low complication rates. For cases involving revision, poor-quality tissue, or generalized ligamentous laxity, arthroscopic ligament reconstruction using autografts or allografts is recommended. Concomitant procedures such as synovectomy, loose body removal, and cartilage debridement or microfracture can be performed during the same operation. A structured postoperative rehabilitation program is essential for achieving optimal outcomes. Early protected mobilization is followed by progressive range of motion (ROM) and strengthening phases, with sport-specific training typically initiated at about 3 months postoperatively. Current evidence suggests that arthroscopic management yields comparable clinical results to open procedures, while enabling the simultaneous treatment of associated joint pathologies and potentially facilitating faster recovery. Arthroscopic management of CLAI should be regarded not merely as a surgical alternative, but as a comprehensive clinical approach that integrates diagnosis, surgical decision-making, and rehabilitation for optimized patient outcomes. This review aims to provide an evidence-informed framework to guide orthopedic surgeons and sports medicine clinicians in the individualized, evidence-based management of CLAI.

Lateral ankle instability is a common problem with substantial morbidity in both the athletic and general population. Guidelines for use of ligament augmentation devices continue to be developed. The below is a case describing surgical treatment of ankle instability using TEKBRACE (TheraMicro, LLC), a new ligament augmentation scaffold, for the anterior talofibular ligament in a patient at high risk of failure.Level of Evidence:Level V.

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.

This study aimed to evaluate training workload and injury history in specifically professional roundnet athletes. An anonymous survey regarding players' injuries specific to roundnet was created with input from two premier roundnet athletes and two orthopedic surgeons. The 56 Spikeball Tour Series professional roundnet athletes from the 2023 season were contacted after the 2023 season to complete an anonymous injury history survey. Overall, 49 (88%) of the 56 professional roundnet athletes from the 2023 season were included in the study. Professional roundnet athletes had been competing in roundnet for a mean of 4 years and train 9.5 months per year. Players reported 82 roundnet injuries comprised of 43 (52%) upper extremity injuries, 24 (29%) lower extremity injuries, and 15 (18%) axial injuries. No reported injuries required surgical treatment. Upper extremity, lower extremity, and axial injuries had an average time to return to sport (RTS) of 1.8 months, 2.8 months, and 2.2 months missed, respectively. In conclusion, the upper extremity is the most commonly injured region in professional roundnet athletes, accounting for about half of roundnet injuries. Professional roundnet athletes most frequently experience significant acute injuries of the elbow and ankle, and significant chronic injuries of the shoulder and lower back.

The association between reduced Achilles tendon structural integrity and ankle instability may reflect alterations in muscle-tendon properties and impairments throughout the lower-extremity kinetic chain following ankle sprain. This study aimed to investigate the effect of an intervention program on Achilles tendon organization in military recruits and to evaluate its impact on tendon structure in participants with ankle instability and those who sustained ankle sprains during training. A total of 387 male recruits (160 intervention and 227 control groups) were screened for Achilles tendon structure (echo types III and IV representing disorganized fibers) at baseline (PRE) and 12 weeks of infantry training (POST). The cohorts reported pre-induction chronic ankle instability and were followed for ankle sprains during training. The intervention group undertook an injury prevention program (5min, five times/wk) while the control group continued their routine physical-fitness sessions. Significanttime×group interactions were found for echo types III and IV fibers (p=0.005 and p=0.032, respectively). The time×instability×groupinteraction was found for echo type IV (p=0.005); the time×instability interaction was found for echo type III (p=0.017). In participants who received exercises, the Achilles tendon structure improved during training. Participants with pre-induction chronic ankle instability and participants who sprained their ankles were more likely to present the disorganized PRE-training tendon structure. Neuromuscular injury-prevention intervention training might be associated with improved tendon quality in those who sprained their ankles during training.