This study investigated the biomechanical mechanisms of inverted orthotic insoles for correcting flexible flatfoot. Clinical experiments demonstrated that a 15° inverted insole can correct the talonavicular coverage angle (TNCA) within the normal range. Patient-specific finite element models validated by TNCA and plantar pressure measurements revealed that inverted insoles reduced stress at the talocalcaneal contact surface by 39% and decreased lateral ligament and plantar fascia tension by 6-13% compared to barefoot conditions. This corrective effect is primarily attributed to the active role of the medial calf muscles, which help alleviate ankle pain and reduce the risk of plantar fasciitis.

To evaluate the effectiveness of comprehensive nursing care combined with an intermittent pneumatic compression (IPC) device in preventing lower extremity deep vein thrombosis (DVT) in long-term bedridden elderly patients. This prospective controlled study included 180 long-term bedridden elderly patients admitted between July 2022 and January 2024. Due to routine clinical practice, participants were not randomly assigned but allocated to control or intervention groups based on physician judgment and patient preference. The control group (n = 81) received conventional nursing care, while the intervention group (n = 99) received IPC treatment combined with comprehensive nursing care. After 2 weeks, DVT incidence, lower limb circumference differences, coagulation indices (prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer), Numerical Rating Scale pain scores, and nursing satisfaction were compared. The intervention group showed significantly greater reductions in thigh and calf circumference differences (P < .001). Prothrombin time and activated partial thromboplastin time were significantly prolonged, while fibrinogen and D-dimer levels were significantly reduced in the intervention group compared to controls (all P < .001). DVT incidence was significantly lower in the intervention group (13.13% vs 33.33%, P = .001). Numerical Rating Scale pain scores decreased more markedly in the intervention group (P < .001), and nursing satisfaction was significantly higher (94.95% vs 82.72%, P = .008). Comprehensive nursing care combined with IPC treatment was associated with reduced lower limb swelling, improved coagulation parameters, lower DVT risk, enhanced pain relief, and higher nursing satisfaction in long-term bedridden elderly patients.

Background: Acute compartment syndrome (ACS) is a limb-threatening surgical emergency most commonly associated with fractures or high-energy trauma. Non-fracture-related ACS in athletes is uncommon and may lead to delayed diagnosis. Repetitive blunt trauma during combat sports has rarely been described as a potential mechanism. Case Methods: The case concerns a 21-year-old elite-level kickboxing athlete who developed acute compartment syndrome of the left lower leg following repeated calf kicks sustained during sparring. The patient presented with rapidly progressive calf pain, swelling, compartment firmness, paresthesias and weight bearing difficulties. CT angiography demonstrated diffuse edema of the posterior compartments associated with a large intramuscular soleus hematoma without active arterial bleeding. Results: In view of the severity of the symptoms and the characteristic clinical presentation, an emergency fasciotomy was performed in operating room. Progressive closure was achieved using the vessel loop shoelace technique, allowing gradual tension-free closure. Wound healing progressed without infection, and physiotherapy was introduced with joint mobilization. The patient achieved full functional recovery after 6 months. Conclusions: This case illustrates an atypical etiology of ACS-repetitive targeted calf strikes-and underscores the importance of early recognition even in the absence of fracture or major trauma. Clinical vigilance remains paramount, and prompt surgical intervention is critical to prevent irreversible muscle and nerve damage. Awareness of such mechanisms is particularly relevant for clinicians managing athletes in combat sports. To our knowledge, this is the first documented case of ACS secondary to repeated calf kicks in kickboxing.

Persistent sciatic artery (PSA) is a rare congenital vascular anomaly that may be complicated by aneurysm formation and distal embolization. A 72-year-old woman presented with acute calf and foot pain despite preserved distal pulses. Computed tomography angiography revealed a complete PSA with aneurysmal degeneration and mural thrombus. Endovascular exclusion using a Viabahn covered stent achieved successful aneurysm exclusion and restoration of distal perfusion. This case demonstrates that endovascular repair is an effective treatment option for PSA aneurysm complicated by distal embolization, offering a safer alternative to open surgery in avoiding sciatic nerve injury.

Wounds caused by caustic paste take longer to heal than wounds from hot-iron disbudding, but little work has focused on factors influencing healing following caustic paste disbudding. The objective of this study was to evaluate the effects of paste area and thickness on disbudding wound characteristics and healing. Twenty female Holstein calves were randomly assigned to one of 2 paste areas: large (22 mm diameter; n = 10 calves) or small (12 mm diameter; n = 10 calves). Within each calf, one horn bud was treated with a 1-mm thick paste and the other with a 2-mm thick layer (n = 20 buds per thickness level; n = 10 buds per area x thickness combination). Disbudding was performed at 4 to 6 d of age using multimodal pain management (sedation, local nerve block, and analgesics). Healing progress was monitored weekly until wounds had fully re-epithelialized. Measurements included wound size and depth, wound tissue type classification, and pressure pain threshold (PPT). The larger paste area created larger wounds than the smaller area (short axis: 23.9 ± 0.64 mm vs. 14.9 ± 0.61 mm; long axis: 25.9 ± 0.67 mm vs. 16.7 ± 0.63 mm). Thicker paste application created larger wounds than did a thinner application (short axis: 20.0 ± 0.51 mm vs. 18.6 ± 0.51 mm; long axis: 22.4 ± 0.51 mm vs. 20.3 ± 0.51 mm). The effect of paste area was observed throughout the healing process, but the effect of thickness was observed only while necrotic tissue was present. We detected no effect of treatment on PPT. Evidence of residual horn tissue was observed following disbudding with the smaller paste area but not when a larger area was applied. In conclusion, creating smaller wounds promotes faster healing following caustic paste disbudding, but may increase the risk of scur development.

Injuries at the medial gastrocnemius-soleus junction are common among athletes and physically active individuals. They typically result from sudden overstretching or repetitive microtrauma, leading to significant calf pain and functional limitations. Diagnosis is primarily clinical, with ultrasound or MRI used to assess injury severity. Most cases are managed conservatively, including rest, cryotherapy, anti-inflammatory therapy, and structured rehabilitation focusing on gradual stretching, eccentric strengthening, and proprioceptive training. Recovery generally occurs within 6-12 weeks, with return to activity guided by functional recovery rather than symptom resolution alone. A thorough understanding of the anatomy, pathophysiology, and evidence-based management strategies is essential to prevent complications, reduce recurrence, and facilitate a safe return to sport. ABSTRACT(CONCISE VERSION): Despite their prevalence in athletes, medial gastrocnemius-soleus junction injuries respond well to early conservative care, with most patients regaining full function. Diagnosis is based on clinical evaluation, supported by imaging when needed. Most cases are treated conservatively with rest, anti-inflammatory measures, and structured rehabilitation. Recovery typically occurs within 6-12 weeks, allowing safe return to activity while minimizing recurrence.

Mechanical hypersensitivity following peripheral nerve injury is common and difficult to treat. It has been suggested that this results from activation of a normally silent spinal cord circuit that links low-threshold mechanoreceptive primary afferents to nociceptive projection neurons in lamina I and that this pathway involves a class of excitatory interneurons known as vertical cells. We have recently identified 2 neurochemical types of vertical cells, based on expression of the gastrin-releasing peptide receptor (GRPR) and neuropeptide FF (NPFF). Although little is known about the role of NPFF cells, those that express GRPR are strongly implicated in itch; for example, it has been reported that ablation of GRPR cells suppresses itch but has no effect on pain. In this study, we have used chemogenetics to inhibit each population separately (in GRPRCreERT2 and NPFFCre mice) and both together (in GRPRCreERT2; NPFFCre mice). We found that the itch evoked by intradermal injection of chloroquine in the calf was suppressed in each case, but there was no effect on baseline mechanical sensitivity. In addition, we saw no effect of the chemogenetic inhibition on either mechanical hypersensitivity or on a measure of spontaneous pain in the spared nerve injury model of neuropathic pain. These results indicate that both of these populations of vertical cells are involved in the itch evoked by chloroquine but do not support a role for these cells in neuropathic mechanical hypersensitivity.

Hemodynamic assessment in patients with lower limb varicose veins should be performed with the patient standing, the limb examined in a non-weight-bearing position, and reflux elicited by appropriate provocative maneuvers. Duplex ultrasound is used to identify reflux and localize the anatomical reflux pathways, with attention to pelvic and nonsaphenous venous pathways. Quantitative parameters, including peak reflux velocity, reflux volume or volume flow, ambulatory venous pressure, venous filling index, and ejection fraction, help assess reflux burden, calf muscle pump function, and venous hypertension. The Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) is a hemodynamic, vein sparing strategy for the outpatient treatment of lower limb varicose veins. It achieves hemodynamic correction by interrupting reflux entry points, preserving or remodeling re-entry points, and maintaining the saphenous trunk. Short-, mid-term, and long-term outcomes of CHIVA are not inferior to, and may in some settings be better than, those of conventional stripping or endovenous thermal ablation. Postoperative pain and ecchymosis are less pronounced, and the need for adjunctive sclerotherapy is lower. In selected patients with limited disease and only mild truncal change, ambulatory selective varices ablation under local anesthesia may be considered. Follow up and outcome assessment should move beyond closure alone. Imaging and functional endpoints should be evaluated together. A standardized postoperative surveillance strategy that integrates hemodynamic parameters with varicose veins scales may help reduce recurrence and improve quality of life.

Background/Objective: Peripheral arterial disease (PAD) is a widespread but underdiagnosed manifestation of systemic atherosclerosis, associated with high morbidity and mortality. Traditional diagnostic methods such as the ankle-brachial index (ABI) have limited sensitivity in certain populations, highlighting the need for reliable blood-based biomarkers. Fatty Acid Binding Protein 3 (FABP3) has emerged as a robust biomarker with diagnostic utility in PAD. To evaluate the diagnostic performance of FABP3 when used in combination with traditional clinical risk factors for PAD in patients presenting to vascular surgery clinics. Methods: A retrospective analysis was conducted on 657 patients presenting to ambulatory vascular surgery clinics at St. Michael's Hospital. Two logistic regression models were compared: (1) Model A: Included standard clinical risk factors (calf pain, age, smoking, diabetes, hypertension, hypercholesterolemia, coronary artery disease, and signs of chronic limb-threatening ischemia); and (2) Model B: Included the same factors as Model A, plus FABP3 levels. Diagnostic metrics including area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were assessed. Results: Among 657 patients, 423 had PAD and 234 did not. Model B (FABP3-integrated model) outperformed Model A, with a higher AUC (0.86 vs. 0.82), sensitivity (96% vs. 81%), specificity (84% vs. 67%), PPV (92% vs. 81%), NPV (94% vs. 65%), and diagnostic accuracy (93% vs. 76%). FABP3 also improved detection in asymptomatic PAD patients (84% detected vs. 0%). Conclusions: Integrating FABP3 with standard clinical risk factors significantly improves PAD diagnosis, especially in asymptomatic and borderline cases. These findings support the potential role of FABP3 in routine PAD screening, warranting further prospective studies for validation.