Perioperative peripheral nerve injury (PPNI) is rare but potentially disabling. In patients with diabetic peripheral neuropathy (DPN), the threshold for nerve injury is lowered due to microvascular compromise and impaired myelin repair. We report a 48-year-old male with type 2 diabetes and chronic foot ulcers who developed immediate left foot drop following low spinal anesthesia for debridement. Electrophysiology revealed conduction block and focal demyelination of the peroneal nerve at the fibular head; high-frequency ultrasound showed no structural abnormality, while lumbar magnetic resonance imaging (MRI) demonstrated a punctate T2 hyperintensity in the left L5 nerve root. Symmetrical sensory deficits supported underlying DPN. The findings suggested L5 nerve root irritation related to spinal anesthesia, resulting in secondary peroneal nerve dysfunction in the setting of diabetic peripheral neuropathy. Conservative management-including neuroprotection, ankle-foot orthosis, glycemic control, offloading, and early rehabilitation-led to significant recovery: dorsiflexion improved from 0/5 to 4/5 by 3 months, with electrophysiological evidence of remyelination. This case underscores the need for a stratified diagnostic approach (rule out central, then clarify peripheral) and highlights that functional nerve injury can occur without compressive findings on imaging. Early multimodal intervention enables favorable outcomes even in vulnerable diabetic patients.

Foot drop resulting from neurological injury severely compromises mobility and gait stability, yet existing assistive solutions often overlook physiological bilateral coordination and lack adaptability to individual gait variability. This study introduces a novel adaptive gait assistance framework for a soft exosuit that simultaneously aims to restore inter-limb coordination and generate personalized ankle joint assistance. First, we design a contralateral-guided adaptive phase synchronization engine that transforms healthy-limb information into an ideal phase reference for the impaired limb, enabling active correction of gait asymmetry. Second, to reconcile stability and personalization, we propose an uncertainty fusion-based adaptive gait assistance that estimates the real-time confidence of each model, arbitrates and fuses their predictions, and produces assistance trajectories that are both robust and individualized. After demonstrating high predictive accuracy and robustness in validation experiments with healthy subjects, a clinical evaluation involving five individuals with foot drop showed significant improvements in ankle kinematics, walking speed, and gait symmetry. Subjective feedback confirmed superior comfort, balance, and confidence over baseline and preset assistance. These preliminary results suggest that the proposed framework can improve gait kinematics, symmetry, and user-perceived walking performance, and support its potential as a personalized assistance strategy for foot-drop rehabilitation.

Charcot-Marie-Tooth (CMT) disease comprises a genetically diverse range of disorders affecting the peripheral nervous system. We report an axonal CMT (CMT 2) case from India with a novel heterozygous variant of uncertain significance detected in the ganglioside-induced differentiation-associated protein 1 (GDAP1) gene. A 12-year-old male patient presented with severe distal lower limb weakness (bilateral foot drop) progressing proximally. Bilateral pes-cavus, high-steppage gait, reduced power in bilateral lower limbs, bilaterally absent ankle jerks, and no cerebellar or pyramidal signs/vocal cord paresis were salient clinical findings that suggested the clinical diagnosis of Hereditary motor and sensory neuropathy (HMSN)/CMT disease. Neurophysiological tests revealed axonal CMT. Genetic studies showed a novel heterozygous missense variant classified as a variant of uncertain significance in the GDAP1 gene. Although the causative role of the variant remained unclear, mutation in the GDAP1 gene, clinical features, and characteristic electrophysiological findings exhibiting axonal CMT supported the subtype diagnosis as probable CMT type 2K in the patient. The present report emphasizes the significance of clinical and neurophysiological findings in CMT when analyzing sequencing data in the era of next-generation sequencing, particularly when variant of uncertain significance are found.

Flatfeet involve a collapse of the medial longitudinal arch, hindfoot valgus, and forefoot abduction. Flexible flatfoot is the most common type and can often be corrected with physiotherapy or orthotics. While some individuals remain asymptomatic, others develop symptoms for reasons that are not fully understood. This cross-sectional study compared plantar pressure distributions in 16 adults with asymptomatic and 16 with symptomatic flexible flatfeet (FPI-6 > 6; navicular drop > 5 mm), using a resistive-sensor-equipped pressure plate during walking and heel-strike running. During walking, symptomatic participants showed significantly higher total and peak forces at metatarsal 5 (p ≤ 0.003), and the midfoot (p ≤ 0.02146). The medial heel had significantly lower peak force (p = 0.00147), and metatarsal 4 showed higher peak force (p = 0.02539). Force ratios indicated a more lateralized pressure distribution in the symptomatic group. During heel-strike running, the symptomatic group exhibited higher total and peak forces at the fifth metatarsal, the midfoot, and the first metatarsal, with shorter time to peak force in the midfoot and the medial part of the heel. No significant ratio differences were found during running. Symptomatic individuals adopted a lateralized pressure distribution pattern, contrasting the traditional expectation of medial overload in flatfoot conditions.

High-arched feet affect approximately 10%-15% of the general population. Although the relationship between plantar pressure and bilateral symmetry is well studied, there is limited evidence regarding the use of Symmetry Index and pressure platforms. The objective of the study is to compare dynamic foot pressures and Symmetry Index during gait between subjects with Pes Cavus and subjects with normal feet. The analysis of asymmetric pressure patterns could benefit from studies that compare dynamic foot pressures and Symmetry Index values in subjects with high-arched feet and normal feet. This analysis can promote better clinical understanding of gait alterations and help solve biomechanical problems that may lead to pathologies, as well as prevent and treat them. A descriptive case-control study was developed from October to December 2024 with 82 participants, 41 with Pes Cavus and 41 normal feet and 71 females of 25.52 ± 5.99 years through a consecutive nonrandom technique. For this study, a baropodometry platform (Neo-Plate, Herbitas) was used, which acquired dynamic gait with a 2-step protocol. The inclusion criteria regarding the selection of subjects were age 18-65 years; if both cavus feet, Navicular Drop Test (NDT) < 9 mm; neutral feet and no lower limb problem or surgery. Regarding SI use, the PC demonstrated to have large asymmetries compared to the control group. Left anterior pressure was lower (44.93% ± 4.59% vs. 48.60% ± 3.43%, p = 0.014), left posterior pressure was higher (55.07% ± 4.58% vs. 51.40% ± 3.43%, p = 0.013) and the left Initial Contact Phase (ICP) was prolonged (123.34 ± 51.75 ms vs. 91.30 ± 31.86 ms, p = 0.036); right medial pressure was higher (58.18% ± 4.08% vs. 53.77% ± 4.79%, p = 0.034). SI measurements were greater in normal foot group than in the PC group with SI 94.15% ± 5.00% versus 93.75% ± 4.59%, p = 0.001, respectively; ICP and lateral SI were both p = 0.001. Findings confirmed that subjects with cavus feet tend to present greater alterations in bilateral symmetry, specifically posteromedial pressure movements and altered gait phases, which are indicative of more probability of future injuries. For this reason, pressure platforms are excellent tools for understanding, analysing and therefore applying the correct treatment according to the SI.

A 49-year-old woman developed a painful right foot drop that progressed to severe lumbosacral plexopathy, resulting in the inability to walk or stand independently. She had a history of juvenile cystinosis requiring renal transplantation and was taking lifelong immunosuppression (tacrolimus). She also had a monoclonal gammopathy of undetermined significance and diabetes. Extensive investigations, including bone marrow and superficial peroneal nerve biopsy, were non-diagnostic. Her neuropathy progressed despite corticosteroids, involving the upper limbs and causing complete loss of upper limb function. A further brachial plexus biopsy was also non-diagnostic. Tacrolimus was switched to sirolimus after which her pain resolved with functional improvements. Tacrolimus-associated plexopathy is rare but should be considered in patients who have undergone a transplant presenting with progressive neuropathy.