This case report presents a 49 year old man with chronic limb threatening ischaemia (CLTI) and seronegative rheumatoid arthritis who presented with ischaemic foot ulcers, rest pain, and severely impaired pedal circulation. Imaging revealed occlusions of the dorsalis pedis, common plantar, and medial plantar arteries, with no visualised perfusion around the foot wounds, classifying the case as no option CLTI in which conventional revascularisation was deemed unfeasible.

High-altitude headache (HAH) is the most common neurological manifestation triggered by hypoxia during rapid ascent above 2500 m, often presenting as an isolated symptom or as part of acute mountain sickness (AMS). HAH shares clinical features with migraine, cluster headache and other primary headache, complicating differential diagnosis. Prevalence varies widely depending on ascent speed and altitude, with higher rates observed in populations ascending rapidly by passive transport and lower rates in those ascending gradually on foot. Controlled normobaric hypoxic chamber studies confirm hypoxia as a potent trigger, with most participants developing HAH within hours. Environmental factors, including fluctuations in barometric pressure, further contribute to headache onset. We propose that the pathophysiology involves activation and sensitization of the trigeminovascular system, with key molecular mediators such as nitric oxide, adenosine, calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide (PACAP) playing central roles. Hypoxia stabilizes hypoxia-inducible factor-1α (HIF-1α), driving transcriptional changes that can prime vascular and neuronal pathways for head pain. Although HAH typically responds to simple analgesics and oxygen, its similarity with migraine suggests that targeted therapies against CGRP and PACAP may offer additional benefits. Future research should clarify the mechanistic continuum between HAH and AMS and evaluate multitarget therapeutic approaches.

Background Plantar fasciitis (PF) is one of the most common causes of heel pain and is associated with significant functional limitation and reduced quality of life. Alterations in foot biomechanics and plantar pressure distribution are considered key contributors. Short foot exercises effectively strengthen intrinsic foot muscles, improve arch support, and dynamic stability. We can incorporate the arch-building gait as a short-foot exercise. This study aims to evaluate and compare biomechanical parameters and plantar forces at the forefoot, midfoot, and heel among individuals with unilateral and bilateral PF and healthy individuals, using a dynamic gait analysis system. Additionally, it analyses the correlations during barefoot walking and arch-building gait. Methods This cross-sectional study was conducted at the Department of Physical Medicine and Rehabilitation (PMR), All India Institute of Medical Sciences (AIIMS), Mangalagiri, India, over 15 months. A total of 141 participants were included: 47 with unilateral PF, 47 with bilateral PF, and 47 healthy individuals. Gait analysis was performed using the Diers Formetric 4D system (DIERS, Biomedical Solutions, Germany) to assess biomechanical gait parameters, as well as plantar force distribution at the forefoot, midfoot, and heel during barefoot walking and arch-building gait. Statistical analysis was carried out using ANOVA, the chi-square test, and Pearson's correlation coefficient, with p-values < 0.05 considered statistically significant. Results A total of 141 participants were included, with 47 in each of the following groups: unilateral (U/L), bilateral (B/L), and normal. No significant differences in biomechanical gait parameters were observed among the groups during barefoot walking. In contrast, during arch-building gait, significant differences were present in cadence and antero-posterior (A/P) centre of pressure. For barefoot walking, a significant difference in midfoot plantar force was found between the unilateral and bilateral PF groups, whereas no significant differences emerged during arch-building gait. Strong-to-moderate positive correlations were observed between barefoot walking and arch-building gait parameters across all groups. Conclusion Individuals with unilateral and bilateral PF show near-normal gait during barefoot walking. Arch-building gait reveals subtle biomechanical changes and improves plantar load distribution. These findings support that the arch-building gait activates the intrinsic foot muscles and can serve as both a sensitive assessment tool and a potential rehabilitation strategy.