Osteochondroma is the most common benign bone tumour but characteristically arises from the metaphysis of long bones during the first two decades of life and ceases growing at skeletal maturity. Metatarsal involvement, new symptomatic onset in adulthood, and a diaphyseal origin are each individually uncommon. We report a 47-year-old woman who presented with four months of progressive, atraumatic dorsal pain and swelling of the left foot and a fixed, tender bony mass in the first intermetatarsal space. Radiographs showed two apposed ("kissing") sessile outgrowths arising from the lateral cortex of the first and the medial cortex of the second metatarsal diaphyses, each maintaining corticomedullary continuity with the parent bone. Magnetic resonance imaging (MRI) showed no discernible cartilage cap, with incidental cuboid marrow oedema and a minimal tibiotalar effusion; inflammatory and metabolic markers were normal. Because of the atypical adult onset, symptomatic progression and clinical-imaging discordance, en bloc excision was performed. Histopathology confirmed a benign osteochondroma with a 1-mm hyaline cartilage cap overlying mature lamellar bone, without atypia. Symptoms resolved completely by three months, with no radiographic recurrence. Apposed diaphyseal osteochondromas on adjacent metatarsals can occur in a non-syndromic adult, departing from the classical metaphyseal, skeletally immature paradigm. A thin cartilage cap may be undetectable on MRI, so histological confirmation is essential when imaging and clinical suspicion diverge; complete excision is curative.

To compare the safety, efficacy, and perioperative outcomes of radiofrequency ablation (RFA) and endovenous microwave ablation (EMA), each combined with foam sclerotherapy, versus traditional high ligation and stripping (HL/S) for symptomatic lower extremity varicose veins. The primary endpoint was the change in Venous Clinical Severity Score (VCSS) from baseline to 12 months postoperatively. This multicenter retrospective study analyzed 305 patients from two hospitals, divided into three groups: RFA + sclerotherapy (n = 102), EMA + sclerotherapy (n = 101), and HL/S (n = 102). Perioperative outcomes (operation time, blood loss, hospital stay), postoperative pain (Visual Analog Scale, VAS), inflammatory markers (CRP, IL-6), dorsal foot venous pressure, coagulation parameters, complication rates, Venous Clinical Severity Score (VCSS), and Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-20) scores were assessed and compared up to 12 months postoperatively. Both minimally invasive groups demonstrated superior perioperative outcomes compared to HL/S, including shorter operation times, less blood loss, and reduced hospital stays. Postoperative pain scores were significantly lower in the RFA and EMA groups, with RFA showing the lowest early pain levels. Inflammatory markers (CRP, IL-6) and coagulation activation (D-dimer, fibrinogen) were significantly lower in the ablation groups, with RFA values being the lowest. Complication rates were lower in the RFA (34.3%) and EMA (41.6%) groups versus HL/S (58.8%). However, no significant differences were observed among the three groups in long-term VCSS, CIVIQ-20 scores, or recurrence rates at 12 months. RFA and EMA combined with sclerotherapy are safe and effective minimally invasive alternatives to HL/S, offering advantages in faster recovery, less pain, reduced inflammatory response, and fewer complications. While perioperative benefits favor thermal ablation, all three techniques provide comparable long-term symptomatic relief and quality-of-life improvement.

Early revision of primary Achilles tendon repair is sometimes necessary, and the Achilles tendon's inherent hypovascularity creates a uniquely challenging biological environment for reoperation. However, the optimal timing for revision and its associated complication risks remain poorly characterized.

Clinical guidelines recommend foot orthoses for patients with patellofemoral pain (PFP) and excessive subtalar pronation. Although Statistical Parametric Mapping (SPM) is established for analysing continuous kinematic waveforms in biomechanics, foot orthoses research in PFP frequently relies on discrete variables (e.g. peak angles). Applying SPM allows detailed assessment of movement adaptations throughout the stance phase that isolated data points may overlook. This study evaluated the immediate effects of medially wedged orthoses on lower limb kinematics, pain, and self-perceived improvement in runners with PFP. Thirty participants (15 men/15 women) ran under two conditions: original shoe insoles (control) and 4° medially wedged orthoses (intervention). Rearfoot, tibial, and femoral 3D kinematics were analysed using SPM. Compared with control, orthoses reduced rearfoot eversion (18-81% stance, p = 0.007), tibial internal rotation (40-84%, p < 0.001), and increased femoral adduction (23-47%, p = 0.011). Acute pain remained unchanged (p = 0.940), but more runners reported self-perceived improvement (p = 0.031). SPM identified time-specific alterations missed by discrete analyses. Medially wedged orthoses reduce distal rotations while increasing proximal adduction. Greater self-perceived improvement suggests short-term clinical benefits despite no immediate pain reduction. .

We report a Gustilo-Anderson type IIIA open talar neck fracture (Hawkins type II) with medial foot dislocation after a fall from a ladder. Treatment consisted of single-stage surgical management including meticulous irrigation and debridement, anatomical reduction with screw fixation, combined with systemic antibiotics, local vancomycin application, plaster cast immobilization, and adjunctive hyperbaric oxygen therapy. Fracture healing proceeded without major complications, and screw removal was performed at 1½ years due to local irritation. At final follow-up, 3½ years after injury, the patient was pain-free in daily life and able to run up to five kilometers. Functional outcome was good, with an AOFAS (American Orthopaedic Foot & Ankle Society) hindfoot score of 87/100 and an FAAM (Foot and Ankle Ability Measure) activities of daily living score of 75/84 (89%). The patient remained active in sports but had limitations in squatting, jumping, and stop-and-go movements, reflected in the FAAM sports score of 17/32 (53%). This case report suggests that functional recovery can be achieved in open, dislocated talar neck fractures.

The genicular nerves are sensory nerves that innervate the knee joint, playing a crucial role in pain transmission. Because of their small size, they are frequently underappreciated and overlooked during routine ultrasound examinations. With the advent of high-resolution ultrasound, these nerves can be visualized directly, facilitating targeted interventions. A detailed understanding of genicular nerve anatomy, ultrasound landmarks, and characteristic imaging appearances has significant clinical implications for managing knee pain. Given the high prevalence of chronic knee pain due to osteoarthritis and post-operative conditions, ultrasound-guided genicular nerve blocks and radiofrequency ablation are increasingly utilized. Traditionally, genicular nerve procedures, targeting three nerves (the superomedial, superolateral, and inferomedial genicular nerves), were performed under fluoroscopic guidance. However, ultrasound offers distinct advantages, including real-time visualization of soft tissues, the absence of radiation exposure, and precise targeting of anatomical locations using revised landmarks and Doppler signal. These advancements have enabled more comprehensive targeting of five nerves: the superomedial genicular nerve, superolateral genicular nerve, inferomedial genicular nerve, recurrent peroneal genicular nerve, and the infrapatellar branch of the saphenous nerve. Although ablation of the recurrent peroneal genicular nerve carries a risk of injury to the common peroneal nerve, potentially resulting in foot drop, precise localization through ultrasound-guidance may help mitigate this complication. This article provides a comprehensive review of genicular nerve anatomy, ultrasound techniques, and interventional approaches, emphasizing the clinical relevance of ultrasound-guided procedures for managing knee pain and diagnosing nerve pathologies.