Insertional Achilles tendinopathy (IAT), with or without an associated Haglund deformity, represents one of the most common causes of posterior heel pain. Although open surgical procedures provide reliable clinical outcomes, they are associated with prolonged rehabilitation periods and higher complication rates. In recent years, endoscopic and percutaneous techniques have emerged as safe and effective alternatives and should now be considered integral components of the surgical treatment spectrum.

Complex soft tissue defects in children require reconstructive solutions that are stable, adaptable, and compatible with long-term growth. The free anterolateral thigh flap offers several advantages in this setting because it can be tailored according to the defect, either as a durable resurfacing flap or as a source of vascularized tissue volume. We report two pediatric cases managed with a free anterolateral thigh flap for different reconstructive purposes. The first patient was an eight-year-old boy with a painful and unstable post-traumatic scar of the right heel after a road traffic accident and previous split-thickness skin grafting. After complete scar excision, reconstruction was performed using an ipsilateral fasciocutaneous anterolateral thigh flap. At two-year follow-up, the flap remained stable, painless, and free of ulceration; the visual analog scale pain score decreased from 6/10 preoperatively to 0/10, and the patient resumed school activities, walked independently with definitive adapted footwear, and required no secondary debulking procedure. The second patient was a seven-year-old boy with xeroderma pigmentosum who presented with a large nasal squamous cell carcinoma extending to the upper lip and pre-nasal cheek region. After tumor excision with 1 cm lateral margins, resection through a healthy deep plane, and bilateral cervical lymph node dissection, reconstruction was achieved using a free fasciocutaneous anterolateral thigh flap harvested from the left thigh. The cervical lymph node dissection was negative, and no adjuvant radiotherapy was administered after multidisciplinary tumor board discussion because complete excision had been achieved and the benefit-risk balance was considered unfavorable in the context of xeroderma pigmentosum. At one-year clinical follow-up, there was no evidence of recurrence. These two cases illustrate how the free anterolateral thigh flap may address different pediatric reconstructive needs, ranging from durable heel coverage to vascularized filling of a central facial cavity after oncologic resection.

Pediatric cardiac arrest primarily arises from asphyxia in infants and trauma in older children, contrasting with adult etiologies dominated by cardiac events. This underscores prevention as the cornerstone of pediatric basic life support, through injury mitigation like child restraint systems and water supervision, safe sleep practices including supine positioning on firm surfaces with caregiver smoking cessation to reduce sudden infant death syndrome, plus awareness of child abuse and adolescent suicide prevention. In hospitals, pediatric early warning systems (PEWS) enable early deterioration detection via vital sign scoring for timely intervention. Major updates in the 2025 pediatric basic life support guidelines reflect evidence-driven refinements. First, hospitals should implement PEWS to prompt rapid response teams for at-risk inpatients. Second, all rescuers (lay and healthcare providers) should employ the two-thumb encircling hands technique for infant chest compressions for optimal depth (about 4 cm), rate (100-120/min), and recoil; one-hand heel compression serves as backup if infeasible. Third, lay rescuers may apply automated external defibrillators for nontraumatic out-of-hospital cardiac arrest in children aged 1 year or older, prioritizing prompt attachment after initial cardiopulmonary resuscitation (CPR) cycles to address potential shockable rhythms. Fourth, for infant foreign body airway obstruction, alternate five back blows (over the spine between scapulae) with five chest thrusts (using heel-of-hand on sternum) until cleared or unresponsive, then transition to CPR. These updates aim to enhance bystander intervention, CPR quality, and survival with favorable neurologic outcomes in pediatric cardiac arrest.

Acute posterior tibialis tendon rupture is a rare injury, most often occurring in association with ankle fractures or severe sprains, and isolated traumatic lacerations are exceptionally uncommon. In this study, we present a 53-year-old Iranian female who arrived with persistent medial ankle pain and lameness as her chief complaint following a glass-induced laceration. On physical examination, she exhibited tenderness and swelling along the medial ankle, difficulty performing a single heel-rise, and weakness in foot inversion, while neurovascular status remained intact. MRI evaluation demonstrated complete rupture of both the posterior tibialis and flexor digitorum longus tendons, without any concomitant ankle fractures. Intraoperative findings confirmed the diagnosis, and given the condition of the tendon ends, primary tendon repair was selected as the surgical approach. The ankle was immobilized for six weeks postoperatively, after which physiotherapy was initiated. At the three-month postoperative follow-up, the patient demonstrated significant pain relief, improved inversion strength, and normalization of gait.

Introduction Chronic heel pain secondary to malunited fractures of the calcaneus can be quite disabling in nature. The etiology of pain depends upon the modality of primary treatment (i.e., operative or nonoperative), as well as the quality of articular reduction. While a number of probable causes have been identified, none of these pain generators have been adequately researched. Methods A total of 32 patients were prospectively evaluated. All had residual heel pain following calcaneal fracture and were divided into two groups (operated and non-operated) based on their primary treatment. The cause of heel pain was identified based on clinical examination findings as well as radiological results. Functional parameters used to objectify pain and disability were the Visual Analogue Scale and the American Orthopaedic Foot & Ankle Society hindfoot scores. Results There were 10 feet in the operated group and 22 in the non-operated group. The most common cause of residual heel pain in the operated group was pain due to prominent hardware. In sharp contrast, subtalar arthritis and peroneal tendon impingement secondary to calcaneal malunion were primarily seen in patients managed conservatively. Calcaneal fractures managed with anatomical reduction and fixation had better functional scores than those treated conservatively. Of the radiological parameters, Böhler angle and talocalcaneal height were significantly associated with the patients' disability scores. Conclusions The traditional view among orthopedic surgeons that chronic pain in the sequelae of old intra-articular calcaneal fractures is secondary to subtalar arthritis only is incorrect. Patients undergoing fixation may have pain due to prominent hardware. All causes must be thoroughly assessed, as more than one may coexist.

Background/Objectives: Delayed-Onset Muscle Soreness (DOMS) is a common consequence of eccentric exercise, characterized by pain, stiffness, and reduced function. This pilot study aimed to evaluate the effect of a single session of Active Release Technique (ART) on gastrocnemius DOMS in amateur football athletes. Methods: Twelve football athletes participated in a randomized split-body design study. All participants completed a bilateral eccentric heel-raise protocol to induce DOMS. One lower limb from each participant was randomly assigned to the ART group (single 8-10 min session), while the contralateral limb served as a control. Pain intensity was assessed using the Numeric Rating Scale (NRS) and the pressure pain threshold (PPT) was measured at baseline and at 24, 48, and 72 h post-exercise. Results: The ART group demonstrated significantly lower NRS scores at 24 h compared with the control group (p = 0.007, r = 0.77). At 48 and 72 h, NRS scores remained significantly lower (48 h: p = 0.001, d = 1.26; 72 h: p = 0.003, d = 1.11). PPT values were also significantly higher in the ART group at 24, 48 and 72 h (24 h: p = 0.026, d = 0.73; 48 h: p < 0.001, d = 1.42; 72 h: p = 0.006, d = 0.98). Conclusions: A single ART session may reduce pain and increase the pressure pain threshold following gastrocnemius DOMS in amateur football athletes. However, given the pilot design, small sample size, and absence of functional outcome measures, these findings should be interpreted with caution and confirmed in future studies.

Objectives: To assess the feasibility, safety, and clinical effectiveness of a response-guided, stepwise endovascular treatment strategy for patients with refractory plantar fasciitis. Methods: This single-center retrospective study included consecutive patients with chronic plantar fasciitis refractory to conservative therapy who were treated between January and June 2025. All patients initially underwent ultrasound-guided direct puncture of the posterior tibial artery, followed by intra-arterial administration of imipenem/cilastatin as a temporary embolic agent. Clinical response was evaluated at 1 month using the visual analogue scale (VAS). Patients showing a <50% pain reduction were classified as non-responders and underwent second-line transcatheter arterial embolization (TAME) via transfemoral access, with selective embolization of pathological neovessels using bioresorbable microspheres. Technical success, pain outcomes, and procedure-related adverse events were assessed during follow-up for up to 6 months. Results: Twelve patients (13 treated feet) were included. First-line embolization was technically successful in all cases. At the 1-month follow-up, 6/13 feet (46.2%) demonstrated clinically meaningful pain reduction and required no further intervention. The remaining 7/13 feet (53.8%) underwent second-line TAME, which was technically successful in all cases and was associated with further pain reduction. Mean VAS scores decreased from 7.36 ± 1.12 at baseline to 1.37 ± 0.52 at 6 months. No major adverse events occurred; minor complications were self-limited. Conclusions: A stepwise endovascular treatment strategy for refractory plantar fasciitis appears feasible and safe, providing a high rate of symptom improvement while allowing procedural complexity to be escalated according to early clinical response.