Plantar fasciitis is the most common cause of heel pain in adults, affecting 10 percent of individuals over their lifetime. Therapeutic stretching remains a cornerstone of conservative management, particularly plantar fascia-specific stretching, combining dorsiflexion of the ankle and toes with targeted digital pressure along the plantar aponeurosis. However, many patients cannot perform these techniques effectively due to limited mobility, age-related restrictions, higher body mass, or improper application of the exercises. This study characterizes the mechanical environment created during plantar fascia-specific stretching and assesses whether a custom-built stretching device could replicate the strain generated by manual techniques. Twelve morphologically normal cadaveric feet were dissected, and the plantar fascia was exposed. Strain sensors were affixed along the fascia, and deformation was measured under various conditions: resting baseline, great toe and lesser toes dorsiflexion with and without direct manual pressure, and application of a custom device with incrementally increased weights to load the plantar fascia. The results demonstrated that dorsiflexion of the metatarsophalangeal joints combined with direct pressure to the plantar fascia reliably produced measurable strain, whereas dorsiflexion alone did not consistently generate adequate strain. Great toe dorsiflexion was not required to induce effective plantar fascia strain when direct pressure was applied. The custom device reproduced the strain levels achieved with manual stretching, but only when configured to deliver targeted pressure at the fascia. These findings suggest that plantar fascia stretch is influenced by both metatarsophalangeal dorsiflexion and direct aponeurosis pressure, and that a properly designed device can replicate clinically relevant strain patterns.

Background: Chronic plantar fasciitis refractory to conservative treatment is a frequent cause of persistent heel pain and functional limitation. Although radial extracorporeal shock wave therapy (rESWT) has shown potential benefit, the relationship between clinical improvement and structural ultrasonographic changes remains unclear. The aim of this study was to evaluate the clinical, functional, and ultrasonographic outcomes associated with rESWT in patients with refractory plantar fasciitis. Methods: We conducted a prospective observational single-center study including 287 patients with plantar fasciitis refractory to conservative treatment for at least 6 months and confirmed by ultrasonography (plantar fascia thickness >4 mm). All patients received four weekly sessions of rESWT. Pain intensity (visual analog scale [VAS]), foot function (Foot Function Index [FFI]), quality of life (EQ-5D), and plantar fascia thickness were assessed at baseline and 3 months after treatment. Results: Significant improvements were observed in pain (mean VAS change, -3.73 points), function (mean FFI-disability change, -32.37 points), and quality of life (improvement in at least one EQ-5D dimension in 81.5% of patients) (all p < 0.001). The mean reduction in plantar fascia thickness was 0.14 mm. Most responders (71.8%) showed clinical improvement despite the absence of a relevant structural change, defined as a reduction in plantar fascia thickness <0.5 mm. In multivariate analysis, physically demanding occupations were associated with a lower probability of response (odds ratio, 0.32; 95% confidence interval, 0.17-0.63). The prognostic model showed moderate discrimination (area under the curve, 0.71). Conclusions: In this observational cohort, rESWT was associated with improvements in pain, function, and quality of life in patients with refractory plantar fasciitis. Clinical improvement frequently occurred despite minimal changes in plantar fascia thickness, suggesting that ultrasonographic thickness may not adequately reflect symptomatic evolution. However, the absence of a control group prevents causal interpretation of these findings.

Plantar fasciitis, which is extensively documented, is a common cause of heel pain in adults. Recent research has indicated that the illness is not only associated with inflammation but also degeneration. In addition to traditional treatments, non-surgical minimally invasive options, such as localized platelet-rich plasma (PRP) injection, have shown promise in the management of plantar fasciitis. PRP is a concentrated solution containing a high concentration of biologically active molecules such as growth factors and cytokines, which are essential for regulating cellular processes including growth, differentiation, angiogenesis, and motility. Recent years have seen a surge in research investigating the efficacy of PRP in treating plantar fasciitis. However, previous studies on the use of PRP for plantar fasciitis have been limited by inadequate evidence, inconsistent methodologies, lack of standardization in PRP composition, and other methodological limitations. The objective of this study was to conduct a literature review on the research progress in PRP therapy for treating plantar fasciitis. The review encompassed an analysis of the active mechanism of PRP, its comparative advantages and disadvantages in relation to commonly employed treatments, and identified potential avenues for further investigation in this field.

Background: The etiology and diagnosis of heel pain are complex and multifactorial, and it has been reported that Baxter's entrapment is responsible for up to 20% of foot disorders. The most conservative treatment of Baxter's entrapment has been the use of custom insoles. Electromyography was considered an effective test to assess muscle activity. The aim of this study was to test the use of insoles of different hardness on muscle activity of the abductor hallucis muscle in subjects with entrapment of the lateral branch of the external plantar nerve. Methods: 18 subjects (7 women and 11 men) diagnosed with nerve entrapment of the first branch of the lateral plantar nerve were recruited. Muscle activity of the adductor hallucis muscle was analyzed with insoles of different hardness in static and dynamic situations using electromyographic evaluation. Results: The statistical analysis did not show statistically significant differences in the muscle activity of the abductor hallucis muscle in the static position, with and without plantar orthoses (p>0.05), in contrast, in dynamic situations statistically significant differences were found between groups (p<0.01). Conclusions: The use of a hard insole decreases the maximum peak muscular activity of the abductor hallucis muscle in subjects with Baxter's nerve entrapment in walking conditions.

BackgroundWith the development of a consensus agreement on the essential clinical diagnostic criteria for Achilles tendinopathy (AT), there is scope to investigate the diagnostic accuracy of clinical tests, their relationship to structural changes observed on ultrasound imaging (USI), and the potential role of USI in the clinical diagnosis of AT. Objectives. To evaluate the relationship between clinical tests and tendon structure via USI.MethodsA pilot cross-sectional study of 23 individuals (14 male, and 9 female) with unilateral, symptomatic AT were recruited from physiotherapy clinics. Assessment included subjective measures and patient-reported outcome measures (pain with loading, stiffness, self-reported function, Victorian Institute of Sport Assessment-Achilles [VISA-A], Pain Catastrophizing Scale, and 12-Item Short Form Survey). Objective tests included palpation, arc sign, Royal London Hospital Test, single-leg heel raise, and hopping. USI subcategorized tendon structure as normal or abnormal. Diagnostic accuracy (positivity rates, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]), receiver operating characteristic analysis, area under the curve (AUC), and effect sizes were calculated.ResultsStiffness and pain on palpation demonstrated high positivity rates (82.6%). Hopping pain demonstrated high positivity rates (78.3%). Pain on palpation and pain during hopping had high sensitivity (0.94) and PPV (0.84) for detecting structural abnormalities. VISA-A and self-reported function had excellent AUC (0.89) for detecting structural change. No test distinguished the degree of structural change.ConclusionsPain on palpation and hopping pain are promising indicators of structural tendon pathology. Patient-reported outcome measures may aid in imaging decisions. Further studies are needed to validate findings.Level of EvidenceLevel IV.

The distal sesamoidean impar ligament (DSIL) is a key component of the equine podotrochlear apparatus, yet its role in conditions such as caudal heel pain and navicular syndrome remains poorly understood. The objective of this study was to characterize the histological properties of the DSIL and evaluate how it is influenced by breed and age. Eighty-four cadaveric forelimb DSIL samples were collected from young, athletic Quarter horses (QHs), Thoroughbreds (TBs), and older, retired Quarter horses. Samples were stained and assessed for vessel size and count, number of nerve fascicles, and the relative density of collagen and adipose tissue. Data were analyzed using general linear models and Kruskal-Wallis tests for continuous variables and Poisson regression for count data, with significance set at P < 0.05. The number of vessels in the DSIL was significantly higher in both young TBs and QHs compared to older QHs (P < 0.0001). In addition, TB horses had a higher vessel count than QHs (P < 0.0001). These findings underscore the DSIL's rich vascularity and its potential role in supporting the navicular bone. Histological characteristics of the DSIL appear to be influenced by both age and breed, offering insights relevant to the pathogenesis of navicular disease.

Calcaneal tuberculosis (TB) is an uncommon manifestation of osteoarticular TB, accounting for <0.1% of skeletal cases. Its nonspecific features such as heel pain and swelling without systemic signs frequently mimic chronic osteomyelitis or bone tumors, often resulting in delayed diagnosis and risk of long-term disability. We report a case of a 20-year-old male presenting with progressive heel pain and swelling. Diagnostic evaluation included plain radiographs, which demonstrated a lytic lesion in the posterior-inferior calcaneus, and magnetic resonance imaging, which revealed marrow involvement. Histopathology of curetted material showed granulomatous inflammation with caseous necrosis. Cartridge-based nucleic acid amplification testing confirmed Mycobacterium tuberculosis. Surgical debridement was performed, and the residual cavity was filled with antibiotic-impregnated polymethylmethacrylate (PMMA) cement. Postoperatively, the patient was commenced on a bedaquiline-based antitubercular regimen as per drug susceptibility testing. The patient's postoperative course was uneventful. Serial follow-up radiographs showed stable cement position and progressive healing changes. By 5 months, the patient achieved pain-free ambulation with no evidence of recurrence or implant-related complications. This case highlights the need for high clinical suspicion of TB when evaluating lytic calcaneal lesions in endemic regions. In addition to systemic antitubercular therapy, the use of antibiotic-loaded PMMA cement after debridement can serve as an effective surgical adjunct by providing local infection control and immediate mechanical stability in the load-bearing hindfoot.