Adult Foot Research Articles

EPIDIDYMO-ORCHITIS CAUSED BY HAND, FOOT, AND MOUTH DISEASE IN ADULTS

Abstract: Hand, Foot, and Mouth disease (HFMD) is predominantly recognized as a childhood disease and is not generally anticipated to manifest in adults. In addition to inducing symptoms such as fever, herpangina, and distal-extremity rashes, HFMD can also lead to rare complications such as encephalitis and onychomadesis. Epididymo-orchitis; however, is not considered an expected complication of HFMD. In our case, a patient diagnosed with HFMD presented with testicular pain four days later, and epididymo-orchitis was subsequently identified in the patient initially suspected of testicular torsion. Cases of Coxsackie virus-related epididymo-orchitis have been reported in the literature, and these cases can be mistaken for torsion, thereby posing the risk of unnecessary surgical interventions. Testicular pain in a young adult with a history of HFMD should be considered as a potential diagnosis of viral epididymo-orchitis.

Is the Silfverskiöld Test a valid tool for evaluating calf muscles spastic overactivity in patients with stroke? A retrospective observational study.

Spastic equinus (plantar flexed) foot is a common postural pattern in patients who suffer from post-stroke spasticity. To date, some clinicians use the Silfverskiöld Test in their practice to differentiate between gastrocnemius and soleus muscle overactivity in patients with spastic equinus (plantar flexed) foot. This use of the Silfverskiöld Test goes beyond its original aim, which was to distinguish isolated gastrocnemius contracture in patients with equinus deformity. The aim of this study was to investigate the Silfverskiöld Test validity for evaluating spastic equinus (plantar flexed) foot (i.e., differentiation between gastrocnemius and soleus muscle overactivity) by checking its outcome against those of selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. The design of the study was retrospective observational. The study was set in a university hospital. Sixty-seven adult stroke patients with spastic equinus (plantar flexed) foot. Each patient underwent selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. All patients were evaluated before diagnostic nerve block by means of the Silfverskiöld Test which was considered positive when ankle joint passive dorsiflexion was greater with the knee flexed than extended. Furthermore, they were assessed before and after nerve block by means of the modified Ashworth Scale and the Tardieu Scale. Our sample included 41 males and 26 females (mean age 57.6 years) suffering from spastic equinus (plantar flexed) foot due to chronic stroke (mean time from onset 2.4 years). Forty-eight patients out of 67 presented with positive Silfverskiöld Test. The χ2 test showed no association between the Silfverskiöld Test and spastic overactivity of the gastrocnemius (P=0.253), soleus (P=0.605) and tibialis posterior (P=0.462) muscles as evaluated by serial selective diagnostic block of the tibial nerve motor branches. Our findings do not support the Silfverskiöld Test as a valid tool for evaluating spastic equinus (plantar flexed) foot to differentiate between gastrocnemius, soleus and tibialis posterior spastic muscle overactivity in adult patients with stroke. The choice for an appropriate management of spastic equinus (plantar flexed) foot in adults with stroke should not be mainly defined on the base of Silfverskiöld Test.

Large Felid Tracks and Bones From Chilly Bowl Cave, Arkansas

Multiple large cat tracks were found within Chilly Bowl Cave, Arkansas, representing at least two individuals of the genus Panthera. Large felid bone fragments were also found in a passageway near the tracks. These poorly preserved skeletal remains primarily consist of metapodials and phalanges and represent the North American Pleistocene jaguar, Panthera onca. Fusion of metapodial epiphyses indicate adult foot size had been reached for this large jaguar. One set of tracks is also consistent with the size and morphology of P. onca. The other tracks are much larger than is known for extant or prehistoric jaguars, and are here attributed to Panthera atrox, the American lion. An alternate hypothesis for the smaller tracks is that they could represent a younger P. atrox instead of P. onca. Regardless of the inability to identify the smaller feline prints to species, these remains and tracks from Chilly Bowl Cave record cave utilization by two separate Pleistocene felids, interpreted here as jaguar and American lion.

Foot and lower leg pain in children and adults with cerebral palsy: a population-based register study on 5,122 individuals

BackgroundPain is common in individuals with cerebral palsy (CP) and the most reported pain site is the foot/lower leg. We analyzed the prevalence of pain in the foot/lower leg and the associations with age, sex, gross motor function, and clinical findings in individuals with CP.MethodThis was a cross-sectional register-study, based on data reported to the Swedish Cerebral Palsy Follow-up Program (CPUP). All participants in CPUP, four years-of-age or older, were included. Pearson chi-square tests and logistic regression were used to analyze the prevalence and degree of pain in the foot/lower leg.ResultsIn total, 5,122 individuals were included from the CPUP database: 58% were males and 66% were under 18 years-of-age. Overall, 1,077 (21%) reported pain in the foot/lower leg. The odds ratios (ORs) of pain were higher in females (OR 1.31, 95% confidence interval (CI) 1.13–1.53), individuals who could ambulate (Gross Motor Function Classification System Level I (OR 1.84, CI 1.32–2.57) and II (OR 2.01, CI 1.46–2.79) compared to level V), and in individuals with decreased range of motion of the ankle (dorsiflexion 1–10 degrees (OR 1.43, CI 1.13–1.83) and ≤ 0 degrees (OR 1.46, CI 1.10–1.93) compared to ≥ 20 degrees). With increasing age the OR of pain increased (OR 1.02, CI 1.01–1.03) as well as the reported pain intensity (p < 0.001).ConclusionsPain in the foot and lower leg appears to be a significant problem in individuals with CP, particularly in those who walk. As with pain in general in this population, both pain intensity and frequency increase with age. The odds of pain in the foot and lower leg were increased in individuals with limited dorsiflexion of the ankle. Given the cross-sectional design causality cannot be inferred and it is unknown if pain causes decreased range of motion of the ankle or if decreased range of motion causes pain. Further research is needed on causal pathways and importantly on prevention.

Evidence for the benefits of negative pressure therapy in the treatment of diabetic foot in adults: a comprehensive approach to improved health

Diabetic foot ulcers represent an increase in recent years in the cures to be carried out by nursing staff. For this reason, the new negative pressure therapy has been chosen, which involves an increase in granulation tissue, leading to complete healing in a minimum time, highlighting the few complications derived from said therapy. Objective: To demonstrate the effectiveness of negative pressure therapy in patients with diabetic foot. Methodology: A narrative review was carried out between December 2022 and November 2023 in the databases of Pubmed, Dialnet, Google Scholar, WOS, Scopus and Cochrane, following a search string, which combines keywords derived from the thesauri “Health Sciences Descriptors” (DeCS) and “Medical Subject Headings” (MeSH), being combined with the Boolean operators “NOT”, “OR” and “AND”. Results: Negative pressure therapy offers a number of significant benefits for adult patients with diabetic foot, improving wound healing, reducing the risk of serious complications and contributing to a better quality of life. It is important to highlight that the implementation of this therapy must be guided by health professionals and adapted to the specific needs of each patient. Conclusion: After comparing the different selected articles, it was determined that the application of negative pressure therapy in diabetic foot ulcers is beneficial in relation to the reduction in healing time compared to conventional wound healing dressings. The associated complications being minimal. Furthermore, treatment with this therapy turns out to be cost-effective by reducing patients' hospital stays, leading to an increase in quality of life.

Effect of Weight Bearing on Medial Longitudinal Arch of Foot in Healthy Adults

Background: The medial longitudinal arch (MLA) of the foot plays a pivotal role in biomechanical stability and mobility. Understanding its behavior under different loading conditions is crucial for both clinical and sports-related applications. Previous studies have offered insights into the arch's adaptability, yet the impact of gender on this dynamic has remained underexplored. Objective: This study aimed to investigate the differences in medial longitudinal arch height between genders in non-weight bearing (NWB) and full weight bearing (FWB) positions, to ascertain if gender influences arch behavior under various loading conditions. Methods: Conducted at the Biomechanics and Kinesiology Laboratory of Shifa Tameer e Millat University, this cross-sectional study enrolled volunteers aged 18 to 40 years with normal foot arches. Exclusion criteria included history of foot pain, foot anomalies, pregnancy, or menstruation at the time of data collection. Navicular height was measured using Kinovea software (Version 0.9.5), with participants in both NWB and FWB positions. The study received approval from the Institutional Review Board and Ethics Committee of Shifa International Hospital (IRB # 0213-23). Statistical analysis was performed using independent and paired sample t-tests. Results: The study involved equal numbers of male and female participants, with no significant gender-based differences observed in navicular height in NWB (Males: Left Foot 5.17 ± 0.865, Right Foot 5.19 ± 0.675; Females: Left Foot 5.24 ± 0.89, Right Foot 5.39 ± 0.867) and FWB positions (Males: Left Foot 4.73 ± 0.834, Right Foot 4.88 ± 0.846; Females: Left Foot 4.83 ± 0.898, Right Foot 4.80 ± 0.837). Significant reductions in navicular height from NWB to FWB were noted across both genders (p &lt; 0.01). Conclusion: The medial longitudinal arch height significantly changes under weight bearing, displaying a similar pattern of adaptability across genders. This indicates that gender does not significantly influence the biomechanical behavior of the MLA under the tested conditions.

Graded Motor Imagery and Fall Risk in Older Adults: An Exploratory Case Series

Background: Altered cortical maps can initiate and maintain a pain experience and older adults who move less may be at increased risk for pain, balance and fall risk issues. Purpose: To determine if a brief graded motor imagery (GMI) session to the plantar surface of the foot in older adults can influence self-reported pain, sensitivity of the nervous system and fall risk. Methods: Forty-one older adults (mean age 76.8) received pain neuroscience education, and GMI to the plantar surface of their feet. Measurements pre- and immediately post- intervention included self-reported pain (Numeric pain rating scale), laterality, fall risk (Brief-BESTest), gait speed (40-meter self-paced walk test - SPWT), and nerve sensitivity (Pressure Pain Thresholds - PPT) to the dorsum of the foot and web space dominant hand. Results: Immediately following treatment, mean self-reported pain improved by 1.24 points (p &lt; 0.001), with a large sub-group meeting the minimal clinically important difference (MCID) for self-reported pain (1.7). Gait speed improved significantly (p &lt; 0.001) meeting MCID (0.1 m/s). Left-right judgement task speed (p &lt; 0.001) and accuracy (p = 0.04) improved. None of the PPT measurements improved. While mean composite Briefest test scores did not reach MCID values (9 points), statistically significant improvements were noted in the biomechanical constraints (p = 0.007) and sensory orientation (p = 0.009) subcomponent scores. Conclusion: A brief, one-time GMI session in older adults can decrease pain and improve scores on tests associated with fall risk but fail to decrease sensitivity of the nervous system. More research is needed to validate the results of this exploratory study.

Correlation between Weight Distribution on the 5th Metatarsal of Right and Left Foot in Youngsters using Podata Postural Stabilometric Foot Plate

Background: The human foot's complex structure plays a vital role in stability and support during various activities. Understanding the weight distribution across the metatarsal bones, particularly the 5th metatarsal, is crucial for maintaining optimal foot health and functionality. Previous studies have indicated variability in weight distribution between the left and right feet, influencing gait patterns and overall foot health. Objective: This study aimed to investigate the correlation between weight distribution on the 5th metatarsal of the right and left foot in young adults, providing insights into foot biomechanics and informing clinical practices and footwear design. Methods: Employing a cross-sectional observational design, the study included 140 individuals aged between 18 and 29 years. Participants with severe musculoskeletal or neurological conditions, pregnancy, or inability to maintain a standing posture were excluded. Weight distribution was assessed using the Podata Postural Stabilometric Foot Plate. Data analysis involved descriptive statistics, t-tests, and calculation of confidence intervals, performed using SPSS Version 25. Results: The mean weight on the 5th metatarsal was 0.467 kg for the left foot (standard deviation: 0.331) and 0.995 kg for the right foot (standard deviation: 0.774). A moderate positive correlation (r = 0.45) was found between the weight distributions on the left and right 5th metatarsals, with a statistically significant p-value of 0.01. Conclusion: The study revealed a significant discrepancy in weight distribution on the 5th metatarsal between the left and right feet among young adults. These findings have critical implications for personalized podiatric care and the design of orthotic devices and footwear, emphasizing the need for further research in foot biomechanics and health.

Hand, Foot, and Mouth Disease in Adults

Hand, Foot, and Mouth Disease in Adults

The Impact of the COVID-19 Pandemic and Lockdown on Adult Foot and Ankle Fractures Presenting to the Largest Trust in the United Kingdom.

Background The COVID-19 pandemic induced unprecedented changes in medical practices, prompting a reassessment of their impact on adult foot and ankle fractures within the National Health Service (NHS). This study employs a retrospective observational approach, leveraging the Pathpoint™ eTrauma platform for a comprehensive analysis of prospectively collected data. Methods Data encompassing weekly fracture incidence, weekly surgical procedures, patient demographics, and mean wait time from injury presentation to surgery were systematically evaluated. The study population included all adults (18+) admitted during five distinct periods: pre-pandemic, national lockdown 1, post-lockdown, national lockdown 2, and national lockdown 3. Results An analysis of 434 foot and ankle fractures revealed that national lockdown 1 exhibited the lowest fracture incidence (4.97 per week) and surgeries performed (4.77 per week), reflecting a notable reduction in trauma cases and elective procedures. Conversely, post-lockdown displayed the highest fracture incidence (7.46 per week) and surgeries performed (6.31 per week), suggesting a resurgence in both trauma and elective surgical activities. The pre-pandemic cohort, characterized by the highest mean age (51.98 years) and mean wait time (8.74 days), served as a temporal baseline. Conclusion While the incidence of fractures decreased during all three national lockdowns compared to pre-pandemic or post-lockdown periods, a gradual increase was observed in subsequent lockdowns. Notably, mean wait times showed a significant reduction, reaching the lowest point (5.79 days) during national lockdown 3. These findings underscore the complex interplay between pandemic-related disruptions, evolving guidelines, and adaptive measures within the healthcare system, influencing the dynamics of foot and ankle fracture management.

A Cross Sectional Analysis of Arch Height and Pressure Distribution in a Normalized Population of More than 1000 Subjects

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: There are normal variations in the shape of an individual’s foot. However, recent investigations involving large, heterogenous populations are scarce, complicating attempts to create a uniform definition of clinical foot arch height. The purpose of this study was to determine the distribution of plantar foot pressures from the general population. Methods: 1015 randomly sampled individuals (2030 feet) had a bipedal standing profile obtained utilizing a high sensitivity pressure mat. Data collected included: total foot length (cm), peak pressure (kPa), peak contact pressure (kPa), and total contact area (cm2). Demographic information and data regarding individual comorbidities previously to be linked to pathologic arch height conditions were collected. A flatfoot was defined as Midfoot total area&gt;Mean+1SD while a high arch was defined as Midfoot total area&lt; Mean-1SD. Results: Our logarithmic transformation the data was representative of a normally distributed dataset and our demographic data closely reflective of the demographics United States population. Data for the right foot vs left foot were: 8.18% and 6.50% of participants had a flatfoot, 78.82% and 79.51% had normal arches, and 13.00% and 13.99% had high arches, respectively. The prevalence of normal bilateral arches was 70.54%, bilateral flat feet was 3.55%, and bilateral high-arched feet was 8.67%. Conclusion: Our data demonstrate a normalized distribution of plantar pressures and arch heights that were sampled from a population larger and more representative of the general populous than previously described. Given that our data may more accurately reflect the spectrum of normal adult foot. With these baseline characteristics defined, future research into arch height associated pathologies may proceed with a more standardized assessment when defining study populations.

Use of phytotherapy in treating diabetic foot in older adults: an integrative review

Objective: to identify the scientific evidence on herbal medicines used in treating diabetic foot in older adults. Methods: an integrative review conducted in the Medical Literature Analysis and Retrieval System, SCOPUS, EMBASE, Web of Science and Latin American and Caribbean Health Sciences Literature databases. The Rayyan platform was used as a supporting tool for archiving, organizing and selecting articles. Results: the search resulted in 158 articles. After identifying, selecting, evaluating eligibility, systematization and performing a full reading of the articles, the final sample consisted of 10 articles. We identified herbal medicines derived from Calendula officinalis, Ageratina pichinchensis, Phellodendron chinense, Curcumin phytosome, Capsicum spp., Rehmannia Glutinosa and Astragalus membranaceus. Conclusion: investigations of herbal compounds derived from four plants used in treating diabetic foot in older adults predominated. Considerations for practice: supported by legislation, nurses can guide users interested in using phytotherapy as an accessible solution with proven efficacy.

Republication of "The Utilization of Internet Resources by Foot and Ankle Patients".

It is critical for patients seeking foot and ankle care to have access to quality online resources, as the treatment of their conditions may involve the use of a variety of diagnostic and therapeutic modalities with which they are unfamiliar. This study was performed to enhance our understanding of if and why patients use Internet-based educational materials, to identify trends in utilization, and to delineate the patient-perceived attributes of quality resources. Questionnaires were distributed to 150 adult foot and ankle patients. The questionnaire consisted of demographic and Internet utilization questions. Statistical analysis was performed to determine the frequency of responses for each question and the relationship between demographics and Internet usage. Younger patients were more likely to use the Internet (P= .006). However, there were no other significant differences in demographic attributes between patients who did (76%) and did not (24%) utilize the Internet (P <.05). Of the participants who didn't search the Internet about their condition, the most commonly cited reason was they preferred to receive information directly from their physician (47%). Among Internet users, most found the quality of resources to be good or very good (75%). However, many patients were unsure of the specific websites they accessed (66%) and if materials were AOFAS sponsored (18%). When asked about the attributes of a reliable website, patients felt that physician and/or medical society endorsement were most important (52% and 46%, respectively). Although physician and medical society endorsement positively shape patients' opinions of online education materials, patients often struggle in remembering the site they visited and if it was sponsored by a certain society. Despite this, patients are generally satisfied with online foot and ankle education resources. Future works must assess whether patient and physician perceptions of quality Internet resources are correlated. Level IV, case series.

Сравнительный анализ репозиционных возможностей ортопедического гексапода Орто-СУВ и его минимизированной («педиатрической») версии (экспериментальное исследование)

Introduction Currently, orthopedic hexapods have been effectively used for long bone, foot and large joint deformity correction in both adults and children. Previous studies demonstrated the superiority of the reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) in comparison with other designs of external fixation devices. However, the reduction capabilities of the minimized version of this hexapod (minimized Ortho-SUV Frame, OSFm) have not been studied yet. Purpose To identify the reduction capabilities of OSFm compared to OSF. Materials and methods The bench test was performed using plastic models of the tibia osteotomized at the middle third of the shaft. One-ring modules were used to fix each of the bone fragments. In the first series of the experiment, the reduction capabilities of OSFm with a standard strut size and in the second series OSF with a short strut size were studied. In each series of experiments, three groups were studied depending on the method of fixing the struts to the rings: directly to the ring, using straight plates, and using Z-shaped plates. Reduction capabilities were assessed by the maximum displacement of the distal bone fragment relative to the proximal one in distraction, translation, angulation, and rotation. Results The magnitude of the maximum distraction of OSF and OSFm with fixation of the struts directly to the rings and with the use of straight plates is the same (p &gt; 0.05). With Z-plates, OSFm outperforms OSF by 27.3 %. OSFm surpasses OSF by 2.8-29.3 % in terms of the planar-parallel movement. OSFm surpasses OSF by 29.6-55.4% in terms of angular movement capabilities. The study of rotational movement found that OSFm exceeds the capabilities of OSF by 20.3-41.3%. Conclusion The findings obtained indicate that OSFm, in comparison with OSF, has better deformity correction capabilities.

Research priorities in foot and ankle conditions: results of a UK priority setting partnership with the James Lind Alliance

ObjectiveTo ascertain the priorities of research in surgical interventions and aftercare in foot and ankle conditions in adults, from inclusive viewpoints of patients, carers, allied professionals and clinicians, as a...

Hallux Valgus Repair with Chevron Osteotomy Significantly Narrows Forefoot Width

Hallux valgus (HV) is a common adult foot deformity. There is uncertainty concerning the effect of HV surgery on foot width. We examined the effect of chevron first metatarsal osteotomy on forefoot width using calibrated pre and postoperative standing radiographs. A retrospective cohort of 50 patients underwent chevron osteotomy HV surgery. All had HVA > 30°, IMA > 11°, DMMA > 3°, >6-month follow-up, and calibrated pre and postoperative standing foot radiographs. Bony width (BW) and soft tissue width (STW) were used to measure the surgery's effect on foot width. Measurements were made preoperatively and 3-6 months following surgery. The study group included 42 women with an average age of 63.4 (±8.3) and a mean BMI of 28.7 (±4.9). Preoperative HVA and IMA were 31.7° (±6.8°) and 13.4° (±2.8°), respectively. Following surgery, HVA and IMA improved significantly, by 15.6° (±5.7°) and 8.7° (±2.3°), respectively. The preoperative average BW was 9.4 cm (±0.6), and the STW was 10.6 cm (±0.7). Following surgery, significant changes in BW and STW were measured, with a mean narrowing of 1.2 cm (±0.4) in BW (p < 0.001) and 0.95 cm (±0.5) in STW (p < 0.001). Paradoxically, an increase in age led to a lower correction of the IMA (p = 0.04, r = 0.57), but higher BW and STW reductions (p = 0.01, r = 0.35 and p = 0.008, r = 0.37, respectively). This study reinforced chevron osteotomy as a valid treatment option that significantly narrows forefoot width; it is thus expected to improve cosmetic outcomes, shoe selection options, and quality of life. This study also found that older age correlates with better forefoot narrowing following hallux valgus repair, possibly due to stiffer soft tissues.

Design and construction of a device for the capture of force and dorsal flexion of the foot in older adults of the Ecuadorian population

Design and construction of a device for the capture of force and dorsal flexion of the foot in older adults of the Ecuadorian population

TENDOACHILLES LENGTHENING IMPROVES BAROPODOMETRIC PRESSURES ONE YEAR AFTER SURGERY FOR IDIOPATHIC TOE WALKERS

Idiopathic Toe-walking (ITW) is a condition where children persistently walk on their toes in the absence of neurological or orthopaedic structural abnormalities. ITW affects 2% of children at the age of 5.5yr. This may eventually result in fixed ankle equinus. There is a paucity of long-term natural history studies in untreated ITW however persisting equinus contractures are implicated in common adult foot conditions.The Aim of this study is to show if the percentage of contact pressure through the hindfoot during standing and walking improve following surgical tendoachilles lengthening one year after surgery in children with ITW when compared to a normative cohort23 patients (46 feet) diagnosed with ITW between 2017-2022; were treated with open zone III Achilles lengthening. We reported patient demographics, clinical resolution, or revision. Passive dorsiflexion range and hindfoot pressure percentage when standing and walking were measured on a baropodometric walkway and compared pre-operatively and at 12-18months postoperatively. We compared this to data from a previously studied normative cohort87% of children had compete resolution of toe-walking. 3 had recurrence with 1 patient having a revision surgery. Mean pre-operative static heel pressure percentage was 15.7%, this improved to 54.7% (p&lt;0.001). This neared normative average of 70.6%. Mean pre-operative dynamic heel pressure percentage was 5.5%, this improved to 44.6% (p&lt;0.001). This neared the normative mean of 52.0%. Mean Passive dorsiflexion in extension and 90˚ knee flexion was −5.8˚ and 0.5˚ respectively. This improved on average by 17.4˚ and 14.5˚ to a new mean of 11.6˚ and 15.0˚ (p&lt;0.001).Open Zone III Achilles lengthening for ITW has high resolution rates. Hindfoot contact pressures and passive ankle dorsiflexion show improvement at 1 year post operatively.

Use of combined shockwave therapy and platelet-rich plasma injection for management of chronic plantar fasciitis in runners: two case reports

Plantar fasciitis is one of the most common causes of foot and heel pain in adults. Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) have each been described as effective treatments for plantar fasciitis; however, the combined use has not been adequately described. This report characterizes successful return to sport in two runners with plantar fasciitis who were treated with ESWT combined with PRP. Patient-reported outcomes were measured using the Foot and Ankle Ability Measure (FAAM). A 69-year-old female had 8 months of pain refractory to physical therapy (PT). A 73-year-old male presented with recent onset of 3 weeks of symptoms. Both runners had exam findings of plantar fasciitis and MRI confirmation. Each elected to complete ESWT along with PT using a foot core program and met functional improvements for both sport and ADL subscales of FAAM after initial ESWT treatment. However, each runner had worsening pain when attempting to run and both elected to proceed with a single leukocyte-poor PRP injection combined with ESWT. This allowed for successful return to running. Both cases highlight how combined ESWT and PRP with a foot core PT progression may be effective in managing plantar fasciitis in running athletes.

L5 mononeuritis, an uncommon cause of foot drop: illustrative case.

New-onset adult foot drop is commonly encountered in neurosurgical practice and has a broad differential, including radiculopathy, peroneal nerve palsy, demyelinating diseases, and central causes. Etiology is commonly identified with comprehensive history, examination, imaging, and investigations. Despite familiarity with the management of lumbar spondylosis and peroneal nerve compression causes, rare or uncommon presentations of nonsurgical causes are important to consider in order to avoid nonbeneficial surgery. The authors report a very uncommon cause of foot drop: new-onset isolated L5 mononeuritis in a 61-year-old nondiabetic male. They provide a review of the etiology and diagnosis of foot drop in neurosurgical practice and detail pitfalls during workup and the strategy for its nonsurgical management. Uncommon, nonsurgical causes for foot drop, even in the setting of degenerative lumbar spondylosis, should be considered during workup to reduce the likelihood of unnecessary surgical intervention. The authors review strategies for investigation of new-onset adult foot drop and relate these to an uncommon cause, an isolated L5 mononeuritis, and detail its clinical course and response to treatment.