Abstract: Cerebral palsy (CP) is a static encephalopathy caused by early insult to the developing central nervous system which results in the heterogenous expression of musculoskeletal impairments. Neuromuscular impairments and altered gait mechanics often impact the development of the lower extremities in CP patients. Hallux flexus (dorsal bunion) refers to the first ray deformity which results from tarsometatarsal (TMT) joint dorsiflexion in combination with metatarsophalangeal (MTP) joint and interphalangeal (IP) joint flexion resulting in elevation of the first metatarsal head. Dorsal bunion is not the most common foot deformity seen in CP patients; therefore, there is a paucity of literature regarding their presentation and management. This deformity can result in significant morbidity, causing skin breakdown and ulceration leading to difficulty with shoe and brace wear. The goal of this paper is to present a review of dorsal bunion and present a case series of surgically corrected dorsal bunion deformities. Level of Evidence: Diagnostic Level 4—case series, technique description. See Instructions for Authors for a complete description of levels of evidence.

Dynamic microcirculation characteristics of plantar skin in response to life-like pressure in diabetes patients.

ObjectivesThe aim of this study is to retrospectively analyze patients who underwent hallux valgus correction surgery using the Minimally Invasive Chevron and Akin (MICA) technique and assess the degree of metatarsal head translation, preoperative and postoperative inter-metatarsal angle (IMA), and postoperative diaphyseal-intermetatarsal angle (D-IMA). The hypothesis of this study is that, following hallux valgus correction using the MICA technique, an undesired increase in D-IMA may occur and that this increase is directly correlated with the percentage of first metatarsal head translation.Materials and MethodsIn total, 20 patients who underwent hallux valgus correction with the MICA technique were analyzed. Preoperative and postoperative dorso-plantar weight-bearing x-rays of the feet were evaluated: preoperative and postoperative IMA, postoperative D-IMA, and the percentage of metatarsal head translation were calculfasated. The Pearson correlation coefficient was calculated to assess the relationship between metatarsal head translation and the increase in postoperative D-IMA.ResultsThe difference between preoperative IMA and postoperative D-IMA was statistically significant with P < .0001. From preliminary analysis, it has emerged that the relationship is linear and the increase in D-IMA is directly correlated with the degree of metatarsal head translation, r = .83.ConclusionFrom this initial retrospective analysis, it emerges that despite the recognized effectiveness of the MICA technique in correcting hallux valgus and reducing IMA, a portion of metatarsal head translation does not lead to a decrease in IMA but rather to an increase in D-IMA. This study suggests a positive linear correlation between the percentage of metatarsal head translation and the increase in D-IMA.

To compare the efficacy of the fourth-generation minimally invasive technique-minimally invasive extra-articular metaphyseal distal transverse osteotomy (META) and Chevron osteotomy in treatment of hallux valgus. A total of 80 patients with hallux valgus, who underwent single-foot surgery between July 2023 and January 2025 and met the inclusion criteria, were included in the study. Among them, 40 patients were treated with META and 40 with Chevron osteotomy. There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, height, weight, body mass index, disease duration, lesion site, hallux valgus deformity degree, as well as preoperative scores of each item (pain, function, alignment, total score) in the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale (AOFAS-Hallux-MTP-IP), scores of each item (pain, walking/standing, social interaction, total score) in the Manchester-Oxford Foot Questionnaire (MOXFQ), hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, and the 1st metatarsal head morphology. The postoperative AOFAS-Hallux-MTP-IP scores, MOXFQ scores, as well as HVA, IMA, DMAA, the 1st metatarsal head morphology, and sesamoid position measured based on weight-bearing foot X-ray films were compared between the two groups; the occurrence of postoperative complications was recorded. All patients in both groups were followed up 6-18 months, and there was no significant difference in the follow-up time between the two groups ( P>0.05). At last follow-up, the scores of all items in AOFAS-Hallux-MTP-IP in both groups were higher than those before operation, and the scores of all items in MOXFQ were lower than those before operation, with significant differences ( P<0.05); there was no significant difference in the change values of all items in MOXFQ between the two groups ( P>0.05). The change value in AOFAS function score in the META group was significantly higher than that in the Chevron osteotomy group ( P<0.05), while there was no significant difference in the change value of AOFAS pain score, alignment score, and total score between the two groups ( P>0.05). After operation, 1 case (2.5%) of superficial incision infection and 2 cases (5.0%) of numbness around the incision occurred in the Chevron osteotomy group, while only 2 cases (5.0%) of numbness around the incision occurred in the META group. Imaging reexamination showed that HVA, IMA, and DMAA in both groups were signifncatly smaller than those before operation ( P<0.05), and there was no significant difference in the change values of the above angles between the two groups ( P>0.05). The 1st metatarsal head morphology and sesamoid position in the META group were better than those in the Chevron osteotomy group after operation, with significant differences ( P<0.05). Both META and Chevron osteotomy can correct hallux valgus deformity, improve foot function, and relieve pain, but META has more advantages in correcting metatarsal rotation and reducing dislocated sesamoids.

Eight week short-term effects of military training on foot structure and function in young adults.

Background:Diabetic forefoot ulcers often result from increased pressure on bony prominences, neuropathy, and poor limb perfusion. The management of these ulcers, particularly when infected, is challenging and can often lead to minor or even major amputation. This study aims to evaluate the efficacy and safety of minimally invasive surgical offloading of recurrent diabetic ulcers of the fifth metatarsal by minimally invasive fifth metatarsal osteotomy and bunionette removal.Methods:A retrospective case series study was conducted of patients who underwent surgical treatment for diabetic foot ulcers on the lateral or plantar side of the fifth metatarsal head between January 2020 and May 2025. Outcomes included time to healing of the primary ulcer and surgical wound, ulcer recurrence, postoperative complications, and reoperation rates. Clinical and radiologic parameters of the feet were assessed, and patient satisfaction Coughlin scores were collected.Results:Ten feet from 9 patients who did not respond successfully to conservative offloading were included. The mean age of the patients was 69.5 years. Five feet were classified as Wagner grade 3 wounds, and 4 as Wagner grade 2 wounds. The ulcers healed completely in a mean time of 9.8 weeks postoperatively. Two patients required 6 weeks of antibiotic treatment because of preexisting osteomyelitis. One postoperative infection occurred. There were no corrective failures, and all patients returned to wearing orthopaedic shoes postoperatively. The overall patient satisfaction using the Coughlin satisfaction score was “good” to “excellent.”Conclusion:Minimally invasive fifth metatarsal osteotomy with bunionette removal appears safe and effective for treating refractory diabetic ulcers of the fifth metatarsal head, including cases with active infection. However, larger studies with functional outcomes are needed to establish definitive treatment guidelines.Level of Evidence:Level IV, case series.

Metatarsal fractures are clinically and economically important and may reflect trauma, insufficiency or fatigue. However, their epidemiology remains poorly understood. We evaluated radiologically confirmed metatarsal fractures identified within Shropshire over a 3-year period. Radiology reports were searched for all patients aged ≥ 18 years between 2020 and 2023, using the terms 'metatarsal' AND 'fracture', to identify patients with ≥ 1 confirmed metatarsal fracture. Age at fracture, sex, fracture description and mechanism were recorded, and population fracture rates estimated, using local census data. A total of 1121 (758 female) individual patients aged 50.7 (18.9) years, fractured 1370 metatarsals, usually the fifth in isolation, with fewer individuals fracturing two, three or four metatarsals. Fractures were located at the metatarsal base (59%), shaft (26%), neck (12%) or head (3%); were mostly oblique, transverse or comminuted; and were usually caused by low-energy inversion injuries or falls. Fracture rates per 100,000 were 105 for women aged 18-29 years, rising to 153 and 142 in the sixth and ninth decades, with comparative male rates of 102, 40 and 31. Overall, women had more metatarsal fractures than men (RR 1.99, 95% CI 1.76-2.26), the sex difference being highest for metatarsal head fractures (RR 2.98 95% CI 1.34-6.60) and lowest for shaft fractures (RR 1.67, 95% CI 1.32-2.12). Most metatarsal fractures are isolated low-energy injuries of the fifth metatarsal. Overall, women suffer twice as many fractures as men, driven by sustained high fracture rates in older women and a steep age-related decline among men. The underlying reasons for this pronounced sex difference are unclear and require further study.

To evaluate the effectiveness of free medial femoral condyle (MFC) functional chimeric perforator flap (FCPF) transplantation in reconstructing joint function by repairing concomitant osteochondral defects and soft tissue defect in hand and foot joints. A retrospective analysis was performed on 6 patients (5 males, 1 female; mean age of 33.4 years, range 21-56 years) with traumatic osteochondral joint defects and associated tendon, nerve, and soft tissue defects treated between January 2019 and November 2024. Defect locations included metacarpal heads (n=2), metacarpophalangeal joint (n=1), first metatarsal head (n=1), base of first proximal phalanx (n=1), and talar head (n=1), with soft tissue defects in all cases. Osteochondral defect sizes ranged from 1.5 cm×1.2 cm×0.7 cm to 4.0 cm×0.6 cm×0.6 cm, and skin defects ranged from 4 cm×3 cm to 13 cm×4 cm. The stage Ⅰ treatment included debridement, antibiotic-loaded bone cement filling of bone-cartilage defects, fracture internal fixation, and coverage with vacuum sealing drainage. Stage Ⅱ involved harvesting a free MFC- FCPF included an osteochondral flap (range of 1.5 cm×1.2 cm×0.7 cm to 4.0 cm×0.6 cm×0.6 cm), gracilis and/or semitendinosus tendon grafts (length of 4-13 cm), saphenous nerve graft (length of 3.5-4.0 cm), and a perforator skin flap (range of 6 cm×4 cm to 14 cm×6 cm), each with independent vascular supply. The flap was transplanted to reconstruct joint function. Donor sites were closed primarily or with skin grafting. Flap survival was monitored postoperatively. Radiographic assessment was used to evaluate bone/joint healing. At last follow-up, the joint function recovery was assessed. All 6 MFC-FCPF survived completely, with primary healing of wounds and donor sites. All patients were followed up 6-44 months (mean, 23.5 months). The flaps at metacarpophalangeal joint in 1 case and at ankle joint in 1 case were treated with degreasing repair because of their bulky appearance, while the other flaps had good appearance and texture. At 3 months after operation, the visual analogue scale (VAS) score for pain during joint movement of recipient site was 0-2, with an average of 0.7; at last follow-up, the VAS score of the donor site was 0-1, with an average of 0.3. According to the Paley fracture healing scoring system, the osteochondral healing of all the 6 patients was excellent. The range of motion of the metacarpophalangeal joint in 3 cases was 75%, 90%, and 100% of contralateral side respectively, the range of motion of the metatarsophalangeal joint in 2 cases was 65% and 95% of contralateral side respectively, and the range of motion of the ankle joint in 1 case was 90% of contralateral side. The hand function was evaluated as excellent in 2 cases and good in 1 case according to the upper limb function evaluation standard of the Chinese Medical Association Hand Surgery Society, and the foot function was evaluated as excellent in 2 cases and fair in 1 case according to the Maryland foot function score of 93, 91, and 69, respectively. The International Knee Documentation Committee (IKDC) score of 6 knees was 91-99, with an average of 95.2. The free MFC-FCPF enables precise anatomical joint reconstruction with three-dimensional restoration of tendon, nerve, capsule, and soft tissue defects, effectively restoring joint function and improving quality of life.

The role of fasciotomy in the treatment of lower extremity crush injuries remains controversial. Late fasciotomy wounds are known to be associated with sepsis and amputation. This report presents the results of a limb-saving treatment procedure for a patient with crushinduced leg compartment syndrome who had undergone fasciotomy before admission. A 36-year-old male patient, trapped under rubble for 37 hours, presented with purulent-necrotic drainage from the fasciotomy site of his right leg. Two radical muscle debridements were performed to excise all necrotic muscles. No signs of sepsis developed postoperatively, and renal function normalized with the aid of hemodialysis. At the 1-year follow-up, the patient was able to walk with the assistance of a walker. Semmes-Weinstein monofilament testing showed a positive response to a 4.31-mm monofilament over the plantar aspect of the first metatarsal head; however, no sensation was detected in the dorsal aspect of the foot. This case highlights that radical muscle debridement may be considered a limb-preserving surgical option in patients with crush-induced leg compartment syndrome, as it can prevent sepsis, improve renal and metabolic function, and potentially obviate the need for amputation.

BackgroundAthletes have been shown to have greater tolerance and, to a lesser extent, a lower sensitivity to mechanical pain. However, little is known as to whether the pressure-pain sensitivity of the plantar tissues of the foot of runners, which are exposed to repeated, high-impact forces during running, differs to those of non-runners. This study evaluated topographical pressure-pain sensitivity maps of the plantar foot, and at a reference site of the palmar hand, in competitive distance runners and healthy, non-runners and explored the relationship between pressure-pain thresholds and skin and subcutaneous tissue morphology.MethodsMechanical pressure-pain thresholds (PPTs) were measured using an algometer fitted with a cylindrical probe (1 cm2) in 23 competitive distance runners [mean (±SD) age, 39.7 ± 12.0 years; height, 1.75 ± 0.09 m; weight, 68.0 ± 8.4 kg] and an equivalent number of healthy non-runners [mean (±SD) age, 36.6 ± 10.1 years; height, 1.73 ± 0.10 m; weight, 77.6 ± 15.9 kg]. PPTs were determined, bilaterally, using an increasing ramp of ≈30 kPa/s at six standardised sites of the plantar foot, including the centre of the plantar calcaneal area (PCA), the Abductor Hallucis muscle belly (ABH), the plantar metatarsal area of the first (1MH), third (3MH), and fifth (5MH) metatarsal heads, the Abductor Digiti Minimi muscle belly (ADM), as well as the Abductor Pollicis Brevis muscle belly (THE) of the corresponding hand. Skin and subcutaneous tissue thickness at each site was measured using B-mode ultrasound equipped with an 18–4 MHz linear array transducer. Potential differences in PPT values and tissue thickness between groups were assessed using three-way repeated-measures ANOVA and pairwise comparisons with Šidák’s adjustment for multiple comparisons. Relationships between measures of PPT and tissue thickness were explored using nonlinear regression with skin and subcutaneous tissue thickness as the independent variable. Akiake’s Information Criterion was used to assess logit and polynomial fits (linear, quadratic and cubic).ResultsMean PPT values in runners were, on average, 24% higher than those of non-runners, across all sites (F1,43 = 4.6, P = 0.038). Pain sensitivity varied significantly across the plantar surface of the foot in both runners and non-runners (F3.2, 139.9 = 82.5, P <0 .001). PPTs at the PCA were significantly higher (range, 18.6–31.7 kPa) and the ABH significantly lower (range, −31.7 − −6.2 kPa) than those at all other foot sites (P < 0.05). Similarly, mean PPT measured at the THE was significantly lower than that measured at all plantar foot sites (range, −36.9 − −5.1 kPa) in both groups. Runners also presented with significantly thinner tissues than non-runners (F4, 177 = 14.1, P = 0.016) at the PCA [−1.5 mm (−2.8, −0.2), P <0 .05], 1MH [−1.0 mm (−2.0, −0.1), P <0 .05], and ADM [−1.4 mm (−2.6, −0.2), P <0 .05]. The relationship between PPT and tissue thickness was best described by a logit function in runners and non-runners (range R2, 88%–95%). Normalization of pedal PPT values to those of the hand, mitigated the bias in plantar foot PPTs between groups, without altering the shape of the logit function.ConclusionDistance runners presented with lowered sensitivity to mechanical pain than non-runners, despite relatively thinner plantar foot tissues. The topographical variation in PPTs across the plantar foot can be effectively modeled as a function of relative plantar tissue thickness, and the hypoalgesic bias in runners may be mitigated by the normalization of PPT values to those of the hand, without altering the shape of the logit function. Hence, centrally-mediated pathways may underpin the mechanical hypoalgesia of the plantar foot in runners.

Gait modification using an insole with protrusions enhancing plantar sensory feedback reduces maximum external knee joint adduction moment in patients with knee osteoarthritis.

IntroductionDeficits in lower-limb muscle strength and altered gait mechanics are common after anterior cruciate ligament reconstruction (ACL). While isokinetic strength testing is widely accepted in return-to-sport assessment, the role of plantar pressure analysis in detecting compensatory gait strategies remains underexplored.MethodsThis study included 10 male patients (30.27 ± 5.59 years; 178.37 ± 6.30 cm; 84.85 ± 10.74 kg) who underwent ACL reconstruction using bone–patellar tendon–bone autografts. Assessments were performed preoperatively and at 3 and 6 months postoperatively, evaluating isokinetic knee strength and plantar pressure distribution during barefoot level walking. Non-parametric Friedman tests with Kendall's W assessed temporal differences, followed by Conover post hoc tests with Bonferroni correction. Spearman's rank correlation examined associations between muscle strength and plantar pressure.ResultsSignificant deficits in extensor strength were found at both postoperative time points compared to preoperative levels (both p < .001), with improvement at six months vs. three (p < .001). Flexor strength showed a similar but less pronounced recovery (p = .005). Plantar pressure analysis revealed changes relative to baseline: reduced hindfoot contact area at six months (p = .035), decreased midfoot maximum force at three (p = .047) and six months (p = .026), and lower peak pressure under the fifth metatarsal head at six months (p = .035). No significant correlations emerged between muscle strength and plantar pressure parameters.DiscussionThese findings suggest plantar pressure analysis may complement return-to-sport evaluation by revealing hindfoot asymmetries persisting despite strength recovery. However, as dynamic plantar pressure parameters do not reflect quadriceps or hamstring status reliably, they cannot replace standard tests like isokinetic dynamometry. Combining plantar pressure metrics with conventional strength and functional assessments may better identify residual gait deficits and guide targeted rehabilitation to lower reinjury risk.

Background: Morton’s neuroma is a painful condition that affects the ball of the foot and is characterized by severe pain and disability. Wearing high heels, the center of gravity of the body shifts forward, decreases the base of support on the weight-bearing foot, the metatarsophalangeal joint moves into hyperextension, and the nerve compresses between metatarsal heads, resulting in neuroma. Objective: To evaluate the prevalence of Morton’s neuroma and its association with pain and disability among high heels wearing sales girls. Methodology: A cross-sectional study was conducted from February to June 2024, at the shopping malls of Faisalabad, during four months after the approval of the synopsis. The study population included 98 sales girls wearing high-heeled shoes, using convenient sampling. The screening of the study population was done by the thumb index finger squeeze test and by a screening form. The participants included were 20 to 35 years old sales girls who wore high-heeled shoes at least 4 times a week for 4 consecutive hours, wearing high-heeled shoes minimum of 1 year, heel length of 5cm or higher. The participants were excluded with a history of fracture and trauma of the foot, history of surgery, deformity of the metatarsophalangeal joint, osteoarthritis, rheumatoid arthritis, ankylosis, spondylitis, claw or hammer toe, and peripheral neuropathy. The Foot Function Index is used to evaluate the impact of foot disability and pain by dividing into three sub-scales: pain, disability, and activity restriction. The score was determined by using a numeric rating scale, which ranges from 0 to 10. Results: According to this study, 59.18% of sales girls have a positive thumb index finger squeeze test, and 40.82% have a negative test. The result of the total prevalence of Morton’s neuroma was analysed by frequency distribution according to the results of 98 participants; 59.18% of participants were diagnosed with Morton’s neuroma, while 40.82% did not have neuroma. Conclusion: It was concluded that the prevalence of Morton’s neuroma among sales girls wearing high heels was high. The findings showed that high heels were significantly associated with Morton’s neuroma.

Objectives: We assessed the difference between quiet stance and gait in the spatial distribution and intensity of foot plantar pressures and whether it is possible to estimate the distribution during gait from data obtained during stance. Methods: A total of 60 healthy subjects with a mean age of 31.0 ± 9.4 years performed two trials for quiet stance and four trials for gait on a baropodometric walkway with their eyes open. Foot plantar pressures were recorded from 10 areas of the foot sole. Results: During quiet stance, the highest plantar pressure occurred at metatarsal heads (M2 to M4) and the medial (MH) and lateral halves of the heel (LH). During gait, the profile of plantar pressure values was like that during stance, but significantly higher. The differences concentrated at the big toe (T1), M2 to M4, MH, and LH, whilst toes (T2,3,4,5) and midfoot (MF) showed the smallest difference. A significant positive correlation was found between the corresponding areas of foot pressure during gait and stance. Conclusions: During quiet stance and gait, the overall profile of plantar pressure distribution was similar. During quiet stance, the subjects loaded more on the heels, in keeping with the known position of the center of pressure just in front of the ankles. During gait, higher pressures on the metatarsal areas are related to the forward propulsion of the center of mass. The correlation between the corresponding areas of foot pressure during gait and stance suggests that the pressure distribution during gait can partly be estimated from that during stance. This finding might be useful in most clinical settings when a single sensorized platform rather than a complete walkway is available.

Pathways of load transfer in custom accommodative insoles for people with diabetes.

Hallux valgus is a triplanar deformity with rotation being a significant contributing factor. Several methods exist for evaluating rotational deformity of the first ray, one of which involves assessing the shape of the lateral edge of the first metatarsal head. This study aimed to investigate the interobserver and intraobserver reliabilities of circle measurements on weight-bearing anteroposterior radiographs to categorize the shape of the lateral edge of the first metatarsal head. A power analysis determined that a minimum of 128 radiographs was required to assess observer agreement for categorical data (alpha = 0.05, beta = 0.2, power = 80%). Patients diagnosed with hallux valgus at our institution between January 2015 and December 2019 were retrospectively reviewed and 128 radiographs were randomly selected. Two foot and ankle surgeons and 2 radiologists evaluated the radiographs on 2 separate occasions, classifying the first metatarsal head shape into 3 categories (angular, intermediate, and round) using circular measurements. Interobserver reliability was assessed using Fleiss’ kappa, whereas intraobserver reliability was evaluated using Cohen kappa. Interobserver reliability for classifying the shape of the lateral edge of the first metatarsal head was found to be very good in both assessments (Fleiss’ kappa = 0.83 and 0.84, respectively). The subcategory analysis revealed the highest agreement for the angular type, followed by the round type, with the lowest agreement observed for the intermediate type. The intraobserver Cohen kappa values ranged from 0.78 to 0.91. The level of interobserver agreement was found to be very good for the classification of the shape of the first metatarsal, and the intraobserver agreements were substantial to very good. In our opinion, this method is reliable and may be useful in determining the necessity for rotation-correcting surgery and advanced imaging with weight-bearing computed tomography.

Background: Pes planus is a condition where the arch of the foot collapses, resulting in the entire sole contacting the ground. The biomechanical implications of pes planus on gait have been widely studied; however, research specific to Black African populations, particularly recreational runners, is scarce. Aim: This study aimed to describe the forefoot centre of pressure (CoP) trajectory during the barefoot gait cycle among Black African recreational runners with pes planus. Methods: A prospective explorative and quantitative study design was employed. Participants included Black African male recreational runners aged 18 to 45 years diagnosed with pes planus. A Freemed™ 6050 force plate was used to collect gait data. Statistical analysis included cross-tabulations to identify patterns. Results: This study included 104 male participants across seven weight categories, with the majority in the 70-to-79 kg range (34.6%, n = 36). Most participants with pes planus showed a neutral foot posture (74.0%, n = 77) on the foot posture index 6 (FPI-6) scale. Flexible pes planus (94.2%, n = 98) was much more common than rigid pes planus (5.8%, n = 6). Lateral displacement of the CoP was observed in the right forefoot (90.4%, n = 94) and left forefoot (57.7%, n = 60). Load distribution patterns differed between feet, with the right foot favouring the medial heel, arch, and metatarsal heads, while the left foot favoured the lateral heel, medial heel, and lateral arch. No statistical significance was found in the cross-tabulations, but notable lateral CoP displacement in the forefoot was observed. Conclusions: The findings challenge the traditional view of pes planus causing overpronation and highlight the need for clinicians to reconsider standard diagnostic and management approaches. Further research is needed to explore the implications of these findings for injury prevention and management in this population.

Diabetic foot ulcers (DFUs) represent a critical global health issue, necessitating the development of advanced smart, flexible, and wearable sensors for continuous monitoring that are reimbursable within foot orthotics. This study presents the design and characterization of a pressure sensor implemented into a shoe insole to monitor diabetic wound pressures, emphasizing the need for a high sensitivity, durability under cyclic mechanical loading, and a rapid response time. This investigation focuses on the electrical and mechanical properties of carbon nanotube (CNT) composites utilizing Ecoflex and polydimethylsiloxane (PDMS). Morphological characterization was conducted using Transmission Electron Microscopy (TEM), Laser Confocal Microscopy, and Scanning Electron Microscopy (SEM). The electrical and mechanical properties of the CNT/Ecoflex- and the CNT/PDMS-based sensor composites were then investigated. CNT/Ecoflex was then further evaluated due to its lower variability performance between cycles at the same pressure, as well as its consistently higher capacitance values across all trials in comparison to CNT/PDMS. The CNT/Ecoflex composite sensor showed a high sensitivity (2.38 to 3.40 kPa−1) over a pressure sensing range of 0 to 68.95 kPa. The sensor’s stability was further assessed under applied pressures simulating human weight. A custom insole prototype, incorporating 12 CNT/Ecoflex elastomeric matrix-based sensors (as an example) distributed across the metatarsal heads, midfoot, and heel regions, was developed and characterized. Capacitance measurements, ranging from 0.25 pF to 60 pF, were obtained across N = 3 feasibility trials, demonstrating the sensor’s response to varying pressure conditions linked to different body weights. These results highlight the potential of this flexible insole prototype for precise and real-time plantar surface monitoring, offering an approachable avenue for a challenging diabetic orthotics application.

Alfred H Freiberg, in 1914 first described the painful condition of the foot due to partial collapse of the joint surface of the second metatarsal head.[1] He believed that trauma caused the condition, hence used the term infarction. He thought that the excessive length of the 2nd ray in combination with the insufficient first ray complex results into an overload of the 2nd ray and subsequently articular collapse of the 2nd joint surface.

Background: Diabetes mellitus foot deformities (FD) comprise all the pathological changes in the foot of a person with diabetes mellitus. The current global burden of FD is worrisome and contributes to the global burden of disability and reduction in the quality of life. Objectives: This study evaluated the prevalence, spectrum of foot deformity and the associated risk factors in subjects with type 2 DM. Materials and Methods: This was a descriptive cross-sectional study involving 98 consenting T2DM subjects at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-eastern Nigeria. Relevant socio-demographic, clinical and Diabetic Neuropathy Symptom (DNS) score data were collected using a structured questionnaire and the DNS questionnaire. Clinical evaluations that included detailed foot, anthropometric, blood pressure measurements, biothesiometry, monofilament testing and lower limb doppler ultrasonography were done. Data was analysed using SPSS version 25. Result: A total of 98 T2DM subjects were evaluated and comprised 51% and 49% male and female subjects, respectively, with a mean age of 59.61 ± 11.62 years and mean DM duration of 11.11 ± 8.48 years. A total of 62.2% of the subjects had foot deformity, of which 30.6%, 4.1%, 13.3%, 8.2%, 7.1% and 4.1% had prominent metatarsal head, pes cavus, pes planus, claw toe, hammer toe, and mallet toe, while 11.2%, 4.1%, 9.2%, 4.1%, 2.0%, 43.95, 3.1%, 1.0% and 28.6% of the subjects had hallus rigidus, hallus varus, hallus valgus (bunion), bunionette, Charcot foot, muscle atrophy, disarticulation, amputation and limited joint mobility, respectively. Foot deformity showed significant association with the age of the subjects, educational level, DM duration, glycaemic control, global obesity and presence of neuropathy. Conclusion: The prevalence of FD in T2DM subjects from this study was very high and FD was significantly associated with some modifiable risk factors that included educational level, glycaemic control and glob