Superselective Transarterial Embolization Using Imipenem/Cilastatin Sodium for Plantar Fasciitis Refractory to Conservative Management.

Background: Tightness of the plantar fascia and calf muscles causes foot pain, altered gait, and reduced work efficiency. Salespersons, due to prolonged standing, repetitive lifting, and limited breaks, are at high risk. Despite global evidence linking these factors to foot disorders, local data from retail workers in Khyber Pakhtunkhwa remain limited. Objective: To determine the prevalence of plantar fascia and gastrocnemius tightness among salespersons in Swat and to identify associated demographic, lifestyle, and occupational factors. Methodology: A cross-sectional analytical study was conducted among 377 salespersons selected through convenience sampling from retail stores and shopping centers in Swat. Data were collected using a structured questionnaire and clinical assessment. The Windlass test evaluated plantar fascia tightness, while the Silfverskiöld test assessed gastrocnemius tightness. Demographic characteristics, body mass index, physical activity, smoking status, footwear type, and occupational factors were recorded. Associations were analyzed using the Chi-square test with a significance level of p<0.05. The study followed STROBE guidelines. Results: The mean age was 26.75±6.19 years, and the mean body mass index was 23.21±4.41. Males constituted 66% of participants. Plantar fascia tightness was found in 52.5%, and gastrocnemius tightness in 72.9% of participants. BMI showed significant associations with gastrocnemius (p=0.001) and plantar fascia tightness (p=0.025). Gender was significantly associated with plantar fascia tightness (p<0.001), with males more affected. Footwear type, physical activity level, and employment duration were significantly associated (p=0.001), while workplace type and daily working hours were not. Conclusion: Plantar fascia and calf muscle tightness are common among Swat salespersons, linked to body mass index, footwear, and lifestyle. Ergonomics, proper footwear, weight management, and stretching are recommended to prevent musculoskeletal issues.

Plantar fasciitis is a common musculoskeletal disorder characterized by degeneration of the plantar fascia due to repetitive mechanical stress that causes microtears, tissue irritation, and persistent heel pain, which can significantly impair daily activities and quality of life. Although conventional treatments are widely used, acupuncture has increasingly been explored as a complementary therapy for pain management. This study aimed to describe the implementation of acupuncture care for a patient with plantar fasciitis at the Bumi Sehat Acupuncture Clinic in Ubud, Gianyar, Bali. A qualitative case study design was applied to document the clinical management process of acupuncture treatment. The study involved a 55-year-old male patient who underwent six acupuncture treatment sessions during April 2025. Data were collected through the traditional four diagnostic methods of Traditional Chinese Medicine, including observation, listening and smelling, inquiry, and palpation, and were recorded using a structured client data sheet. The patient was diagnosed with plantar fasciitis associated with Cold-Bi syndrome. The therapeutic approach included acupuncture point stimulation combined with moxibustion to remove meridian obstruction, warm the channels, and promote the circulation of Qi and blood. Clinical evaluation across treatment sessions demonstrated progressive improvement in symptoms, including a gradual reduction in plantar pain, decreased heel elevation during walking, improved functional mobility, and resolution of calf stiffness and sleep disturbance. By the fifth treatment session, the patient reported complete relief from pain and regained normal walking ability, which was maintained at the sixth session without recurrence. These findings suggest that structured acupuncture care may contribute to pain reduction and functional recovery in patients with plantar fasciitis. The study provides clinical insight into the application of acupuncture as a complementary therapeutic option in the management of plantar fasciitis.

The plantar fascia (PF) is exposed to repetitive loading in runners; it remains unclear whether chronic training in young, asymptomatic athletes leads to changes in PF thickness or stiffness. To compare PF thickness and elasticity between asymptomatic elite runners and sedentary controls using B-mode ultrasound and shear-wave elastography (SWE), and to test the hypothesis that prolonged mechanical loading induces adaptive changes in PF stiffness. In this cross-sectional study, 56 participants were included: 38 elite runners (12 short-distance, 11 middle-distance, 15 long-distance) and 18 sedentary controls. Bilateral B-mode ultrasound and longitudinal 2-dimensional SWE virtual touch tissue imaging quantification were performed at proximal (≈1 cm from the calcaneal insertion) and distal (≈6 cm) PF sites using an Acuson S2000 system (Siemens, Munich, Germany) with a 4 to 9 MHz linear array transducer. Primary outcomes were PF thickness (mm) and shear-wave velocity (m/s). Gender distribution did not differ between groups (χ2, P = .748). Age differed across subgroups (analysis of variance, P = .011), and body mass index was lower in middle- and long-distance runners than in sedentary controls (P = .042). Thickness: No differences were observed between runners and sedentary controls (all P > .10); among runner subgroups, a difference was detected only at the left-proximal site (P = .043), with the highest values in short-distance runners. Proximal thickness exceeded distal thickness (P < .001). SWE: No differences were found between-group at any site (all analysis of variance, P > .45); effect sizes were small (Hedges, g −0.07 to −0.29), and post hoc power to detect such small effects was low (~6%–16%). Proximal SWE was higher than distal SWE (P < .001); at the distal site, left-sided values were higher than right-sided values (Wilcoxon, P = .032). Among sedentary participants, females had higher proximal SWE than males (P ≈ 0.014–0.053), whereas no gender effect was observed in runners. Reliability: Intraclass correlation coefficient was 0.965 to 0.979 for distal SWE (excellent) and 0.755 for right-proximal SWE (good); thickness intraclass correlation coefficients ranged from 0.765 to 0.814. In young, asymptomatic elite runners, chronic training is not associated with a measurable change in PF thickness or stiffness compared with sedentary peers. Differences are predominantly site-dependent (proximal > distal), and a gender effect was observed only among sedentary individuals. Adaptation of the PF to mechanical loading may occur without macroscopic hypertrophy or increased stiffness.

To assess the prevalence of ultrasound-detected abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among Division I collegiate athletes and to identify associated demographic and sport-related risk factors. Multi-institutional, 3-year observational study. Preseason screening evaluations conducted at collegiate athletic programs. A total of 533 Division I collegiate athletes representing 18 sports. All participants underwent ultrasound imaging of bilateral patellar tendons, Achilles tendons, and plantar fasciae. Abnormalities were defined as the presence of hypoechogenicity, morphologic thickening, or neovascularity. Prevalence of sonographic abnormalities and their association with demographic and sport-specific variables, along with the presence or absence of symptoms at the time of scanning. The highest prevalence of abnormalities was observed in the patellar tendon (36.1%), followed by the Achilles tendon (7.1%) and plantar fascia (2.4%). Most abnormalities were asymptomatic, although athletes with abnormalities were significantly more likely to report current pain. Older age was associated with increased risk of Achilles tendon and plantar fascia abnormalities, while male sex and participation in explosive or running sports were linked to higher prevalence of patellar tendon abnormalities. This study represents the largest known assessment of tendon and fascia ultrasound abnormalities in a collegiate athlete cohort. Findings support the use of ultrasound as an accessible, real-time diagnostic tool for early identification of subclinical pathology, which may allow for targeted interventions aimed at reducing time-loss injuries and optimizing long-term athlete health.

Plantar fasciitis is one of the most common causes of heel and plantar pain and is considered a clinical entity with multifactorial etiology. Current knowledge points to the importance of biomechanical predisposing factors, especially the morphology of the foot arch and its influence on the distribution of mechanical load during static and dynamic movement tasks. A high medial longitudinal arch of the foot (pes cavus) is associated with increased foot rigidity, reduced adaptive cushioning capacity, and a shift of plantar load to the heel and forefoot, which can lead to increased mechanical stress on the plantar fascia. Professional ballet dancers represent a specific population with extreme functional demands on the foot. Ballet technique, especially work on demi-pointe and en pointe, requires repeated extra-physiological plantar flexion, high demands on the stability of the medial longitudinal arch, and precise control of the foot axis. At the same time, the aesthetic and technical requirements of ballet promote the development of a pronounced arch of the foot, which can lead to structural and functional adaptations of the pes cavus type. The aim of this article is to synthesize the available biomechanical and clinical knowledge on the relationship between foot arch type and plantar fasciitis through a narrative review of the literature and to interpret it in the context of the specific requirements of professional ballet. A high arch reduces the contact area of the midfoot, limits adaptive dorsiflexion, and increases local mechanical stress on the plantar fascia. Data specifically focused on professional ballet dancers are limited in the available literature. This article therefore presents a hypothesis-generating framework and emphasizes the need for targeted prospective studies in the field of dance medicine and physiotherapy.

To investigate the efficacy of extracorporeal shock wave therapy (ESWT), high-intensity laser therapy (HILT), and exercise therapy in patients diagnosed with plantar fasciitis. A total of 84 patients diagnosed with plantar fasciitis were randomized into 3 groups: ESWT combined with a home exercise program (n = 28), HILT combined with a home exercise program (n = 30), and a home exercise program alone (control) (n = 26). The ESWT group underwent a total of 3 ESWT sessions, performed once a week, whereas the HILT group underwent a total of 15 HILT sessions over 3 weeks. All 3 groups were evaluated at the beginning of the treatment, at the end of the treatment (week 3), and at the 12th week for pain levels (measured using the visual analog scale [VAS]), plantar fascia thickness, and the Foot Function Index (FFI). Because of the nature of the interventions, participant masking was not possible; however, assessor masking was strictly adhered to. Eighty-four patients completed the study. Significant reductions in plantar fascia thickness, VAS scores, and FFI values were observed in all 3 groups (P < .05). However, baseline-adjusted analyses detected no meaningful between-group differences at 12 weeks (P > .05; small effect sizes). Our study demonstrated that ESWT, HILT, and exercise therapy each effectively reduced pain levels and improved functional capacity in the treatment of plantar fasciitis. Adding ESWT or HILT to a structured home exercise program did not provide an incremental clinical benefit during the follow-up period. The findings support exercise therapy as a practical first-line option.

Explainable deep learning-based multiclass classification of foot radiographs into normal, plantar fasciitis, and flatfoot.

ABSTRACT Background: Plantar fasciitis is one of the most common causes of heel pain and functional limitation in adults. Tightness of the gastrocnemius–soleus complex and Achilles tendon increases tensile stress on the plantar fascia, contributing to persistent symptoms. Stretching interventions are widely recommended; however, comparative evidence between calf stretching and Achilles tendon stretching remains limited. Objective: To compare the effectiveness of calf muscle stretching and Achilles tendon stretching in reducing pain and improving functional ability in individuals with plantar fasciitis. Methods: A randomized comparative study was conducted on 50 participants (aged 25–45 years) diagnosed with plantar fasciitis and positive windlass test. Participants were randomly allocated into two groups: Group A (n = 25) received calf muscle stretching, and Group B (n = 25) received Achilles tendon stretching. Both groups followed a supervised stretching protocol (30–40 seconds hold, 3 repetitions, 5 days per week) for four weeks. Pain intensity was measured using the Visual Analog Scale (VAS), and functional disability was assessed using the Foot Function Index (FFI). Statistical analysis was performed using paired and independent t-tests with significance set at p &lt; 0.05. Results: Both groups demonstrated significant improvements in VAS and FFI scores after four weeks (p &lt; 0.001). However, the Achilles tendon stretching group showed significantly greater reductions in post-treatment VAS (t = 3.908, p &lt; 0.001) and FFI (t = 5.690, p &lt; 0.001) compared to the calf stretching group. Percentage reduction in pain and disability was higher in the Achilles stretching group (VAS: 51.27%; FFI: 57.00%) than in the calf stretching group (VAS: 26.11%; FFI: 24.78%). Conclusion: Both stretching techniques were effective in reducing pain and improving function in patients with plantar fasciitis. However, Achilles tendon stretching demonstrated superior outcomes and may be recommended as a more effective conservative management strategy.

Plantar fasciitis is a common degenerative foot disease that significantly impairs quality of life. The disease is characterized by multifactorial pathogenesis, diverse intervention strategies, and heterogeneous therapeutic effects. Despite extensive research findings, the fragmented nature of these results hinders a comprehensive understanding of the field. This study employed a bibliometric approach to analyze the literature data obtained from the Web of Science database over the past 15years. The aim was to explore the knowledge structure, research trends, and collaborative features of this field from a quantitative perspective using bibliometric analysis. The study revealed a fluctuating trend in publications within the field, with the United States, Harvard Medical School, and Karl B. Landorf leading the research output and collaboration. Foot and Ankle International emerged as the most prolific and frequently cited journal in this domain. The research hotspots in this field primarily focus on "plantar fasciitis," "heel pain," and "extracorporeal shock wave therapy." Meanwhile, "shear wave elastography," "plantar fascia thickness," "systematic review," and "musculoskeletal disease" represent the research trends in this field. In addition, this study identifies the literature that has had a significant impact on the field. By organizing the entire research field of plantar fasciitis, this study provides decision support for future clinical practice and scientific research.

Background Plantar fasciitis is one of the main causes of heel pain, which is one of the most prevalent complaints in foot and ankle clinics. Surgery may be necessary if conservative therapies have failed. The appropriate surgical technique has been debated, open plantar fasciotomy and percutaneous plantar fasciotomy are the two common surgical techniques. The aim of the study is to compare the outcomes of open release versus percutaneous midsole release of the plantar fascia in this study to treat recalcitrant heel pain. Methods A prospective study was conducted on 54 patients who had unresponsive plantar fasciitis following conservative treatment for at least six months. 20 patients in the 54 enrolled cases had open plantar fascia release, whereas the remaining 34 patients had percutaneous mid-sole plantar fascia release. All patients' surgical outcomes were evaluated using the Foot and Ankle Disability Index (FADI) both before and after the procedure and a follow-up period of one year was used to assess the functional results. Results The percutaneous plantar fasciotomy group's mean foot and ankle disability index score improved statistically significantly from 39 ± 6 preoperatively to 101 ± 3 postoperatively, compared to 38 ± 5 preopera tively and 98 ± 2 postoperatively for the open plantar fasciotomy group at the final follow-up. Two patients in the percutaneous group experienced numbness at the site of surgery, compared to seven in the open group. By the time of the last follow-up, there had been no recurrence of pain. Discussion We performed a percutaneous release of the mid-sole plantar fascia with a minimum incision and little dissection. We could thus access the plantar fascia effectively while preserving the surrounding tissues and maintaining optimal cosmetic results. Open plantar fascia release is the most conventional technique. However, disadvantages of the surgery include large wound, longer postoperative recovery time, and potential postoperative occurrence of complex regional pain syndrome. Conclusion Both open and percutaneous plantar fascia releases resulted in a considerable improvement in the patients' limb function and pain symptoms. The long-term curative results of the two surgical treatments were identical. Due to fewer postoperative problems, percutaneous plantar fascia release is a superior procedure.

Plantar fasciitis causes heel pain and functional limitations; conservative treatment typically includes plantar fascia and calf stretching. High-intensity laser therapy (HILT) offers deeper photobiomodulation and potential tissue-healing benefits, but robust evidence of added clinical benefit remains limited. This study aims to evaluate the efficacy of HILT combined with plantar fascia stretching exercises compared with a sham control for the treatment of plantar fasciitis. This study was designed as a randomized, double-blind, sham-controlled trial conducted at the outpatient clinic of a university hospital. Participants were randomly allocated into 2 groups: the HILT group and the sham treatment group. Both groups received 9 treatment sessions over 3 weeks. The HILT group received active laser therapy, while the sham group received identical treatment without laser emission. The HILT used a wavelength of 1064 nm in continuous mode, with a power output of 12 W applied for 250 seconds, delivering an energy density of 120 J/cm² applied to a 25-cm² area for a total energy of 3000 J. In addition to the assigned interventions, all participants performed a standardized self-stretching exercise program targeting the plantar fascia and Achilles tendon throughout the study period. The primary outcome was pain intensity measured using a visual analog scale. Secondary outcomes included ultrasonographic measurement of plantar fascia thickness (PFT) and the subjective foot and ankle ability measure (FAAM) score, recorded before and immediately after the intervention. A total of 34 patients diagnosed with unilateral plantar fasciitis were enrolled in this study. Based on intragroup comparison, both groups demonstrated statistically significant improvements in all outcomes compared with baseline (P<.001). However, no significant differences were found between the 2 groups across all outcomes. The mean difference in pain reduction, measured by the visual analog scale, was -35.3 (95% CI -45.3 to -25.0) mm in the HILT group and -30.4 (95% CI -46.3 to -14.4) mm in the sham group (-5.0 mm, 95% CI -14.3 to 4.3; P=.59). Similarly, reductions in PFT and improvements in FAAM scores showed no significant differences between groups (mean difference -0.02 mm, 95% CI -0.2 to 0.1; P=.90 and 5.6 points, 95% CI -1.1 to 12.4; P=.40, respectively). There was no additional clinical effectiveness of HILT on pain reduction, decreased PFT, or increased FAAM scores compared with sham laser when combined with standard stretching exercises for plantar fasciitis and the Achilles tendon.

Plantar fasciitis (PF) is characterized by heel pain and functional limitations, with hyperpronation identified as a primary risk factor. Mechanical correction of malalignment is one of several therapeutic options, but no one has settled on a single, comprehensive treatment protocol. The aim of this study was to examine the effect of a multimodal rehabilitation program that incorporates both active and passive correction of the foot’s pathomechanics on pain intensity, function, plantar fascia thickness, foot posture, and ankle dorsiflexion range of motion in patients with PF, in comparison to a conventional rehabilitation protocol. A randomized controlled trial involving 48 patients (21 males and 27 females) aged 40 to 60 years and clinically diagnosed with PF. They were randomly assigned to either the experimental or control groups. The control group received a conventional rehabilitation program (self-stretching, mobilization of the ankle and subtalar joint, myofascial release, and ultrasound), while the experimental group received the multimodal rehabilitation program that included low-dye tape, short foot exercise, and unilateral heel raising, in addition to the same self-stretching and mobilization given to the control group. Both groups were given 3 sessions per week for 8 consecutive weeks (2 months). Outcome measures included pain intensity (using visual analogue scale and pressure pain threshold) and foot posture (via the foot posture index and rear foot angle. Functional impairment (using the foot function index). Dorsiflexion range of motion (assessed with a bubble inclinometer), and plantar fascia thickness (measured via ultrasonography). Post-treatment, both groups showed significant improvements in all outcomes (p < 0.001), except for the foot posture index, which wasn’t significant in the control group (p = 0.097). However, the rear foot angle and foot posture index showed significant differences between groups, favoring the experimental group (p = 0.046 and p = 0.027, respectively). Both programs effectively improved clinical outcomes and reduced plantar fascia thickness in patients with PF. However, the multimodal rehabilitation program demonstrated greater improvement in foot posture measures. Thorough rehabilitation targeting clinical outcomes and biomechanical aspects may yield superior results in the management of PF. The trial was registered on June 8, 2024, on clinicaltrials.gov (NCT06456944). https://clinicaltrials.gov/study/NCT06456944.

ABSTRACT Objective Soccer is one of the sports with the highest number of injuries in both sexes with a prevalence of 13% around the ankle-foot area. Various strategies have been proposed to prevent injuries like FIFA 11+ warm-up. Its reliability has been questioned due to the diversity of results obtained depending on the movement pattern studied and the body region analyzed. Few studies have analyzed its acute effects on distal structures, such as plantar soft tissue properties, local perfusion or temperature. The objective of this study was to determine the acute effects of performing the FIFA 11+ on mechanical and physiological properties in ankle-foot regions. Method The sample included 120 amateur men and women soccer players. Various mechanical properties of the muscle and tendon such as oxygen saturation in the muscle, skin temperature, range of motion of the ankle and maximum isometric force of the toes were analyzed, before and after performing the FIFA 11 +. Results: indicate the absence of significant differences in any of the variables analyzed, except for the mechanical response of the plantar fascia (p < 0.0014). Conclusion FIFA 11+ may not provide a sufficiently strong local stimulus to generate mechanical and metabolic responses in the different structures of the foot and ankle, even though it remains an established long-term injury-prevention program. Other warm-up strategies to enhance its effects may consider incorporating.

Peripheral musculoskeletal structures may undergo secondary changes after stroke, but tendon-specific adaptations and their relationship with functional recovery are not well defined. This study examined lower extremity tendon thickness in patients with post-stroke hemiplegia before and after a four-week inpatient rehabilitation program and explored associations between tendon thickness and clinical improvement. In this prospective observational study, 45 patients with post-stroke hemiplegia completed a four-week rehabilitation program. Quadriceps, patellar, Achilles tendon and plantar fascia thicknesses were measured bilaterally at baseline and post-treatment using ultrasonography. Clinical assessments included the Berg Balance Scale (BBS), Functional Ambulation Classification (FAC), Barthel Index, Brunnstrom stages and Modified Ashworth Scale (MAS). Fifteen healthy volunteers served as controls (single assessment). Continuous variables are presented as mean ± SD when approximately normally distributed and as median (IQR) otherwise; p-values were adjusted for multiplicity in secondary analyses as specified. Paretic-side quadriceps tendon thickness (primary outcome) increased from 5.94 ± 0.96 to 6.48 ± 0.95 mm (p < 0.001), with 21/45 (46.7%) exceeding minimal detectable change with a 95% confidence interval (MDC95). Baseline paretic-side quadriceps thickness was lower than controls (p_adj = 0.048) but did not differ post-treatment (p_adj > 0.99). Patellar and Achilles tendons and plantar fascia also showed consistent bilateral increases (all p < 0.001). Balance and functional outcomes improved over the period (BBS Δ: 6 [4-9]; FAC improved by ≥1 level in 27/45 [60.0%]; Barthel improved with median paired Δ: 0 [0-5]; all p < 0.001). Changes in quadriceps tendon thickness showed modest positive associations with changes in BBS (both sides) and Barthel (non-paretic side). Lower-extremity tendon morphology in post-stroke hemiplegia appeared dynamic over a 4-week inpatient rehabilitation period, with quadriceps tendon thickness broadly paralleling improvements in balance and functional independence. Larger, longer-term studies are needed to clarify clinical utility.

Plantar fasciitis (PF) is a common cause of heel pain that affects the health-related quality of life of many individuals and has various treatment options. Two effective interventions are corticosteroid (CS) injections and dextrose prolotherapy (DP). This study aimed to compare the efficacy and safety of DP and CS in patients with PF systematically. Relevant studies, including those comparing DP and CS for treating PF, were identified by searching electronic databases until August 2025. The visual analog scale (VAS) pain score, foot function index (FFI), and plantar fascia thickness (PFT) were compared between the groups in the short term (0.5-1month) and mid-term (3months). Statistical analyses were performed via RevMan 4.5.1, and p<0.05 was considered statistically significant. Five RCTs and two cohort studies, with a total of 567 patients, were included in the meta-analysis. The analysis revealed that at the short-term follow-up (1month), corticosteroid injections were more effective at reducing the VAS pain scores than dextrose prolotherapy for general VAS score (MD=1.85, 95% CI [0.05, 3.64], p=0.04), the VAS score at the first step in the morning (MD=1.26, 95% CI [0.49, 2.02], p=0.001), and the VAS score for pain while walking (MD=1.85, 95% CI [0.68, 3.02], p=0.002). Similarly, at the short-term follow-up (1month), the analysis revealed a significantly greater reduction in the FFI score (MD=18.81, 95% CI [0.06, 37.55]) and PFT (MD=0.26mm, 95% CI [0.07, 0.45]) in the CS group than in the DP group. At 3months, the analysis revealed a significant decrease in the FFI score (p=0.003) in the DP group compared with the CS group, whereas no significant difference was observed in the VAS scores or PFT. In patients with plantar fasciitis, CS injections had greater efficacy than DP did in the short term; however, their efficacy became similar in the mid-term follow-up, with DP outperforming CS in terms of foot function. Further trials with standardized protocols and long-term follow-ups are needed to address potential biases.

To investigate whether ultrasound-guided preoperative portal localization in a modified double-medial-portal endoscopic technique reduces postoperative complications while maintaining comparable clinical outcomes in patients with recalcitrant plantar fasciitis. A retrospective study was performed on 62 patients suffering from stubborn plantar fasciitis with a calcaneal spur from January 2023 to August 2024. 32 patients had a traditional endoscopic partial release of the plantar fascia, whereas 30 patients underwent a modified release guided by ultrasound. Two medial portals were used by both the traditional and altered groups. Every patient was monitored for a minimum of 12months. The clinical results for both groups were assessed using the Visual Analogue Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the medial longitudinal arch angle (MLAA), and the Arch Index (AI). Both groups showed significant improvements in VAS and AOFAS scores at one, six and 12months postoperatively. No significant between-group differences were observed in pain relief, functional recovery, or foot structural parameters at any follow-up time point. The ultrasound-guided group demonstrated a significantly lower incidence of postoperative complications. Patient-reported satisfaction appeared to be higher in the ultrasound-guided group. Ultrasound-guided modified double-medial-portal endoscopic surgery provides comparable clinical outcomes with fewer postoperative complications, suggesting a safety advantage rather than superior efficacy in recalcitrant plantar fasciitis.

To characterize ankle magnetic resonance imaging (MRI) features in pediatric and young adult patients with familial Mediterranean fever (FMF) and compare them with those in juvenile idiopathic arthritis (JIA) and chronic nonbacterial osteomyelitis (CNO) in order to identify distinguishing or overlapping imaging features among the three conditions. Twelve ankle MRI examinations from 11 patients with FMF (mean age 12.4 years, 7 females) were retrospectively evaluated and compared with 22 examinations from 17 patients diagnosed with JIA (12 patients/14 ankles, mean age 14.3 years, 8 females) or CNO (5 patients/8 ankles, mean age 10.2 years, 3 females). Calcaneal enthesitis features were assessed at the insertion site of the Achilles tendon, plantar fascia, and the long plantar tendon. Also evaluated were the presence of diffuse calcaneal bone marrow edema (BME), midfoot arthritis, synovitis, and tenosynovitis. Insertional calcaneal BME, an enthesitis-related feature, was more prevalent in FMF patients compared to both JIA and CNO, while among the three evaluated entheses, long plantar tendon enthesitis was significantly more prevalent in FMF patients only compared to those with JIA (p < 0.001). CNO presented a predominantly osseous inflammation pattern with diffuse calcaneal BME (87.5%, p < 0.001) and additional hindfoot BME (75%, p < 0.002), clearly distinct from FMF. Synovitis and tenosynovitis were more commonly observed in JIA patients, although the differences compared to FMF and CNO were not statistically significant. Although imaging features overlap among FMF, CNO, and JIA, distinct MRI patterns emerge: enthesitis predominates in FMF, osteitis in CNO, and synovitis in JIA.

Material properties of intrinsic foot structures in individuals with plantar fasciitis.

Type 2 diabetes mellitus (T2DM) is associated with connective-tissue complications, but effects on human deep fascia remain poorly understood. This study employed atomic force microscopy (AFM) nanoindentation and multiphoton imaging to quantify region-specific biomechanical and structural changes of deep fasciae in T2DM. Fascia lata, thoracolumbar fascia, and plantar fascia from 17 T2DM and 17 control male deceased (<24 h post-mortem) donors were analyzed. AFM was used to quantify nanoscale stiffness (Young's modulus) under hydrated conditions. Label-free multiphoton microscopy comprising Second Harmonic Generation (SHG), Two-Photon Excited Fluorescence (TPEF), and Fluorescence Lifetime Imaging Microscopy (FLIM) was used to assess collagen organization, autofluorescence, and fluorescence decay kinetics. AFM revealed significantly increased stiffness in diabetic plantar fascia (87 ± 3.1 vs 40 ± 1.2 kPa, p = 0.004) and fascia lata (28 ± 1.2 vs 16 ± 0.5 kPa, p < 0.001) compared to controls, while thoracolumbar fascia stiffness did not differ significantly between groups. Stiffness changes showed no significant association with age or body mass index. SHG forward-to-backward ratios did not differ significantly between groups, suggesting preserved collagen supramolecular organization. However, TPEF ratios were significantly elevated in diabetic plantar fascia and fascia lata, suggesting increased accumulation of autofluorescent species. FLIM revealed a significant decrease in mean fluorescence lifetime (τₘ) in diabetic plantar fascia, indicative of altered collagen microenvironment, possibly due to glycation or oxidative modifications. T2DM induces site-specific biomechanical stiffening and biochemical remodeling of human deep fascia, particularly in load-bearing regions. These changes suggest mechanisms involving glycation and oxidative stress, providing mechanistic insights into musculoskeletal complications associated with diabetic fasciopathy.