Achilles tendinitis, a prevalent condition among athletes, is marked by inflammation and degeneration of the Achilles tendon due to factors such as overuse and mechanical overload. Current treatments are often limited in efficacy, prompting the exploration of novel therapeutic approaches. Exosomes, small extracellular vesicles released from cells, have emerged as promising agents for tendon healing due to their ability to transfer bioactive molecules and modulate cellular processes. This review examines the role of exosomes in the treatment of Achilles tendinitis, highlighting their anti-inflammatory, regenerative, and immunomodulatory properties. Exosomes derived from mesenchymal stem cells (MSCs) and tendon stem cells (TSCs) can reduce inflammation by modulating cytokine levels and suppressing proinflammatory pathways. They promote tenocyte proliferation, enhance extracellular matrix (ECM) synthesis, and improve tendon structure and function. Preclinical studies demonstrate significant benefits of exosome therapy, including reduced inflammation, improved collagen organization, and enhanced biomechanical properties of the tendon. Early clinical trials indicate that exosome-based therapies are safe and potentially effective, showing promise in reducing pain and improving tendon function. However, challenges such as standardizing exosome isolation and characterization, navigating regulatory pathways, and understanding long-term safety and efficacy must be addressed. Future research should focus on optimizing exosome sources, dosages, delivery methods, and exploring combination therapies to enhance therapeutic outcomes. Exosomes could revolutionize the management of Achilles tendinitis, offering a novel and effective treatment modality.

Introduction: Plantar fasciitis (PF) is a common cause of heel pain, particularly affecting individuals involved in running sports and those with prolonged standing activities. While various nonoperative treatments are available, there is no consensus on the optimal therapy. Corticosteroid injections offer short-term relief but have associated risks and limited long-term efficacy. Platelet-rich plasma (PRP) has emerged as a potential alternative, with conflicting evidence regarding its effectiveness compared to corticosteroids. Materials and methods: This systematic review and meta-analysis adhered to Cochrane and PRISMA guidelines. We included level 1 and level 2 studies from 2015 to 2023 that compared intralesional corticosteroid and PRP injections for treating PF with at least 6 months of follow-up. Comprehensive searches were conducted in Medline, Embase, Scopus, and Google Scholar. Data extraction and quality assessment were independently performed by two reviewers, using the Cochrane risk of bias tool. Statistical analyses, including heterogeneity and subgroup analyses, were conducted using Review Manager 5.3. Results: From 826 initial studies, 13 met inclusion criteria, encompassing 941 patients (PRP 476, corticosteroids 465). Platelet-rich plasma demonstrated no significant pain relief over corticosteroids at 3 months [standard mean difference (SMD) = −0.37; 95% confidence interval (95% CI) = −1.15 to 0.41; I² = 96%; p = 0.35]. However, PRP showed statistically significant improvements in VAS scores at 6 months (SMD = −1.92; 95% CI = −3.33 to −0.51; I² = 98%; p = 0.008) and 1 year (SMD = −0.37; 95% CI = −0.70 to −0.03; I² = 0%; p = 0.03). For function, PRP resulted in significant improvements in American Orthopaedic Foot & Ankle Society (AOFAS) scores at 6 months (SMD = 0.89; 95% CI = 0.09 to 1.69; I² = 94%; p = 0.03) but not at 3 months (SMD = −0.09; 95% CI = −0.63 to 0.44; I² = 86%; p = 0.73) or 1 year (SMD = 1.68; 95% CI = −0.09 to 3.45; I² = 96%; p = 0.06). Conclusion: Platelet-rich plasma is more effective than corticosteroid injections for pain control from 6 months to 1 year. In the short term, PRP offers no significant advantage. Interpretation of these findings should consider the quality of studies, risk of bias, and variability in PRP preparation protocols, which affect the internal and external validity. Thus, compelling evidence for PRP's superiority in PF treatment remains elusive.

Osteochondral lesions (OCL) are increasingly being identified at present. These lesions include both osteochondritis dissecans (OCD) and osteochondral fractures. Improved diagnostic modalities, like magnetic resonance imaging (MRI), have become more effective in accurately identifying and quantifying these lesions. While lesions that are small and have some attachment with the rest of the bone respond well to nonoperative treatment, those that are larger in size and those who have failed a trial of nonoperative treatment are recommended to undergo surgical management. Many surgical options have been described. Of these, microfracture (MF) has been extensively used. This procedure results in the release of bone marrow and stimulation of cells to produce fibrocartilage. Additionally, orthobiologics like platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) have been used to further enhance the healing response. This review attempts to bring forth the available literature on the use of MF and BMAC in the treatment of OCL.

Background: Symptomatic ankle osteoarthritis (OA) is a debilitating condition characterized by pain and functional impairment. Platelet-rich plasma (PRP) therapy has emerged as a potential treatment to alleviate symptoms and delay surgical interventions in ankle OA, akin to its established role in knee OA. Materials and methods: A systematic search was conducted across major databases from inception to present, following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies assessing PRP therapy for ankle OA in adults were included. Data extraction and risk of bias assessment were performed using standardized tools. Meta-analyses were conducted where appropriate to synthesize outcomes, including visual analog scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, and Foot and Ankle Disability Index (FADI) scores. Results: From 107 initial records, 6 studies met inclusion criteria, comprising 3 studies for meta-analysis. Platelet-rich plasma injections showed no significant reduction in VAS pain scores [standardized mean difference (SMD) 1.04, 95% CI, −0.95 to 3.02, p = 0.31]. However, significant improvements were observed in AOFAS scores (SMD 1.82, 95% CI, 0.79 to 2.86, p = 0.0006) and FADI scores (SMD −1.32, 95% CI, −2.01 to −0.63, p < 0.0001), indicating enhanced joint function and reduced disability. Conclusion: Platelet-rich plasma therapy demonstrates potential benefits in improving functional outcomes and delaying surgical interventions for ankle OA. While pain reduction outcomes were inconclusive, significant improvements in joint function suggest PRP as a viable non-surgical treatment option. Standardization of protocols and larger randomized trials are warranted to further validate these findings and optimize clinical practice.

Introduction: Trimalleolar ankle fractures have a worse prognosis than other ankle fractures and are in most cases associated with other injuries. Adequate reduction is the key to restoring ankle function. Four percent of the syndesmosis may remain unstable due to poor reduction or interposed structures. The objective of this paper is to study the incidence and epidemiology of syndesmotic loose bodies in trimalleolar ankle fractures. Materials and methods: Thirty-nine trimalleolar ankle fractures were retrospectively studied. Radiographs and computed tomography (CT) were performed. Fractures were classified according to Weber/Arbeitsgemeinschaft für Osteosynthesefragen (AO), and posterior malleolar fractures were classified according to Haraguchi and Bartoníček/Rammelt. Inclusion criteria: Adult patients with acute trimalleolar ankle fractures treated by the same surgical team were included. Pathological fractures and patients treated by another team were excluded. Age, sex, laterality, and the presence of loose syndesmotic bodies were documented. Student's t-test and Chi-squared tests were performed to analyze the statistical relationship between the studied variables. Results: Seven patients were men and 32 were women, with a mean age of 60 years (range 25–98 years). We found 33 B3 fractures (45%) of which were associated with loose bodies. There were only six C2 fractures, and two of them were associated with loose bodies (33%) (p = 0.0004). There were significant differences in the distribution by sex for the presence of syndesmotic loose bodies. The incidence is 57% for males and 41% for females. No association between loose bodies and Haraguchi or Bartoníček/Rammelt types was found. All loose bodies were visible on CT, and only two cases on X-ray. Conclusion: The incidence of loose bodies in the series studied is 43.5%. Syndesmotic loose bodies are statistically associated with B3 fractures. The statistical incidence is higher in men. Performing CT scans on all trimalleolar fractures is mandatory. Level of evidence—IV.

Aim and background: The foot and ankle form one of the most complex joints of the human body. Clinical examination complemented with the right diagnostics help to make reasonable diagnosis and plan treatment for the same. Weight-bearing radiographs are the norm; however, they are not sufficient to evaluate a dynamic deformity, which is best evaluated by weight-bearing fluoroscopy. Technique: A mini C-arm in a Western setting or a tilting fluoroscopy unit in an Indian setting, with a provision to allow the patient to stand on a step and perform the dynamic single-limb weight-bearing stance, can provide the best diagnostic imaging when dealing with dynamic deformities such as pes planus, and the technique for the same is described here. Conclusion: Dynamic weight-bearing fluoroscopy evaluates the relationships between the various bones of the foot and ankle and helps to plan the treatment for that specific type of pes planus. Clinical significance: A deformity such as pes planus, which has resulted from the malalignment of the talotarsal joint (TTJ), can be easily identified, and appropriate treatment measures can be planned, which would be missed in static imaging of the foot.

Various nonsurgical modalities (total contact cast, braces, and custom-made foot orthosis) and surgical modalities (exostectomy, deformity correction, and arthrodesis) are described to treat the midfoot collapse causing rocker-bottom deformity in a diabetic foot with Charcot arthropathy. The Eichenholtz stage does not describe an acute presentation of chronic foot arthropathy with a midfoot ulcer and a rocker-bottom deformity. The author reports a 60-year-old diabetic woman with a long-standing nonhealing left midfoot ulcer and a rocker-bottom deformity with features of the acute stage (pain, swelling, warmth). Multiple surgeries were done elsewhere, but the ulcer persisted. A simple exostectomy, tarsal tunnel release (TTS), and customized footwear in the postoperative period healed the nonhealing ulcer and achieved a good functional outcome. This surgery achieves a sensate, stable, plantigrade foot, mitigating the shearing forces and focal areas of increased pressure that cause the midfoot collapse and nonhealing ulcers. An acute presentation in chronic midfoot arthropathy with an ulcer and rocker-bottom deformity needs a place and mention in the Eichenholtz stage classification of Charcot arthropathy as stage IV.

Hallux reconstruction remains a challenging endeavor. The main aim of reconstruction is robust soft tissue cover with minimal contour abnormality to permit normal footwear and mobility. We had a young female present with gangrenous hallux. After discussing the various treatment options, a single-stage procedure was undertaken using a free wraparound medial plantar artery flap combined with an iliac bone graft. This innovative approach allowed for simultaneous restoration of soft tissue coverage and bony support, resulting in remarkable functional and esthetic improvement. The postoperative period was uneventful, resulting in a stable discharge. The patient was able to attend work and function in her premorbid capacities well, with remarkable functional and esthetic improvement.