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Diabetic foot ulcers are a frequent and serious complication of diabetes with a high risk of amputation. Exercise has been shown to promote wound healing; however, patients with non-healing foot ulcers have limited ability to exercise due to the foot ulcer. Other strategies are therefore warranted. We evaluated the effect of eight weeks of two-leg passive movement exercise on wound healing in patients with non-healing diabetic foot ulcers. Twenty-one patients were included in the study and randomized into either a control or a passive movement exercise intervention group. The primary outcome measure was the wound area. Sixteen participants completed the trial. Wound sizes for the passive movement intervention group were 274 mm and 58 mm at baseline and week 8, compared to 148 mm (p=0.31) and 136 mm (p=0.51) in the control group (week 16; 7 mm vs. 23 mm , p=0.55). The mean wound area percentual reduction between baseline and week 8 was higher in the intervention group (76% vs. 36%, difference 40%, p=0.062). The two-leg passive movement intervention showed a non-significant difference in wound healing and was well tolerated by patients with diabetic foot ulcers. Although the study shows potential, the results should be interpreted with its limitations of being underpowered and potentially confounded. We encourage larger randomized controlled trials to be conducted, to elucidate whether the two-leg passive movement intervention can be used to accelerate wound healing in non-healing ulcers.

Podiatric surgery is a registered specialty in Australia, supported by nationally accredited training programs and decades of safe, effective practice. Despite this, podiatric surgeons are excluded from public hospitals and government‐funded services, eliminating their ability to contribute to high‐demand areas of surgical care. This commentary explores systemic barriers to the integration of podiatric surgeons within the Australian health system. It draws on national regulatory frameworks, clinical audit data, and international comparisons including interprofessional agreements in the United Kingdom and United States, to examine how a well‐trained but vastly underutilised specialist surgical workforce remains siloed outside public care. Structural reforms would allow podiatric surgeons to participate in multidisciplinary teams, reduce surgical waiting times, and support patients with complex foot and ankle conditions, especially those with conditions such as diabetic foot disease, that are known to deteriorate with time, and patients from marginalised and remote demographics. International examples show that enabling access and removing funding exclusions improve service equity, alleviate surgical bottlenecks, and bring Australia in line with global best practice.

Background Haglund's syndrome, a common cause of pain in the posterior heel that consists of painful swelling of the local soft tissues and prominence of the posterosuperior calcaneal projection, presents significant challenges in treatment, particularly when conservative management fails. This study evaluates the functional outcomes following oblique partial excision of the posterosuperior portion (calcaneal tuberosity osteotomy) of the calcaneus for Haglund's syndrome. Methods A cohort of 30 patients, aged 18 years and older, with persistent heel pain unresponsive to conservative treatments, underwent partial osteotomy using a medial or lateral approach. Patients were assessed pre-operatively and post-operatively at six weeks, three months, and six months using the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Data were analyzed using descriptive statistics and the Friedman test to evaluate changes in AOFAS scores over time. Results The mean AOFAS score improved significantly from 55.17 pre-operatively to 79.27 at six months post-operatively. At six months, 16 (53.3%) participants had AOFAS scores between 80-89, indicating good functional outcomes, while 14 (46.7%) had scores between 70-79. The improvement in functional outcomes was statistically significant (p < 0.001). The study also found both lateral and medial surgical approaches yielded similar results. Conclusion Partial osteotomy of the calcaneal tuberosity is a safe and effective surgical intervention for Haglund's syndrome, leading to significant functional improvements. The use of AOFAS scoring provides a reliable assessment of outcomes, confirming the procedure's efficacy.

First metatarsophalangeal (MTP) joint fusion is a widely accepted surgical intervention for treating severe arthritis, deformities, and instability of the first MTP joint. This paper provides a review of a single surgeon's experience with continuous compression implants (CCI), which offer a notable advantage by providing uniform compression across a larger surface area of the fusion site compared to plate and screw constructs. This design potentially reduces soft tissue irritation and, consequently, the need for subsequent implant removal. It also saves on cost and has the potential to reduce the length of surgery.  A retrospective review was conducted on 27 patients (n=36 feet) who underwent primary first metatarsophalangeal joint (MTPJ) fusion using continuous compression implants (CCI) between March 2020 and April 2024 at Bradford Royal Infirmary. Patient data were collected from the surgeon's logbook and medical records. The outcomes analyzed included the fusion rate and complications. Statistical analysis was performed using SPSS version 22.0, with p<0.05 considered significant.  The mean age of the cohort was 60.24 years (range 41-90), with 88.88% female. The ratio of left to right was 70%. The mean follow-up duration was 27 months (range 6-48 months). Complete fusion of the first MTPJ was achieved in 34 out of 36 feet (94.4%). Nonunion occurred in one patient, while delayed union was observed in another. Clinically, 35 out of 36 patients (97.3%) reported satisfaction with the procedure, with one patient requiring metalwork removal and revision due to loosening. Early results show that the rate of fusion achieved by using the CCI for the first MTPJ arthrodesis in our series was comparable to that of other devices quoted in the literature.

Extraneural perineuriomas are rare, benign soft tissue tumors arising from perineurial cells, which form the protective lining of peripheral nerves. These tumors are infrequently encountered in the foot, posing diagnostic challenges due to their rarity and non-specific clinical presentation. Here, we describe the case of a 45-year-old woman, who had a swelling over the right foot dorsum for four years for which an excision biopsy was done. Her histopathological variant and immunohistochemistry were consistent with extraneural perineurioma. This article aims to present a comprehensive review of extraneural perineuriomas, focusing on a case study involving the foot, and to discuss the clinical and histopathological characteristics, differential diagnosis, treatment options, and prognosis of this uncommon entity.

Introduction The first tarsometatarsal joint (TMTJ) is often overlooked regarding foot pathology or a secondary measure in most studies, despite its heavy involvement in surgical procedures and foot stability. The primary aim of this study is to assess the effect of the first TMTJ morphology on the incidence of arthritis and post-operative complications following a Lapidus procedure. Materials and methods A total of 39 feet/subjects (19 left and 20 right) were assessed by two independent reviewers. The first TMTJ angle and articulating surface shape were measured, and relevant descriptive data was compiled. Statistical analysis was used to analyse variable outcomes via a logistical regression model and inter-rater reliability tests to determine the validity of the methods used.  Results A statistically significant relationship between first TMTJ angle and incidence of arthritis was revealed but not with articulating surface shape, or between either measure of first​​​​​​​ TMTJ morphology and post-operative complications. Inter-rater reliability tests showed a very strong correlation between inter-rater measurements.  Discussion The smaller the angle of the first​​​​​​​ TMTJ, the increased incidence of arthritis; therefore, it may be an early sign for clinicians to look for and implement prophylactic interventions sooner. Furthermore, it also signifies that conducting corrective surgeries at this joint will likely have a positive effect on decreasing arthritis pathology. The strong inter-rater reliability findings offer validity to the methods used in this study however can be improved using expert radiographers and AI software.  Conclusion The first​​​​​​​ TMTJ angle and shape of the articulating surface are both valuable predictors of the incidence of arthritis; however, this study cannot claim that they are good predictors for post-surgical complications. Further research is needed to address the limitations found in this study however it is a valuable initial step in identifying foot pathology early and initiating early management.

From my office window I saw this guy in a blue suit walk out of one of the dark clouds.

Background Venous leg ulcers (VLUs) are chronic, difficult-to-heal wounds caused by venous insufficiency that significantly impact patient quality of life. Current treatment options often include compression therapy, wound debridement, and advanced dressings. Advanced wound care products such as high-purity type I collagen-based skin substitutes (HPTCs) and dehydrated human amnion/chorion membrane (dHACM) have emerged as promising therapeutic options. This randomized, controlled clinical trial aimed to compare the clinical efficacy and healing outcomes of HPTC versus dHACM in the treatment of VLUs. Methodology This prospective, randomized, controlled study was conducted at a tertiary care hospital. A total of 60 patients with chronic VLUs were randomized into the following two groups: Group A received HPTC (n = 30), and Group B received dHACM (n = 30). Patient demographics, ulcer characteristics, pain scores, and healing rates were recorded over a six-week period. Percentage wound size reduction and vascular infiltration were primary outcomes. Time taken for complete healing, pain reduction, quality of life improvement, recurrence, scar quality, and adverse events were secondary outcomes. Results Complete wound closure was achieved in 70% (21/30) of HPTC-treated patients versus 43.3% (13/30) of dHACM-treated patients (p < 0.05). The mean time to complete healing was significantly shorter in the HPTC group (42.6 ± 9.8 days) compared to the dHACM group (46.2 ± 8.7 days, p = 0.047). The mean percentage wound closure at seven weeks was 78.9 ± 17.8 % for HPTC versus 65.4 ± 7.9 % for dHACM (p < 0.001). The comprehensive histopathological analysis at day five post-application provided statistically significant improvements in vascularity infiltration (46% increase), neo-epithelialization (64% increase in migration), fibroblast activity (45% increase), capillary density (65% increase), optimal inflammatory modulation (43% reduction in acute inflammation), and superior collagen deposition (49% increase) favoring HPTC. Pain scores showed significant improvement in both groups. Adverse events were minimal in both groups. The structural stability of the scars was better rated in the HPTC group. No significant difference in recurrence rate was observed. Conclusions HPTC demonstrated superior efficacy over dHACM in treating VLUs, with faster healing rates, higher closure percentages, pain reduction, and scar quality in VLUs, supporting its role as a preferred advanced skin substitute and as an effective treatment option for chronic VLUs.