Diabetic foot ulcers (DFUs) are among the most serious complications of diabetes and are a source of reduced quality of life and financial burden for the people involved. For effective DFU management, an evidence-based treatment strategy that considers the patient's clinical context and wound condition is required. This treatment strategy should include conventional practices (surgical debridement, antibiotics, vascular assessment, offloading, and amputation) coordinated by interdisciplinary DFU experts. In addition, several adjuvant therapies can be considered for nonhealing wounds. In this narrative review, we aim to highlight the current trends in DFU management and review the up-to-date guidelines.

Since its introduction, weight-bearing computed tomography (WBCT) has gained prominence due to its ability to produce accurate three-dimensional images under natural loading conditions, making it particularly useful for assessing complex foot deformities. This review aimed to focus on the diseases of the foot and categorized the pathological conditions into forefoot disease (hallux valgus), midfoot disease (Lisfranc injuries and midfoot osteoarthritis), and progressive collapsing foot deformity. For each category, the authors detail how WBCT enhances diagnostic accuracy and informs treatment strategies. In hallux valgus, WBCT allows for more precise measurement of established parameters and reveals crucial information about metatarsal pronation and ray instability. For midfoot pathologies, WBCT’s superiority in detecting subtle Lisfranc injuries and characterizing midfoot osteoarthritis is emphasized, highlighting the development of novel measurement techniques. The review extensively covers the application of WBCT in assessing the complex three-dimensional features of PCFD, including hindfoot valgus, midfoot/forefoot abduction, medial column instability, peritalar subluxation, and valgus tilting, presenting several WBCT-specific measurements and the use of distance mapping to quantify joint surface interaction. The authors conclude that WBCT, potentially enhanced through integration with artificial intelligence (AI), represents a significant advancement in foot and ankle care, promising improved diagnostic accuracy, streamlined treatment planning, and, ultimately, better patient outcomes.

Background/Objectives: Hindfoot valgus malalignment, characterized by the lateral deviation of the calcaneus and medial tilting of the talus, disrupts hindfoot biomechanics and increases strain on subtalar joint. This study evaluates weightbearing and non-weightbearing imaging modalities to identify dynamic alignment changes and their diagnostic implications. This study aims to (1) quantify changes in subtalar joint parameters between non-weightbearing computed tomography (NWBCT) and weightbearing computed tomography (WBCT) in patients with hindfoot valgus; (2) evaluate correlations between WBCT and standard radiographic parameters; and (3) identify radiographic predictors of subtalar joint status during weightbearing. Methods: We reviewed 70 patients with confirmed hindfoot valgus malalignment (hindfoot valgus angle >5°), identified through radiographic measurements. Of these, 32 underwent both NWBCT and WBCT, while 38 underwent WBCT alone. Hindfoot alignment angle (HAA) and hindfoot alignment ratio (HAR) were measured on hindfoot alignment radiographs, while heel valgus angle (HVA), talocalcaneal distance (TCD), subtalar joint subluxation (SL) and calcaneofibular distance (CF) were assessed on CT. Results: WBCT revealed significant increases in HVA and SL (both, p < 0.001) and decreases in TCD and CF (p < 0.001 and p = 0.002, respectively) compared to NWBCT, reflecting dynamic subtalar joint changes under weightbearing conditions. Receiver operating characteristic (ROC) analysis identified hindfoot alignment angle (HAA) as the most reliable predictor of talocalcaneal osseous contact, with a cutoff value of >9.25° based on Youden’s index, yielding a sensitivity of 73% and specificity of 81.8%. Inter- and intra-observer reliabilities for all parameters were excellent (ICC > 0.81). Conclusions: WBCT provides critical insights into subtalar joint dynamics under physiological loads, surpassing NWBCT in assessing weightbearing-induced alignment changes. Although standard radiographic parameters, particularly HAA, can serve as reliable, cost-effective predictors of subtalar joint pathology in resource-limited settings, WBCT should still be preferred when available, especially in patients with significant malalignment or when detailed dynamic evaluation is needed to guide clinical decision-making.

Otgonsaikhan Nomkhondorj, Jaeho Cho. JKFAS 2025;29:121-4. https://doi.org/10.14193/jkfas.2025.29.3.121

Otgonsaikhan Nomkhondorj, Jaeho Cho. JKFAS 2025;29:9-15. https://doi.org/10.14193/jkfas.2025.29.1.9

Background/Objectives: The peroneus quartus (PQ) is an accessory musculotendinous structure of the lateral leg with variable origin and distal attachment. Although its anatomy has been described in cadaveric and imaging studies, the morphologic patterns encountered on routine ankle MRI remain clinically relevant. This study aimed to characterize MRI-visible PQ morphology in a Korean clinical cohort and to compare the observed patterns with previously reported anatomical variants. An illustrative surgically treated case was also reviewed. Methods: Three hundred ankle MRI examinations obtained between February 2020 and February 2024 were reviewed. After exclusion of 33 examinations in which the peroneal compartment could not be reliably assessed, 267 unique patients were included. Two readers independently evaluated PQ presence and distal attachment using predefined MRI criteria. Interobserver agreement was assessed with Cohen’s kappa. The surgically treated case was reviewed separately as an illustrative clinical correlation. Results: A PQ was identified in 41 of 267 ankles (15.4%; 95% CI, 11.5–20.2%). The proximal origin was directly visualized in 32 PQ-positive examinations, arising from the peroneus brevis in 19 and the distal fibula in 13; in nine examinations, the origin was outside the MRI field of view. Thirty-five PQs (85.4%) inserted into the retrotrochlear calcaneal region, whereas six (14.6%) joined the peroneus longus tendon distally. Interobserver agreement was complete for both PQ detection and distal attachment classification (κ = 1.00). In the illustrative case, a symptomatic ganglion was associated with an operatively confirmed degenerative PQ tendon tear. Conclusions: The PQ was identified in 15.4% of ankle MRIs in this selected Korean clinical cohort and showed two predominant MRI-visible distal attachment patterns. Most inserted into the retrotrochlear calcaneal region, whereas a smaller proportion joined the peroneus longus tendon. These findings describe MRI-visible anatomy rather than the full anatomical spectrum. The surgical case further illustrates that symptomatic pathology may involve the PQ tendon and its adjacent sheath.