Objectives: Ankle sprains represent the second most common cause of emergency department access for musculoskeletal injury and lateral ankle ligament complex tears account for 850,000 cases annually in the United States with a relapse rate of 70%. Clinical examination is limited due to its subjectivity and the difficulty of identifying a specific involvement of the ligament; therefore, US and MRI are frequently requested. Therefore, the goal of this study is to analyze the available literature on the use of ultrasound (US) and magnetic resonance imaging (MRI) to diagnose injuries to the anterior talofibular ligament (ATFL) with a meta-analytic approach. Methods: According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, all studies regarding the diagnostic accuracy of ultrasound and magnetic resonance imaging ATFL injuries were searched and assessed. The data were obtained from two independent reviewers with 12 and 3 years of experience in meta-analysis. A QUADAS-2 (Quality Assessment of Studies of Diagnostic Accuracy Studies) checklist was carried out to assess the risk of biases. From the selected studies, the sensitivity, specificity, and accuracy data were extracted. Results: Nine studies were included. The results of the meta-analysis demonstrate a greater sensitivity for ultrasound [96.88 (95% CI: 94–99) (fixed effects); 97 (95% CI: 94–99) (random effects)] compared to MRI [88.50 (95% CI: 85–91) (fixed effects); 86.98 (95% CI: 77–94) (random effects)], p < 0.05. The result of this meta-analysis shows that the less expensive diagnostic technique is also the most sensitive for the diagnosis of ATFL tears. Ultrasound articles resulted to have non-heterogeneity [(p = 0.2816; I° = 21.4607%)]. Conclusion: This meta-analysis demonstrates that US appears to be a highly sensitive diagnostic technique for diagnosing tears of the ATFL. Compared to MRI, the sensitivity of US result was higher.

Hallux rigidus (HR) is the clinical manifestation of osteoarthritis of the first metatarsophalangeal (MTP1) joint and affects about 2.5% of people older than 50 years. The condition may significantly impact patients’ quality of life, leading to debilitating pain and limited range of motion (ROM). Numerous hypotheses have been postulated about contributing factors to the development of the disease, but with poor proven association. Some types of footwear over others may transmit altered pressure and stress toward the forefoot and this can significantly contribute to development of the condition. The purpose of this review is therefore to analyze the importance of correct footwear and if an incorrect shoe can influence the development and/or worsening of symptoms in patients affected by HR. From the results of the studies, it appears that symptoms improve with rigid-soled low-heeled shoes such as boots and worsen with flat flexible-soled shoes such as sandals and tennis shoes, which should therefore be avoided. Despite this, although incorrect footwear increases symptoms, a direct correlation with the development of the condition has not been detected but rather an improvement in comfort in some types of shoes than in others. In predisposed patients, incorrect footwear is more a way to increase symptoms than a real risk factor for the development of the disease, remaining in a very low risk percentage to be considered indicative. (www.actabiomedica.it)

Civinini Morton's Syndrome (CMS), better known as Morton's Neuroma, is a benign enlargement that typically affects the third common digital branch of the plantar nerve. It is a common cause of metatarsalgia leading to debilitating pain. It prefers the female gender, with a female to male ratio of 5:1 and an average age of 50 years at time of surgery. Precise aetiology remains under debate, with four etiopathogenetic theories often cited in the literature. Clinical symptoms, physical exam and instrumental evidence are important in assessing and grading the disease. Biomechanics seem to play an important role, especially regarding the usefulness of correct footwear. The first approach in the early stages of this condition usually begins with shoe modifications and orthotics, designed to limit the nerve compression. In order to prevent or delay the development of CMS, shoes should be sufficiently long, comfortable, broad toe-boxed, should bear a flat heel and a sufficiently thick external sole which should not be excessively flexible. Most authors suggested that an insole with medial arch support and a retrocapital bar or pad, just proximal to the metatarsal heads, displaces the pressure sites and can be beneficial to relieve the pain from the pinched nerve. A threshold period of 4.5 months appears to emerge from the results of the analysed studies, indicating that, beyond this period and in neuromas larger than 5-6 mm, orthotics and/or shoes modifications do not seem to give convincing results, proving to be more a palliation for the clinical condition to allow an acceptable life with pain rather than a real treatment.