Plantar fasciitis is a common condition characterized by inflammation and degeneration of the plantar fascia, leading to heel pain and reduced mobility. Affecting both athletic and non-athletic populations, it is a leading cause of foot-related medical visits. Conservative treatments, including rest, physical therapy, and corticosteroid injections, provide relief for most patients, but a subset experiences persistent symptoms requiring advanced therapies. Emerging biologic treatments, such as platelet-rich plasma (PRP) and mesenchymal stem/stromal cell (MSC) therapy, have demonstrated potential in promoting tissue regeneration and reducing inflammation. Recently, MSC-derived extracellular vesicles (MSC-EVs) have gained attention for their regenerative properties, offering a promising, cell-free therapeutic approach. EVs mediate tissue repair through immunomodulation, anti-inflammatory signaling, and extracellular matrix stabilization. Preclinical studies suggest that EV therapy may improve tendon and ligament healing by promoting M2 macrophage polarization, inhibiting excessive metalloproteinase activity, and enhancing vascular remodeling. This review explores the potential of MSC-EVs as an innovative, non-surgical treatment for plantar fasciitis, addressing their mechanisms of action and current evidence in musculoskeletal regeneration.

Background: Ankle fractures are a frequent injury in the adult population and a quarter of all ankle fractures are classified as unstable, requiring surgical intervention. Plate-and-screw construct is the traditionally used fixation method for fibula fractures. The use of an intramedullary nail is an alternative fixation method, with current literature supporting very low complication rates and hardware removal surgeries. The purpose of this study was to evaluate the outcomes, including complication rates and implant removal rates, using a fibula nail with both proximal and distal fixation capabilities by an experienced surgeon. Methods: We retrospectively reviewed 203 consecutive fibula nail cases from a single surgeon using a mini-open technique for anatomic reduction. Demographic, operative, clinical, and radiographic outcome data were analyzed, specifically examining complication rates and need for implant removal. Results: The average follow-up was 18.8 months (6-54 months). All fractures healed. We identified 2 cases of superficial wound infection, 1 superficial peroneal nerve irritation, and 1 case of implant removal. In the first 110 cases, 2 fractures were converted to a plate intraoperatively prior to a technique modification which has prevented this occurrence. No deep infection, delayed union, or nonunion occurred. Conclusion: Our data support that fibula nails with proximal and distal locking capabilities offer an alternative to plating with the potential for lower complication rates and lower need for implant removal. Level of evidence: Level IV, case series.

Background: The risk of symptomatic degeneration at the interphalangeal (IP) joint after arthrodesis of the hallux metatarsophalangeal (MTP) joint remains undetermined and is a common question from patients considering the procedure. This study investigated the rate of subsequent hallux IP joint fusion after first MTP joint arthrodesis. Methods: Patients who underwent hallux MTP joint arthrodesis were identified from a large national commercial insurance database (PearlDiver) by Current Procedural Terminology ( CPT ) code. Patients who underwent first IP fusion were also identified. To ensure continued enrollment of patients, the subset of patients with verified insurance claims in the database for all of the subsequent 10 years were analyzed. The Kaplan-Meier curve for survivorship free of subsequent IP fusion was generated covering 10 years from the index operation. Results: Of 15,771 patients with MPT joint arthrodesis active on the database to 10 years, 166 had IPJ fusion after MPT joint fusion. The risk of undergoing IP fusion within 10 years after a previous first MTP fusion was 1.052% (95% CI 0.9%-1.1%). The mean time between the 2 procedures was 4.0 years. Because CPT codes in the database were reported without laterality, a small subset of patients may have undergone subsequent contralateral IP fusion. Therefore, this result should be regarded as an upper limit of the estimated rate. Conclusion: The rate of subsequent hallux IP joint fusion of around 1% within 10 years after a first MTP joint fusion in this large database population highlights the durability of the clinical result of first MTP joint fusion and should reassure patients and surgeons considering the procedure.

Case: A 17-year-old adolescent boy complained of plantar pain at the first metatarsal 2 months after a catfish spine injury. Imaging was consistent with a retained foreign body, and surrounding osteolysis was concerning for osteomyelitis. He underwent surgical debridement and was found to have inflammation and necrosis, apparently caused by catfish spine venom. Conclusion: Although osteolytic lesions are commonly attributed to infection or tumor, in the situation of venomous injuries, osteolysis can be a sequela of the severe local inflammatory reaction due to the toxins. Debridement is vital to remove the offending agent and the local toxins from the venom.