Diabetic foot osteomyelitis (DFO) is a severe complication of diabetes mellitus and a leading cause of non-traumatic lower extremity amputation. Treatment remains clinically challenging with high recurrence rates despite standard antibiotic therapy and surgical debridement. This narrative review synthesizes current evidence on novel operative and nonoperative therapies for DFO, focusing on emerging biomaterials, local antibiotic delivery systems, innovative surgical techniques, and adjunctive topical agents. Studies examining bioabsorbable and nonabsorbable antibiotic carriers, such as calcium sulfate beads, collagen sponges, and bioactive glass, demonstrate promising infection resolution rates and a potential to reduce the surgical burden, though most are limited by small cohorts and observational designs. Similarly, alternative surgical approaches (i.e., cancelloplasty, conservative bone excision, and tibial cortex distraction) have shown early success in limb preservation. Nonoperative strategies, including adjunct antimicrobials, antimicrobial peptides, and topical oxygen, offer additional options, particularly for patients unfit for surgery. While initial outcomes are encouraging, the supporting evidence is heterogeneous and primarily limited to case series and small, noncomparative trials. Overall, these novel therapies show potential as adjuncts to established DFO management, but further prospective research is indicated to define their long-term efficacy, safety, and role in clinical practice.

Background: Flatfoot deformity is associated with altered lower extremity biomechanics and functional impairment during gait. However, evidence describing spatio-temporal gait alterations remains heterogeneous and has not been consistently synthesized across studies. Methods: A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (via PubMed) and Scopus were searched through 24 March 2025 for studies evaluating gait characteristics in individuals with flatfoot or progressive collapsing foot deformity. Studies reporting spatio-temporal parameters in both flatfoot and healthy control cohorts were included in quantitative synthesis. Random-effects meta-analyses were performed to evaluate gait velocity, stance duration, stride length, and cadence. Results: Fifteen studies met inclusion criteria, of which five provided sufficient data for meta-analysis. Compared with healthy controls, individuals with flatfoot demonstrated longer stance duration and shorter stride length. No differences were observed in gait velocity or cadence. Substantial heterogeneity was present across all pooled outcomes (I² > 80%), reflecting variability in study populations, disease characteristics, and gait analysis methodologies. Conclusions: Flatfoot is associated with consistent spatio-temporal gait adaptations characterized by longer stance duration and reduced stride length. Despite heterogeneity among included studies, these findings suggest consistent spatio-temporal gait adaptations that may serve as clinically relevant markers of altered gait mechanics and functional impairment. Further studies with standardized protocols are needed to refine the role of gait analysis in the assessment and management of flatfoot.

A majority of patients with brachial plexus injuries (BPIs) develop neuropathic pain, which is not consistently resolved by medications or surgery. Peripheral nerve stimulation (PNS) shows promise as a supplemental treatment for BPI-associated pain, but comprehensive reviews analyzing its efficacy are limited. Therefore, this study aimed to summarize existing literature on the efficacy of PNS for treating BPI-associated neuropathic pain. A systematic literature search was performed in PubMed, Embase, and Web of Science, querying articles assessing PNS for treatment of neuropathic pain in adults with BPIs. Descriptive statistics and narrative syntheses summarized study characteristics, demographic and clinical data, and pain-related outcomes. Of 409 articles from the initial search, 9 met inclusion criteria. In 8 studies (88.9%), PNS was clinically effective in pain reduction. Of these, 5 (62.5%) used percutaneous electrode placement, 2 (25.0%) used open implantation, and 1 (12.5%) used transcutaneous stimulation. Peripheral nerve stimulation demonstrated pain-reduction capabilities in both preganglionic and postganglionic BPIs. These early findings show promise for PNS for treating refractory pain in patients with limited therapeutic options. Still, PNS for treating BPI-associated pain is an evolving and understudied field. Continued research is needed to better assess its indications, efficacy, and optimal settings to create a personalized pain-management approach.

Deep tissue infection is a serious complication following operative fixation of pilon fractures, yet the influence of intraoperative factors and microbial characteristics remains underexplored. In this retrospective review of 123 patients treated with open reduction and internal fixation, we evaluated demographic, injury-related, operative, and microbiologic variables associated with deep infection. Patients who developed infection had longer operative times than those who did not. This modestly powered study found that operative duration was not independently associated with infection risk after adjustment for key covariates. Larger studies are needed to confirm this finding. Deep infection rates did not differ by surgical approach or time to fixation. Nine patients (7.3%) developed deep infection, with cultures demonstrating a heterogeneous microbial profile most commonly including Pseudomonas aeruginosa, Enterococcus faecalis, Staphylococcus aureus, and Enterobacter cloacae. Deep infections resulted in nonunion in 67% (6/9), PTOA in 44% (4/9), and amputation in 33% (3/9) of cases.