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.

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.

Extensor muscle strengthening exercise (EMSE) and extracorporeal shockwave therapy (ESWT) are established treatments for chronic lateral epicondylitis (LE) of the elbow. Polydeoxyribonucleotide (PDRN) is also a regenerative option, yet their combined synergistic efficacy remains unclear. This randomized controlled trial investigates the synergistic effect of PDRN combined with EMSE and ESWT. Forty-eight patients with chronic LE were randomly allocated to receive EMSE and ESWT plus either a 3 mL saline (Group 1) or a 3 mL PDRN (5.625 mg/3 mL) injection at the common extensor tendon origin (Group 2). Functional outcomes, including visual analog scale of pain, Mayo elbow performance score (MEPS), and hand grip strength index (HGSI), along with ultrasonographic findings, were evaluated at baseline, 6, and 12 weeks. Both groups demonstrated overall post-treatment improvements. However, at 6 weeks, Group 2 exhibited significantly greater increases in MEPS ( p = 0.002) and common extensor tendon depth (CETD, p = 0.003), alongside a greater decrease in color Doppler activity ( p = 0.001) than Group 1. At 12 weeks, Group 2 maintained significantly superior improvements in CETD ( p = 0.008) and HGSI ( p = 0.035). These findings highlight the potential of PDRN as an effective adjunctive therapy to enhance the clinical and structural outcomes of EMSE and ESWT in chronic LE. Registry : ClinicalTrials.gov, TRN: NCT06753630, Registration date: 02/12/2024.