Introduction: Plantar fasciitis is a common disease that requires a comprehensive and individual approach to treatment. Despite the widespread prevalence of this condition, the opinion on the etiology and treatment of plantar fasciitis is still extremely controversial. Today, there are quite a large number of scientific and practical publications confirming that functional shortening of the gastrocnemius muscle is the cause of a number of diseases of the foot and ankle. One of these pathologies is plantar fasciitis (PF), which can often develop secondarily as a result of disorders of the biomechanics of the foot, including as a result of functional shortening of the gastrocnemius muscle. This article presents an analysis of the results of using eccentric training of the gastrocnemius muscle in the treatment of recurrent plantar fasciitis.

Purpose: to analyze the clinical efficacy of eccentric training of the gastrocnemius muscle in the treatment of recurrent after conservative treatment plantar fasciitis.

Materials and Methods: We prospectively reviewed the results of eccentric training of the gastrocnemius muscle in 102 patients (128 feet) with diagnosed plantar fasciitis recurring after at least one year of conservative treatment. Patients were divided into 2 groups depending on the results of the Silfverskiold test: group 1 - patients with a positive Silfverskiold test (77 patients; 97 feet), group 2 - patients with a negative Silfverskiold test (25 patients; 31 feet). The diagnosis of plantar fasciitis was confirmed instrumentally using MRI and ultrasound. The training period was 12 weeks. The average follow-up period was 20 months (6-24) from the end of training. At the control examination, the volume of dorsiflexion of the foot and subjective assessment of the patients' condition were assessed using the SF-36 and AOFAS scales. Pain syndrome was assessed using the VAS scale.

Results: In both groups, statistically significant increase in the volume of dorsiflexion of the foot and improvement in the condition according to the results of the questionnaires for assessing the quality of life (SF-36), AOFAS and VAS scale were noted at the end of the training cycle and in the long-term period. However, in group 1 (patients with a positive Silfverskiold test), the positive dynamics were more statistically significant than in group 2 (patients with a negative Silfverskiold test).

In some patients (11 patients, 19 feet: 9 patients (15 feet) - in group 1; 3 patients (4 feet) - in group 2) at the end of the training course, a slight decrease in pain syndrome was noted, in connection with which these patients underwent surgical intervention: proximal release of the medial head of the gastrocnemius muscle was performed in 10 patients (18 feet). One patient (2 feet) with a significant limitation of dorsiflexion of the foot, which persisted after the end of the course of eccentric training of the gastrocnemius muscle, and a negative Silveskold test underwent lengthening of the gastrocnemius-soleus complex according to Strayer.

Discussion: Plantar fasciitis in the majority of cases correlates with functional shortening of the gastrocnemius muscle. Today there is a wide choice of conservative methods for treating plantar fasciitis in orthopedic practice. Surgical intervention should be considered in case of ineffectiveness of conservative treatment. In patients with clinically and instrumentally confirmed diagnosis of plantar fasciitis, recurring after conservative treatment, in the absence of other causes of heel pain and with clinically confirmed presence of isolated functional shortening of the gastrocnemius muscle, eccentric training of the gastrocnemius muscle is highly effective and can be considered an additional stage of conservative treatment before making a decision on surgical intervention and a mandatory component of postoperative rehabilitation.

Background: Hygroma is the most common tumor–like formation of the hand in children. Hygromas are distinguished by a variety of names (ganglion, synovial cyst, synovioma, bursitis), the lack of common views on etiopathogenesis and treatment, the frequency of relapses and disappearance without treatment. Currently, there are many ways to treat hygroma, which can be divided into two large groups: radical surgical and gentle surgical methods of treatment.

Aims: - compare the results of treatment of wrist joint hygromia in pediatric patients with radical and minimally invasive methods of treatment according to literature data and our own observations.

Methods. For the period 2020-2025, a study was performed based on the analysis of the treatment results of 137 patients with wrist joint hygroma aged 7 to 17 years. All patients were divided into two groups. In the first group (n= 90), a minimally invasive treatment method was used: puncture of the hygroma with extraction of the contents, administration of a sclerosing drug (70% alcohol, exposure – 1 min). Patients of group 2 (n=47) underwent radical surgical treatment with resection of the main cyst, cyst pedicle and cuff adjacent to the joint capsule. Treatment results were monitored after one, 14 and 30 days, and long–term results were monitored after a year in all operated patients.

Results. In the first group, the median DASH score decreased over the year from 37 points (before treatment) to 1 point, and the pain intensity index for VAS decreased from 67 points before treatment to 2 points. The second group also showed positive dynamics, but less pronounced than in the first group. In patients of this group, the DASH score decreased from 39 points before treatment to 21 points after treatment, and on the VAS scale from 68 to 7 points. Statistically significant differences in treatment results between the groups were revealed (p < 0.001). In the 1st group of children with the use of minimally invasive treatment, the recurrence rate was 3% at the follow-up period of 1 year, in the 2nd group, relapses were observed three times more often – 5%.

Conclusions. Thus, a minimally invasive puncture method for the treatment of wrist joint Gyro in children can prevent the development of persistent hand dysfunction, the formation of contractures and ankylosis, prevent the development of relapses, the occurrence of persistent pain syndrome and recurrence of the disease.

Summary. One of the most frequently performed and effective operations is total arthroplasty, but obesity is one of the most common comorbidities, so the effectiveness of conservative treatment of morbid obesity in patients with coxarthrosis remains relevant and insufficiently studied.

Purpose of the study: the effectiveness of obesity treatment in patients with coxarthrosis, to determine the dynamics of pain syndrome and the functional state of the patient depending on weight loss.

Materials and methods. A prospective cohort single-center study was conducted in the clinic for 10 years, 236 patients with morbid obesity were examined: 69 (29.2%) men and 167 (70.8%) women, the average age was 64.0 ± 7.1 years and BMI 43.8 ± 2.8 kg / m² . Conservative treatment of obesity was carried out and, in addition to weight indicators, pain syndrome and the functional state of the patient according to the Harris scale were examined.

Results. The study showed that treatment of morbid obesity in 20.8% of patients with coxarthrosis is ineffective, in other cases the dynamics of weight loss and BMI show the greatest decrease by 9 months of treatment, but only 21.8% of patients in terms of BMI go beyond the limits of morbid obesity, that is, their BMI becomes less than 40 kg / m² , during the same observation period, pain syndrome and functional indicators are the best throughout the study, and by 12 months of observation they almost return to the initial level.

Conclusion: Conservative treatment of morbid obesity in patients with coxarthrosis is effective in 23.7% of patients, in the rest, weight loss did not lead to a decrease in the stage of obesity, but the most pronounced effect (BMI 38.7±3.9 kg/ m² – 13.0%) was observed 9 months after the start of treatment.

Introduction: treatment of periprosthetic joint infection (PJI) with functioning sinus tract is characterized by a high failure rate. Local antimicrobial therapy could be considered as a possible perspective method to improve the rates of infection eradication in this category of patients.

Materials and methods: the study included 46 patients with a fistulous form of knee PJI who were admitted for two-stage reimplantation to the clinic of the Vreden National Medical Research Centre for Traumatology and Orthopedics for the period 2014-2018 (retrospective group, n=30) and 2020-2022 (prospective group, n=16). The following parameters were analyzed: basic laboratory tests, microbiology findings, intraoperative parameters, the effectiveness of infection eradication at the stages of treatment.

Results: there was no significant difference in laboratory parameters and the pathogen structure in comparison groups. Attention is drawn to the significantly shorter operation time, the volume of blood loss and blood loss speed in the prospective group of patients. Eradication of infection after the first stage was achieved in 87,5% of patients of the prospective group and in 76,7% of patients of the retrospective group. The effectiveness of the second stage in the prospective group was 92,7%, in the retrospective group – 78.3%. As a result, the overall effectiveness of two-stage treatment in patients of the prospective group was significantly higher (p < 0,05) than in patients of the comparison group: 81,2% and 64,3%, respectively.

Conclusions: The proposed method of local antibacterial therapy allowed to increase the effectiveness of two-stage treatment of the fistulous form of PJI by reducing the proportion of recurrent infections from 35,7% in the retrospective group to 18,8% in the prospective cohort. Obtained result allows us to recommend the proposed regimen for wider clinical use, however, prospective randomized controlled trials are necessary to recommend it as a routine treatment algorithm.

Relevance. Being a fairly successful operation knee replacement does not always meet the expectations of patients. Significant parts of them have restrictions on some important types of daily activities. Increasing the degree of satisfaction determines the relevance of this publication.

The aim of the study. To improve patient satisfaction rates after knee replacement by recreating natural biomechanics.

Materials and methods. The hypothesis of the importance of surgical access and surgical techniques for restoring function formed the basis of the study. The study included 164 patients with grade III-IV Kellgren-Lawrence osteoarthritis who underwent total knee replacement with cruciate retaining implant (Triathlon). All patients were divided into two clinical groups. The first group included 85 patients (51.8%) who underwent TKA with a traditional mechanical alignment technique. The second group consisted of 79 patients (48.2%) who underwent surgery according to the protocol we developed, which included the principles of kinematic alignment and the technique of arthroplasty while preserving the extensor apparatus and ligament attachment sites. We conducted a comparative assessment of the postoperative functional results of various knee arthroplasty techniques.

Results. The analysis of the results on the OKS, WOMAK, and KSS scales determined superior indicators in the main group, especially in the early stages of postoperative follow-up. Although with an increase in the period of postoperative follow-up, the advantage of the main group of patients according to traditional scales was gradually lost. However, the FJS-12 scale significantly showed greater satisfaction in the main group.

Conclusion. Restoration of the natural biomechanics of the knee joint is the key to patient satisfaction after arthroplasty. The basis of this reconstruction is the preservation of the kinematic axes of knee joint movements and the normal relationships of soft-tissue structures.

Introdction: Pathological changes of the patellofemoral joint (PFJ) of traumatic nature occur mainly in non-disabled people of young and middle age groups, leading an active lifestyle, as well as in athletes and military personnel, which has an undeniable social significance.

Posttraumatic arthritis of the patellofemoral joint arising as a result of patellar fracture are quite common. According to some researchers, the incidence of posttraumatic arthritis of the patellofemoral joint varies from 7.1 to 35.9%. The greatest number of fractures of this region falls on its inner part. Recent studies show that stable fixation of bone fragments is achieved through metal osteosynthesis of the patella. Such operations may provoke earlier functional wear of the joint.

Various diagnostic methods such as X-ray radiography and standard CT scanning provide insufficient insight into patellofemoral osteoarthritis. The introduction of dynamic CT will allow a more accurate assessment of anatomical features and biomechanics in the patellofemoral joint, which will improve the results of treatment of patients with this pathology.

Purpose of the study: To improve the diagnosis of posttraumatic arthritis of the patellofemoral joint in patients who underwent osteosynthesis of the patella after its closed fracture by using dynamic CT examination.

Materials and Methods: This study describes the results of 74 (100%) patients, including 41 (55.4%) males and 33 (44.6%) females aged 20 to 70 years(M±s50.7±13.3 years) with a history of patellar fracture with subsequent osteosynthesis, who underwent physical examination, dynamic CT examination of the knee joint between 2000 and 2018. All patients were questioned by VAS scale (10 scores), KOOS scale, assessment of lateral hyperextension and horizontal instability of the of the patella was assessed.

Results: An analysis of the obtained data. VAS scale result (M±s)in all patients was 5.3±2.0. The total score on the KOOS scale (M±s) in all patients amounted to 36,94±3,8. According to the results of dynamic CT examination revealed that 39 (52.7%) patients had signs of lateral facet hypercompression. hypercompression of the lateral facet of the patella (narrowing of the articular gap < 3 mm), at 20 (27%) of patients - instability of the patella (TT-TG index value greater than 15 mm).

Conclusion: According to the data of the study in the period (12.5±5.5) after patellar trauma and osteosynthesis in 48.6% of patients have pathology of the patellofemoral joint is revealed in the form of lateral hypercompression of the patella (52.7%) and patellar instability (27%), which are accompanied by pain (on VAS scale more than 6 points) and knee joint dysfunction (on KOOS scale less than 25 points).

Introduction. Osteolysis caused by polyethylene wear debris remains a leading cause of revision total hip arthroplasty, particularly in young and active patients.

Purpose of the study - to present a clinical case of a successful long-term (28 years) total hip arthroplasty performed on a 27-year-old patient. The key factors for the success of the primary endoprosthesis were the correct positioning of the components and the use of a ceramic-cross-linked polyethylene friction couple. In addition, an algorithm for revision interventions for inlay wear and periprosthetic osteolysis is presented.

Materials and Methods. A 55-year-old male patient came to the clinic with complaints of pain in the area of the right hip joint, which increased with loading. From the anamnesis it is known that in 1996, at the age of 27, the patient underwent primary total hip replacement of the right hip joint for aseptic necrosis of the femoral head. At the follow-up examination, the patient was found to have pain syndrome. The Harris scale score was 45 points. Radiographs and CT scans showed signs of head decentration in the acetabulum and extensive zones of periacetabular osteolysis.

Results. One year after surgery, the patient walks without a limp, assessing the result of the revision treatment as excellent. The amplitude of passive movements: extension/flexion 5°/0°/120°, abduction/adduction 30°/0°/30°, external/internal rotation 30°/0°/30°. The functional assessment of the joint according to the Harris scale was 90 points. On control radiographs, the position of the endoprosthesis components was correct, the periacetabular osteolytic defect was filled with allogenic bone.

Conclusions. This case highlights the importance of accurate component positioning and optimal bearing couple selection for achieving long-term success in total hip arthroplasty. Isolated replacement of modular components with bone grafting of an osteolytic defect may be a justifiable choice of surgical management for inlay wear and osteolysis, provided the components are stable in fixation

Purpose of the study: to examine the available data on spring-ligament and its role in the development of flatfoot deformity

Materials and methods: An analysis of various medical literature sources containing data from both original and external studies on the diagnosis and treatment of ligamentous injuries in flatfoot deformity was conducted. Electronic medical and general scientific databases were used as sources: PubMed, ScienceDirect, eLIBRARY. A total of 74 scientific works were found based on the query: spring ligament, spring complex, adult acquired flatfoot deformity, progressive collapsing foot deformity, пружинная связка, плосковальгусная деформация стопы. For the literature review, 29 sources were selected. The time interval of the analyzed literature is from 1988 to 2025.

Results: The conducted study demonstrates that in recent decades, there has been a noticeable shift in focus from the importance of the posterior tibial tendon to the functioning of the ligamentous apparatus in the development of flatfoot deformity. Nevertheless, the primary method of correcting the deformity remains the performance of various types of osteotomies and arthrodesis, combined with or without soft tissue reconstruction. However, according to both clinical and anatomical studies, the reconstruction of the spring complex allows for significant correction of the deformity; however, long-term studies are lacking. The main questions that remain poorly studied at this time are the optimal timing and methodology for the reconstruction of the ligamentous apparatus of the foot.

Introduction: In recent years, modern literature has focused more and more attention on congenital skeletal defects. One of the most common malformations is fibular hemimelia (FH). This anomaly includes the complete or partial absence of the fibula, as well as the presence of a fibular cord. Foot deformity is a leading problem and requires complex orthopedic reconstructions. Due to the increase in the number of patients, the severity of deformities, and the lack of a unified approach to the treatment of FH, we decided to consider the main modern aspects of classifying, treating, and predicting the life of a patient with congenital fibular hemimelia (FH).

Objective: to study the experience of modern approaches and concepts in diagnosis and treatment, as well as in predicting outcomes in the treatment of patients with fibular hemimelia.

Materials and methods: our work examined the analysis of literature data based on such search engines as PubMed, Google Scholar, Elibrary, Cyberleninka in the period from 1982 to 2024, we also reviewed scientific papers and monographs. From the sample obtained, the material corresponding to the stated research topic was selected (the full list of articles used is presented in the list of references). Describing the etiology, pathogenesis and development of FH, methods of its diagnosis and treatment depending on the severity of the deformity.

Results: To improve the quality of life of patients with FH, orthopedists need to unify approaches to the diagnosis and surgical treatment of these patients.