Background: Haglund syndrome is a common disease that causes posterior heel pain. This study compared the clinical outcomes of dorsal closing wedge calcaneal osteotomy (DCWCO) and posterosuperior prominence resection (PPR) for the treatment of Haglund syndrome. Methods: This retrospective study included 12 patients who underwent DCWCO and 32 patients who underwent PPR from January 2010 to August 2016. Patients were evaluated using the American Orthopedic Foot Ankle Society ankle-hindfoot scale (AOFAS), Victorian Institute of Sport Assessment Scale for Achilles tendinopathy (VISA-A), Fowler-Philip angle, Bohler's angle, and calcaneal pitch angle preoperatively and postoperatively (at 3 months, 6 months, 1 year, and the latest follow-up). Results: Both groups exhibited a significant increase in their AOFAS and VISA-A scores after surgery. The DCWCO group had lower AOFAS scores than the PPR group at 6 months (77.6 ± 5.1 vs. 82.8 ± 7.8; P = 0.037) but had higher scores at the latest follow-up (98.2 ± 2.3 vs. 93.4 ± 6.1; P = 0.030). The DCWCO group had lower VISA-A scores at 3 months (56.9 ± 13.9 vs. 65.2 ± 11.0; P = 0.044) but higher scores at the latest follow-up (98.2 ± 2.6 vs. 94.3 ± 5.0; P = 0.010) than the PPR group. Both groups exhibited significant changes in the Fowler-Philip angle and Bohler's angle after surgery. The postoperative Fowler-Philip angle of the DCWCO group was greater than that of the PPR group (35.9°± 4.9°vs. 31.4°± 6.2°; P = 0.026). However, there was no statistically significant difference in any other angle of the two groups postoperatively. Conclusions: Compared to the PPR group, the DCWCO group had poorer short-term clinical outcomes but provide better long-term function and symptom remission. This method can be a good option for those patients with higher functional expectations.

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Back ground：A three-dimensional finite element model of the whole foot with high geometric similarity was established and used to simulate the conditions after whole talar prosthesis implantation with several fixation methods, including Screw fixation of subtalar+talus-navicular joint, fixation with screws at only the subtalar joint, and fixation without screws. The biomechanical characteristics of the talus prosthesis were assessed in different gait phases to guide the selection of surgical methods in clinical practice.Methods：With the three-dimensional CT data of a volunteer's foot, Mimics13.0 and Geomagic10.0 software were used to carry out geometric reconstruction of the ankle-related tissues, and Hypermesh10.0 software was used for grid division and material attribute selection. Finally, the data were imported into Abaqus 6.9, and the simulated screw data were applied to different models. Finite element models with different fixation methods were simulated, and the stresses exerted by the human body in three gait phases (heel-strike, midstance and push-off) were simulated. The pressure changes in the articular surface around the talus or the prosthesis, the micromotion of the talus and the prosthesis and ankle motion were measured. Results：Finite element analysis on the biomechanical mechanism showed that screw fixation of the prosthesis in different gait phases mainly increases the pressure on the tibialis articular surface as well as decreases the pressure on the fused articular surface and joint micromotion, which hinders ankle motion. The indicator values were nearly the same in the models of fixation without screws and the normal state.Conclusion：The 3D finite element model created in this study has been verified to be an accurate and reliable model. The biomechanical mechanism varies by fixation method according to finite element analysis. Fixation of the prosthesis without screws yields values most similar to normal values.

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AimsMechanical stimulation is a key factor in the development and healing of tendon-bone insertion. Treadmill training is an important rehabilitation treatment. This study aims to investigate the benefits of treadmill training initiated on postoperative day 7 for tendon-bone insertion healing.MethodsA tendon-bone insertion injury healing model was established in 92 C57BL/6 male mice. All mice were divided into control and training groups by random digital table method. The control group mice had full free activity in the cage, and the training group mice started the treadmill training on postoperative day 7. The quality of tendon-bone insertion healing was evaluated by histology, immunohistochemistry, reverse transcription quantitative polymerase chain reaction, Western blotting, micro-CT, micro-MRI, open field tests, and CatWalk gait and biomechanical assessments.ResultsOur results showed a significantly higher tendon-bone insertion histomorphological score in the training group, and the messenger RNA and protein expression levels of type II collagen (COL2A1), SOX9, and type X collagen (COL10A1) were significantly elevated. Additionally, tendon-bone insertion resulted in less scar hyperplasia after treadmill training, the bone mineral density (BMD) and bone volume/tissue volume (BV/TV) were significantly improved, and the force required to induce failure became stronger in the training group. Functionally, the motor ability, limb stride length, and stride frequency of mice with tendon-bone insertion injuries were significantly improved in the training group compared with the control group.ConclusionTreadmill training initiated on postoperative day 7 is beneficial to tendon-bone insertion healing, promoting biomechanical strength and motor function. Our findings are expected to guide clinical rehabilitation training programmes.Cite this article: Bone Joint Res 2023;12(5):339–351.

Twenty-one young asthmatics, 2-6 years of age (mean 4 years), were given an open trial of salbutamol syrup to assess its safety. Each patient was given 1 mg, then 2 mg, q8h for two weeks. Only one patient experienced side-effects and this was at the 2 mg dose. It is concluded that salbutamol syrup is safe at a dose of 1 to 2 mg q8h for the asthmatic children in this age group.