ain on the plantar surface of the foot subsumes constellations of symptoms arising from various underlying conditions. In this article we present the clinical findings of the diseases that most commonly cause plantar pain, the diagnostic procedures available, and an overview of the treatment options. For reasons of space we restrict ourselves to the two most highly prevalent conditions, plantar fasciitis and metatarsalgia. Methods We carried out a selective survey of the literature in the PubMed database. The search terms were "metatarsalgia", "transfer metatarsalgia," "Morton neuroma," "Freiberg disease," "Freiberg's infraction," "plantar fasciitis," "plantar spur," and "heel pain." We also took account of national and international recommendations and our own experience. Plantar fasciitis Symptoms and clinical picture Patients with plantar fasciitis (PF) complain of pain in the medial plantar part of the heel. The pain occurs when they take the first steps after getting out of bed in the morning or following a period of inactivity. After initial improvement, the pain worsens in the course of the day.

Purpose Aim of the study was to evaluate the surgical, clinical and audiological outcome of 32 implantations of the Bonebridge, a semi-implantable transcutaneous active bone conduction implant. Methods In a retrospective cohort study, we analyzed data for 32 implantations in 31 patients (one bilateral case; seven age < 16 years) with conductive or mixed hearing loss, malformations, after multiple ear surgery, or with single-sided deafness as contralateral routing of signal (CROS). Results Four implantations were done as CROS. Five cases were simultaneously planned with ear prosthesis anchors, and 23 implantations (72%) were planned through three-dimensional (3D) “virtual surgery.” In all 3D-planned cases, the implant could be placed as expected. For implant-related complications, rates were 12.5% for minor and 3.1% for major complications. Implantation significantly improved mean sound field thresholds from a preoperative 60 dB HL (SD 12) to 33 dB HL (SD 6) at 3 postoperative months and 34 dB HL (SD 6) at > 11 postoperative months (p < 0.0001). Word recognition score in quiet at 65 dB SPL improved from 11% (SD 20) preoperatively to 74% (SD 19) at 3 months and 83% (SD 15) at > 11 months (p < 0.0001). The speech reception threshold in noise improved from − 1.01 dB unaided to − 2.69 dB best-aided (p = 0.0018). Conclusion We found a clinically relevant audiological benefit with Bonebridge. To overcome anatomical challenges, we recommend preoperative 3D planning in small and hypoplastic mastoids, children, ear malformation, and simultaneous implantation of ear prosthesis anchors and after multiple ear surgery.

Background: Minimally invasive techniques of Akin osteotomy have grown in popularity, as early results suggest faster recovery, earlier return to work, and minimized wound healing problems. Preserving lateral cortex integrity during first phalanx osteotomy thereby presents a challenge because of the lack of direct visual control. This retrospective comparative study investigated clinical and radiographic outcomes of minimally invasive and open Akin osteotomy with different fixation methods and analyzed whether or not intraoperative violation of the lateral cortex caused loss of correction or delayed bone healing. Methods: One hundred eighty-four patients (210 feet) with symptomatic hallux valgus and pathologic interphalangeal angle (IPA) of at least 10 degrees underwent surgery combined with Akin osteotomy. Minimally invasive Akin osteotomies were fixed in 124 feet with 2 crossing percutaneous K-wires and compared to 86 Akin osteotomies by open technique with double-threaded (head and shank) screw fixation. At 1 day and 6 and 12 weeks postoperatively, IPA and bony consolidation were radiographically and clinically assessed. Results: Mean preoperative IPA was 13.4 ± 3.6 degrees in minimally invasive (MI) and 13.3 ± 3.5 degrees in open surgery (OS) cases ( P > .05). Intraoperative breach of the lateral cortex occurred in 12 (13.9%) in OS and 64 (51.6%) in MI cases. Whereas the breach occurred in open technique mainly during manual correction by applying a medial closing force, it was caused predominantly by the use of the burr in minimally invasive technique. After 12 weeks, the mean IPA was 4.1 ± 1.4 degrees in MI and 4.8 ± 1.2 degrees in OS cases ( P > .05). Bony consolidation was complete after 6 and 12 weeks in OS and MI, respectively. Three deep infections occurred in the OS Group after Lapidus arthrodesis and 2 deep infections were registered in the MI Group after minimally invasive chevron and Akin osteotomy. The infections were not at the site of the Akin osteotomy. Conclusion: Breach of the lateral cortex did not impair bone healing or correction of IPA. Minimally invasive Akin osteotomy with K-wire fixation provided equivalent correction of IPA compared to open surgery with screw fixation. Level of Evidence: Level III, retrospective comparative series.

Objectives: In 2012 the first active bone conduction implant was introduced, but did not fit into the mastoids of some adults and many children. Thus, a geometry change of the transducer was proposed (BCI 602). In this study, we aimed to determine whether these changes improved the mastoid cavity fit of the implant in children and young adults. Design: We retrospectively analyzed computed tomography scans of 151 mastoids from 81 children and adolescents (age range, 5 mo to 20 yr) and 52 control mastoids from 33 adults. After three-dimensional reconstruction of the temporal bone from computed tomography, we virtually implanted the BCI 602 into the mastoids, and compared the bone fit with that of the BCI 601. Results: The BCI 602 could be virtually implanted in 100% of patients ≥12 years old, while the BCI 601 transducer could be completely embedded in the bone of only 70% of these mastoids. Moreover, virtual implantation of the BCI 602 was possible in 75% of children 3 to 5 years of age, while the BCI 601 did not fit in the mastoids of any patients under 5 years old without the use of lifts. Conclusions: Compared to the BCI 601, placement of the BCI 602 allegedly requires less bone removal. The newer BCI 602 transducer is more likely than its predecessor to be completely accommodated in the mastoid bone among all age groups and indications. Preoperative planning is still recommended to avoid exposure of delicate structures.

Casing diameter is the most limiting factor for Bonebridge implantation in children. A modified implant casing with a truncated cone and reduced diameter and volume would increase the number of hearing impaired children who can be rehabilitated with a Bonebridge implant. Radiological planning for Bonebridge implantation is necessary in all children.