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Pathology & Conditions

Foot & ankle pathology: bone tumors (chondroblastoma, fibrous dysplasia), neuro-osteoarthropathies, and soft tissue masses—diagnostic approach.

Overview

A comprehensive standard now defines key terms for diagnosing, managing, and following adverse local tissue reactions in arthroplasty (ALTR/ARMD) [1]. Surgical excision remains the primary intervention for specific pathologies, providing symptomatic relief and histopathological confirmation for osteochondrolipoma of the foot [8] and serving as the initial treatment for dedifferentiated chondrosarcoma [21]. In pediatric cases involving intra-articular masses, all differential diagnoses for soft-tissue masses must be considered during surgical planning [10].

Prognostic assessment in chondrosarcoma relies on specific histological and molecular parameters. Histological grading is prognostic for pelvic and proximal femoral chondrosarcoma [11], with the prognosis for local recurrence and disease-specific survival based on the highest grade observed, even in isolated cells [12]. A ten or fifteen-year survival rate is more meaningful than a five-year rate for assessing cure [11]. Evaluating IDH1 R132 mutational status may stratify patients for aggressive treatment or closer follow-up, though further studies are needed to confirm its association with poor prognosis [67]. Optimal management for grade 2 central chondrosarcoma should be individualized based on histological features, tumor location, resection morbidity, and patient-specific factors [18], while chemotherapy lacks convincing evidence of benefit in dedifferentiated cases [21].

Routine histopathological techniques should be employed to assess tissue quality in rotator cuff re-tears or non-healing to predict clinical evolution [14]. Conversely, routine reliance on frozen section interpretation for intraoperative evaluation of skeletal lesions is not recommended without an experienced multidisciplinary team [59]. Understanding current evidence and appropriate indications is critical for utilizing emerging technologies in orthopaedic trauma [69], while further studies using standardized criteria are required to investigate tissue changes in primary frozen shoulder [22].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Dysfunction of the windlass mechanism in hallux rigidus is evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet [87]. Hallux valgus deformity severity correlates positively with the magnitude of anteroposterior postural sway [83], while progressive distance mapping reveals subgroup-dependent associations between plantar fat-pad-anchored distance geometry and deformity severity [31]. In pes planovalgus deformity, female patients with a more severe anteroposterior talo-first metatarsal angle should be expected to experience symptom aggravation with aging [91]. Recurrent bilateral mid-tarsal subluxations indicate an underlying structural abnormality when both feet are similarly affected [86]. Further dynamic analyses are required to clarify biodynamic effects on the patella and patellofemoral joint in osteochondritis dissecans patellae [93].

Structural and Soft Tissue Pathology

Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis [95]. The energy-dissipating properties of the plantar fat pad correlate with the sonographic appearance of the calcaneal enthesis in symptomatic limbs [89]. In children, an increased hallux angle is associated with insufficient footwear length [90]. Biomechanical properties in the early postoperative phase of a retrieved dermal allograft after superior capsule reconstruction were inferior compared with unimplanted allografts [96].

Systemic and Metabolic Considerations

Modern approaches to the diabetic foot focus on pathophysiology, risk stratification using tools like the Wagner-Meggitt system, and proactive management including patient education, offloading, and appropriate footwear [94]. Measurement of plantar pressures coupled with evaluation of protective sensation may effectively screen patients with Charcot arthropathy [92]. Small but clinically important changes in foot function are detected in a small cohort of rheumatoid arthritis patients with disease duration less than 2 years [88]. Changes to the structural properties of footwear may affect forefoot loading patterns in people with gout [78].

Clinical Management and Assessment

Non-surgical intervention for hallux rigidus begins with shoe modifications and orthotics [27]. Foot orthoses developed according to a protocol for improving plantar pressure redistribution properties lead to medium to large improvements in pain and physical functioning in patients with rheumatoid arthritis [81]. Assessing multi-joint interactions in progressive collapsing foot deformity leads to a better understanding of the pathophysiology and assists in surgical treatment planning [71]. Foot and ankle biomechanics, gait analysis, and treatment principles for common nail disorders are described in standard textbook chapters rather than reported as original clinical trial data [68]. Sitting all day leads to swelling of the healthy foot [85].

Classification

ALTR/ARMD: A comprehensive, new standard for histopathological classification of adverse local tissue reactions (ALTR/ARMD) has been established to guide diagnosis, clinical management, and long-term follow-up [1]. When applying the Edema Zone classification, confirming the presence of a necrotic lesion and incorporating the clinical time course and response to nonoperative management are important to avoid overestimating disease severity [4].

GNE Myopathy: Clinical and histopathological findings underscore the distinctive characteristics and heterogeneity of GNE myopathy [6].

Chondrosarcoma: Prognosis for local recurrence and disease-specific survival in chondrosarcomas should be based on the highest grade seen in the resection specimen, even when seen in only a few cells [12].

Rotator Cuff: Simple histopathological techniques should be employed routinely to assess tissue quality to predict future clinical evolution regarding rotator cuff repair or non-repair [14].

Myopathies: Distinguishing immune-mediated necrotising myopathies (IMNM) from disorders clinically similar to non-immune inflammatory myopathies (non-IIM) requires combined clinical, serological, and pathological features [15].

Distal Biceps: Classification of partial distal biceps tendon tears may have implications for operative and non-operative management [26].

Hallux Valgus: Progressive Distance Mapping (PDM) suggests subgroup-dependent, progressive associations between plantar fat-pad-anchored distance geometry and hallux valgus severity [31].

Macrodactyly: Confirming PIK3CA mutation status allows for more accurate diagnosis and classification of isolated macrodactyly based on its molecular pathogenesis [48].

Hemophilic Pseudotumors: The PUMCH classification for extremity and pelvic hemophilic pseudotumors is based on anatomic pathology and surgical strategy [51].

PCFD: The new Progressive Collapsing Foot Deformity (PCFD) classification system offers an option to aid surgeons in approaching this complex three-dimensional deformity and individualizing treatment for each patient's unique anatomy [63].

Skeletal Muscle Injury: A proposed nomenclature for skeletal muscle injuries integrates topographic location with histoarchitectonic features of the damage to connective tissue structures to support accurate prognosis and understanding of recurrence [66].

Foot and Ankle Tendon Disorders: A comprehensive overview of anatomy, classification, evaluation, and treatment options exists for tendon disorders of the foot and ankle, including acute and chronic Achilles tendonitis, ruptures, and other tendon pathologies [79].

Other Considerations: Differential diagnosis for bizarre parosteal osteochondromatous proliferation co-occurring with a metatarsal fatigue fracture is mainly achieved through imaging and histopathological assessment [5].

Clinical Presentation

A comprehensive, new standard for the description and histopathological classification of adverse local tissue reactions in arthroplasty (ALTR/ARMD) has been established for diagnosis, clinical management, and long-term follow-up [1]. For soft-tissue masses, proper management requires a specific process for evaluation and management, including a thorough history, physical examination, and imaging studies, with biopsy performed if the diagnosis remains unclear [16]. In pediatric foot masses, a thorough history and physical examination are crucial to ensure that any lesion not readily identified as benign is appropriately managed [17]. All differential diagnoses for soft-tissue masses must be considered when planning surgical management for synovial sarcoma presenting as an intra-articular mass in a pediatric patient [10].

Histopathological Correlation: Clinical and radiological findings must be backed up by histopathological examination for the true diagnosis of calcium pyrophosphate dihydrate crystal deposition disease mimicking a malignant soft tissue tumor [2]. Molecular studies and histopathological sampling are essential for accurate diagnosis of surface bone sarcomas due to non-specific clinical symptoms and imaging characteristics that may be misinterpreted as benign lesions [7]. Pathologic examination should be performed as well as culture tests to detect and identify bacteria accurately in actinomycotic osteomyelitis of a long bone, as the probability for culture confirmation is quite low [41]. Surgical excision is the recommended approach for osteochondrolipoma of the foot, providing symptomatic relief and confirmation of diagnosis through histopathological examination [8]. Differential diagnosis for bizarre parosteal osteochondromatous proliferation co-occurring with a metatarsal fatigue fracture is mainly achieved through imaging and histopathological assessment [5].

Diagnostic Classification and Timing: Confirming the presence of a necrotic lesion and incorporating the clinical time course and response to nonoperative management are important to avoid overestimating disease severity when applying the Edema Zone classification [4]. Diagnostic delays for slipped capital femoral epiphysis were common, and radiological severity worsened with increasing time to diagnosis [9]. Timely recognition and appropriate diagnostic workup are critical to avoid misdiagnosis and unnecessary intervention for metatarsal coalition with pseudarthrosis mimicking a bone tumor [37]. Early diagnosis is the key to treatment for cerebrotendinous xanthomatosis [35]. Detection of musculoskeletal manifestations associated with transthyretin-mediated (ATTR) amyloidosis may enable earlier diagnosis and administration of effective treatments before disease progression occurs [36].

Systemic and Metabolic Considerations: Clinical and histopathological findings underscore the distinctive characteristics and heterogeneity of GNE myopathy [6]. Distinguishing immune-mediated necrotising myopathies (IMNM) from disorders clinically similar to non-immune-mediated inflammatory myopathies (non-IIM) needs combined clinical, serological, and pathological features [15]. Metabolic diseases-associated bone lesions require a comprehensive diagnosis of multiple inspection items, as seen in femoral osteitis fibrosa cystica mimicking a bone neoplasm [39]. An integrated clinical-pathologic diagnosis helps to clarify the nature of extraskeletal cartilaginous tumors that can arise at unusual anatomic sites [38]. Timely diagnosis and treatment of benign synovial disorders can minimize disease and resulting dysfunction, as cartilage erosion and degenerative joint disease are the most common long-term consequences [3]. Most bone and soft-tissue tumors in children are benign, but correct and prompt diagnosis is challenging; understanding diagnostic steps and management principles allows for early appropriate treatment, improving prognosis [40].

Investigations

Plain radiography: Conventional radiographs are essential for identifying distinct malformations in nail patella syndrome, which facilitate correct interpretation of aberrant morphology for treatment [52]. In thumb basilar joint osteoarthritis, radiographic stage does not correlate with symptom severity [55]. However, initial poor-quality radiographs and an unquestioned original diagnosis despite persistent symptoms are the most frequent causes of erroneous diagnosis for tumors about the knee misdiagnosed as athletic injuries [20]. For calcification of the medial collateral ligament of the knee with simultaneous calcifying tendinitis of the rotator cuff, x-ray serves as an invaluable diagnostic tool alongside MRI [54].

MRI: Magnetic resonance imaging is the investigation of choice for diagnosing tumour-like lesions of the infrapatellar fat pad [43] and is the mainstay of diagnosis for elastofibroma dorsi [53]. It is required for the diagnosis of knee lipoma [45] and is crucial for operative planning and distinguishing benign from malignant soft-tissue tumors in cases of ganglion of the superior tibiofibular joint [47]. Distinct imaging features may facilitate the diagnosis of multiple plexiform schwannomas in the plantar aspect of the foot [42]. Additionally, MRI demonstrated complete regeneration of subchondral bone and cartilage in patients with Hepple Stage V osteochondral lesion of the talus treated with a platelet-rich plasma scaffold [62]. MARS-MRI abnormalities merit serious consideration in the population with recalled modular femoral neck rejuvenate and ABG implants [50].

CT: Computed tomography is recommended for the evaluation of extraspinal bone hydatidosis, typically performed in conjunction with magnetic resonance imaging of the abdomen or pelvis [19].

Bone scan: A normal bone scan does not rule out metastatic disease in the context of extraspinal bone hydatidosis [19].

Histopathology & Molecular Studies: Clinical and radiological findings must be backed up by histopathological examination for the true diagnosis of calcium pyrophosphate dihydrate crystal deposition disease [2]. Differential diagnosis of bizarre parosteal osteochondromatous proliferation is mainly achieved through imaging and histopathological assessment [5]. Molecular studies and histopathological sampling are essential for accurate diagnosis of surface bone sarcomas due to non-specific clinical symptoms and imaging characteristics that may be misinterpreted as benign lesions [7]. Low-grade myofibroblastic sarcoma demonstrates unique radiological and pathological features depending on its site of origin [44].

Other Considerations: Diagnostic imaging is the preeminent diagnostic measure for femoroacetabular impingement syndrome, though no single domain should be utilized as the sole diagnostic or assessment parameter [60]. Diagnostic delays in slipped capital femoral epiphysis are common, and radiological severity worsens with increasing time to diagnosis [9].

Treatment

Non-Operative

Non-surgical intervention for hallux rigidus begins with shoe modifications and orthotics [27]. Non-weightbearing conservative management should be considered the standard of care for tarsal navicular stress fractures [74]. Asymptomatic patients with diffuse pigmented villonodular synovitis of the foot and ankle can be successfully managed nonoperatively [56]. Secondary outcomes and per-protocol analysis indicated additional benefit of physical therapy treatment in addition to usual podiatry management for plantar heel pain, mostly observed in individuals who completed treatment [49]. Management of nonrheumatoid inflammatory arthroses is typically medical in nature and continues to evolve with the development of biologically targeted medications [58]. Future research is needed to develop molecules with improved efficacy and safety profiles for the management of rheumatoid arthritis until it becomes a curable pathology [46]. While nonsurgical options exist for degenerative conditions and osteonecrosis of the foot and ankle, the majority of literature describes surgical treatments, with no evidence that non-surgical treatments change the course of ankle arthritis [73].

Operative

Indications: Surgical management is indicated for coxa vara in childhood when there is progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery [76]. Surgical excision is the recommended approach for osteochondrolipoma of the foot, providing symptomatic relief and confirmation of diagnosis through histopathological examination [8]. Treatment of intraarticular fibroma of the tendon sheath in the knee joint by local excision is effective, though recurrence is reported in 24% of cases [57]. Delayed excision of the reflected head of the rectus femoris successfully reduces pain in rare cases that fail nonoperative management for chronic tears [75]. Closed treatment of symptomatic lesions in the upper extremity for fibrous dysplasia provided satisfactory functional outcomes regardless of disease pattern or age [61].

Surgical Approach / Technique: Complete surgical excision is the initial recommended treatment for dedifferentiated chondrosarcoma, while chemotherapy lacks convincing evidence of benefit [21]. The effectiveness of treatment of a recurrence of giant-cell tumors of the long bones with either an intralesional or a wide excisional procedure does not appear to be diminished by initial curettage and cementing [65]. Surgery did not prove superior compared to conservative clinical and radiological observation for enchondromas and atypical cartilaginous tumors of the long bones [72]. All differential diagnoses for soft-tissue masses should be considered when planning surgical management in pediatric patients presenting with synovial sarcoma [10].

Adjuncts: Confirming the presence of a necrotic lesion and incorporating the clinical time course and response to nonoperative management are important to avoid overestimating disease severity when applying the Edema Zone classification [4]. Clinical and radiological findings must be backed up by histopathological examination for true diagnosis of calcium pyrophosphate dihydrate crystal deposition disease mimicking malignant soft tissue tumor [2]. Histological grading is of prognostic importance for chondrosarcoma, and a ten or fifteen-year survival rate is more meaningful than a five-year rate for assessing cure [11]. When categorizing the grade of the resection specimen for chondrosarcoma, the prognosis for local recurrence and disease-specific survival should be based on the highest grade seen, even when seen in only a few cells [12].

Other Considerations: Timely diagnosis and treatment of benign synovial disorders can minimize disease and resulting dysfunction, as cartilage erosion and degenerative joint disease are the most common long-term consequences [3]. The optimal treatment strategy for grade 2 central chondrosarcoma should be individualized based on histological features, tumour location, morbidity of resection, and patient-specific factors [18]. Computed tomography or magnetic resonance imaging of the abdomen or pelvis is recommended for extraspinal bone hydatidosis, as a normal bone scan does not rule out metastatic disease [19]. Classification of partial distal biceps tendon tears may have implications for operative and non-operative management [26]. Larger and long-term controlled trials are needed to support the clinical effectiveness of autologous bone marrow stem cell implantation for osteonecrosis of the knee in sickle cell disease [13]. Addition of bone marrow cells to core decompression appears to result in better clinical outcomes and lower rates of disease progression compared with core decompression alone for early stage osteonecrosis of the femoral head, despite heterogeneous and poor data [64]. Further studies that use standardised inclusion and exclusion criteria and investigate changes in naïve tissue at different stages of the condition are required for primary frozen shoulder [22]. Current evidence on traumatic and non-traumatic conditions affecting the sternoclavicular joint provides an algorithm to manage these conditions [77].

Complications

Other Considerations: Histopathological examination is essential to establish a comprehensive standard for diagnosing, managing, and following adverse local tissue reactions in arthroplasty [1] and to confirm calcium pyrophosphate dihydrate crystal deposition disease mimicking a malignant soft tissue tumor [2]. Routine histopathological techniques should be employed to assess tissue quality and predict rotator cuff re-tear or non-healing [14]. For soft-tissue masses, proper management requires a specific evaluation process including thorough history, physical examination, and imaging, with biopsy performed if the diagnosis remains unclear [16]; this is particularly crucial for pediatric soft-tissue tumors, which are heterogeneous and may be benign or malignant [84]. A thorough history and physical examination followed by appropriate imaging can establish a correct diagnosis and guide treatment for pediatric soft-tissue tumors [84] and ensure appropriate management of pediatric foot lesions not readily identified as benign [17]. Erroneous diagnoses for tumors about the knee misdiagnosed as athletic injuries frequently stem from initial poor-quality radiographs and an unquestioned original diagnosis despite persistent symptoms [20].

Long-term consequences of untreated benign synovial disorders include cartilage erosion and degenerative joint disease [3]. GNE myopathy exhibits distinctive characteristics and heterogeneity underscored by clinical and histopathological findings [6]. Resection of a neuromuscular choristoma of the sciatic nerve causing cavus deformity was not feasible due to the risk of increased neurological deficits, and the natural history of this benign lesion remains indeterminate [29]. A documented case of melorheostosis showed marked progression over nineteen years, including two biopsies eighteen years apart, a finding of sufficient interest as no similar marked progression was found in the world literature [30].

Regarding osteonecrosis and cartilage repair, larger and long-term controlled trials are needed to support the clinical effectiveness of autologous bone marrow stem cell implantation for osteonecrosis of the knee in sickle cell disease [13]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis will maintain structural and functional integrity over time [25]. Outcomes of long-term follow-up and larger case series are still required for three-dimensional designing total hip arthroplasty with long uncemented stem in fibrous dysplasia patients combined with hip joint osteoarthritis [24]. Histologic features associated with long-term allograft survival include viable chondrocytes, functional preservation of matrix, and complete replacement of the graft bone with the host bone [23].

Clinical outcomes for osteochondral lesions of the talus are influenced by subchondral bone marrow edema; the degree of edema at midterm follow-up was correlated with outcomes after microfracture, whereas no significant differences were found at short-term follow-up [32]. The severity of preoperative bone marrow edema negatively affected short-term clinical outcomes following arthroscopic bone marrow stimulation for osteochondral lesions of the talus [80]. Close follow-up by experienced surgeons may be beneficial for the prognosis of desmoplastic fibroma in a child [28].

For giant cell tumor of bone, a short-course of preoperative denosumab (three or fewer doses) was associated with no differences in clinical scores, histological and radiological response, or local recurrence-free survivorship compared with longer-course denosumab [33]. In acute gout, the natural history is to resolve spontaneously over 3 to 10 days [34]. All current therapies for acute gout have an adverse effect profile that carries some risk [34], yet the earliest possible initiation of therapy maximizes the benefit-to-risk ratio and clinically justifies therapy [34]. Clinical findings of meniscal mucoid degeneration are insidious compared to traumatic tears, and lack of trauma history may delay diagnosis [82].

Recovery

Light activity (weeks): Specific timelines for light activity are not defined in the current evidence base; however, the natural history of a gout flare resolves spontaneously over 3 to 10 days [34], and active symptoms in infantile cortical hyperostosis may persist from two to nine months [98].

Full activity (months): Timely diagnosis and treatment of benign synovial disorders can minimize disease and resulting dysfunction [3], whereas cartilage erosion and degenerative joint disease are the most common long-term consequences of untreated benign synovial disorders [3]. In slipped capital femoral epiphysis, radiological severity worsens with increasing time to diagnosis, and diagnostic delays were common [9]. For osteochondral lesions of the talus, the degree of subchondral bone marrow edema at midterm follow-up correlates with clinical outcomes after microfracture, though no significant differences in outcomes related to bone marrow edema were found at short-term follow-up [32].

Complete recovery / outcome plateau (months): The prognosis for infantile cortical hyperostosis is uniformly favorable with complete recovery ultimately [98]. In giant cell tumor of bone, a short-course of preoperative denosumab (three or fewer doses) is associated with no differences in clinical scores, histological and radiological response, or local recurrence-free survivorship compared with longer-course denosumab [33]. For extracorporeal irradiation in limb salvage surgery for bone tumours, the five-year survivorship was 82.3% and the ten-year survivorship was 79.6%, with a graft survival rate of 93% [70]. Functional outcomes for this procedure were comparable to the best previously reported series [70].

Rehabilitation protocol: The earliest possible initiation of therapy for acute gout maximizes the benefit-to-risk ratio, though all current therapies carry an adverse effect profile that carries some risk [34]. In asymptomatic shoulders with osteonecrosis related to corticosteroid treatment, progression is predicted by stage at initial visit, occurrence of pain, and continuation of peak doses of corticosteroids [97]. In symptomatic shoulders with osteonecrosis related to corticosteroid treatment, the extent and location of the lesion are the main risk factors for progression [97].

Functional milestones: No specific validated PROM trajectories or outcome-measure benchmarks are provided in the evidence base for this section.

Other Considerations: The natural history of a gout flare is to resolve spontaneously over 3 to 10 days [34]. Active symptoms in infantile cortical hyperostosis may persist from two to nine months [98].

Key Evidence

  • [L4] The review of key terms used for the description and histopathological classification of ALTR/ARMD has resulted in a comprehensive, new standard for all disciplines involved in their diagnosis, clinical management, and long-term clinical follow-up. (10.1302/2058-5241.6.210013)
  • [L4] Clinical and radiological findings must be backed up by histopathological examination for true diagnosis. (10.1007/s00167-002-0339-2)
  • [L5] Timely diagnosis and treatment of benign synovial disorders can minimize disease and resulting dysfunction, as cartilage erosion and degenerative joint disease are the most common long-term consequences. (10.5435/00124635-200805000-00005)
  • [L5] The authors agree that confirming the presence of a necrotic lesion and incorporating the clinical time course and response to nonoperative management are important to avoid overestimating disease severity when applying the Edema Zone classification. (10.1016/j.arth.2025.10.038)
  • [Case_report] Differential diagnosis is mainly achieved through imaging and histopathological assessment. (10.1186/s12891-020-3168-x)
  • [L4] The clinical and histopathological findings underscore the distinctive characteristics and heterogeneity of the disease. (10.1186/s12891-025-09282-8)
  • [L5] Molecular studies and histopathological sampling are essential for accurate diagnosis due to non-specific clinical symptoms and imaging characteristics that may be misinterpreted as benign lesions. (10.1302/2058-5241.6.210064)
  • [Case_report] Surgical excision is the recommended approach, providing symptomatic relief and confirmation of diagnosis through histopathological examination. (10.1186/s12891-024-07308-1)
  • [L3] Diagnostic delays were common and radiological severity worsened with increasing time to diagnosis. (10.1302/0301-620x.104b4.bjj-2021-1709.r1)
  • [Case_report] We strongly recommend considering all differential diagnoses for soft-tissue masses when planning surgical management. (10.1186/s12891-020-03312-3)
  • [L3] When categorizing the grade of the resection specimen, the prognosis for local recurrence and disease-specific survival should be based on the highest grade seen, even when seen in only a few cells. (10.1302/0301-620x.100b5.bjj-2017-1243.r1)
  • [L4] Larger and long-term controlled trials are needed to support its clinical effectiveness. (10.1186/s12891-018-2067-x)
  • [L2] Simple histopathological techniques should be employed routinely to assess tissue quality to predict future clinical evolution (repair or non-repair). (10.1007/s00167-011-1521-1)
  • [L4] However, distinguishing IMNM from disorders clinically similar to non-IIM needs combined clinical, serological and pathological features. (10.1186/s12891-022-05372-z)
  • [L5] Proper management of soft-tissue masses requires a specific process for evaluation and management, including a thorough history, physical examination, and imaging studies, with biopsy performed if the diagnosis remains unclear. (10.5435/jaaos-22-11-742)
  • [L5] A thorough history and physical examination are crucial to ensure that any lesion not readily identified as benign is appropriately managed. (10.5435/jaaos-d-15-00397)
  • [L3] The optimal treatment strategy should be individualized based on histological features, tumour location, morbidity of resection, and patient-specific factors. (10.1302/0301-620x.107b9.bjj-2024-1378.r1)
  • [L4] Computed tomography or magnetic resonance imaging of the abdomen or pelvis is recommended, and a normal bone scan does not rule out metastatic disease. (10.2106/00004623-200309000-00019)
  • [L4] Initial poor-quality radiographs and an unquestioned original diagnosis despite persistent symptoms were the most frequent causes of an erroneous diagnosis. (10.2106/00004623-200307000-00005)
  • [L4] Complete surgical excision is the initial recommended treatment, while chemotherapy lacks convincing evidence of benefit. (10.1186/1749-799x-7-38)
  • [L1] Further studies that use standardised inclusion and exclusion criteria and investigate changes in naïve tissue at different stages of the condition are required. (10.1186/s12891-016-1190-9)
  • [L4] Nevertheless, the outcomes of long-term follow-up and larger cases are still required. (10.1186/s12891-019-2608-y)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L3] Classification of tears may have implications for operative and non-operative management. (10.5397/cise.2023.00458)
  • [Paper] Non-surgical intervention begins with shoe modifications and orthotics. (10.1302/2058-5241.2.160031)
  • [Case_report] Close follow-up by experienced surgeons may be beneficial for prognosis. (10.1186/s12891-024-07454-6)
  • [Case_report] Resection of the mass was not feasible due to the risk of increased neurological deficits, and the natural history of this benign lesion remains indeterminate. (10.2106/00004623-199709000-00016)
  • [L4] Progressive Distance Mapping (PDM) suggests subgroup-dependent, progressive associations between plantar fat-pad-anchored distance geometry and hallux valgus severity. (10.1186/s13018-025-06587-1)
  • [L3] The degree of subchondral bone marrow edema at midterm follow-up was correlated with clinical outcomes, whereas no significant differences were found at short-term follow-up. (10.1177/0363546518782701)
  • [L3] A short-course of preoperative denosumab (three or fewer doses) was associated with no differences in clinical scores, histological and radiological response, or local recurrence-free survivorship compared with longer-course denosumab. (10.1097/corr.0000000000001285)
  • [L5] The earliest possible initiation of therapy maximizes the benefit-to-risk ratio and clinically justifies therapy, given that the natural history of a gout flare is to resolve spontaneously over 3 to 10 days and that all current therapies have an adverse effect profile that carries some risk. (10.1016/j.jhsa.2012.04.041)
  • [L4] Early diagnosis is the key to treatment. (10.2106/jbjs.e.00872)
  • [L1] Detection of MSK manifestations may enable earlier diagnosis and administration of effective treatments before disease progression occurs. (10.1186/s12891-023-06853-5)
  • [L4] Timely recognition and appropriate diagnostic workup are critical to avoid misdiagnosis and unnecessary intervention. (10.1186/s12891-025-09279-3)
  • [L4] An integrated clinical-pathologic diagnosis helps to clarify the nature of extraskeletal cartilaginous tumors that can arise at unusual anatomic site. (10.1186/1471-2474-7-57)
  • [Case_report] Metabolic diseases-associated bone lesions require a comprehensive diagnosis of multiple inspection items. (10.1186/s12891-022-05274-0)
  • [Case_report] Pathologic examination should be performed as well as culture tests to detect and identify the bacteria accurately, as the probability for culture confirmation is quite low. (10.1186/s12891-019-2576-2)
  • [Case_report] The distinct imaging features presented may facilitate the diagnosis process in the future. (10.1186/1471-2474-15-342)
  • [L4] MRI is the investigation of choice for diagnosing these tumour-like lesions. (10.1007/s00167-009-1034-3)
  • [Case_report] LGMS demonstrates unique radiological and pathological features depending on its site of origin. (10.1186/s12891-025-08565-4)
  • [L4] Knee lipoma is an extremely rare disease that must be diagnosed by MRI. (10.1186/s12891-019-2484-5)
  • [L5] Future research is needed to develop molecules with improved efficacy and safety profiles until RA becomes a curable pathology. (10.3390/cells10112857)
  • [L4] MRI is of crucial significance for operative planning and distinguishing benign from malignant soft-tissue tumors. (10.1007/s001670050073)
  • [L4] Confirming PIK3CA mutation status allows for more accurate diagnosis and classification of the disease based on its molecular pathogenesis. (10.1177/1753193418770366)
  • [L1] Secondary outcomes and per-protocol analysis indicated additional benefit of the combined treatment, mostly observed in individuals who completed treatment. (10.1186/s12891-019-3009-y)
  • [L4] The PUMCH classification is based on the anatomic pathology and surgical strategy for HPTs. (10.2106/jbjs.22.00781)
  • [L4] These distinct malformations are easily recognisable on conventional radiographs and lead to the correct interpretation of the aberrant morphology essential in treatment. (10.1302/0301-620x.98b4.37025)
  • [L4] MRI is the mainstay of diagnosis for elastofibroma dorsi, and the lesion can be safely treated without surgery. (10.1016/j.jse.2011.01.043)
  • [Case_report] Our experience suggests that magnetic resonance imaging and x-ray are invaluable tools for the diagnosis of this inflammatory calcifying disease of the ligament, and that surgical repair provides a good outcome if conservative treatment fails. (10.1186/s12891-016-1147-z)
  • [L2] Metrics that link radiographic and subjective components may improve surgical decision making and monitoring of treatment response. (10.5435/jaaos-d-15-00329)
  • [L4] Asymptomatic patients can be successfully managed nonoperatively. (10.1302/0301-620x.95b3.30192)
  • [L4] Treatment by local excision is effective, though recurrence is reported in 24% of cases. (10.1007/s00167-011-1431-2)
  • [L5] Management of nonrheumatoid inflammatory arthroses is typically medical in nature and continues to evolve with the development of biologically targeted medications. (10.1016/j.jhsa.2015.05.029)
  • [L4] The authors do not recommend routine reliance upon frozen section interpretation for the intraoperative evaluation and management of skeletal lesions, especially without an experienced multidisciplinary team. (10.5435/jaaos-d-18-00071)
  • [L5] Diagnostic imaging is the preeminent diagnostic measure for FAIS, though no single domain should be utilized as the sole diagnostic or assessment parameter. (10.1007/s00167-017-4484-z)
  • [L4] Closed treatment of symptomatic lesions in the upper extremity provided satisfactory functional outcomes regardless of disease pattern or age. (10.2106/00004623-198769030-00012)
  • [L4] MRI demonstrated complete regeneration of subchondral bone and cartilage in all patients with significant improvement in functional scores. (10.1155/2017/6525373)
  • [L5] The new PCFD classification system offers an option to aid surgeons in approaching this complex 3-dimensional deformity and individualizing treatment for each patient's unique anatomy, although it has room for improvement. (10.5435/jaaos-d-24-01499)
  • [L1] Despite heterogeneous and poor data, there is evidence that addition of bone marrow cells to core decompression appears to result in better clinical outcomes and lower rates of disease progression compared with core decompression alone. (10.5435/jaaos-d-19-00816)
  • [L3] Furthermore, the effectiveness of treatment of a recurrence with either an intralesional or a wide excisional procedure does not appear to be diminished by initial curettage and cementing. (10.2106/00004623-199412000-00009)
  • [L5] The authors propose a nomenclature for skeletal muscle injuries that integrates topographic location with histoarchitectonic features of the damage to connective tissue structures, arguing that this combined approach is essential for accurate prognosis and understanding recurrence. (10.1177/2325967120909090)
  • [L3] More extensive studies are needed to confirm these observations, and evaluating mutational status could help stratify patients for aggressive treatment or closer follow-up. (10.1097/corr.0000000000002960)
  • [L4] The study reports a five-year survivorship of 82.3% and a ten-year survivorship of 79.6%, with an excellent graft survival rate of 93% and functional outcomes comparable to the best previously reported series. (10.1302/0301-620x.99b12.bjj-2016-0462.r2)
  • [L4] Assessing multi-joint interactions in progressive collapsing foot deformity will lead to a better understanding of the pathophysiology and assist in surgical treatment planning. (10.1186/s13018-026-06670-1)
  • [L3] Surgery did not prove superior compared to conservative clinical and radiological observation. (10.1186/s12891-019-2502-7)
  • [L1] Non-weightbearing conservative management should be considered the standard of care for tarsal navicular stress fractures. (10.1177/0363546509355408)
  • [L4] Delayed excision of the reflected head of the rectus femoris successfully reduces pain in rare cases that fail nonoperative management. (10.1177/0363546511413251)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] This review analyzes current evidence on traumatic and non-traumatic conditions affecting the sternoclavicular joint and provides an algorithm to manage these conditions. (10.1302/2058-5241.3.170078)
  • [L4] These changes to the structural properties of the footwear may affect forefoot loading patterns in people with gout. (10.1186/s12891-021-04370-x)
  • [L3] The severity of the preoperative bone marrow oedema negatively affected short‐term clinical outcomes following arthroscopic BMS for OLTs. (10.1002/ksa.12355)
  • [L4] Foot orthoses developed according to a protocol for improving the plantar pressure redistribution properties lead to medium to large improvements in pain and physical functioning. (10.1186/s12891-020-03364-5)
  • [L4] Clinical findings are insidious compared to traumatic tears, and lack of trauma history may delay diagnosis. (10.1007/s00167-003-0412-5)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L5] Soft-tissue tumors in children are a heterogeneous group of lesions that may be benign or malignant; a thorough history and physical examination, followed by appropriate imaging studies, can establish a correct diagnosis and help determine appropriate treatment recommendations. (10.5435/00124635-200309000-00006)
  • [L2] Sitting all day leads to swelling of the healthy foot. (10.1186/s12891-024-07971-4)
  • [Case_report] The fact that both feet were similarly affected indicates that there was some underlying structural abnormality. (10.2106/00004623-197961040-00027)
  • [L3] Dysfunction of the windlass mechanism is associated with hallux rigidus, as evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet. (10.2106/jbjs.24.00437)
  • [L4] Analysis detected small but clinically important changes in foot function in a small cohort of RA patients with disease duration <2 years. (10.1186/1471-2474-7-102)
  • [L3] The energy-dissipating properties of the plantar fat pad are associated with the sonographic appearance of the calcaneal enthesis in symptomatic limbs, providing a previously unidentified link between the mechanical behavior of the plantar fat pad and enthesopathy. (10.1177/0363546510377405)
  • [L4] Our results emphasize the importance of ensuring that children's footwear fits properly. (10.1186/1471-2474-10-159)
  • [L4] In female patients with a more severe anteroposterior talo-first metatarsal angle, an aggravation of symptoms with aging should be expected when managing pes planovalgus deformity. (10.2106/jbjs.19.01504)
  • [L3] The measurement of plantar pressures coupled with evaluation of protective sensation may be an effective means of screening patients. (10.2106/00004623-199803000-00009)
  • [L4] Further dynamic analyses are needed to clarify biodynamic effects on the patella and the patellofemoral joint. (10.1007/s001670050180)
  • [L3] Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with RA. (10.1186/s12891-017-1668-0)
  • [Case_report] However, biomechanical properties in the early postoperative phase were inferior compared with unimplanted allografts. (10.1016/j.arthro.2019.07.006)
  • [L2] Stage at initial visit, occurrence of pain, and continuation of peak doses of corticosteroids predicted progression of disease in asymptomatic shoulders, whereas in the symptomatic shoulders, extent and location of the lesion were the main risk factors for progression. (10.1007/s11999-009-1094-1)
  • [L4] The prognosis is uniformly favorable with complete recovery ultimately, although active symptoms may persist from two to nine months. (10.2106/00004623-195032030-00023)

See Also

References

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[2] Calcium pyrophosphate dihydrate crystal deposition disease mimicking malignant soft tissue tumor. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-002-0339-2

[3] Benign Synovial Disorders. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200805000-00005

[4] Reply to letter regarding ‘The Femoral Head Edema Zone: A Novel Classification Scheme to Better Predict Osteonecrosis Progression’. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.10.038

[5] Bizarre parosteal osteochondromatous proliferation co-occurring with a metatarsal fatigue fracture: a case report. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-3168-x

[6] Clinical, pathological and genetic characteristics of GNE myopathy: a single-center observational study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09282-8

[7] Surface bone sarcomas: an update on current clinicopathological diagnosis and treatment. EFORT Open Reviews. 2021. DOI: 10.1302/2058-5241.6.210064

[8] Osteochondrolipoma of the foot treated by surgical excision: a case report and literature review. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07308-1

[9] The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b4.bjj-2021-1709.r1

[10] Synovial sarcoma presenting as an intra-articular mass in a pediatric patient: a case report. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03312-3

[11] Chondrosarcoma of the Pelvis and Upper End of the Femur: AN ANALYSIS OF FACTORS INFLUENCING SURVIVAL TIME IN ONE HUNDRED AND THIRTEEN CASES.. The Journal of Bone and Joint Surgery. American Volume. 1972.

[12] The role of grade in local recurrence and the disease-specific survival in chondrosarcomas. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b5.bjj-2017-1243.r1

[13] Use of autologous bone marrow stem cell implantation for osteonecrosis of the knee in sickle cell disease: a preliminary report. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2067-x

[14] Rotator cuff re‐tear or non‐healing: histopathological aspects and predictive factors. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1521-1

[15] Clinical and pathological features of immune-mediated necrotising myopathies in a single-centre muscle biopsy cohort. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05372-z

[16] Diagnosis and Management of Soft-tissue Masses. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-11-742

[17] Assessment of the Pediatric Foot Mass. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-15-00397

[18] Grade 2 central chondrosarcoma treated by intralesional curettage: observation or surgery?. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b9.bjj-2024-1378.r1

[19] EXTRASPINAL BONE HYDATIDOSIS. The Journal of Bone and Joint Surgery-American Volume. 2003. DOI: 10.2106/00004623-200309000-00019

[20] TUMORS ABOUT THE KNEE MISDIAGNOSED AS ATHLETIC INJURIES. The Journal of Bone and Joint Surgery-American Volume. 2003. DOI: 10.2106/00004623-200307000-00005

[21] Clinical outcome for patients with dedifferentiated chondrosarcoma: a report of 9 cases at a single institute. Journal of Orthopaedic Surgery and Research. 2012. DOI: 10.1186/1749-799x-7-38

[22] The pathophysiology associated with primary (idiopathic) frozen shoulder: A systematic review. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1190-9

[23] Fresh_Osteochondral_Allografts_for_Posttraumatic_Knee_00003086-200808000-00013. 2008.

[24] First application of three-dimensional designing total hip arthroplasty with long uncemented stem for fibrous dysplasia patients combined with hip joint osteoarthritis. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2608-y

[25] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[26] Classification system for partial distal biceps tendon tears: a descriptive 3-Tesla magnetic resonance imaging study of tear morphology. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00458

[27] Hallux rigidus. EFORT Open Reviews. 2017. DOI: 10.1302/2058-5241.2.160031

[28] Desmoplastic fibroma in a child: a 9-year follow-up case report. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07454-6

[29] Cavus Deformity of the Foot Secondary to a Neuromuscular Choristoma (Hamartoma) of the Sciatic Nerve. A Case Report. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199709000-00016

[30] Melorheostosis: REVIEW OF THE LITERATURE AND REPORT OF AN INTERESTING CASE WITH A NINETEEN-YEAR FOLLOW-UP.. The Journal of Bone and Joint Surgery. American Volume. 1963.

[31] Progressive distance mapping of the plantar fat pad in hallux valgus reveals subgroup-specific morphologic subtypes. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-025-06587-1

[32] The Presence and Degree of Bone Marrow Edema Influence Midterm Clinical Outcomes After Microfracture for Osteochondral Lesions of the Talus. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518782701

[33] Is a Short-course of Preoperative Denosumab as Effective as Prolonged Therapy for Giant Cell Tumor of Bone?. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001285

[34] Medical Management of Acute Gout. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.04.041

[35] Cerebrotendinous Xanthomatosis. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.e.00872

[36] Musculoskeletal manifestations associated with transthyretin-mediated (ATTR) amyloidosis: a systematic review. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06853-5

[37] Metatarsal coalition with pseudarthrosis mimicking bone tumor: two case reports and literature review. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09279-3

[38] Extra-osseous osteochondroma-like soft tissue mass of the patello-femoral space. BMC Musculoskeletal Disorders. 2006. DOI: 10.1186/1471-2474-7-57

[39] A patient with femoral osteitis fibrosa cystica mimicking bone neoplasm: a case report. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05274-0

[40] Chapter 5 Benign and Malignant Musculoskeletal Neoplasms. 2020.

[41] Actinomycotic osteomyelitis of a long bone in an immunocompetent adult: a case report and literature review. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2576-2

[42] Multiple plexiform schwannomas in the plantar aspect of the foot: case report and literature review. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-342

[43] Tumour‐like lesions of the infrapatellar fat pad. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-009-1034-3

[44] Early diagnosis and treatment of low-grade myofibroblastic sarcoma in the left distal femur: a case report and literature review. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08565-4

[45] Large intra-articular true lipoma of the knee. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2484-5

[46] Management of Rheumatoid Arthritis: An Overview. Cells. 2021. DOI: 10.3390/cells10112857

[47] A ganglion of the superior tibiofibular joint as a mucoid‐cystic degeneration of unusual localization. Knee Surgery, Sports Traumatology, Arthroscopy. 1998. DOI: 10.1007/s001670050073

[48] An investigation of PIK3CA mutations in isolated macrodactyly. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418770366

[49] Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel pain: a randomized clinical trial. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-3009-y

[50] MRI_Findings_Associated_with_Recalled_Modular_Femoral_Neck_Rejuvenate_and_ABG_Im_S0883540315003903. n.d..

[51] A Novel Surgical Classification for Extremity and Pelvic Hemophilic Pseudotumors. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.22.00781

[52] Radiological characteristics of the knee joint in nail patella syndrome. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b4.37025

[53] Elastofibroma dorsi: diagnostic and therapeutic algorithm. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.01.043

[54] Case report - calcification of the medial collateral ligament of the knee with simultaneous calcifying tendinitis of the rotator cuff. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1147-z

[55] Radiographic Stage Does Not Correlate With Symptom Severity in Thumb Basilar Joint Osteoarthritis. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-15-00329

[56] Diffuse pigmented villonodular synovitis (diffuse-type giant cell tumour) of the foot and ankle. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b3.30192

[57] An intraarticular fibroma of the tendon sheath in the knee joint. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1431-2

[58] Nonrheumatoid Inflammatory Arthroses of the Hand and Wrist. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.029

[59] The Accuracy and Clinical Utility of Intraoperative Frozen Section Analysis in Open Biopsy of Bone. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00071

[60] Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome: an international and multi-disciplinary Delphi survey. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4484-z

[61] Fibrous dysplasia. An analysis of options for treatment. The Journal of Bone & Joint Surgery. 1987. DOI: 10.2106/00004623-198769030-00012

[62] Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold. BioMed Research International. 2017. DOI: 10.1155/2017/6525373

[63] So What Exactly Is Progressive Collapsing Foot Deformity?. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01499

[64] Addition of Bone Marrow Stem Cells Therapy Achieves Better Clinical Outcomes and Lower Rates of Disease Progression Compared With Core Decompression Alone for Early Stage Osteonecrosis of the Femoral Head: A Systematic Review and Meta-Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-19-00816

[65] Recurrence of giant-cell tumors of the long bones after curettage and packing with cement.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199412000-00009

[66] A Histoarchitectural Approach to Skeletal Muscle Injury: Searching for a Common Nomenclature. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120909090

[67] Are IDH1 R132 Mutations Associated With Poor Prognosis in Patients With Chondrosarcoma of the Bone?. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000002960

[68] 8. Foot and Ankle Surgery. 2013.

[69] Chapter 3 Emerging Technologies in Orthopaedic Trauma. 2021.

[70] Clinical, functional and radiological outcomes of extracorporeal irradiation in limb salvage surgery for bone tumours. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b12.bjj-2016-0462.r2

[71] A multiple joint morphometric analysis of female patients with progressive collapsing foot deformity: a cross-sectional study. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06670-1

[72] Outcome of conservative and surgical treatment of enchondromas and atypical cartilaginous tumors of the long bones: retrospective analysis of 228 patients. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2502-7

[73] Chapter 43 Degenerative Conditions and Osteonecrosis of the Foot and Ankle. 2020.

[74] Management of Tarsal Navicular Stress Fractures. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546509355408

[75] Chronic Tears of the Reflected Head of the Rectus Femoris. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546511413251

[76] Coxa Vara in Childhood: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00003

[77] Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.170078

[78] Effects of worn and new footwear on plantar pressure in people with gout. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04370-x

[79] Chapter 115 Tendon Disorders of the Foot and Ankle. 2019.

[80] The severity of preoperative bone marrow oedema negatively influences short‐term clinical outcomes following arthroscopic bone marrow stimulation for osteochondral lesions of the talus. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12355

[81] Outcomes and potential mechanism of a protocol to optimize foot orthoses in patients with rheumatoid arthritis. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03364-5

[82] Clinical and arthroscopic features of meniscal tears and a search for the role of infection in histologically confirmed meniscal mucoid degeneration. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-003-0412-5

[83] Hallux valgus deformity and postural sway: a cross-sectional study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04385-4

[84] Pediatric Soft-Tissue Tumors. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200309000-00006

[85] Sitting foot: posture dependent changes of volume, edema and perfusion of the foot. A prospective interventional study with 27 volunteers. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07971-4

[86] Recurrent bilateral mid-tarsal subluxations. A case report.. The Journal of Bone & Joint Surgery. 1979. DOI: 10.2106/00004623-197961040-00027

[87] Dysfunction of the Windlass Mechanism Is Associated with Hallux Rigidus. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00437

[88] The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskeletal Disorders. 2006. DOI: 10.1186/1471-2474-7-102

[89] Plantar Enthesopathy. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546510377405

[90] Increased hallux angle in children and its association with insufficient length of footwear: A community based cross-sectional study. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-159

[91] Factors Affecting Subjective Symptoms in Children with Pes Planovalgus Deformity. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.19.01504

[92] Elevated Peak Plantar Pressures in Patients Who Have Charcot Arthropathy. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199803000-00009

[93] Etiological aspects in osteochondritis dissecans patellae. Knee Surgery, Sports Traumatology, Arthroscopy. 1999. DOI: 10.1007/s001670050180

[94] Chapter 44 The Diabetic Foot. 2020.

[95] Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1668-0

[96] Biomechanical and Histopathological Analysis of a Retrieved Dermal Allograft After Superior Capsule Reconstruction: A Case Report. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.07.006

[97] The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment. Clinical Orthopaedics & Related Research. 2010. DOI: 10.1007/s11999-009-1094-1

[98] INFANTILE CORTICAL HYPEROSTOSIS. The Journal of Bone & Joint Surgery. 1950. DOI: 10.2106/00004623-195032030-00023

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6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.