Evaluation of in-shoe plantar pressure and shear during walking for diabetic foot ulcer prevention.

Objective: To investigate reliability and changes of in-shoe plantar pressure and shear during walking at three cadences with two insole designs. This was a precursor to the investigation of plantar loading in people with diabetes for potential foot ulcer prevention.

Method: A sensorised insole system, capable of measuring plantar pressure and shear at the heel, fifth metatarsal head (5MH), first metatarsal head (1MH) and hallux, was tested with ten healthy participants during level walking.

A Wearable Insole System to Measure Plantar Pressure and Shear for People with Diabetes.

Pressure coupled with shear stresses are the critical external factors for diabetic foot ulceration assessment and prevention. To date, a wearable system capable of measuring in-shoe multi-directional stresses for out-of-lab analysis has been elusive. The lack of an insole system capable of measuring plantar pressure and shear hinders the development of an effective foot ulcer prevention solution that could be potentially used in a daily living environment.

Postural control during quiet standing and voluntary stepping response tasks in individuals post-stroke: a case-control study.

Background: Postural control impairments following a stroke have an impact on mobility, reduce independence, and increase the risk of falls. Assessing these impairments during tasks representative of real-life situations, such as quiet standing (QS) and voluntary stepping response (VSR), will enhance our understanding of how the postural control system is impaired in individuals post-stroke (IPS). It will also inform the development of a more targeted and effective rehabilitation to prevent falls in IPS.

A qualitative study exploring the experiences and perceptions of patients with rheumatoid arthritis before and after wearing foot orthoses for 6 months.

Foot pathology in people with rheumatoid arthritis (RA) can have a psychosocial impact, but interventions such as foot orthoses can reduce foot pain, improving physical activity and quality of life. A previous meta-analysis concluded that foot orthoses can relieve pain and disability and enhance patient's well-being. The aim of this study was to explore the experiences of people with RA, before and after wearing foot orthoses for 6 months.

A Systematic Review to Identify the Effects of Biologics in the Feet of Patients with Rheumatoid Arthritis.

Ninety percent of patients with rheumatoid arthritis (RA) feel foot pain during the disease process. Pharmacological treatment of RA has a systematic effect on the body and includes: Nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARDs) and biologics. The objective of our review was to examine the impact of biologics on patients with RA 'foot.

Conservative Treatment for Acute Ankle Sprain: A Systematic Review.

The aim was to identify conservative treatments available for acute ankle sprain and to evaluate their effectiveness with respect to pain relief and short-term recovery of functional capacity. A systematic review of the relevant literature was conducted via a data search of the PROSPERO, PubMed, Scopus, CINAHL, PyscINFO and SPORTDiscus databases, from inception until December 2019, focusing on randomised control trial studies. Two of the authors independently assessed the quality of each study located and extracted the relevant data.

Systematic review of the psychometric properties of patient-reported outcome measures for rheumatoid arthritis in the foot and ankle.

Objective: To identify self-reported outcome measures specific to the foot and ankle in patients with rheumatoid arthritis and to investigate the methodological quality and psychometric properties of these measures.

Method: A systematic review focusing on patients with rheumatoid arthritis.

Setting: The search was conducted in the PubMed, SCOPUS, CINAHL, PEDro and Google Scholar databases, based on the following inclusion criteria: population (with rheumatoid arthritis) > 18 years; psychometric or clinimetric validation studies of patient-reported outcomes specific to the foot and ankle, in different languages, with no time limit.

Evaluation of orthotic insoles for people with diabetes who are at-risk of first ulceration.

Objective: This study focussed on pressure relieving orthotic insoles designed for retail footwear and people with diabetes and at risk of first forefoot ulceration. The aim was to investigate whether the pressure relieving effects of a customised metatarsal bar and forefoot cushioning are sensitive to bar location and shape, and material choice.

Research Design And Methods: Patient-specific foot shape was used to design an orthotic insole, with metatarsal bar location and shape customised according to plantar pressure data.

Contributions of foot muscles and plantar fascia morphology to foot posture.

Background: The plantar foot muscles and plantar fascia differ between different foot postures. However, how each individual plantar structure contribute to foot posture has not been explored. The purpose of this study was to investigate the associations between static foot posture and morphology of plantar foot muscles and plantar fascia and thus the contributions of these structures to static foot posture.

Morphology of the Toe Flexor Muscles in Older Adults With Toe Deformities.

Objective: It has been suggested that atrophied or weak toe flexor muscles are associated with the formation of toe deformities, but there is little evidence to support this theory. This study aimed to determine whether the size of the toe flexor muscles differed in older adults with and without toe deformities.

Methods: Forty-four older adults (>60 years) were recruited for the study.

Optimisation of rocker sole footwear for prevention of first plantar ulcer: comparison of group-optimised and individually-selected footwear designs.

Background: Appropriate footwear for individuals with diabetes but no ulceration history could reduce the risk of first ulceration. However, individuals who deem themselves at low risk are unlikely to seek out bespoke footwear which is personalised. Therefore, our primary aim was to investigate whether group-optimised footwear designs, which could be prefabricated and delivered in a retail setting, could achieve appropriate pressure reduction, or whether footwear selection must be on a patient-by-patient basis.

Challenging the foundations of the clinical model of foot function: further evidence that the root model assessments fail to appropriately classify foot function.

Background: The Root model of normal and abnormal foot function remains the basis for clinical foot orthotic practice globally. Our aim was to investigate the relationship between foot deformities and kinematic compensations that are the foundations of the model.

Methods: A convenience sample of 140 were screened and 100 symptom free participants aged 18-45 years were invited to participate.

A narrative review of musculoskeletal problems of the lower extremity and back associated with the interface between occupational tasks, feet, footwear and flooring.

At least 50% of workers are exposed to the risk of musculoskeletal disorders (MSD) due to spending prolonged hours standing at work. There is a lack of information regarding issues with the feet, solutions to the problem, and links between MSD, feet, footwear and flooring. The present article provides a narrative review of the research in this area, based on 31 papers.

Estimating the material properties of heel pad sub-layers using inverse Finite Element Analysis.

Detailed information about the biomechanical behaviour of plantar heel pad tissue contributes to our understanding of load transfer when the foot impacts the ground. The objective of this work was to obtain the hyperelastic and viscoelastic material properties of heel pad sub-layers (skin, micro-chamber and macro-chamber layers) in-vivo. An anatomically detailed 3D Finite Element model of the human heel was used to derive the sub-layer material properties.

Effects of Age on Strength and Morphology of Toe Flexor Muscles.

Study Design Descriptive, cross-sectional. Background Age-related muscle atrophy is common in lower-limb muscles. We therefore speculated that foot muscles may also diminish with age.

The evaluation of three treatments for plantar callus: a three-armed randomised, comparative trial using biophysical outcome measures.

Background: Callus is one of the most common foot skin complaints experienced by people of all ages. These painful and unsightly lesions often result in disability. The 'gold standard' of treatment is scalpel debridement by a trained specialist; however, people also seek over-the-counter remedies.

'Trial and error…', '…happy patients' and '…an old toy in the cupboard': a qualitative investigation of factors that influence practitioners in their prescription of foot orthoses.

Background: Foot orthoses are used to manage of a plethora of lower limb conditions. However, whilst the theoretical foundations might be relatively consistent, actual practices and therefore the experience of patients is likely to be less so. The factors that affect the prescription decisions that practitioners make about individual patients is unknown and hence the way in which clinical experience interacts with knowledge from training is not understood.

Are clinical measures of foot posture and mobility associated with foot kinematics when walking?

Background: There is uncertainty as to which foot posture measures are the most valid in terms of predicting kinematics of the foot. The aim of this study was to investigate the associations of clinical measures of static foot posture and mobility with foot kinematics during barefoot walking.

Method: Foot posture and mobility were measured in 97 healthy adults (46 males, 51 females; mean age 24.

An action research approach to facilitating the adoption of a foot health assessment tool in India.

Background: India has a diabetes population that is growing and alongside this, the incidence of limb threatening foot problems is increasing. Foot health care provision does not yet meet this demand. In one locality in India, clinicians had an unstructured approach to foot health assessments resulting in poor adoption of evidence based guidelines from the West and a persistence of serious foot complications.

Foot posture and function have only minor effects on knee function during barefoot walking in healthy individuals.

Background: Foot posture has been postulated as a risk factor for overuse injuries of the knee, however the link between foot posture and knee joint function is unclear. The aims of this study were to: (i) compare knee adduction moment and knee joint rotations between normal, planus and cavus foot posture groups, and (ii) to determine the relationship between rearfoot and midfoot joint rotations and knee adduction moment magnitude.

Methods: Rotation of the knee, rearfoot and midfoot was evaluated in 97 healthy adults that were classified as normal (n=37), cavus (n=30) or planus (n=30) for the Foot Posture Index, Arch Index and normalised navicular height.

Foot posture is associated with kinematics of the foot during gait: A comparison of normal, planus and cavus feet.

Variations in foot posture are associated with the development of some lower limb injuries. However, the mechanisms underlying this relationship are unclear. The objective of this study was to compare foot kinematics between normal, pes cavus and pes planus foot posture groups using a multi-segment foot model.

Movement of the human foot in 100 pain free individuals aged 18-45: implications for understanding normal foot function.

Background: Understanding motion in the normal healthy foot is a prerequisite for understanding the effects of pathology and thereafter setting targets for interventions. Quality foot kinematic data from healthy feet will also assist the development of high quality and research based clinical models of foot biomechanics. To address gaps in the current literature we aimed to describe 3D foot kinematics using a 5 segment foot model in a population of 100 pain free individuals.

Pilot study demonstrating that sole mechanosensitivity can be affected by insole use.

Insoles are known to alter plantar loads and thus plantar sensory input. We therefore hypothesised that plantar somatosensory sensation could be modified over time by use of hard metatarsal pads. A sample of 12 healthy female participants was randomly allocated to either soft metatarsal pads (n=6, latex foam, Shore A11) or hard metatarsal pads groups (n = 6, thermoplastic, ShoreA65).

The assessment and management of diabetes related lower limb problems in India-an action research approach to integrating best practice.

Background: In this article the authors explore the current issues and barriers related to achieving successful outcomes to diabetic foot complications in India. This was achieved by engaging clinicians in taking ownership of the problems and facilitating them in the identification of solutions to action change in clinical practice.

Methods: This was accomplished through facilitating participants in this study via a process of problem identification and planning, the first phases of an action research cycle approach.

Development and evaluation of prefabricated antipronation foot orthosis.

Our aim was to develop and evaluate a new antipronation foot orthosis that addressed problems perceived by clinicians and users with existing foot orthoses. Clinicians and users were engaged to develop a user specification for the orthosis, and orthotic geometry and materials were developed using clinical reasoning. The orthotic material properties were tested and the ability of the orthosis to reduce foot pronation evaluated on 27 individuals.