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Hodgson L, Price C, Reay J, Nester C, Morrison SC. Navigating the integration of knowledge and research evidence in clinical practice for children's foot health: A multi-professional survey. J Foot Ankle Res 2024; 17:e12034. [PMID: 39049500 DOI: 10.1002/jfa2.12034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Access to clinical services for children with foot and ankle problems are important, but unravelling the complexity of practice and service delivery can be challenging. The pursuit and implementation of research evidence is critical for driving positive change in practice, but little is understood about the approaches to knowledge and research acquisition in children foot health. AIM The aim of the study was to: (1) explore multi-professional habits of knowledge and research evidence acquisition in children's foot health; and (2) understand how clinicians integrate information for children and their families into their practice. METHODS This was a descriptive, cross-sectional online survey. Participants were included if they worked in the UK and had experience of working within paediatric services. RESULTS There were complete responses from 247 health professionals, representing physiotherapists (n = 160), podiatrists (n = 50), orthotists (n = 25), nurses and specialists in community public health nurses (health visitors) (n = 12). Three main themes were generated from the data: (1) Factors that influence knowledge and inform clinical practice. (2) The role of Professional Bodies in informing professional knowledge. (3) Health Professionals' views on managing health information for parents and caregivers. CONCLUSIONS This work advances understanding of the value health professionals' place in the development of materials for informing professional knowledge, as well as highlighting some of the challenges with translation of knowledge into clinical practice. The findings offer a national perspective of health professionals working on children's foot health and have highlighted that some of the most valued influences on clinical practice come from peer-to-peer networking.
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Affiliation(s)
- Lisa Hodgson
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
| | - Carina Price
- School of Health and Society, University of Salford, Salford, UK
| | - Julie Reay
- School of Health and Society, University of Salford, Salford, UK
| | - Chris Nester
- School of Health Professions, Keele University, Keele, UK
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Reddy Donthireddy SK, Suh JH, Woodbridge DMK. Orthotic Prescription for Pediatric Flexible Flat Feet using Convolutional Neural Networks. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1105-1108. [PMID: 36085685 DOI: 10.1109/embc48229.2022.9871698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pediatric flexible flat foot (PFFF) is known to in-crease the foot structure's load, causing potential disability. Foot orthoses are one of the most common non-surgical methods to improve the medial longitudinal arch of the foot for improving PFFF. However, orthoses are not routinely prescribed due to their high cost, and discomfort caused by a restriction of foot movement. Furthermore, there are no quantitative standards or guidelines for an orthotic prescription, which makes the decision-making process of less experienced podiatrists chal-lenging. In this study, the authors investigated convolutional neural networks to classify the needs of orthotic prescription. Using image augmentation techniques and training a VGG-16 model, we achieved high precision and recall, 1 and 0.969 accordingly, to classify orthotic prescription needs.
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Carrasco AC, Silva MF, Guenka LC, Silva CT, Moura FA, Cardoso JR. Non-radiographic validity and reliability measures for assessing foot types: A systematic review. Foot Ankle Surg 2021; 27:839-850. [PMID: 33431323 DOI: 10.1016/j.fas.2020.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Foot type classification is well recognized in clinical practice and orthopedic literature, a universally accepted classification or standardized measures to determine foot types are lacking. The objective of this study was to identify which non-radiographic assessment methods are considered valid and/or reliable for the classification of foot types. METHOD A systematic database search was performed. Only cross-sectional studies that performed reliability and/or validity analysis of non-radiographic methods were included. To evaluate the risk of bias, the Critical Appraisal Tool (CAT) was used to evaluate the measurement properties of objective clinical methods. RESULTS Twenty-six studies were included. The results of reliability and validity, in general, demonstrated high scores, but, inconsistencies were related to the variability of the measurements, heterogeneity of the methods used to determine reliability and validity, and lack of parameters for classifying foot types, which resulted in few elements to determine which method of foot type evaluation is valid and reliable. CONCLUSION Given the Intraclass Correlation Coefficient and CAT results and the presence of normative values, the static measurements of the "Arch Height Index", "Foot Posture Index", and "Staheli Arch Index" can be suggested to classify foot types.
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Affiliation(s)
- Aline C Carrasco
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil; Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | - Mariana F Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Leandro C Guenka
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Carla T Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Felipe A Moura
- Laboratory of Applied Biomechanics, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Jefferson R Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil.
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Alsancak S, Guner S, Güven E, Özgün AK, Akkaş Y, Alkıs N. Paediatric flat foot and foot dimension in Central Anatolia. BMC Pediatr 2021; 21:200. [PMID: 33906615 PMCID: PMC8077819 DOI: 10.1186/s12887-021-02645-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Information on the foot structures of Central Anatolian children is limited. Foot structures of children aged 6–10 years were shown to be different according to sex and increasing age. Objective This study aimed to compare the foot anthropometric values by age and sex and collect the foot anthropometric data to reveal the relationship between pes planus and pes cavus in the arches of children according to age. Methods Footprints of 335 children (180 boys and 155 girls) aged 6–10 years were taken by the pedigraph method and evaluated using 18 different parameters. The TFL (Truncated foot length), FL (foot length), Arch Index, Chippaux Smirak Index, Staheli Arc Index, and foot rotation values of the children were examined. To examine the relationship between the parameters, normality values were examined. Independent samples t-test was used to analyze sex differences in terms of foot size and shape. Results Correlations between other parameters were determined using the correlations analysis method. TFL, metatarsal circumference, and FL were strongly correlated with age in the children. Foot rotation increased with body mass index in the girls compared to that in the boys. According to the evaluation results with the classification made with the Staheli arch index, 63.3% pes planus, 9.8% pes cavus and 27.7% of the normal arch structure were identified. Conclusions Planning shoe production accordingly will contribute to the development of healthy feet in children. This article focused on foot structures of in Central Anatolia and to identify early foot deformities in children. This study found that the length of the TFL was smaller in boys than in girls.
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Affiliation(s)
- Serap Alsancak
- Department of Prosthetics & Orthotics, Faculty of Health Science, Ankara University, Ankara, Turkey
| | - Senem Guner
- Department of Prosthetics & Orthotics, Faculty of Health Science, Ankara University, Ankara, Turkey.
| | - Enver Güven
- Department of Prosthetics & Orthotics, Faculty of Health Science, Ankara University, Ankara, Turkey
| | - Ali Koray Özgün
- Department of Prosthetics & Orthotics, Faculty of Health Science, Ankara University, Ankara, Turkey
| | - Yunis Akkaş
- Department of Prosthetics & Orthotics, Faculty of Health Science, Ankara University, Ankara, Turkey
| | - Neslihan Alkıs
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ankara University, Ankara, Turkey
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Deschamps K, Nester C, Newton V, Gijon-Nogueron G, Simsek E, Brabants A. The biopsychosocial-digital continuum of foot orthosis practice and research: the VALUATOR model. J Foot Ankle Res 2021; 14:25. [PMID: 33789716 PMCID: PMC8011079 DOI: 10.1186/s13047-021-00468-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/22/2021] [Indexed: 02/05/2023] Open
Abstract
Foot orthoses have been used for decades despite uncertainty surrunding their therapeutic efficacy. Orthoses have been used exclusively to affect neuro-biomechanical input and outcome variables, however, there is emerging evidence that therapeutic efficacy may be affected by a psychological stimulus. Critical appraisal of the literature highlights that there is no holistic model upon which foot orthosis practice is taught, practised nor investigated. This paper introduces a conceptual model of foot orthosis practice (Value Based Foot Orthosis Practice (VALUATOR) model) that embraces a broader range of factors that are pertinent to orthosis practice, incorporating contemporary health service behaviours and values into orthosis practice for the first time.Within the VALUATOR model, foot orthosis design and clinical value is considered along a bio-psycho-social-digital continuum that reflects the reality of foot orthosis practice. The model contextualises the variable outcomes that are observed in research and practice within 6 key areas: 1) value, 2) person-centered approach, 3) zone of optimal bio-psycho-social stress, 4) bio-psycho-social assessment, 5) monitoring, 6) primary and secondary clinical strategies.The VALUATOR model is targeted at students, lecturers, scientists and practitioners and includes carefully chosen terminology to support a robust basis for educational and scientific discussion. It is believed that it provides a contemporary viewpoint and a structured conceptual metaphor that builds on existing evidence from a wide range of sources, invites constructive intellectual debate, and is anchored in the experiences of practitioners too. Stress testing the VALUATOR model will help determine its model and support further developments and evolution of orthotic practice in a evidence based way.
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Affiliation(s)
- Kevin Deschamps
- Department of Podiatry, Artevelde University of Applied Sciences, Ghent, Belgium
- KULeuven- Department of Rehabilitation Sciences- Musculoskeletal Rehabilitation, Research Group, Campus Brugge, Spoorwegstraat 12, 8200 Brugge, Belgium
- Haute Ecole Leonard De Vinci, Institut D’Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Bruxelles, Belgium
| | - Chris Nester
- School of Health & Society, Brian Blatchford Building, Frederick Road Campus, University of Salford, Salford, M6 6PU UK
| | - Veronica Newton
- School of Health & Society, Brian Blatchford Building, Frederick Road Campus, University of Salford, Salford, M6 6PU UK
| | | | - Engin Simsek
- School of Physical Therapy and Rehabilitation Sciences, Dokuz Eylul University, İzmir, Turkey
| | - Antoine Brabants
- Haute Ecole Leonard De Vinci, Institut D’Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Bruxelles, Belgium
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Pietrzak K, Nowocień K, Kraszewski B. Flexibility does not affect the dorsiflexion of foot and the popliteal angle in young adults. Foot Ankle Surg 2020; 26:763-765. [PMID: 31668802 DOI: 10.1016/j.fas.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/28/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to assess how flexibility affects the dorsiflexion of foot and the popliteal angle test results in junior high school students. METHODS The subjects were 142 students from the 2nd, and 3rd year of Poznań junior high schools (age between 13 and 15). Each subject was examined 6 times: there were 3 raters, a specialist in orthopaedics, a resident doctor and a physical therapy student, and each of them performed 2 measurements. Flexibility was also measured using the Beighton scale (score from 0 to 9). RESULTS Since the Beighton scale is ordinal in order to evaluate the relationship between flexibility and the range of motion Spearman's rank correlation coefficient was calculated. The statistical analysis showed no correlation between flexibility measured on the Beighton scale and the range of passive foot dorsiflexion and the popliteal angle. CONCLUSIONS The degree of flexibility does not affect the dorsiflexion of the foot and the popliteal angle in junior high students. At this age the range of dorsiflexion is determined by the length of the triceps surae muscle while the popliteal angle depends on the length of the muscles on the back of the thigh.
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Affiliation(s)
- Krzysztof Pietrzak
- The Department of Spondyloorthopedics and Biomechanics of the Spine, University of Medical Sciences, 28 Czerwca 1956 137, Poznań, 61-501, Poland.
| | - Krzysztof Nowocień
- Department of Orthopaedics and Traumatology, University of Medical Sciences Poznan, Poland
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Morrison SC, Tait M, Bong E, Kane KJ, Nester C. Symptomatic pes planus in children: a synthesis of allied health professional practices. J Foot Ankle Res 2020; 13:5. [PMID: 31998410 PMCID: PMC6979376 DOI: 10.1186/s13047-020-0372-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background This study sought to explore professional perspectives on the assessment and management of symptomatic pes planus in children. Methods Data was collected from three professional groups (podiatrists, physiotherapists, and orthotists) with experience of managing foot problems in children. The survey was undertaken in the United Kingdom via a self-administered, online survey. Data was captured over a four-month period in 2018. Results Fifty-five health professionals completed the survey and the results highlighted that assessment techniques varied between professions, with standing tip-toe and joint range of motion being the most common. Treatment options for children were diverse and professionals were adopting different strategies as their first line intervention. All professions used orthoses. Conclusions There were inconsistencies in how the health professionals assessed children presenting with foot symptoms, variation in how the condition was managed and differences in outcome measurement. These findings might be explained by the lack of robust evidence and suggests that more effort is needed to harmonise assessment and treatment approaches between professions. Addressing discrepancies in practice could help prioritise professional roles in this area, and better support the management of children with foot pain.
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Affiliation(s)
| | | | | | - Kyra J Kane
- 2Wascana Rehabilitation Centre, Saskatchewan Health Authority, Saskatchewan, Canada
| | - Chris Nester
- 3School of Health and Society, University of Salford, Salford, UK
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Gijon-Nogueron G, Martinez-Nova A, Alfageme-Garcia P, Montes-Alguacil J, Evans AM. International normative data for paediatric foot posture assessment: a cross-sectional investigation. BMJ Open 2019; 9:e023341. [PMID: 30987983 PMCID: PMC6500282 DOI: 10.1136/bmjopen-2018-023341] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The foot posture index (FPI) is an observational tool designed to measure the position of the foot. The objective of this study was to establish international reference data for foot posture across childhood, and influence of body mass index (BMI) on paediatric foot posture. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS The dataset comprised 3217 healthy children, aged from 3 to 15 years. Contributing data were acquired from Spain, UK and Australia. INTERVENTIONS Foot posture was described by means and z-score of the FPI and the height and weight of each subject was measured and the BMI was calculated. RESULTS The foot posture of 3217 children were reviewed. A pronated (FPI ≥+6) foot posture was found in 960 (29.8%) children, a normal (FPI 0 to +6) foot posture in 1776 (55.2%) and a highly pronated (FPI +10) foot posture was found in 127 children (3.9%) (range -4 to +12 FPI). Less than 11% were found to have a supinated foot type (n=354). Approximately 20% of children were overweight/obese, but correlation between BMI and FPI was weak and inverse (r=-0.066, p<0.01), refuting the relationship between increased body mass and flatfeet. CONCLUSIONS This study confirms that the 'flat' or pronated foot is the common foot posture of childhood, with FPI score of +4 (3) the average finding. Trend indicated a less flatfoot with age, although non-linear. A wide normal range of foot posture across childhood is confirmed.
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Affiliation(s)
- Gabriel Gijon-Nogueron
- Nursing and Podiatry, Universidad de Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | | | | | | | - Angela Margaret Evans
- Podiatry, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
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Nester CJ, Graham A, Martinez-Santos A, Williams AE, McAdam J, Newton V. National profile of foot orthotic provision in the United Kingdom, part 1: practitioners and scope of practice. J Foot Ankle Res 2017; 10:35. [PMID: 28775767 PMCID: PMC5540424 DOI: 10.1186/s13047-017-0215-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022] Open
Abstract
Background Foot orthoses have been advocated in the management of a wide range of clinical foot and lower limb problems and are within the scope of podiatry, orthotic and physiotherapy practice. Previous reports into the provision of orthoses have consistently identified significant issues with services and devices, but data were never specific to foot orthoses. The aim of this first of a series of papers was to report the first ever national multi professional profile of foot orthosis provision in the United Kingdom. Methods Quantitative and qualitative data were collected from podiatrists, orthotists and physiotherapists via an online questionnaire. The topics, questions and answers were developed through a series of pilot phases. The professions were targeted through electronic and printed materials. Data were captured over a 10 month period in 2016. Results A total of 499 responses were included in analysis, including 357 podiatrists, 93 orthotists and 49 physiotherapists. The results reveal wide ranging practices across podiatrists, orthotists and physiotherapists, provision of orthoses through different health care departments (uni and multidisciplinary), for different health conditions (acute and chronic), and involving different types of orthoses (prefabricated and customised). Conclusion Foot orthoses in the United Kingdom are provided in areas of well recognised health and rehabilitation priorities. A wide range of orthotic devices and practices are employed and different professions provide foot orthoses in different ways. Electronic supplementary material The online version of this article (doi:10.1186/s13047-017-0215-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C J Nester
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - A Graham
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - A Martinez-Santos
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - A E Williams
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - J McAdam
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - V Newton
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
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Abstract
PURPOSE To determine the intrarater and interrater reliability of the arch height index (AHI) in children developing typically. The AHI is tested with a device that measures foot structure. METHODS Thirty children, ages 6 to 12 years, participated for a total of n = 60 feet. The AHI measurements were taken by 2 investigators in sitting and standing and repeated twice by each investigator in a single visit. Intrarater and interrater reliabilities were determined using intraclass correlation coefficient (ICC) (2,1) statistical analysis. RESULTS The mean age was 9.61 ± 1.96 years. The intrarater and interrater reliability had an ICC 0.76 or more in both sitting and standing. The average AHI value was 0.36 ± 0.02 in sitting and 0.32 ± 0.02 in standing. CONCLUSIONS Pediatric therapists, physicians, and orthotists should consider using the AHI as an objective measure to be used for research, to assess foot structure, monitor change over time, and assist with treatment planning in children.
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