Understanding the nature and mechanism of foot pain

Overcoming Barriers: Sex Disparity in Surgeon Ergonomics

BACKGROUND

Musculoskeletal discomfort is widely experienced by surgeons across multiple surgical specialties. Developing technologies and new minimally invasive techniques add further complexity and ergonomic stressors. These stressors differentially affect male and female surgeons, but little is known about the role these sex disparities play in surgical ergonomic stress. We reviewed existing literature to better understand how ergonomic stress varies between male and female surgeons.

STUDY DESIGN

A literature search was performed via PubMed including but not limited to the following topics: ergonomics, surgeons, female surgeons, women surgeons, pregnancy, and operating room. A review of available quantitative data was performed.

RESULTS

Female surgeons endure more pronounced ergonomic discomfort than their male counterparts, with added ergonomic stress associated with pregnancy.

CONCLUSIONS

A 4-fold method is proposed to overcome ergonomic barriers, including (1) improved education on prevention and treatment of ergonomic injury for active surgeons and trainees, (2) increased departmental and institutional support for ergonomic solutions for surgeons, (3) partnerships with industry to study innovative ergonomic solutions, and (4) additional research on the nature of surgical ergonomic challenges and the differential effects of surgical ergonomics on female surgeons.

Muscle strength and foot pressure vary depending on the type of foot pain

This study compared muscle strength and foot pressure among patients with metatarsalgia, patients with plantar fasciitis, and healthy controls. A total of 31 patients with foot pain (14 metatarsalgia and 17 plantar fasciitis) and 29 healthy controls participated in the study. The strengths of the plantar flexor and hip muscles were measured using isokinetic and handheld dynamometers, respectively. Foot pressure parameters, including the pressure-time integral (PTI) and foot arch index (AI), were assessed using pedobarography. Compared with the healthy control group, plantar flexor strength was significantly reduced in the affected feet of the metatarsalgia and plantar fasciitis groups (F = 0.083, all p < 0.001); however, hip strength was significantly decreased only in the affected feet of the metatarsalgia group (F = 20.900, p < 0.001). Plantar flexor (p < 0.001) and hip (p = 0.004) strength were significantly lower in the metatarsalgia group than in the plantar fasciitis group. The PTI was lower in the forefeet of the affected feet in the metatarsalgia (p < 0.001) and plantar fasciitis (p = 0.004) groups. Foot AI (p < 0.001) was significantly reduced only in the metatarsalgia group. These results suggest the need to consider the evaluation of muscle strength and foot pressure in both feet for the diagnosis and treatment of foot pain.

Prevalence and Associated Factors of Ankle-Foot Pain Among Nurses Working in Surgical Units of Comprehensive Specialized Hospitals in Amhara Regional State, Northwest Ethiopia, 2022

Background

Ankle-foot pain is a serious public health concern among nurses and has a significant impact on the quality of the health care service delivery system. However, little is known about the prevalence and factors associated with ankle-foot pain among nurses working in surgical units in Ethiopia.

Purpose

The study aimed to assess the prevalence and associated factors of ankle-foot pain among nurses working in surgical units of comprehensive specialized hospitals in Amhara regional state, Northwest Ethiopia, 2022.

Participants and Methods

An institution-based cross-sectional study was conducted among 409 nurses working in surgical units of comprehensive specialized hospitals, from May 15 to June 7, 2022. A simple random sampling technique was employed. Data were collected by five BSc nurses using a structured self-administered questionnaire. The collected data were entered into Epi-data version 4.6 and exported to SPSS version 23 for analysis. The descriptive statistics and bivariable and multivariable logistic regression analyses were computed. Finally, variables were declared as statistically significant at P < 0.05 using the odds ratio and 95% CI.

Results

The prevalence of ankle-foot pain among nurses working in surgical units was 51.8% (95% CI = 46.9-57.5). More than 10 years of working experience [AOR = 3.48, 95% CI = 1.35-8.92], working 48 or more hours per week [AOR = 2.69, 95% CI = 1.27-6.00], prolonged standing [AOR = 5.72, 95% CI = 3.20-10.25], high physical job demand [AOR = 2.41, 95% CI = 1.53-3.80], and low job control [AOR = 2.34, 95% CI = 1.47-3.71] had statistically significant association with ankle-foot pain.

Conclusion

This study found that ankle-foot pain was common among nurses working in surgical units. Having more years of work experience, working more hours per week, prolonged standing, high physical job demand, and low job control were statistically associated with ankle-foot pain.

Qualitative exploration of patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviors in diabetes

INTRODUCTION

Diabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare professionals (HCPs) on barriers and/or facilitators to foot self-care behaviors in diabetes and areas of consensus and/or tension between patient and HCP perspectives.

RESEARCH DESIGN AND METHODS

This was a sequential, qualitative study that used a hermeneutic phenomenological approach. Phase I involved nine in-depth, semi-structured patient interviews. Phase II involved seven in-depth semi-structured interviews with HCPs (podiatrists, diabetes nurses, foot health practitioners (FHPs) and general practitioners (GPs)). In phase III, findings from phases I and II were brought back to two patient interview groups (five patients in total) to try and identify any areas of consensus and tension between HCP and patient perspectives.

RESULTS

Patient and HCP perspectives had several areas of alignment: concerns over consequences of diabetes complications; the importance of patient education and frustrations around aspects of health service delivery. There were also some notable tensions identified: mixed messaging from HCPs around whose responsibility patient foot health is; and who patients should initially consult following the development of a foot problem. Overall, patients expressed that motivation to undertake good foot self-care behaviors was generated from their lived experiences, and was enhanced when this aligned with the information they received from HCPs. HCPs appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients.

CONCLUSIONS

This study has identified points of misalignment between the views of patients and practitioners that may help to explain why adherence to foot self-care among patients with diabetes is low. Our results suggest that better outcomes may stem from HCPs focusing on supporting autonomous motivation for self-care and enhancing the rationale through referencing patients' own experience rather than focussing on increasing patient knowledge. Renewed focus on consistency of messaging by HCPs around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot specialist HCPs may also help to improve uptake and adherence to foot self-care behaviors in diabetes.

Validity and reliability of the Persian version of self-administered foot evaluation questionnaire (SAFE-Q) in people with foot orthopedic problems

INTRODUCTION

Foot problems are one of the main causes of seeing a doctor. According to the World Health Organization's definition of health, the healthcare system must consider patients' quality of life as an important entity. In this regard, many tools have been developed to evaluate patients' opinions about their health status. The purpose of the present study is to evaluate the validity and reliability of the Persian version of the Foot Self-Assessment Questionnaire (SAFE-Q) in patients with foot orthopedic problems.

METHOD

215 people aged 17-60 years with orthopedic foot problems were included in this cross-sectional study. The Spearman correlation coefficient of SAFE-Q questionnaires versus Foot Function Index (FFI) questionnaire was evaluated for the convergent validity. Forty-three people randomly completed SAFE-Q again one week later. Intraclass correlation coefficient (ICC) and Cronbach's alpha was calculated to evaluate the test-retest reliability and internal consistency of the SAFE-Q, respectively.

RESULTS

A strong relationship was found between the SAFE-Q total score and other scales with FFI questionnaire (r = 0.52 to 0.87). ICC test-retest reliability and Cronbach's alpha were 0.981 and 0.98 for SAFE-Q, respectively.

CONCLUSION

The results indicate that the Persian version of the SAFE-Q questionnaire has acceptable validity and reliability and can be used to assess the health status and quality of life of Persian speakers with orthopedic foot problems.

Foot Pain is Common, But Frequently Improves 1 Year After Total Knee Arthroplasty

BACKGROUND

Osteoarthritis frequently affects multiple joints through the lower limbs. This study sought to examine the incidence of foot pain in subjects undergoing total knee arthroplasty (TKA) and determine if foot symptoms improved following surgery.

METHODS

Six hundred ten subjects undergoing TKA completed patient-reported outcome measures preoperatively, and at 6 and/or 12 months after surgery including the incidence and severity of foot or ankle pain, Knee Injury and Osteoarthritis Outcome Scores (KOOS) Joint Replacement, Oxford Knee Scores (OKS), EQ5D, and satisfaction.

RESULTS

Foot or ankle pain was reported in 45% before, 32% at 6 months, and 36% at 12 months after TKA. Of those with preoperative foot pain, 42% at 6 months and 50% at 12 months reported no foot pain after TKA, and the Visual Analog Scale severity reduced from a mean of 4.0 before to 1.7 after surgery. Those with preoperative foot pain had lower baseline KOOS (P = .001), OKS (P = .001), and more depression/anxiety (P = .010), but experienced equivalent postoperative KOOS, OKS, and satisfaction with surgery, compared to those without foot pain.

CONCLUSION

Foot or ankle pain was reported by nearly half of TKA subjects, but resolved after surgery in 50%. Those with preoperative foot pain experienced at least equivalent improvement in knee-related symptoms and mobility compared to those without foot pain. The presence of foot pain should not be a deterrent to TKA.

The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes

Diabetic foot syndrome is one of the most costly complications of diabetes. Damage to the soft tissue structure is one of the primary causes of diabetic foot ulcers and most of the current literature focuses on factors such as neuropathy and excessive load. Although the role of blood supply has been reported in the context of macro-circulation, soft tissue damage and its healing in the context of skin microcirculation have not been adequately investigated. Previous research suggested that certain microcirculatory responses protect the skin and their impairment may contribute to increased risk for occlusive and ischemic injuries to the foot. The purpose of this narrative review was to explore and establish the possible link between impairment in skin perfusion and the chain of events that leads to ulceration, considering the interaction with other more established ulceration factors. This review highlights some of the key skin microcirculatory functions in response to various stimuli. The microcirculatory responses observed in the form of altered skin blood flow are divided into three categories based on the type of stimuli including occlusion, pressure and temperature. Studies on the three categories were reviewed including: the microcirculatory response to occlusive ischemia or Post-Occlusive Reactive Hyperaemia (PORH); the microcirculatory response to locally applied pressure such as Pressure-Induced Vasodilation (PIV); and the interplay between microcirculation and skin temperature and the microcirculatory responses to thermal stimuli such as reduced/increased blood flow due to cooling/heating. This review highlights how microcirculatory responses protect the skin and the plantar soft tissues and their plausible dysfunction in people with diabetes. Whilst discussing the link between impairment in skin perfusion as a result of altered microcirculatory response, the review describes the chain of events that leads to ulceration. A thorough understanding of the microcirculatory function and its impaired reactive mechanisms is provided, which allows an understanding of the interaction between functional disturbances of microcirculation and other more established factors for foot ulceration.

A Cross-Sectional Study on the Prevalence of Footpad Dermatitis in Canadian Turkeys

Footpad dermatitis (FPD) can be a prevalent issue in commercial turkey production. This study aimed to identify the bird, housing, and management-related factors associated with the prevalence of FPD in the Canadian turkey flocks. A questionnaire and flock health scoring system were developed and disseminated to ~500 commercial turkey farmers across Canada. Farmers were asked to score FPD on a subset of 30 birds within their flock using a 0–2 scoring scale based on severity. The prevalence of FPD in the flock was calculated as the percentage of affected birds (score 1 or 2). A multivariate linear regression modeling was used to identify the factors associated with the prevalence of FPD. Four variables were included in the final model and accounted for 26.7% of the variation in FPD prevalence among the flocks. FPD prevalence was higher with increasing bird weight (3.6 ± 1.13), higher in flocks bedded with straw (12.1 ± 7.9), higher in flocks where birds were picked up less frequently during daily inspections (11.6 ± 8.10), and higher in flocks that used feed/water additives to reduce litter moisture (20.5 ± 10.59). These findings are a preliminary exploratory assessment of risk factors related to FPD prevalence on Canadian turkey farms. While these findings emphasize the importance of litter management and the stockperson, estimates and P-values from this study should be interpreted with caution. Further, longitudinal studies with the identified variables are required to better determine their influence on FPD.

Effect of foot health and quality of life in patients with Parkinson disease: A prospective case-control investigation

BACKGROUND

Parkinson's disease (PD) is a common neurodegenerative disorder, characterised by the presence of motor disturbances. Therefore, it can be related to musculoskeletal and orthopaedic problems, particularly in the foot status, that are linked to a negative effect on overall health, mobility and social function.

OBJECTIVE

The aim was to analyse the impact of foot health and quality of life in patients with Parkinson's disease and people without Parkinson's disease, with normalised reference scores, in the light of the values recorded with regard to foot health status and overall health.

MATERIAL AND METHODS

This is a prospective case-control investigation. A sample of Parkinson's patients (n = 62) including 24 men and 38 women was recruited, and foot HQoL was measured using the Foot Health Status Questionnaire Spanish (Sp_FHSQ).

RESULTS

The PD group recorded lower levels of foot health quality of life (HQoL) with lower scores on the Sp_FHSQ in general foot health, general health, physical activity, social capacity and vigour sub-scales. Regarding the rest of the sub-scales of the Sp_FHSQ, foot pain showed higher values in the PD group. Differences between the cases and control groups were analysed by means of a Mann-Whitney U test, showing statistical significance (P < 0.05).

CONCLUSIONS

PD presents an increased negative impact on foot health and quality of life which appears to be related to the chronic neurodegenerative disease.

Influence of foot pain on frailty symptoms in an elderly population: a case-control study

BACKGROUND

Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty.

OBJECTIVE

To determine whether foot pain can influence a greater degree of frailty.

DESIGN AND SETTING

Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain.

METHODS

A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS).

RESULTS

There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS.

CONCLUSIONS

These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.

Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review

ABSTRACT

Mechanism-based classification of pain has been advocated widely to aid tailoring of interventions for individuals experiencing persistent musculoskeletal pain. Three pain mechanism categories (PMCs) are defined by the International Association for the Study of Pain: nociceptive, neuropathic, and nociplastic pain. Discrimination between them remains challenging. This study aimed to build on a framework developed to converge the diverse literature of PMCs to systematically review methods purported to discriminate between them; synthesise and thematically analyse these methods to identify the convergence and divergence of opinion; and report validation, psychometric properties, and strengths/weaknesses of these methods. The search strategy identified articles discussing methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system. Studies that assessed the validity of methods to discriminate between categories were assessed for quality. Extraction and thematic analysis were undertaken on 184 articles. Data synthesis identified 200 methods in 5 themes: clinical examination, quantitative sensory testing, imaging, diagnostic and laboratory testing, and pain-type questionnaires. Few methods have been validated for discrimination between PMCs. There was general convergence but some disagreement regarding findings that discriminate between PMCs. A combination of features and methods, rather than a single method, was generally recommended to discriminate between PMCs. Two major limitations were identified: an overlap of findings of methods between categories due to mixed presentations and many methods considered discrimination between 2 PMCs but not others. The results of this review provide a foundation to refine methods to differentiate mechanisms for musculoskeletal pain.

Ankle and Foot Pain and Associated Factors Among Nurses at Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia: Cross-Sectional Study

Background

Ankle–foot pain is a significant public health problem in nurse professionals and has great burdens to the individuals, healthcare systems, and community at large. However, there is limited evidence on the prevalence of ankle–foot pain and its associated factors among nurses in Ethiopia. Thus, the finding of this study will help to address health problems resulting from ankle–foot pain among nurses.

Purpose

The aim of this study was to determine the prevalence and associated factors of ankle–s–foot pain among nurse working in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia.

Patients and Methods

An institutional-based cross-sectional study was conducted on a total of 366 nurses, and a simple random sampling technique was used to recruit study participants. Data were collected by using a self-administered adapted standardized Nordic questionnaire. Descriptive statistics and a bivariate logistic regression model were done to identify factors associated with ankle–foot pain. Those variables with a P-value less than 0.05 with 95% CI in multivariate model were taken as statistically significant. Finally, AOR with 95% confidence interval at a P-value of <0.05 was reported.

Results

The prevalence of self-reported ankle–foot pain among nurses was 43.7% (95% CI=38.5–49.1). Older age (AOR=7.669, 95% CI=2.316−25.390), low shoe comfort (AOR=4.215, 95% CI=2.031–8.745), multiple foot conditions (AOR=6.102 95% CI=1.959–19.008), working night shifts (AOR=2.047, 95% CI=1.098−3.816), high physical demand (AOR=3.487, 95% CI=1.988–6.116), and nurses working in the intensive care unit (AOR=2.402, 95% CI=1.219–4.732) showed a statistically significant association with ankle–foot pain.

Conclusion

This study indicated that the prevalence of ankle–foot pain is commonly reported among nurses working in Ayder Comprehensive Specialized Hospital. Therefore, awareness and prevention of ankle and foot pain in nurses should be prioritized to reducing risk factors. Nurses should give attention to comfortable footwear, and further longitudinal research is recommended.

Degree of Impact of Tailor's Bunion on Quality of Life: A Case-Control Study

Tailor’s bunion (TB) disease should be considered one of the foot injuries that causes disability in feet as well as general health. This case–control descriptive study investigated and contrasted the effects of different TB types in a sociodemographic population using the Foot Health Status Questionnaire (FHSQ). A sample of 100 subjects with a mean age of 51.70 ± 17.78 years was recruited and requested to reply to a foot health survey. Results were self-reported. Subjects were scored. Participants with TB type III (TB3) registered lower scores for foot pain, foot function, footwear, and foot health. Physical activity and social capacity had higher scores, and vigor and general health were lower. A Kruskal–Wallis test was used for systematic differences between the FHSQ and different TB types. In all analyses, statistical significance was considered a p-value <0.05 with a 95% confidence interval. Statistically significant differences were found between all domains of the FHSQ and TB, except for the social capacity domain and vigor. The FHSQ is an important measurement tool in TB subjects, showing that factors such as sex, age, and footwear used throughout an individual’s life are significantly associated with the development of TB3 and its influence on foot pain and foot health.

ACR Appropriateness Criteria® Chronic Foot Pain

Chronic foot pain is a frequent clinical complaint, which can significantly impact the quality of live in some individuals. These guidelines define best practices with regards to requisition of imaging studies based on specific clinical scenarios, which have been grouped into different variants. Each variant is accompanied by a brief description of the usefulness, advantages, and limitations of different imaging modalities. The present narrative is the result of an exhaustive assessment of the available literature and a thorough review process by a panel of experts on Musculoskeletal Imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Bionic Footwear Effect to Lower Limb Locomotion in Biomechanical Analysis

Many scientific data have proven that regular wearing of high-heeled shoes adversely affects human health. Recent evidence suggested that bionic heels imitated hoofed animals have attracted widespread attention. However, few biomechanical studies have investigated the effects of bionic high-heeled footwear on the lower limbs. Accordingly, this study aimed to examine the impact of bionic high-heeled shoes (HHS) on the biomechanical characteristics of lower limbs by comparing kinematics and kinetics of walking in HHS and bionic flat-bottomed shoes (FBS). they find that when the subjects wore HHS, the loading is concentrated in the forefoot region for a much longer time. Couple with HHS lacks the cushioning effect of the complete sole, the sole has to rely only on plantar flexion and dorsiflexion of the ankle joint to cushion the impact force, which will undoubtedly increase the fatigue damage of the ankle joint. The unique split-toe structure balances the loading between the toes could reduce the risk of toes injury during walking. However, there are still risks of injury to the lower limbs of HHS, especially the ankle and knee joints.

Toe flexor strength is associated with mobility in older adults with pronated and supinated feet but not with neutral feet

Background

Older adults are known to have more pronated foot posture and decreased toe flexor strength (TFS), as well as decreased mobility in daily life compared to young adults. Although foot posture is reported to be an influential factor for walking biomechanics in young adults, there is less information on this subject in older adults. Age-related reduction in TFS is shown to be associated with impairments of functional performance, but it is poorly understood whether foot posture influences the relationships between TFS and functional performances. Therefore, the present study aimed to elucidate this concern by examining older women.

Methods

Seventy community-dwelling older women (76.8 ± 4.4 years) voluntarily participated in this study. Foot posture was evaluated by the 6-item foot posture index (FPI). Based on the FPI score, participants were allocated to pronated, neutral, or supinated group (n = 33, 26, and 11, respectively). TFS was assessed using a toe grip dynamometer in a seated position. Scores of 30-s chair stand, timed up-and-go, 5-m comfortable-speed walking, and static balance tests were determined to evaluate functional performances. Pearson’s correlation coefficients were computed to examine the relationships between TFS and functional performances in each group.

Results

TFS positively correlated with comfortable walking speed in the pronated (r = 0.37, p = 0.03) and supinated (r = 0.76, p < 0.001) groups, but not in the neutral group (r = 0.17, p = 0.42). For the two significant relationships, an analysis of covariance showed that there was no significant difference between the pronated and supinated groups in the slopes of the regression lines, suggesting a similar relative contribution of TFS to comfortable walking speed between the two groups. In addition, TFS tended to negatively correlate with timed up-and-go time in the pronated (r = − 0.32, p = 0.07) and supinated (r = − 0.56, p = 0.08) groups, and positively correlate with 30-s chair stand score in the pronated group (r = 0.31, p = 0.08).

Conclusions

The present study indicates that TFS would be associated with mobility, walking performance in particular, in older women with pronated and supinated feet but not with neutral feet.

Custom insoles versus sham and GP-led usual care in patients with plantar heel pain: results of the STAP-study - a randomised controlled trial

OBJECTIVES

To compare custom-made insoles to sham insoles and general practice (GP)-led usual care in terms of pain at rest and during activity at 12 weeks follow-up in individuals with plantar heel pain.

METHODS

In this randomised clinical trial 185 patients aged 18 to 65 years, with a clinical diagnosis of plantar heel pain for at least 2 weeks, but no longer than 2 years were recruited. Patients were randomly allocated into three groups: (1) GP-led treatment, plus an information booklet with exercises (usual care; n=46), (2) referral to a podiatrist for treatment with a custom-made insole plus an information booklet with exercises (custom-made insole; n=70) and (3) referral to a podiatrist and treatment with a sham insole plus an information booklet with exercises (sham insole; n=69). As well as the primary outcome of pain severity (11-point Numerical Rating Scale) we used the Foot Function Index (0 to 100) as a secondary outcome.

RESULTS

Of 185 randomised participants, 176 completed the 12-week follow-up. There was no difference in pain or function between the insole and the sham groups at 12 weeks. Participants in the GP-led usual care group reported less pain during activity at 12 weeks, (mean difference (MD) 0.94, 95% CI 0.23 to 1.65), less first step pain (MD 1.48, 95% CI 0.65 to 2.31), better function (MD 7.37, 95% CI 1.27 to 13.46) and higher recovery rates (RR 0.48, 95% CI 0.24 to 0.96) compared with participants in the custom insole group.

CONCLUSIONS

Referral to a podiatrist for a custom-made insole does not lead to a better outcome compared to sham insoles or compared to GP-led usual care.

TRIAL REGISTRATION NUMBER

NTR5346.

Sex Differences in Frail Older Adults with Foot Pain in a Spanish Population: An Observational Study

Frailty is a condition that can increase the risk of falls. In addition, foot pain can influence older adults and affect their frail condition. The main objective was to measure the frailty degree in older adults in a Spanish population with foot pain from moderate to severe. Method: This is a cross-sectional descriptive study. A sample of people older than 60 years (n = 52), including 26 males and 26 females, were recruited, and frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS). Results: Spearman’s correlation coefficients were categorized as weak (rs ≤ 0.40), moderate (0.41 ≤ rs ≥ 0.69), or strong (0.70 ≤ rs ≥ 1.00). There was a statistically significant correlation for the total score (p < 0.001) and most of the subscales of the 5-Frailty scale compared with the EFS, except for Mood (p > 0.05). In addition, females and males showed similar 5-Frailty and Edmonton Frail scales scores with no difference (p > 0.05). Conclusion: Foot pain above 5 points, i.e., from moderate to severe, does not affect the fragility more in one sex than another.

Foot care knowledge and practices among Japanese nurses and care workers in home care and adult service center: a cross- sectional study

Background

Foot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers at home care and adult day service center, along with their demographic characteristics and daily care for clients.

Methods

This study analyzed 232 randomly selected front-line nurses and care workers working at home care or adult day service center in one of the selected cities, Aichi Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman's rank correlation tests.

Results

Among the 305 surveyed, 232 (62 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status.Higher accuracy differences in the early detection of foot problems and skin tears on lower limbs in knowledge category were observed between nurses and care workers. The nurses as well as the care workers had low accuracy rates of knowledge questions regarding the use of shoes and socks subscale.For practice, both nurses and care workers had low mean scores for checking client's shoes (2.0/5.0 and 2.1/5.0, respectively), method for reducing ingrown nail pain (2.6/5.0 and 1.9/5.0, respectively), and opportunity for discussing foot care with others (2.7/5.0 and 2.2/5.0, respectively). A significant correlation between knowledge and practice scores was observed among nurses (0.331, p < 0.05) and care workers (0.339, p < 0.001).

Conclusions

Despite the presence of several barriers toward enhanced care delivery to clients needing it most, nurses and care workers clearly understood the importance of foot care. These findings indicate that foot care should be focused by nurses and care workers to improve the knowledge and practice of foot care and to suggest future implications that efficient and understandable tools are needed considering their current working situation.

Development and evaluation of a dual density insole for people standing for long periods of time at work

BACKGROUND

Appropriate footwear is important for those who stand for prolonged periods of time at work, enabling them to remain comfortable, healthy and safe. Preferences for different footwear cushioning or hardness are often person specific and one shoe or insole will not be the choice for all. The aim of this study was to develop a range of insole options to maintain comfort during long periods of standing at work and test insole material preferences in the workplace.

METHODS

The study consisted of two parts. Part one evaluated 9 insoles of the same geometry that varied in hardness under 2 different plantar regions (n = 34). Insole preference, plantar pressure and selected anthropometric foot measures were taken. Three insole designs based on the most preferred options were identified from this part. In part two, these three insoles were evaluated with 22 workers immediately after trying them on (1 min) and after a working day. Foot anthropometric measures and subjective questions concerning material hardness preferences and self-reported foot characteristics were used to investigate whether either had a relationship with insole preference.

RESULTS

Part one found insole preference predominantly varied according to material hardness under the medial arch rather than the heel/forefoot. Softer material under the heel and forefoot was associated with a reduction in peak pressures in these regions (p < 0.05). The most preferred insole had lower pressures under the hallux and first metatarsal phalangeal joint, and greater pressures and contact area under the medial midfoot (p < 0.05) compared to the least preferred insole. Height and foot anthropometrics were related to insole preference. In part two, under real world conditions, insole preference changed for 65% of participants between the immediate assessment (1 min) and after a whole workday, with dorsum height related to the latter (p < 0.05). Subjective questions for self-assessed arch height and footwear feel identified 66.7% of the insole preferences after 1 day at work, compared to 36% using immediate assessment of insole preference.

CONCLUSION

Preference for material hardness varies underneath the medial arch of the foot and is time dependent. Simple foot measures and questions about comfort can guide selection of preferred insoles.

Intervention study of a foot-care programme enhancing knowledge and practice among nurses and care workers at in-home service providers

Aim

To evaluate the foot-care educational programme for nurses and care workers at in-home service providers.

Design

A non-randomized controlled study with random cluster sampling method.

Methods

Study participants were nurses and care workers of 21 in-home service providers, including home-visit nursing and care providers, 1-day care service centres or care centres with rehabilitation programme in Japan. Foot-care programme with foot-care tools as a package or standard care comprising 3-5 sessions over 2 months was provided to 110 participants (87 were on analysis). The outcomes were changes in foot-care knowledge and scores in pre-post interventions. Data were analysed with descriptive statistics, t test, logistic regression analysis and ANCOVA.

Results

Before adjusting for background, total scores of knowledge and practice categories were higher than the baseline in the intervention group (43 participants) compared with the control group (44 participants). After background correction due to potential bias of non-random cluster sampling, significant between group differences were observed in mean score changes in skin and consultation subscales of the practice category.

Cross-cultural adaptation, translation, and validation of the Spanish Foot and Ankle Outcome Score questionnaire

The Spanish Foot and Ankle Outcome Score questionnaire (FAOS-S) may be considered a health evaluation tool with 42 questions for assessing foot health disorders. To date, FAOS has been validated in different languages, but a Spanish version was lacking. Consequently, the purpose of this study was to translate and validate the Spanish version of the FAOS (FAOS es). A suitable method was developed for the translation protocol and cross-cultural validation from Swedish to Spanish. Regarding the total marks from each domain, agreement degrees and confidence were analysed using the Cronbach's α and intraclass correlation coefficient, respectively. In addition, the mean ± SD differences between pretest and posttests were calculated and completed using of the Bland and Altman distribution plots. Excellent agreement between the two versions based on Cronbach's α was demonstrated. Five domains consisting of pain, symptoms of foot disorders, activities of daily living, sports and recreation, and foot and ankle quality of life were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the pain, stiffness, other foot disorder-related symptoms, and quality of life domains. There were no significant differences among any domain (P > .05). There were no statistically significant differences (P = .000) for the mean ± SD differences between pretest and posttests (56.2524 ± 19.064 [51.98-60.52] and 57.45 ± 21.02 [52.74-62.16] points, respectively). Bland and Altman plots or clinically pertinent variations were not statistically significantly different. The FAOS is considered a strong and valid questionnaire with adequate repeatability in the Spanish community.

Foot health and quality of life in patients with rheumatoid arthritis: a cross-sectional study

OBJECTIVE

The aim of this study is to identify foot health factors related to the quality of life in patients with rheumatoid arthritis (RA).

SETTING

In this cross-sectional study, a total of 293 subjects were analysed, 229 of whom were in the RA group and 64 in the control group. In the RA group, 173 patients were female, and 50 in the control group.

PARTICIPANTS

Patients with foot pain and RA (according to the American College of Rheumatology/European League Against Rheumatism 2010 rheumatoid arthritis classification criteria) and with foot pain but no RA were recruited (Granada, Spain).

INTERVENTION

Two researchers independently interviewed the patients to obtain data for the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Clinical data were obtained using the Short Form 12-Item questionnaire (quality of life) (primary outcome), Visual Analogue Scale for pain (VAS pain), the Manchester Foot Pain Disability Index (MFPDI) and the Foot Function Index (FFI). Anthropometric measurements were obtained using a foot measurement platform, the Foot Posture Index and the Manchester Scale of Hallux Valgus (secondary outcomes).

RESULTS

Of the 293 subjects, 76.1% were female. Significant differences were observed between the RA and the control group (p<0.001) with regard to VAS pain (general, foot and hand), MFPDI and FFI. In terms of anthropometric measurements, significant differences were only recorded for midfoot and forefoot width (p=0.03). For the physical health component, multivariable linear regression with the parameters age, gender, VAS pain (general) and the presence of RA presented an R² value of 48.8%, while for the mental health component the corresponding value was 5.6%.

CONCLUSION

Morphological and structural characteristics of the foot are not necessarily associated with pain, disability and loss of function. The presence of RA, a higher score on VAS pain (general), female gender and older age are all associated with the physical component of the quality of life of patients with RA.

Are custom-made foot orthoses of any interest on the treatment of foot pain for prolonged standing workers?

BACKGROUND

The prolonged standing position is an important factor in the onset of foot musculoskeletal disorders among workers. Safety shoes, designed to protect against the physical constraints of the work environment, do not address this issue to date.

OBJECTIVES

The goal of this study is to assess the possible benefits of custom-made foot orthoses among prolonged standing workers.

STUDY DESIGN

repeated measures without control group.

METHODS

Thirty-four standing workers who suffer from foot pain volunteered for the study. Custom-made foot orthoses, designed by a podiatrist, were 3D-printed and distributed to each volunteer. Static balance as well as static and dynamic plantar pressure measurements were carried out with sensors inserted in the safety shoes, before and after three weeks of wearing foot orthoses daily. A questionnaire on pain and comfort was also distributed before and after treatment.

RESULTS

Feelings of pain, discomfort and heavy legs were found to be significantly reduced after wearing 3D-printed orthoses (p<0.05). Additionally, in static and dynamic conditions, a significant decrease in mean peak pressure in the rearfoot area was observed along with a significant increase in mean peak pressure in the midfoot area (p<0.05). There was also a significant improvement of balance in the medial-lateral direction.

CONCLUSION

Custom-made orthoses significantly increase the well-being of standing workers in our experimental testing conditions. The custom-made shape allows for a better balanced distribution of foot peak pressure thanks to its support and stimulation of the foot arches particularly through a shift of pressure from the heel to the midfoot.

One-Stage Metatarsal Interposition Lengthening With an Autologous Fibula Graft for Treatment of Brachymetatarsia

Objective: Brachymetatarsia is defined as the pathological shortening of a metatarsal bone, which can cause cosmetic problems and pain in the forefoot. The main surgical treatment options are: extension osteotomy, interposition of a bone graft, and callus distraction. Usually, a bone graft from the iliac crest is used for the interposition osteotomy. The operative technique of graft extraction from the fibula has not been described in the literature yet. Methods: Eight feet with brachymetatarsia in 5 patients were evaluated retrospectively. The minimum follow-up period was 2 years. Via a dorsal V/Y skin incision, a central osteotomy on the metatarsal bone was done. A graft was obtained from the anterior fibula. The graft was inserted and fixed by a locking plate. Additional soft tissue procedures were done. Results: We had bony consolidation in all cases. The mean extension was 9.01 mm (5.49 to 12.54 mm). This corresponded to a mean 20.3% extension of the entire metatarsal. High patient satisfaction as well as high satisfaction regarding the cosmetic results were achieved. There were no postoperative complications. The range of motion of the metatarsal-phalangeal joint IV was 20% less preoperative in terms of plantar flexion. Standing up on tiptoes was possible in all patients postoperatively. One patient reported mild symptoms after sports activities. Conclusions: Because of its anatomy the graft adapts to the metatarsal IV bone. As our study showed, harvesting from the distal fibula causes no functional restriction. In terms of wound and bone healing as well as pain symptoms, this method should be considered as an alternative to the standard iliac graft.

Translation, cross-cultural adaptation, and reliability of the Foot Posture Index (FPI-6) - Brazilian version

Background: The Foot Posture Index (FPI) is a quick, easy, and reliable clinical assessment for measuring foot posture variation in different environments. The aim of the study was to translate the FPI into Brazilian Portuguese and assess its inter and intra-observer reliability. Methods: The cross-cultural adaptation of the 6-item version of the FPI (FPI-6) was accomplished using standard guidelines. Forty-two volunteers participated in the reliability process, assessed by two examiners and at three different occasions, evaluated using the intraclass correlation coefficient (ICC). The agreement between reliability assessments was investigated by the standard error of measurement (SEM) and the minimal detectable change (MDC₉₀). Results: The Brazilian version of the FPI-6 showed excellent inter and intraobserver reliability for the dominant (ICC = 0.91 and 0.90) and nondominant lower limb (ICC = 0.94 and 0.92). The agreement was considered excellent for SEM with values representing less than 5% in relation to the total FPI-6 score. The MDC₉₀ showed that changes in the score greater than 1.82 (for interobserver) and 1.90 (for intraobserver) can be considered as clinical changes in foot posture. Conclusion: The Brazilian version of the FPI-6 has proved reliable in terms of inter and intraobserver reliability and can therefore be used both in clinical practice and in scientific research.

Analyzing the effect of an arch support functional insole on walking and jogging in young, healthy females

BACKGROUND AND OBJECTIVE

The aim of this study was to explore the effectiveness of arch support functional insoles to prevent metatarsalgia.

METHOD

Twenty-five healthy females participated in the study. A Vicon motion capture system was used to collect kinematics data of the lower limb. An AMTI force plate was used to record the vertical ground reaction force (GRF), and the Novel Pedar-X System was used to measure foot pressure while subjects wore normal insoles or functional insoles with an arch support during walking and jogging.

RESULTS

With the arch support functional insoles, the first metatarsal (FM) region's contact area was increased and the peak pressure and time-pressure integral of the FM and second and third metatarsal (SATM) were areas decreased. This suggests a lower risk of longitude stress injuries in these areas. The ankle dorsiflexion angle of jogging with the 'arch support functional insoles' (RF) and walking with the 'arch support functional insoles' (WF) were significantly increased at initial contact and the knee and hip flexion angle of RF and WF were reduced. The peak hip extension angle of WF and RF also declined. The vertical loading rate of RF was lower, which would be beneficial in reducing the risk of lower limb injuries during jogging.

CONCLUSIONS

The results demonstrate that arch support functional insoles can be used effectively to prevent and decrease pain and promote a suitable weight-bearing pattern in the foot for promoting the health of young females.

Translation and Test⁻Retest of the Spanish Podiatry Health Questionnaire (PHQ-S)

Background: The Podiatric Health Questionnaire (PHQ) is a health-related questionnaire consisting of six questions designed for measuring foot health status. To date, the PHQ has only been validated in the English-language version. Thus, this study aimed to perform the Spanish translation and test⁻retest procedures of the PHQ (PHQ-S). Method: The forward/backward translation and test⁻retest reliability methods were applied from English to Spanish languages. Regarding the total score for each domain, internal consistency and reliability were determined by the Cronbach α and intraclass correlation coefficient (ICC) with a confidence interval (CI) of 95%. Results: High internal consistency was shown for the six domains: (1) walking with a Cronbach α of 0.97; (2) hygiene and nail care with 0.93 and 093, respectively; (3) foot pain with 0.91; (4) worry and concern domain with 0.904; (5) quality of life with 0.87; and (6) the self-perception of how their feet are feeling measured by a visual analogic scale with 0.92. Excellent test⁻retest reliability (ICC = 0.99 (95% CI = 0.96⁻0.98)) was shown for the total score. Conclusions: The PHQ-S was shown to be a valid and reliable tool for an acceptable use in the Spanish population.

Transcultural Adaptation and Validation of the Spanish Bristol Foot Score (BFS-S)

The Bristol Foot Score is considered an instrument for measuring the impact of foot problems and pain. It was developed and validated in United Kingdom. Therefore, this aim was to perform the transcultural adaptation and validation of the Spanish version. The recommended forward/backward translation protocol was applied for the procedure of translation, transcultural adaptation and validation to Spain. Considering each domain and question, internal consistency and reliability were analyzed through the Crombach alpha (α) and intraclass correlation coefficient (ICC) with a 95% confidence interval (95% CI). A very good internal consistency was shown for the 3 domains: concern and pain showed a Cronbach of 0.896, footwear and general foot health of 0.790, mobility 0.887. Each question had a very good test-retest reliability, ranged from 0.721 to 0.963 with no systematic differences (P>0.05) in each question of the Spanish Bristol Foot Score (BFS-S) questionnaire. The test-retest reliability was excellent (ICC 95%): concern and foot pain 0.950 (0.913-0971); footwear and general foot health 0.914 (0.851-0.950), mobility 0.973 (0.953-0.984) and there were no sistematic differences in any domain (P > 0.05). The BFS-S was shown to be a valid and reliable tool with an acceptable use in the Spanish population.

Peroneal muscle activity during different types of walking

BACKGROUND

As the most common form of movement, walking happens not only on flat but also on uneven surfaces, where constant loss and regaining of balance occur. The main balancing function of the ankle joint is performed by tibial muscles. When changing inclination in a frontal plane, an essential balancing function is performed by the peroneal muscles. One of the methods for improving the activity of peroneal muscles is walking with different foot placement. The objective of this study was to analyze the activity of the peroneal muscles when performing different types of walking.

METHODS

Sixteen healthy participants took part in this study, walking on a flat surface (NORM), on a medial incline ramp with the plantar surface of the foot fully placed on the surface (FULL), and on a medial incline ramp with elevated lateral part of the foot (LAT). We monitored the changes of EMG signals in peroneus longus (PL), peroneus brevis (PB), tibialis anterior (TA), soleus (SOL), gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) muscles. We monitored kinematic parameters (gait speed, stride length, contact time, foot position). The parametric ANOVA test and a non-parametric Friedman test were used at an alpha level of 0.05.

RESULTS

This study shows that the EMG activities of peroneal muscles increases when walking on the medial incline ramp. Statistically significant EMG differences were observed in the peroneal muscles, TA and GL muscles. We observe a very high percentage of normalized EMG value of the PL muscle in LAT walking. Walking on a medial incline ramp impacts the foot position, contact time, and stride length but not the gait speed.

CONCLUSIONS

Walking on a medial incline ramp could be an effective exercise to improve the neuro-muscular function of the peroneal muscles and, therefore, might be a suitable exercise for people with weakened ankle evertors.

Region-specific foot pain and plantar pressure in people with rheumatoid arthritis: A cross-sectional study

BACKGROUND

It is unclear whether region-specific foot pain may influence plantar pressure in people with established rheumatoid arthritis. The aim was to determine the association between region-specific foot pain and region-specific plantar pressure.

METHODS

Twenty-one people with rheumatoid arthritis and 19 age- and sex-matched controls participated in this study. Self-reported foot pain in the toes, forefoot, midfoot and rearfoot was assessed using foot diagrams. Peak pressure and pressure time integrals for the toes, forefoot, midfoot and rearfoot were calculated using a pressure mat system. Differences in foot pain and pressure between the groups were calculated using appropriate regression models. To determine associations between region-specific pain and pressure, linear regression models were used while adjusting for body mass and participant group.

FINDINGS

Participants with rheumatoid arthritis were primarily elderly female with long disease duration. Compared to controls, participants with rheumatoid arthritis had higher odds of foot pain at the toes (Odds Ratio (OR) = 10.4, P = 0.001), forefoot (OR = 6.3, P = 0.006) and rearfoot (OR = 10.1, P = 0.011). Participants with RA had higher peak pressure at the rearfoot (P = 0.003) and higher pressure time integrals at the forefoot (P = 0.005), midfoot (P = 0.016) and rearfoot (P < 0.001). After adjusting for body mass and participant group, peak pressure was significantly higher at the toes in those with midfoot pain and rearfoot pain.

INTERPRETATION

People with rheumatoid arthritis experience region-wide foot pain and demonstrate differences in pressure distribution compared to people without rheumatoid arthritis. Foot pain at the midfoot and rearfoot is also associated with increases in plantar pressure at the toes.

A Preliminary Study on the Effect of Computer-Aided Designed and Manufactured Orthoses on Chronic Plantar Heel Pain

INTRODUCTION

Chronic plantar heel pain (CPHP) is a significant, painful condition referring to a range of undifferentiated foot conditions that affect the heel of the foot.

METHOD

Participants presenting with CPHP of more than 6 months' duration were recruited on a first through the door basis. Computer-Aided Design and Computer-Aided Manufactured (CAD-CAM) orthoses were designed and constructed for each participant, then dispensed as per normal practice. Pre- and postintervention assessment of pain was performed at baseline and after 6 weeks of use, utilizing the pain subset of the Foot Function Index (FFI).

RESULTS

There was a significant reduction in the mean pain scores for all participants in all constructs of the FFI. Total FFI score was also significant ( P = .003).

CONCLUSION

CAD-CAM orthoses have the potential to become a treatment modality of choice in CPHP since they have resulted in a significant improvement in heel pain after only 6 weeks' use.

LEVELS OF EVIDENCE

Therapeutic, Level IV: Prospective, comparative trial.

Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis

BACKGROUND

Plantar heel pain (PHP) is common. Foot orthoses are often applied as treatment for PHP, even though there is little evidence to support this.

OBJECTIVE

To investigate the effects of different orthoses on pain, function and self-reported recovery in patients with PHP and compare them with other conservative interventions.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A systematic literature search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL and Google Scholar up to January 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials comparing foot orthoses with a control (defined as no intervention, sham or other type of conservative treatment) reporting on pain, function or self-reported recovery in patients with PHP.

RESULTS

Twenty studies investigating eight different types of foot orthoses were included in the review. Most studies were of high quality. Pooled data from six studies showed no difference between prefabricated orthoses and sham orthoses for pain at short term (mean difference (MD) of 0.26 (95% CI -0.09 to 0.60)). No difference was found between sham orthoses and custom orthoses for pain at short term (MD 0.22 (95% CI -0.05 to 0.50)), nor was there a difference between prefabricated orthoses and custom orthoses for pain at short term (MD 0.03 (95% CI -0.15 to 0.22)). For the majority of other interventions, no significant differences were found.

CONCLUSIONS

Foot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP.

PROSPERO REGISTRATION NUMBER

CRD42015029659.

Footwear interventions for foot pain, function, impairment and disability for people with foot and ankle arthritis: A literature review

OBJECTIVE

To conduct a literature review on the effectiveness of footwear on foot pain, function, impairment and disability for people with foot and ankle arthritis.

METHODS

A search of the electronic databases Scopus, Medline, CINAHL, SportDiscus and the Cochrane Library was undertaken in September 2017. The key inclusion criteria were studies reporting on findings of footwear interventions for people with arthritis with foot pain, function, impairment and/or disability. The Quality Index Tool was used to assess the methodological quality of studies included in the qualitative synthesis. The methodological variation of the included studies was assessed to determine the suitability of meta-analysis and the grading of recommendations, assessment, development and evaluation (GRADE) system. Between and within group effect sizes were calculated using Cohen's d.

RESULTS

1440 studies were identified for screening with 11 studies included in the review. Mean (range) quality scores were 67% (39-96%). The majority of studies investigated rheumatoid arthritis (n = 7), but also included gout (n = 2), and 1st metatarsophalangeal joint osteoarthritis (n = 2). Meta-analysis and GRADE assessment were not deemed appropriated based on methodological variation. Footwear interventions included off-the-shelf footwear, therapeutic footwear and therapeutic footwear with foot orthoses. Key footwear characteristics included cushioning and a wide toe box for rheumatoid arthritis; cushioning, midsole stability and a rocker-sole for gout; and a rocker-sole for 1st metatarsophalangeal joint osteoarthritis. Between group effect sizes for outcomes ranged from 0.01 to 1.26. Footwear interventions were associated with reductions in foot pain, impairment and disability for people with rheumatoid arthritis. Between group differences were more likely to be observed in studies with shorter follow-up periods in people with rheumatoid arthritis (12 weeks). Footwear interventions improved foot pain, function and disability in people with gout and foot pain and function in 1st metatarsophalangeal joint osteoarthritis. Footwear interventions were associated with changes to plantar pressure in people with rheumatoid arthritis, gout and 1st metatarsophalangeal joint osteoarthritis and walking velocity in people with rheumatoid arthritis and gout.

CONCLUSION

Footwear interventions are associated with reductions in foot pain, impairment and disability in people with rheumatoid arthritis, improvements to foot pain, function and disability in people with gout and improvements to foot pain and function in people with 1st metatarsophalangeal joint osteoarthritis. Footwear interventions have been shown to reduce plantar pressure rheumatoid arthritis, gout and 1st metatarsophalangeal joint osteoarthritis and improve walking velocity in rheumatoid arthritis and gout.

Relation between foot pain and plantar pressure in pregnancy

Background/aim: Hormonal and structural changes that occur during pregnancy cause alterations in body biomechanics. These alterations reach their peak in the last trimester. Adaptive changes that appear in the foot result in pain in the foot and ankle. Pedobarography is a noninvasive measurement method that can be used to understand the origin of such pain. Materials and methods: One hundred and thirty-one pregnant women who did not have a foot or ankle problem prior to pregnancy volunteered to take part in the study. Pain was quantified by a visual analog scale (VAS). A cut-off value of 2.95 was taken to divide the subjects into two groups: Group 1 (n = 70) with VAS scores of <2.95 and Group 2 (n = 61) with VAS scores of ?2.95. Plantar pressure measurements were taken by Tekscan HR Mat using midgait protocol. Results: Forces experienced by the total right foot area, right forefoot, and the midfoot for both feet were significantly higher in Group 2 (P < 0.05). Contact area was significantly larger in Group 2 (P < 0.05). Conclusion: Results indicate that presence and severity of foot pain during pregnancy are related to the force distribution along the foot, especially at midfoot and the contact area.

The reliability and validity of the Korean version of the foot function index for patients with foot complaints

[Purpose] The purpose of this study was to establish the reliability and validity of the Foot Function Index translated into Korean for use in patients with plantar fasciitis and foot/ankle fracture. [Subjects and Methods] Thirty-six subjects with foot complaints, 14 males and 22 females, participated in the study. Reliability was determined by using the intra-class correlation coefficient and Cronbach’s alpha for internal consistency. Validity was examined by correlating Foot Function Index scores with the Short Form-36 and the Visual Analog Scale scores. [Results] Test-retest reliability was 0.90 for the pain subscale, and 0.94 and 0.91 for the disability and activity limitation subscales, respectively. The criterion-related validity was established by comparison with the Korean version of the Short Form-36 and Visual Analog Scale. [Conclusion] The Korean version of the Foot Function Index was shown to be a reliable and valid instrument for assessing foot complaints.

Relationship between foot pain, muscle strength and size: a systematic review

BACKGROUND

Foot pain is common and disabling and thought to be associated with muscle weakness. Understanding the relationship between pain and weakness may help identify effective treatment targets.

OBJECTIVES

To conduct a systematic review to evaluate the relationship between foot pain and foot muscle weakness, or muscle size as a proxy for weakness.

DATA SOURCES

Electronic databases and reference lists were searched for all years to April 2015.

ELIGIBILITY CRITERIA

Full-text articles were retrieved based on the question 'Does the study evaluate an association between foot pain and foot muscle weakness or size?'

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened eligible studies, extracted data and completed a methodological rating.

RESULTS

Eight studies were identified evaluating the relationship between foot pain and foot muscle strength (n=6) or size (n=2). Four studies reported a significant relationship between pain and toe flexor force. One study reported a significant relationship between heel pain and reduced forefoot muscle size. One study reported an inconsistent association depending on measurement technique. One study reported no association between pain and hindfoot muscle size. One study reported no association between low to moderate pain and toe flexion force.

LIMITATIONS

Due to data heterogeneity, no data were pooled for meta-analysis.

CONCLUSION

There is evidence of a significant association between foot pain and muscle weakness when foot pain is of high intensity and primarily measured by toe flexion force. However there is inconsistent evidence that lower intensity foot pain is associated with other measures of foot muscle weakness or size. Systematic Research Registry ID reviewregistry166.

The effect of foot orthoses with forefoot cushioning or metatarsal pad on forefoot peak plantar pressure in running

Background

Foot orthoses are frequently used in sports for the treatment of overuse complaints with sufficient evidence available for certain foot-related overuse pathologies like plantar fasciitis, rheumatoid arthritis and foot pain (e.g., metatarsalgia). One important aim is to reduce plantar pressure under prominent areas like metatarsal heads. For the forefoot region, mainly two common strategies exist: metatarsal pad (MP) and forefoot cushioning (FC). The aim of this study was to evaluate which of these orthosis concepts is superior in reducing plantar pressure in the forefoot during running.

Methods

Twenty-three (13 female, 10 male) asymptomatic runners participated in this cross-sectional experimental trial. Participants ran in a randomised order under the two experimental (MP, FC) conditions and a control (C) condition on a treadmill (2.78 ms⁻¹) for 2 min, respectively. Plantar pressure was measured with the in-shoe plantar pressure measurement device pedar-x®-System and mean peak pressure averaged from ten steps in the forefoot (primary outcome) and total foot was analysed. Insole comfort was measured with the Insole Comfort Index (ICI, sum score 0–100) after each running trial. The primary outcome was tested using the Friedman test (α = 0.05). Secondary outcomes were analysed descriptively (mean ± SD, lower & upper 95%-CI, median and interquartile-range (IQR)).

Results

Peak pressure [kPa] in the forefoot was significantly lower wearing FC (281 ± 80, 95%-CI: 246–315) compared to both C (313 ± 69, 95%-CI: 283–343; p = .003) and MP (315 ± 80, 95%-CI: 280–350; p = .001). No significant difference was found between C and MP (p = .858). Peak pressures under the total foot were: C: 364 ± 82, 95%-CI: 328–399; MP: 357 ± 80, 95%-CI: 326–387; FC: 333 ± 81 95%-CI: 298–368. Median ICI sum scores were: C 50, MP 49, FC 64.

Conclusions

In contrast to the metatarsal pad orthosis, the forefoot cushioning orthosis achieved a significant reduction of peak pressure in the forefoot of recreational runners. Consequently, the use of a prefabricated forefoot cushioning orthosis should be favoured over a prefabricated orthosis with an incorporated metatarsal pad in recreational runners with normal height arches.

Electronic supplementary material

The online version of this article (doi:10.1186/s13047-016-0176-z) contains supplementary material, which is available to authorized users.

The influence of insoles with a peroneal pressure point on the electromyographic activity of tibialis anterior and peroneus longus during gait

Background

Peroneus longus acts as a foot evertor and pronator, thus ensuring stability of the talocrural joint by curbing inversion movement of the rearfoot. Increased activation of the peroneus longus muscle in the stance phase could have a stabilising effect on the ankle joint. This study aimed to determine whether the activity of the peroneus longus muscle could be increased by the targeted use of a specially formed lateral pressure element in a customised orthopaedic insole.

Methods

This was a laboratory-based study that utilised a randomised crossover design. Thirty-four healthy participants walked along a walkway in neutral footwear wearing a control insole or a sensorimotor insole with a lateral pressure point adjacent to the tendon of the peroneus longus muscle. The electromyographic muscle activity of the peroneus longus and tibialis anterior muscles was measured using surface electromyography. Contact with the ground was recorded via two pressure sensors under the sole of the shoe. Muscle activity during the stance phase was analysed in the time and amplitude domains and compared statistically with paired t-tests for both insole types.

Results

In 27 out of the 34 participants, an additional activity peak of the peroneus longus muscle was observed in the loading response phase with the sensorimotor insole, which reached its maximum at 29.7 % (±4.5 %) of the stance phase. When averaged over all 34 participants, the integrated electromyographic output for the peroneus longus in the mid-stance phase revealed a significant higher activity (p < 0.001, post hoc power = 0.98, effect size: Cohen’s d = 0.71) with the sensorimotor insole (18.1 ± 11.3 % MVCs) than with the control insole (11.2 ± 7.7 % MVCs). No significant effects were established for the other gait phases or for the tibialis anterior.

Conclusions

An increase of muscle activity of the peroneus longus muscle was observed during the loading response and mid-stance phase, when orthopedic insoles with a lateral pressure point were worn. We conclude that the pressure point changes afferent information and leads to an increased peroneus longus activation in the time interval in which the pressure point exerted pressure on the peroneal tendon.

Screening Sonography of the Ankle/Foot to Correlate Pain and Pathology

The objective of this study was to determine if a relationship exists between sonographic pathological findings of the ankle/foot and self-reported ankle/foot pain. Symptomatic and asymptomatic participants were recruited and evaluated using sonographic imaging of the ankle and foot bilaterally. Participants also completed the Short Form<@150>12 (SF-12, a national physical and mental health scoring system), a visual analog scale (VAS) for pain, and the Victorian Institute of Sports Assessment–Achilles (VISA-A, a scoring system for Achilles tendon abnormalities), as well as provided a health history and demographic information. Twenty-five participants were evaluated. Symptomatic participants had below average physical SF-12 scores (mean [SD], 48.3 [7.3]), while asymptomatic patients had above-average physical SF-12 scores (54.9 [4.0]). Painful right ankle and/or foot were significantly associated with SF-12 physical health ( R2 = 0.2, P < .03) and VISA-A ( R2 = 0.6, P < .001) scores. Painful left ankle/foot was associated with only VISA-A ( R2 = 0.5, P < .003). The modified D’Agostino scores for positive sonographic evidence of pathology were statistically linked to painful right ( P < .02) and left ankle/foot ( P < .04). The combination of SF-12 physical health score, palpable myofascial trigger points (MTrPs), and MTrPs sonographically visualized were statistically associated with the VAS for pain ( P < .02). In conclusion, sonography of the foot/ankle combined with self-reported data could aid in the holistic evaluation of ankle/foot pain.

The STAP-study: The (cost) effectiveness of custom made orthotic insoles in the treatment for plantar fasciopathy in general practice and sports medicine: design of a randomized controlled trial

BACKGROUND

Plantar fasciopathy is a common cause of foot pain, accounting for 11 to 15% of all foot symptoms requiring professional care in adults. Although many patients have complete resolution of symptoms within 12 months, many patients wish to reduce this period as much as possible. Orthotic devices are a frequently applied option of treatment in daily practice, despite a lack of evidence on the effectiveness. Therefore, the objective is to study the (cost)-effectiveness of custom made insoles by a podiatrist, compared to placebo insoles and usual care in patients with plantar fasciopathy in general practice and sports medicine clinics.

METHOD/DESIGN

This study is a multi-center three-armed participant and assessor-blinded randomized controlled trial with 6-months follow-up. Patients with plantar fasciopathy, with a minimum duration of complaints of 2 weeks and aged between 18 and 65, who visit their general practitioner or sport physician are eligible for inclusion. A total of 185 patients will be randomized into three parallel groups. One group will receive usual care by the general practitioner or sports physician alone, one group will be referred to a podiatrist and will receive a custom made insole, and one group will be referred to a podiatrist and will receive a placebo insole. The primary outcome will be the change from baseline to 12 weeks follow-up in pain severity at rest and during activity on a 0-10 numerical rating scale (NRS). Secondary outcomes include foot function (according to the Foot Function Index) at 6, 12 and 26 weeks, recovery (7-point Likert) at 6, 12 and 26 weeks, pain at rest and during activity (NRS) at 6 and 26 weeks and cost-effectiveness of the intervention at 26-weeks. Measurements will take place at baseline and at, 2, 4, 6, 12 and 26 weeks of follow-up.

DISCUSSION

The treatment of plantar fasciopathy is a challenge for health care professionals. Orthotic devices are frequently applied, despite a lack of evidence of the effectiveness on patient reported outcome. The results of this randomized controlled trial will improve the evidence base for treating this troublesome condition in daily practice.

TRIAL REGISTRATION

Dutch Trial Registration: NTR5346 . Date of registration: August 5(th) 2015.