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Anderson L, Ihaka B, Bowen C, Dando C, Stewart S. Do Dynamic Plantar Pressures Differ Based on Sonographic Evidence of Metatarsophalangeal Joint Synovitis in People With Rheumatoid Arthritis? ACR Open Rheumatol 2024; 6:113-122. [PMID: 38117793 PMCID: PMC10933642 DOI: 10.1002/acr2.11635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE The metatarsophalangeal joints (MTPJs) are the most common location for synovitis in people with rheumatoid arthritis (RA), yet their association with plantar foot pressures has received very little attention. This study aimed to determine whether plantar pressures differed based on sonographic evidence of MTPJ synovitis in people with RA. METHOD Ultrasound was used to assess synovitis (grey scale synovial hypertrophy and power Doppler signal) in MTPJs 1 to 5 using the combined EULAR/Outcome Measures in Rheumatology scoring system. Peak pressure (PP) and pressure time integrals (PTIs) were assessed during barefoot walking for seven plantar foot regions (heel, midfoot, first metatarsal, second metatarsal, third to fifth metatarsals, hallux, lesser toes). Mixed-effects linear regression was used to determine the difference in PP and PTI between MTPJs with none/minimal synovitis and MTPJs with moderate/severe synovitis. RESULTS Thirty-five participants with RA were included. Mean age was 66.3 years and mean disease duration was 22.2 years. Participants with sonographic evidence of moderate/severe synovitis at the first MTPJ had reduced PTI at the hallux compared with those with none/minimal synovitis at this joint (P = 0.039). Participants with moderate/severe synovitis at the second MTPJ and fourth MTPJ had reduced PP and reduced PTI at lesser toes compared with those with none/minimal synovitis in these joints (all P ≤ 0.048). No significant differences were observed for synovitis in other joints. CONCLUSION These findings may be suggestive of an inverse relationship between plantar pressure and soft tissue pathology, which is consistent with an offloading strategy and reduced use of the toes during propulsion.
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Affiliation(s)
| | - Belinda Ihaka
- Active Living and Rehabilitation, Aotearoa, and Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of TechnologyAucklandNew Zealand
| | | | | | - Sarah Stewart
- Active Living and Rehabilitation, Aotearoa, and Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of TechnologyAucklandNew Zealand
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Ihaka B, Rome K, Came H. Diabetes podiatry services for Māori in Aotearoa: a step in the right direction? J Foot Ankle Res 2022; 15:59. [PMID: 35945591 PMCID: PMC9361539 DOI: 10.1186/s13047-022-00564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Māori with diabetes are at a 65% greater risk of amputation compared to non-Māori with diabetes. Despite evidence to support the role of podiatrists in reducing diabetes-related lower limb amputations; the effectiveness of diabetes podiatry services at the community and secondary level to achieve this for Māori is largely unknown. Diabetes podiatry services need to be reorientated and be culturally applicable to Indigenous communities. Transforming diabetes podiatry services and practice may reduce Indigenous amputation rates and improve quality of life for an unserved community.
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Affiliation(s)
- B Ihaka
- Faculty of Health & Environmental Sciences, School of Clinical Sciences, AUT, Auckland, 1142, New Zealand.
| | - K Rome
- Faculty of Health & Environmental Sciences, School of Clinical Sciences, AUT, Auckland, 1142, New Zealand
| | - H Came
- Faculty of Health & Environmental Sciences, School of Public Health, AUT, Auckland, 1142, New Zealand
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Carroll M, Al-Busaidi IS, Coppell KJ, Garrett M, Ihaka B, O'Shea C, Wu J, York S. Diabetes-related foot disease research in Aotearoa New Zealand: a bibliometric analysis (1970-2020). J Foot Ankle Res 2022; 15:23. [PMID: 35313947 PMCID: PMC8939115 DOI: 10.1186/s13047-022-00528-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background The aim of this bibliometric study was to examine trends in the quality and quantity of published diabetes-related foot disease (DRFD) research in Aotearoa/New Zealand (NZ) over the past five decades. Method In July 2021, the Scopus® database was searched for DRFD-related publications (1970–2020) using predetermined search and inclusion criteria. Bibliometric data were extracted from Scopus® and Journal Citation Reports. Retrieved bibliometric indicators were analysed in Biblioshiny, an R Statistical Software interface and reported using descriptive statistics. Results Forty-seven DRFD-related articles were identified. The annual number of publications showed a significant upward trend increasing from one in 1988 to a peak of six in 2018 (P < 0.001). The majority of identified articles (n = 31, 66%) were published in the last decade (2011–2020). Basic/clinical research accounted for 87% (n = 41) of publications and 14 (30%) investigated the screening and/or prevention of DRFD. The average citation per article was 20.23 (range: 0–209) and the median impact factor was 4.31 (range, 1.82–79.32). Over a third of articles (36%) had an international authorship network. Funding was reported in 15 (32%) articles; 12 (26%) were supported by public national grants vs. three (6%) reporting industry-sponsorship. Conclusion DRFD articles authored by NZ researchers have increased over the past five decades. Despite NZ researchers having increased their global impact through collaborative networks, most of the research was classified as low-level evidence, with limited focus on Indigenous Māori and limited financial support and funding. Increased funding for interventional research is required to enable a higher level of evidence-based and practice-changing research to occur. With rates of diabetes-related amputations higher in Māori future research must focus on reducing inequalities in diabetes-related outcomes for Māori by specifically targeting the prevention and screening of DRFD in primary care settings in NZ. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00528-5.
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Affiliation(s)
- Matthew Carroll
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | | | - Kirsten J Coppell
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Michele Garrett
- Community and Long Term Conditions Directorate, Auckland District Health Board, Auckland, New Zealand
| | - Belinda Ihaka
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Claire O'Shea
- Waikato District Health Board, Hamilton, New Zealand
| | - Justina Wu
- Waikato District Health Board, Hamilton, New Zealand
| | - Steve York
- High Risk Foot Clinic, Northland District Health Board, Whangarei, New Zealand
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Dixon CJ, Knight T, Binns E, Ihaka B, O'Brien D. Clinical measures of balance in people with type two diabetes: A systematic literature review. Gait Posture 2017; 58:325-332. [PMID: 28865394 DOI: 10.1016/j.gaitpost.2017.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 02/02/2023]
Abstract
Approximately 422 million people have diabetes mellitus worldwide, with the majority diagnosed with type 2 diabetes mellitus (T2DM). The complications of diabetes mellitus include diabetic peripheral neuropathy (DPN) and retinopathy, both of which can lead to balance impairments. Balance assessment is therefore an integral component of the clinical assessment of a person with T2DM. Although there are a variety of balance measures available, it is uncertain which measures are the most appropriate for this population. Therefore, the aim of this study was to conduct a systematic review on clinical balance measures used with people with T2DM and DPN. Databases searched included: CINAHL plus, MEDLINE, SPORTDiscus, Dentistry and Oral Sciences source, and SCOPUS. Key terms, inclusion and exclusion criteria were used to identify appropriate studies. Identified studies were critiqued using the Downs and Black appraisal tool. Eight studies were included, these studies incorporated a total of ten different clinical balance measures. The balance measures identified included the Dynamic Balance Test, balance walk, tandem and unipedal stance, Functional Reach Test, Clinical Test of Sensory Interaction and Balance, Berg Balance Scale, Tinetti Performance-Oriented Mobility Assessment, Activity-Specific Balance Confidence Scale, Timed Up and Go test, and the Dynamic Gait Index. Numerous clinical balance measures were used for people with T2DM. However, the identified balance measures did not assess all of the systems of balance, and most had not been validated in a T2DM population. Therefore, future research is needed to identify the validity of a balance measure that assesses these systems in people with T2DM.
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Affiliation(s)
- C J Dixon
- Torbay Physiotherapy and Hand Therapy, 1042 Beach Road, Torbay, Auckland, New Zealand.
| | - T Knight
- Taranaki Base Hospital, David Street, New Plymouth 4310, New Zealand.
| | - E Binns
- Physiotherapy Department, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - B Ihaka
- Podiatry Department, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - D O'Brien
- Physiotherapy Department, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
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Otter SJ, Rome K, Ihaka B, South A, Smith M, Gupta A, Joseph F, Heslop P. Protective socks for people with diabetes: a systematic review and narrative analysis. J Foot Ankle Res 2015; 8:9. [PMID: 25977708 PMCID: PMC4431172 DOI: 10.1186/s13047-015-0068-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/04/2015] [Indexed: 01/22/2023] Open
Abstract
Padded socks to protect the at-risk diabetic foot have been available for a number of years. However, the evidence base to support their use is not well known. We aimed to undertake a systematic review of padded socks for people with diabetes. Additionally, a narrative analysis of knitted stitch structures, yarn and fibres used together with the proposed benefits fibre properties may add to the sock. Assessment of the methodological quality was undertaken using a quality tool to assess non-randomised trials. From the 81 articles identified only seven met the inclusion criteria. The evidence to support to use of padded socks is limited. There is a suggestion these simple-to-use interventions could be of value, particularly in terms of plantar pressure reduction. However, the range of methods used and limited methodological quality limits direct comparison between studies. The socks were generally of a sophisticated design with complex use of knit patterns and yarn content. This systematic review provides limited support for the use of padded socks in the diabetic population to protect vulnerable feet. More high quality studies are needed; including qualitative components of sock wear and sock design, prospective randomized controlled trials and analysis of the cost-effectiveness of protective socks as a non-surgical intervention.
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Affiliation(s)
- Simon J Otter
- School of Rehabilitation & Occupation Studies, AUT University, North Shore Campus, Private Bag 92006, Auckland, 1142 New Zealand
| | - Keith Rome
- School of Rehabilitation & Occupation Studies, AUT University, North Shore Campus, Private Bag 92006, Auckland, 1142 New Zealand
| | - Belinda Ihaka
- School of Rehabilitation & Occupation Studies, AUT University, North Shore Campus, Private Bag 92006, Auckland, 1142 New Zealand
| | - Andrew South
- School of Rehabilitation & Occupation Studies, AUT University, North Shore Campus, Private Bag 92006, Auckland, 1142 New Zealand
| | - Mandy Smith
- Fashion Design, School of Art & Design, AUT University, WW Building, 9 Mount Street, 1010 Private Bag 92006, Auckland, 1142 New Zealand
| | - Amit Gupta
- Textile and Design Laboratory, AUT University, WW Building, 9 Mount Street, 1010 Private Bag 92006, Auckland, 1142 New Zealand
| | - Frances Joseph
- Textile and Design Laboratory, AUT University, WW Building, 9 Mount Street, 1010 Private Bag 92006, Auckland, 1142 New Zealand
| | - Peter Heslop
- Textile and Design Laboratory, AUT University, WW Building, 9 Mount Street, 1010 Private Bag 92006, Auckland, 1142 New Zealand
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Ihaka B, Bayley A, Rome K. Foot problems in Maori with diabetes. N Z Med J 2012; 125:48-56. [PMID: 22932654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The prevalence of diabetes and its associated manifestations is higher in New Zealand Maori than New Zealand Europeans. There is no current evidence regarding podiatric clinical characteristics of Maori with diabetes. The aim of this study was to determine the clinical and foot characteristics of Maori with diabetes using a podiatry-specific assessment tool. METHOD This study used a cross-sectional design. Participants with diabetes were recruited from two Maori Primary Health Organisations. Podiatric-specific characteristics (vascular, neurological and musculoskeletal) were recorded. Patient demographics and general medical conditions were also recorded. RESULTS Fifty-three participants were recruited and displayed risk factors for diabetes-related complications (mean disease duration 12 years, mean HbA1c 8.3%) including 49% of participants with hypertension. Podiatric-specific characteristics revealed unremarkable neurovascular results. However, many participants presented with pre-ulcerative lesions and current pedal ulceration (53% and 8% respectively). Although many participants had good foot-care knowledge (>85%), a modified classification tool of foot risk status determined that a high percentage of participants required regular podiatric management and screening (60%). CONCLUSION Despite this population living with a chronic condition for more than 10 years and displaying poor long-term glycaemic control, there was no evidence of microvascular or macrovascular complications in the lower limb. However, there was a high prevalence of pre-ulcerative lesions which unmonitored and undetected may predispose the foot to ulceration. The detection of current ulceration in this study alongside other risk factors for diabetes-related complications necessitates the need for appropriate podiatric screening and podiatry management.
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Affiliation(s)
- Belinda Ihaka
- Department of Podiatry, AUT University, Faculty of Health and Environmental Sciences, 90 Akoranga Dr, Northcote 0627, Private Bag 92006, Auckland 1142, New Zealand.
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