201,189 research outputs found
The FragmentatiOn Of Target (FOOT) experiment and its DAQ system
No full textThe FragmentatiOn mymargin Of Target (FOOT) experiment aims to provide precise nuclear cross section measurements for two different fields: hadrontherapy and radio-protection in space. The main reason is the important role the nuclear fragmentation process plays in both fields, where the health risks caused by radiation are very similar and mainly attributable to the fragmentation process. The FOOT experiment has been developed in such a way that the experimental setup is easily movable and fits the space limitations of the experimental and treatment rooms available in hadrontherapy treatment centers, where most of the data takings are carried out. The trigger and data acquisition system needs to follow the same criteria and it should work in different laboratories and different conditions. It has been designed to acquire high statistics samples to fulfill the accuracy requirements of the physics analysis. Data-taking is being monitored online to allow the shift crew to verify the correct functioning of the system
Diabetic foot disease and oedema
No full textDiabetic foot ulcers (DFUs) are common and disabling, giving rise to significant morbidity and mortality as well as worldwide socioeconomic problems. Despite treatment, DFUs readily become chronic wounds and may lead to major lower limb amputations. The pathogenesis of DFUs is complex and the main aetiologies are peripheral neuropathy, ischaemia from peripheral arterial disease and biomechanical abnormalities. Microvascular disease is also a significant problem for people with diabetes and contributes to foot ulceration. Successful management of DFUs consists of debridement, infection control, the use of offloading appliances and revascularisation where necessary. Foot ulcers are usually associated with infection and inflammation which lead to surrounding oedema of the foot. Standard offloading devices such as total contact casts and removable cast walkers do not actively reduce foot oedema. There is promising evidence that active oedema reduction by intermittent pneumatic compression in the diabetic foot improves ulcer healing. The objective of this article is to review the association of foot oedema and DFUs, including the role of appliances which reduce oedema. The information presented is vital to those involved in the management of DFUs. © The Author(s) 2012
Protocol for the Foot in Juvenile Idiopathic Arthritis trial (FiJIA): a randomised controlled trial of an integrated foot care programme for foot problems in JIA
No full text<b>Background</b>:
Foot and ankle problems are a common but relatively neglected manifestation of juvenile idiopathic arthritis. Studies of medical and non-medical interventions have shown that clinical outcome measures can be improved. However existing data has been drawn from small non-randomised clinical studies of single interventions that appear to under-represent the adult population suffering from juvenile idiopathic arthritis. To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with foot and ankle problems exists.
<b>Methods/design</b>:
An exploratory phase II non-pharmacological randomised controlled trial where patients including young children, adolescents and adults with juvenile idiopathic arthritis and associated foot/ankle problems will be randomised to receive integrated podiatric care via a new foot care programme, or to receive standard podiatry care. Sixty patients (30 in each arm) including children, adolescents and adults diagnosed with juvenile idiopathic arthritis who satisfy the inclusion and exclusion criteria will be recruited from 2 outpatient centres of paediatric and adult rheumatology respectively. Participants will be randomised by process of minimisation using the Minim software package. The primary outcome measure is the foot related impairment measured by the Juvenile Arthritis Disability Index questionnaire's impairment domain at 6 and 12 months, with secondary outcomes including disease activity score, foot deformity score, active/limited foot joint counts, spatio-temporal and plantar-pressure gait parameters, health related quality of life and semi-quantitative ultrasonography score for inflammatory foot lesions. The new foot care programme will comprise rapid assessment and investigation, targeted treatment, with detailed outcome assessment and follow-up at minimum intervals of 3 months. Data will be collected at baseline, 6 months and 12 months from baseline. Intention to treat data analysis will be conducted.
A full health economic evaluation will be conducted alongside the trial and will evaluate the cost effectiveness of the intervention. This will consider the cost per improvement in Juvenile Arthritis Disability Index, and cost per quality adjusted life year gained. In addition, a discrete choice experiment will elicit willingness to pay values and a cost benefit analysis will also be undertaken
Liquid crystal thermography in neuropathic assessment of the diabetic foot.
No full textPrimary aetiologic factors of diabetic foot disease include peripheral neuropathy and peripheral vascular disease. Assessment of circulation, neuropathy, and foot pressure is
employed routinely to determine the risk of foot ulceration in the patient with diabetes mellitus. Routine neuropathic evaluation includes assessment of sensory loss in the
plantar skin of the foot using both the Semmes Weinstein monofilament and the biothesiometer. Progressive degeneration of sensory nerve pathways is thought to affect
thermoreceptors and mechanoreceptors. However, thermological measurements of the foot to assess responses to thermal stimuli and cutaneous thermal discrimination threshold are relatively uncommon. Recent improvements in liquid crystal technology (LCT) including insensitivity to pressure, faster response times, lower cost and fast image
acquisition offer potential for routine thermographic assessment of the diabetic foot. The present study was designed to evaluate if an association exists between abnormal plantar thermal images and sensory loss under conditions of normal loading. The system comprises a robust measurement platform, thermochromic liquid crystal polyester sheet (TLC), instrumentation and analysis software. In vitro calibration was performed to
characterise three physical forms of TLC on the basis of linearity, hysteresis, pressure sensitivity and response time. An in vivo pilot evaluation study of the system was
performed using three sub-groups (i) neuropathic diabetic (n=30), (ii) non neuropathic diabetic (n=30) and (iii) a healthy control group (n=30). The principal results of this
study indicate raised plantar temperatures for the diabetic groups at baseline and post stress relative to the control group. Furthermore, poor recovery response to thermal
stimulus in the neuropathic diabetic group suggests degeneration of thermoreceptors. Thus by assessing the thermal parameters at the same sites as that of sensory testing, the new LCT based approach appears capable of providing an alternative confirmation of clinical neuropathy and offers potential as an improved method compared to existing techniques
Podiatry interventions in the rheumatoid foot
No full textThis review assessed the effectiveness of podiatry interventions in patients with rheumatoid arthritis. The authors reported that foot orthoses and adaptations to hosiery and footwear design appear to have a beneficial effect in terms of foot pain. However, the paucity and poor quality of the evidence precludes firm conclusions being drawn. Further research is required
Neuropathy - gait changes in the diabetic foot
No full textMotor neuropathy in patients with diabetes can lead to weakness in the muscles of the foot and lower leg, which in turn can lead to characteristic changes to the structure of the foot, such as an altered arch profile. Such structural changes often occur at sites of abnormally high pressure, which can result in tissue breakdown and ulceration particularly in individuals who also have sensory neuropathy
Kinematic coupling between the foot and lower limb during gait
No full textINTRODUCTION:
Abnormal kinematic coupling between the foot and lower limb has been associated with chronic overuse injuries of the lower extremity during running. However, the normal coupling relationship between the two segments remains
unclear. The equivocal findings in the literature may be due to previous studies concentrating on determining coupling at discrete instances only, along with the
failure to include the midtarsal joint in coupling analyses. By including motion across the midtarsal joint and measures of continuous coupling, this research aimed to gain a more complete understanding of the relationship between foot and lower limb kinematics during gait.
METHODS:
Following the development of a multi-segment foot model, in-vitro and invivo studies were conducted to assess the validity and reliability of determining foot and lower limb segmental kinematics during gait. Three experiments were then undertaken to assess the rigidity of the kinematic coupling between the forefoot, rearfoot and shank by manipulating step width, running speed, foot strike pattern and mode of gait (run versus walk). Kinematic coupling was assessed by determining how well matched the angular displacements of two adjacent segments (e. g rearfoot
eversion/inversion with shank intemal/external rotation) were in both spatial and temporal terms using both discrete point and cross correlation analyses.
RESULTS:
Although the in-vitro study suggested care should be taken when interpreting data obtained from skin mounted markers the modelling and analysis approach used in-vivo was found to have good within- and between-day reliability. In all conditions it was evident that following touchdown, the shank internally rotated, the rearfoot everted and the forefoot dorsiflexed and abducted. This was followed by the reversal of the segmental angular displacements starting with that of the shank, followed by the rearfoot and then the forefoot. During running, coupling between rearfoot
eversion/inversion and shank internal/external rotation was consistently high (r > 0.92) regardless of step width, speed or foot strike pattern. In walking, however, this
coupling value was low (r = 0.49). Rearfoot eversion/inversion was also highly coupled with both forefoot dorsiflexion/plantarflexion and abduction/adduction in running and walking. However, there was little evidence of any coupling between rearfoot eversion/inversion and forefoot eversion/inversion.
CONCLUSION:
The consistently high kinematic coupling between the rearfoot and shank during running suggests a robust coupling mechanism that is able to withstand changes in the loading of the subtalar joint. However, lower coupling between these two segments in walking, implies that the relationship is not entirely rigid and some degree of elasticity exists at the subtalar joint. Strong coupling of forefoot sagittal and transverse plane motions with rearfoot frontal plane motion during running and
walking suggests the two segments are linked via the action of the midtarsal joint. From the timings of discrete kinematic events it appeared that shank external rotation
was driving rearfoot inversion and that this in turn was causing the forefoot to plantarflex and abduct. This implies that a kinetic chain exists with proximal
segments driving motion of the distal segments during propulsion.
IMPLICATIONS:
If the proximal segments drive the motion of the foot then injuries associated with excessive or prolonged pronation should not only be treated using orthoses, but also by using interventions to modify the kinematics of the joints
proximal to the ankle-joint-complex. Future work should determine the effects of muscle stiffness on subtalar joint kinematics since this may have important implications in terms of lower extremity injuries
Foot and ankle problems in children and young people: a population-based cohort study
No full textThe aim of this research was to describe the epidemiology, presentation and healthcare use in primary care for foot and ankle problems in children and young people (CYP) across England. We undertook a population-based cohort study using data from the Clinical Practice Research Datalink Aurum database, a database of anonymised electronic health records from general practices across England. Data was accessed for all CYP aged 0–18 years presenting to their general practitioner between January 2015 and December 2021 with a foot and/or ankle problem. Consultation rates were calculated and used to estimate numbers of consultations in an average practice. Hierarchical Poisson regression estimated relative rates of consultations across sociodemographic groups and logistic regression evaluated factors associated with repeat consultations. A total of 416,137 patients had 687,753 foot and ankle events, of which the majority were categorised as “musculoskeletal” (34%) and “unspecified pain” (21%). Rates peaked at 601 consultations per 10,000 patient-years among males aged 10–14 years in 2018. An average practice might observe 132 (95% CI 110 to 155) consultations annually. Odds for repeat consultations were higher among those with pre-existing diagnoses including juvenile arthritis (OR 1.73, 95% CI 1.48 to 2.03). Conclusions: Consultations for foot and ankle problems were high among CYP, particularly males aged 10 to 14 years. These data can inform service provision to ensure CYP access appropriate health professionals for accurate diagnosis and treatment
The Amsterdam Foot Model: a clinically informed multi-segment foot model developed to minimize measurement errors in foot kinematics
No full textBackground: Foot and ankle joint kinematics are measured during clinical gait analyses with marker-based multi-segment foot models. To improve on existing models, measurement errors due to soft tissue artifacts (STAs) and marker misplacements should be reduced. Therefore, the aim of this study is to define a clinically informed, universally applicable multi-segment foot model, which is developed to minimize these measurement errors. Methods: The Amsterdam foot model (AFM) is a follow-up of existing multi-segment foot models. It was developed by consulting a clinical expert panel and optimizing marker locations and segment definitions to minimize measurement errors. Evaluation of the model was performed in three steps. First, kinematic errors due to STAs were evaluated and compared to two frequently used foot models, i.e. the Oxford and Rizzoli foot models (OFM, RFM). Previously collected computed tomography data was used of 15 asymptomatic feet with markers attached, to determine the joint angles with and without STAs taken into account. Second, the sensitivity to marker misplacements was determined for AFM and compared to OFM and RFM using static standing trials of 19 asymptomatic subjects in which each marker was virtually replaced in multiple directions. Third, a preliminary inter- and intra-tester repeatability analysis was performed by acquiring 3D gait analysis data of 15 healthy subjects, who were equipped by two testers for two sessions. Repeatability of all kinematic parameters was assessed through analysis of the standard deviation (σ) and standard error of measurement (SEM). Results: The AFM was defined and all calculation methods were provided. Errors in joint angles due to STAs were in general similar or smaller in AFM (≤2.9°) compared to OFM (≤4.0°) and RFM (≤6.7°). AFM was also more robust to marker misplacement than OFM and RFM, as a large sensitivity of kinematic parameters to marker misplacement (i.e. > 1.0°/mm) was found only two times for AFM as opposed to six times for OFM and five times for RFM. The average intra-tester repeatability of AFM angles was σ:2.2[0.9°], SEM:3.3 ± 0.9° and the inter-tester repeatability was σ:3.1[2.1°], SEM:5.2 ± 2.3°. Conclusions: Measurement errors of AFM are smaller compared to two widely-used multi-segment foot models. This qualifies AFM as a follow-up to existing foot models, which should be evaluated further in a range of clinical application areas.Biomechatronics & Human-Machine Contro
The impact of pregnancy on foot health
No full textAlthough pregnancy should be a joyous experience
to all expectant mothers, it is also known to bring about a
number of bodily changes which could impose lifestyle limitations
throughout the nine months of pregnancy. In this study, the
authors sought to evaluate the impact of pregnancy on foot
health. A prospective non-experimental study was conducted.
The authors interviewed 40 expectant Maltese mothers using the
Bristol Foot Score (BFS). Results showed a significant difference
(p < 0.001) in foot health in the recruited subjects from Time
0 (15 weeks pregnancy) to Time 1 (37 weeks pregnancy),
implying that pregnancy imposes a negative impact on foot
health. This finding is of key importance and needs to be taken
into consideration by all health stakeholders if better health
care is to be offered to all expectant mothers. Both locally
and internationally, antenatal care aims to monitor pregnant
women’s general health and foetal development. However, very
little attention is given to foot health. The authors highlight
the importance of providing all expectant mothers with footcare
education and podiatry services in the Antenatal Clinic.peer-reviewe
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