30,928 research outputs found
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
Development of a practical guide for the early recognition for malignant melanoma of the foot and nail unit
No full textBackground: malignant melanoma is a rare but potentially lethal form of cancer which may arise on the foot. Evidence suggests that due to misdiagnosis and later recognition, foot melanoma has a poorer prognosis than cutaneous melanoma elsewhere.Methods: a panel of experts representing podiatry and dermatologists with a special interest in skin oncology was assembled to review the literature and clinical evidence to develop a clinical guide for the early recognition of plantar and nail unit melanoma.Results: a systematic review of the literature revealed little high quality data to inform the guide. However a significant number of case reports and series were available for analysis. From these, the salient features were collated and summarised into the guide. Based on these features a new acronym "CUBED" for foot melanoma was drafted and incorporated in the guide.Conclusions: the use of this guide may help clinicians in their assessment of suspicious lesions on the foot (including the nail unit). Earlier detection of suspicious pedal lesions may facilitate earlier referral for expert assessment and definitive diagnosis. The guide is currently being field tested amongst practitioner
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
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
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-mouth disease in Tanzania from 2001 to 2006.
No full textFoot-and-mouth disease (FMD) is endemic in Tanzania, with outbreaks occurring almost each year in different parts of the country. There is now a strong political desire to control animal diseases as part of national poverty alleviation strategies. However, FMD control requires improving the current knowledge on the disease dynamics and factors related to FMD occurrence so control measures can be implemented more efficiently. The objectives of this study were to describe the FMD dynamics in Tanzania from 2001 to 2006 and investigate the spatiotemporal patterns of transmission. Extraction maps, the space-time K-function and space-time permutation models based on scan statistics were calculated for each year to evaluate the spatial distribution, the spatiotemporal interaction and the spatiotemporal clustering of FMD-affected villages. From 2001 to 2006, 878 FMD outbreaks were reported in 605 different villages of 5815 populated places included in the database. The spatial distribution of FMD outbreaks was concentrated along the Tanzania-Kenya, Tanzania-Zambia borders, and the Kagera basin bordering Uganda, Rwanda and Tanzania. The spatiotemporal interaction among FMD-affected villages was statistically significant (P≤0.01) and 12 local spatiotemporal clusters were detected; however, the extent and intensity varied across the study period. Dividing the country in zones according to their epidemiological status will allow improving the control of FMD and delimiting potential FMD-free areas
Risk of foot-and-mouth disease spread due to sole occupancy authorities and linked cattle holdings
No full textLivestock movements in Great Britain are well recorded, have been extensively analysed with respect to their role in disease spread, and have been used in real time to advise governments on the control of infectious diseases. Typically, livestock holdings are treated as distinct entities that must observe movement standstills upon receipt of livestock, and must report livestock movements. However, there are currently two dispensations that can exempt holdings from either observing standstills or reporting movements, namely the Sole Occupancy Authority (SOA) and Cattle Tracing System (CTS) Links, respectively. In this report we have used a combination of data analyses and computational modelling to investigate the usage and potential impact of such linked holdings on the size of a Foot-and-Mouth Disease (FMD) epidemic. Our analyses show that although SOAs are abundant, their dynamics appear relatively stagnant. The number of CTS Links is also abundant, and increasing rapidly. Although most linked holdings are only involved in a single CTS Link, some holdings are involved in numerous links that can be amalgamated to form “CTS Chains” which can be both large and geographically dispersed. Our model predicts that under a worst case scenario of “one infected – all infected”, SOAs do pose a risk of increasing the size (in terms of number of infected holdings) of a FMD epidemic, but this increase is mainly due to intra-SOA infection spread events. Furthermore, although SOAs do increase the geographic spread of an epidemic, this increase is predominantly local. Whereas, CTS Chains pose a risk of increasing both the size and the geographical spread of the disease substantially, under a worse case scenario. Our results highlight the need for further investigations into whether CTS Chains are transmission chains, and also investigations into intra-SOA movements and livestock distributions due to the lack of current data
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
A survey to investigate the association of pain, foot disability and quality of life with corns
No full textBackground
Corns are a common foot problem affecting a large proportion of the population. This study describes the characteristics of corns experienced by 201 participants taking part in a randomised controlled trial to investigate associations between demographic and corn parameters on pain, foot related disability and quality of life (QoL).
Methods
Pain from the main (index) corn was measured using a visual analogue scale (VAS); foot related disability was assessed with the Foot Disability Questionnaire (now known as the Manchester Foot Pain and Disability Index) and quality of life was recorded with the EQ-5D questionnaire. The effect of demographic and corn parameters on the pain and quality of life outcomes was assessed with analysis of variance (ANOVA) methods. The effect of the same factors on a linear combination of the foot-related disability outcome measures was assessed using multivariate ANOVA methods. Pain was also tested for its mediating properties on the causal pathway between the independent variables and quality of life.
Results
The mean pain score was 5.29 points on a 10 cm VAS, with females reporting substantively higher pain levels than males. Age affected foot-related disability, with lower levels on all domains of the MFPDI reported in older participants; each year of advancing age was associated with falls of: 0.009 points on the Concern about Appearance (CA) domain; 0.047 points on the Functional Limitation (FL) domain and 0.048 points on the Pain Intensity (PI) domain. Sex and corn type also affected disability, with higher scores reported by females and participants with plantar corns.
Conclusions
The effect of pain was shown to mediate the relationship between sex and foot-related disability. The presence of plantar corns has a more detrimental effect on QoL than dorsal/inter-digital corns
Journal of Foot and Ankle Research, one year on
No full textJournal of Foot and Ankle Research was launched one year ago, and a number of its key achievements are highlighted in this editorial. Although the journal is underpinned by professional bodies associated with the podiatry professions in the UK and Australasia, its content is aimed at the wider foot and ankle research community. Nevertheless, the journal's achievements over the past year reflect the development of research in the profession of podiatry. From this perspective, the journal may be viewed as contributing to the overall attainment of some of the profession's key goals and strategic aims over the last decade, across the UK and Australasia. The journal has also witnessed policy changes in the last year, and these are discussed - notably, the decision not to accept case reports for publication. We also report on a few of the key metrics, providing readers with a summary of the journal's performance over the last yea
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