The experiences of podiatrists prescribing custom foot orthoses and patients using custom foot orthoses for foot pain management in the United Kingdom: A focus group study.

INTRODUCTION: Foot pain can be a significant burden for patients. Custom foot orthoses (CFOs) have been a mainstay in podiatry treatment for foot pain management and improving foot function. However, little is known about podiatrists' experience of prescribing CFOs or patient experience of using foot orthoses (FOs), including CFOs, for foot pain. METHODS: A focus group (FG) discussion with three FOs users (Female = 2 and Male = 1) was conducted in November 2022 within a private podiatry practice. This group represented non-experts from the general local population of individuals with existing or previous foot pain who have personally experienced using either over-the-counter FOs or CFOs. An online FG discussion with five musculoskeletal (MSK) specialist podiatrists (Female = 2 and Male = 3) was also conducted in December 2022. This group represented podiatrists with specialist knowledge in foot biomechanics and clinical experience in CFO provision. The FG discussions were recorded and lasted 49 and 57 min respectively. Transcribed data was manually coded, and a thematic analysis was undertaken to identify patterns within the collected data. RESULTS: The participants in the patient FG detailed mixed experiences of the prescription process and CFOs received, with reports of limited involvement/input in their prescription, the need for frequent adjustments and high costs. The impact on footwear choices, replicability and transferability of CFOs into different types of shoes and technologies to aid design were also highlighted. In the podiatrist FG, lack of confidence in design and manufacture processes, prescription form language, relationship and communication building with manufacturers, variability in the CFOs issued and the need for better student education in CFO provision emerged as key themes. CONCLUSION: Patients and podiatrists shared similar views on CFO provision, namely poor communication with manufacturers leading to dissatisfaction with the CFOs prescribed causing negative impacts on patient experiences. Podiatrists called for greater education at registration level to increase new graduate podiatrist knowledge in CFO design and manufacture and better collaboration with manufacturing companies.

Verrucous Carcinoma of the Foot: A Single Canadian Center Experience on Diagnosis, Management, and Outcomes.

INTRODUCTION: Verrucous carcinoma (VC) was first described in 1948 by Dr. Ackerman. It is a low-grade cutaneous squamous carcinoma that usually develops in the oral cavity, the anogenital region, and the plantar surface of the foot. Clinically, there is low suspicion for malignancy given the slow growth of VC lesions and their wart-like appearance. Diagnosis can be difficult because of the benign histological appearance with well-differentiated cells and absence of dysplasia. Surgical excision is the only satisfactory form of treatment for plantar VC; however, this becomes difficult given its benign clinical appearance and the pathologic misinterpretation of the lesion as a benign hyperplasia. While there are case reports and retrospective studies of patients with plantar VC in the literature, we present the largest case series of plantar VC within North America, with recurrence despite negative margins. METHODS: We report on all the plantar VC excised between 2014-2023. We report six cases of VC, their treatment, and their outcomes. RESULTS: Six patients obtained a diagnosis of plantar VC by incisional biopsy. All patients underwent excision of their lesions and had negative margins reported on the final pathology. All patients developed nonhealing wounds at the site of their lesion excision; therefore, biopsies were performed to confirm a recurrence. All patients had a recurrence of VC at the initial site. All patients underwent re-excision of the lesions. Despite negative margins again on final pathology, all patients had a subsequent second recurrence. Ultimately, all patients underwent an amputation as definitive management. Each patient had an average of 3 operations. There were 4 different surgeons and different pathologists reporting their findings. CONCLUSIONS: Our experience with plantar VC suggests that an aggressive approach to surgical management is needed. Furthermore, management is optimized with the combined expertise of an experienced dermatopathologist and surgeon. Despite negative margins and repeated excisions, VC lesions recur and invade local tissues to the extent that only amputation of the involved foot has resulted in cure.

Navigating the integration of knowledge and research evidence in clinical practice for children's foot health: A multi-professional survey.

BACKGROUND: Access to clinical services for children with foot and ankle problems are important, but unravelling the complexity of practice and service delivery can be challenging. The pursuit and implementation of research evidence is critical for driving positive change in practice, but little is understood about the approaches to knowledge and research acquisition in children foot health. AIM: The aim of the study was to: (1) explore multi-professional habits of knowledge and research evidence acquisition in children's foot health; and (2) understand how clinicians integrate information for children and their families into their practice. METHODS: This was a descriptive, cross-sectional online survey. Participants were included if they worked in the UK and had experience of working within paediatric services. RESULTS: There were complete responses from 247 health professionals, representing physiotherapists (n = 160), podiatrists (n = 50), orthotists (n = 25), nurses and specialists in community public health nurses (health visitors) (n = 12). Three main themes were generated from the data: (1) Factors that influence knowledge and inform clinical practice. (2) The role of Professional Bodies in informing professional knowledge. (3) Health Professionals' views on managing health information for parents and caregivers. CONCLUSIONS: This work advances understanding of the value health professionals' place in the development of materials for informing professional knowledge, as well as highlighting some of the challenges with translation of knowledge into clinical practice. The findings offer a national perspective of health professionals working on children's foot health and have highlighted that some of the most valued influences on clinical practice come from peer-to-peer networking.

Foot Problems in Older Adults Presenting to a Falls and Balance Clinic.

INTRODUCTION: Foot problems, including musculoskeletal problems, peripheral neuropathy, peripheral arterial disease and dermatologic pathology are common in older adults and are associated with an increased risk of falling. Multicomponent podiatry interventions have been shown to reduce the incidence of falls. This paper aimed to identify older adults requiring podiatry input in a Falls and Balance clinic; to describe the model of foot health care they receive; to explore cross-sectional associations between foot problems and function and ultimately demonstrate the role of podiatry input in the multidisciplinary management of falls risk. METHODS: Cohort study of patients attending a Falls and Balance Clinic for Comprehensive Geriatric Assessment. Demographic information was collected and functional independence, mobility, foot problems, and footwear were assessed in the clinic. RESULTS: One-hundred and two patients were included; median age 79.3 (73-84.3) years, 68.6% female, 93.1% residing independently, 62.7% used a gait aid. Podiatry referrals were made in 80.4% of cases, with muscle weakness being the most common problem identified (90.2%); 74.8% were found to be wearing inappropriate footwear. Most patients received footwear education and half were prescribed foot and ankle strengthening exercises. Hallux and lesser toe weakness were associated with lower Short Physical Performance Battery scores (p < 0.001). CONCLUSION: The majority of older adults in the Falls and Balance Clinic required podiatry input, with foot weakness and inappropriate footwear being common reasons for referral. Those with weakness of the hallux and lesser toes had poorer balance and mobility, which is known to be associated with greater falls risk. This highlights the need for podiatry assessment and interventions as part of the multidisciplinary approach to the management of falls risk in older adults.

Assessment of rheumatoid arthritis patients' knowledge about foot problems related to their illness and foot care practice.

INTRODUCTION: Foot problems are very common in rheumatoid arthritis (RA). Podiatric intervention through therapeutic education of RA patients on the different potential foot problems could improve patients' knowledge and management of their foot problems. This study aimed to evaluate the knowledge of RA patients on podiatric problems related to their illness and foot care practices. METHODS: This was a cross-sectional study including patients diagnosed with RA and aged older than 18 years. Sociodemographic data, disease characteristics, and therapeutic data were collected. RA foot problems knowledge and foot care practice were assessed using a questionnaire combining questions developed from the literature search and a pretested validated questionnaire. RESULTS: Overall, 103 patients were included of whom 94 were female. The mean age was 56 years (±10 years) and the mean disease duration was 15 years (±10 years). Over 77% of patients reported never having received foot-health-related education. With regard to their knowledge about RA foot involvement, patients were aware that RA can affect the feet similarly to the hands (83%), lead to deformation of the foot (86%), lead to walking difficulties and falling (68%), and produce skin lesions of the foot (31%). Regarding participant's knowledge of appropriate footwear, 65% agreed that it would be beneficial to wear quality standard sports shoes. However, less than one-third of patients know the podiatrist's skills. CONCLUSION: Our study showed an awareness of the repercussions of RA on feet but a lack of knowledge on proper foot care, thus identifying a need for foot health therapeutic education.

Describing the development and implementation of a novel collaborative multidisciplinary approach to deliver foot health supports for individuals experiencing homelessness and its outcomes.

Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point.

Tumours of the foot: A 10 years retrospective analysis.

INTRODUCTION: The foot is a complex structure composed of several tissues, each of which can be the origin of the proliferation and development of the tumour. Most lesions about the foot are reactive or inflammatory, but some are true neoplasms. METHOD: This is a retrospective analysis of 4997 patient records treated in the Orthopaedic Oncology Unit of University Malaya Medical Centre, Malaysia, between 1 January 2010 to 31 December 2020. Demographic data of 195 patients with foot tumours were analysed out of 4997 neoplasm patients. RESULTS: There were 195 cases of foot tumours: 148 were benign, and 47 were malignant. 47 were bone tumours, 4 were metastases, and 144 were soft tissue tumours. Six patients succumbed to the disease, two cases of giant cell tumour (GCT) and one patient with synovial sarcoma had a recurrence. Treatment of foot tumours was wide resection in general. However, in metastasis cases, amputation was done. The majority of tumours were in the toes and dorsum of the foot. Soft tissue tumours of the foot occur in the elderly population in contrast to bone tumours, mainly in the second decade of life. The gender distribution was almost equal for foot tumours. Ganglion and Giant Cell Tumour of the bone are the commonest benign soft tissue and bone tumours. The most common malignant soft tissue and bone tumours are malignant melanoma and chondrosarcoma. The amputation rate is 5.64% the recurrence rate is 1.54%. Mortality rate is 3.08%. The MSTS score is 79%, and the TESS score is 76.23%. CONCLUSION: Foot tumours are relatively rare, mostly originating from soft tissue and exhibiting a benign nature. Nonetheless, a noteworthy proportion-approximately a quarter of these tumours-demonstrate malignancy. The surgical interventions undertaken in managing these tumours and associated functional outcomes generally yield acceptable results.

Painless and non-invasive treatment of plantar warts utilizing traditional Chinese medicine soaking: A case report.

BACKGROUND: Warts result from an infection with the human papilloma virus (HPV). Plantar warts, also known as Verruca plantaris, can be notably painful for the patient and possess contagious qualities, thus necessitating assertive treatment. Despite several available approaches for addressing plantar warts, efficacy remains elusive. CASE PRESENTATION: One 22-year-old firefighter suffered from numerous plantar warts. After 26 days of traditional Chinese medicine soaking, the rashes completely disappeared. The treatment was without complications or discomfort, and a three-month follow-up showed no recurrence. CONCLUSION: Our case investigation highlighted the efficacy of herbal soaking as a safe, painless, and non-invasive therapeutic option, positioning it as a potential avenue for managing multiple plantar warts.

Implementing an integrated diabetic foot care programme in Ireland: podiatrists' experience.

BACKGROUND: International evidence suggests that an integrated multidisciplinary approach to diabetic foot management is necessary to prevent ulceration and progression to amputation. Many health systems have introduced policies or models of care supporting the introduction of this evidence into practice, but little is known about the experiences of those involved in implementation. This study addresses this gap by examining the experiences of podiatrists providing integrated diabetic foot care. METHODS: Between October 2017 and April 2018, an online survey comprising closed and open-ended questions on podiatrists' demographics, clinical activity, links with other services, continuous professional development activities and experiences of implementing the Model of Care was administered to podiatrists (n = 73) working for Ireland's Health Service Executive in the community and hospital setting. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS: The response rate was 68% (n = 50), with 46% (n = 23), 38% (n = 19) and 16% (n = 8) working across hospital, community and both settings, respectively. Most reported treating high-risk patients (66%), those with active foot disease (61%) and educating people about the risk of diabetes to the lower limb (80%). Reported challenges towards integrated diabetic foot care include a perceived lack of awareness of the role of podiatry amongst other healthcare professionals, poor integration between hospital and community podiatry services, especially where new services had been developed, and insufficient number of podiatrists to meet service demands. CONCLUSION: Previous evidence has shown that there is often a gap between what is set out by a policy and what it looks like when delivered to service users. Results from the current study support this, highlighting that while most podiatrists work in line with national recommendations, there are specific gaps and challenges that need to be addressed to ensure successful policy implementation.

The treatment of plantar warts using microwave-A review of 85 consecutive cases in the United States.

BACKGROUND: Plantar warts (verrucae plantaris) are a common source of pain for patients and are often refractory to treatment. Previous work has shown a high clearance rate of verrucae using a surface-based microwave device (Swift®). AIMS: To assess the efficacy, defined as the complete visible clearance of warts, in patients with verrucae plantaris receiving microwave treatment. PATIENTS: We undertook a retrospective review and identified records of 85 patients who underwent a course of microwave treatment at a single US-based podiatry centre. Efficacy was analyzed on the basis on intention-to-treat. RESULTS: In patients who received ≥1 session there was a complete clearance rate of 60.0% (51/85) (intention-to-treat; 59 patients completed treatment, 26 lost to follow-up) and 86.4% (51/59) per treatment completion; no significant differences in clearance rates of children and adults were observed (61.0% [25/41] vs. 59.1% [26/44]). There were 31 patients who received three sessions of microwave therapy with a clearance rate of 71.0% (22/31) as per intention-to-treat (27 patients completed treatment, 4 lost to follow-up). An average of 2.3 sessions (SD: 1.1; range: 1-6) was required for the complete clearance of plantar warts. Complete clearance was also observed in some patients with recalcitrant warts following additional treatment sessions (42.9% [3/7]). A significant reduction in wart related pain was reported for all patients undergoing treatment. Some patients continued to report a reduced amount of pain post-therapy compared with pretherapy. CONCLUSIONS: Microwave treatment of verrucae plantaris appears to be a safe and effective procedure.

Microwave therapy for the treatment of plantar warts.

BACKGROUND: Plantar warts, or verrucae plantaris, are common lesions causing considerable pain during weightbearing activity. Although current treatment modalities have low success rates, microwave therapy has been introduced as a promising intervention. This study aimed to determine the effectiveness of microwave therapy for the treatment of plantar warts and to determine the clinical factors associated with plantar wart resolution. METHODS: A retrospective analysis of 150 plantar warts from 45 patients treated with microwave therapy was undertaken. Binomial regression was conducted to explore clinical characteristics (age, gender, immunosuppression, impaired healing, multiple vs single wart, location of lesion, lesion diameter) associated with lesion resolution. RESULTS: Of the total 150 plantar warts treated with microwave therapy, 125 (83.3%) warts resolved and 25 (17%) warts did not resolve. The mean (SD) total treatment sessions for resolved lesions was 2.8 (1.0). Decreasing age (P = 0.046) was the only clinical characteristic associated with resolution. CONCLUSIONS: This retrospective study has shown that plantar warts may be resolved with two to three sessions of microwave therapy, which may be more successful in younger populations.

Predicting the outcome of plantar heel pain in adults: a systematic review of prognostic factors.

BACKGROUND: Plantar Heel Pain (PHP) is a common disorder with many treatment pathways and is not self-limiting, hence prognostic information concerning recovery or recalcitrance is needed to guide practice. In this systematic review, we investigate which prognostic factors are associated with favourable or unfavourable PHP outcomes. METHODS: MEDLINE, Web of Science, EMBASE, Scopus and PubMed electronic bibliographic databases were searched for studies evaluating baseline patient characteristics associated with outcomes in prospective longitudinal cohorts or after specific interventions. Cohort, clinical prediction rule derivation and single arms of randomised controlled trials were included. Risk of bias was evaluated with method-specific tools and evidence certainty with GRADE. RESULTS: The review included five studies which evaluated 98 variables in 811 participants. Prognostic factors could be categorised as demographics, pain, physical and activity-related. Three factors including sex and bilateral symptoms (HR: 0.49[0.30-0.80], 0.33[0.15-0.72], respectively) were associated with a poor outcome in a single cohort study. The remaining four studies reported twenty factors associated with a favourable outcome following shockwave therapy, anti-pronation taping and orthoses. Heel spur (AUC = 0.88[0.82-0.93]), ankle plantar-flexor strength (Likelihood ratio (LR): 2.17[1.20-3.95]) and response to taping (LR = 2.17[1.19-3.90]) were the strongest factors predicting medium-term improvement. Overall, the study quality was low. A gap map analysis revealed an absence of research that included psychosocial factors. CONCLUSIONS: A limited number of biomedical factors predict favourable or unfavourable PHP outcomes. High quality, adequately powered, prospective studies are required to better understand PHP recovery and should evaluate the prognostic value of a wide range of variables, including psychosocial factors.

Persistence of orthopaedic hoof blocks for the treatment of lame cattle kept permanently at pasture.

AIMS: To compare the retention by New Zealand dairy cows kept at pasture in a lame cow group, of three hoof block products commonly used in the remediation of lameness. METHODS: Sixty-seven farmer-presented Friesian and Friesian x Jersey dairy cows from a single herd in the Manawatu region (New Zealand) suffering from unilateral hind limb lameness attributable to a claw horn lesion (CHL) were randomly allocated to one of three treatments: foam block (FB), plastic shoe (PS) and a standard wooden block (WB). Blocks were applied to the contralateral healthy claw and checked daily by the farm staff (present/not present) and date of loss was recorded. Blocks were reassessed on Day 14 and Day 28 and then removed unless further elevation was indicated. Daily walking distances were calculated using a farm map and measurement software. Statistical analyses included a linear marginal model for distance walked until block loss and a Cox regression model for the relative hazard of a block being lost. RESULTS: Random allocation meant that differences between products in proportion used on left or right hind foot or lateral or medial claw were small. Mean distance walked/cow/day on farm tracks whilst the block was present was 0.32 (min 0.12, max 0.45) km/day; no biologically important difference between products in the mean distance walked was identified. Compared to PS, cows in the WB group were five times more likely to lose the block (HR = 4.8 (95% CI = 1.8-12.4)), while cows in the FB group were 9.5 times more likely to lose the block (HR = 9.5 (95% CI = 3.6-24.4)). CONCLUSIONS: In this study, PS were retained for much longer than either FB or WB. As cows were managed in a lame cow group for the study duration, walking distances were low and did not impact on the risk of block loss. More data are needed to define ideal block retention time. CLINICAL RELEVANCE: In cows with CHL the choice of block could be based on the type of lesion present and the expected re-epithelisation times.

Emerging role of bone scintigraphy single-photon emission computed tomography/computed tomography in foot pain management.

Foot and ankle joints being weight-bearing joints are commonly subjected to wear and tear and are prone to traumatic and other pathologies. Most of these foot and ankle pathologies present with pain. The diagnosis of pathology and localization of pain generators is difficult owing to the complex anatomy of the foot and similar clinical presentation. This makes the management of foot pain clinically challenging. Conventional anatomical imaging modalities are commonly employed for evaluation of any anatomical defect; however, these modalities often fail to describe the functional significance of the anatomical lesions, especially in presence of multiple lesions which is common in ankle and foot; however, hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) by virtue of its dual modalities, that is, highly sensitive functional imaging and highly specific anatomical imaging can serve as a problem-solving tool in patient management. This review attempts to describe the role of hybrid SPECT/CT in overcoming the limitation of conventional imaging and describes its potential application in the management of foot and ankle pain.

Epithelioma Cuniculatum (Plantar Verrucous Carcinoma): A Systematic Review of Treatment Options.

Epithelioma cuniculatum (EC) is a subtype of verrucous carcinoma (VC) that affects the feet. Treatment involves complete tumor removal by wide local excision (WLE) or Mohs micrographic surgery (MMS). Extensive local destruction may require amputation. We sought to compare reported treatment methods for EC and determine their efficacy by assessing for tumor recurrence and treatment-associated complications. A systematic review of the literature spanning multiple databases was performed. To date, surgical excision is recommended as the standard of care for treatment of EC, with amputation considered in more advanced cases. Mohs micrographic surgery appears to be a promising treatment modality for EC and may have lower recurrence rates than WLE but requires further investigation.

Strategic palmar trimming before conventional shoeing shows potential for managing underrun heels in horses.

Background: Underrun heels are among the most hoof imbalances, causing poor performance in hoses. Several corrective shoeing protocols have been performed, but the outcomes have yet to be consistent. In this study, we proposed an alternative trimming protocol for managing underrun heels: strategic palmar trimming before conventional shoeing. Therefore, the current study aimed to investigate the potential of strategic palmar trimming before conventional shoeing for managing hoof imbalance in horses with underrun heels. Methods: Eleven affected horses were divided into control (5 horses with 14 defective hooves) and experimental (6 horses with 16 defective hooves) groups. The experimental group underwent strategic palmar trimming before conventional shoeing, while the control horses received regular trimming before traditional shoeing. Dorsal hoof wall angle (DHWA)/heel angle (HA) ratios, heel-bulb distance, and six parallel lines indicating solar surface dimension were determined before, and after 5, 10, 15, 20, 25, and 30 weeks of the different trimming protocols. Palmar trimming distance was only measured in experimental horses. Results: A group-by-time interaction was observed for DHWA/HA ratios and solar surface dimension. Separate effects for group and time were observed in the heel-bulb distance. A modification in hoof conformation was detected at 25-30 weeks only in horses in the experimental group, including decreases in DHWA/HA ratio, heel-bulb distance, and palmar trimming distance, coinciding with an increase in palmar width of trimmed hooves. Conclusions: Different trimming protocols produced a different effect on hoof conformation. Therefore, tactical remedial trimming can potentially control poor hoof conformation in horses with underrun heels.

Incorporating 'Green Podiatry' into your clinic, and into your life.

BACKGROUND: This commentary outlines practical ways of positively incorporating green podiatry, foot health, physical activity benefits, and relevance to climate change into the clinical setting as Conference of Parties (COP27) approaches. Recent reports from the Intergovernmental Panel on Climate Change, the World Economic Forum, and undergraduate curricula concerns, are presented. MAIN BODY: Climate change is irrefutable, and as health professionals, podiatrists can discuss the benefits and principles of green podiatry with patients of all ages in their clinics, appreciating that people are increasingly worried about the climate crisis. Feet as fundamental for independent, healthy, and carbon-neutral active transport, needs to become a key message. The three pillars for green podiatry are exercise, evidence, and the everyday changes that all podiatrists can make. Likewise, podiatrists can encourage their patients, and in doing so, join with community leadership, alongside other allied health and medical peers. CONCLUSION: Podiatrists have a shared responsibility to work and live as 'green' as possible, and to share this message with patients. Reducing waste, physically and in the form of unnecessary treatment, and supporting a review of supply chains, are important aspects of reducing health care emissions. Promoting feet as carbon-neutral transport, and physical activity as evidence based and health enhancing, are a sound contribution to twenty-first century public health. Podiatry has a great opportunity for positive legacy.

Effects of insoles adapted in flip-flop sandals for persistent heel pain: a protocol for a sham-controlled randomised trial.

INTRODUCTION: Persistent heel pain is a prevalent complaint affecting up to 10% of the population. Insoles adapted in flip-flop sandals are an alternative treatment for pain and function of individuals with persistent heel pain, showing improvement within 12 weeks of treatment. Most studies considered foot posture and biomechanics to prescribe insoles for persistent heel pain, but few verified the effects of a 12-week treatment on pain catastrophising. This study will investigate the effects of insoles adapted in flip-flop sandals on pain intensity, function, functional walking capacity and pain catastrophising of individuals with persistent heel pain. METHODS AND ANALYSIS: This is a protocol for a sham-controlled randomised trial. Eighty individuals with persistent heel pain will be assessed and randomised into two intervention groups: insoles adapted in flip-flop sandals and flip-flop sandals with sham (ie, flat) insoles. Assessments will be conducted at baseline (T0), after 6 weeks (T6), 12 weeks postintervention (T12) and after a 4-week follow-up (T16). The primary outcome will be the pain intensity, and secondary outcomes will be foot function, functional walking capacity and pain catastrophising. Analysis of variance with mixed design (if normal distribution) or Friedman's test (if not normal distribution) will verify intergroup and intragroup differences. Bonferroni post hoc tests will be performed in case of significant group or time interaction. Intent-to-treat analysis will be used, and a significance level of 5% and 95% CIs will be considered. ETHICS AND DISSEMINATION: This study was approved by the research ethics committee of the Federal University of Rio Grande do Norte (registry no. 4,018,821). Results will be disseminated to individuals, submitted to a peer-reviewed journal and disclosed in scientific meetings. TRIAL REGISTRATION NUMBER: NCT04784598.

Impact of COVID-19 pandemic on foot care services in Ontario, Canada.

BACKGROUND: The COVID-19 pandemic has directly affected the delivery of health care services in Canada, including foot care. The goal of this descriptive study was to understand the impact of the early COVID-19 pandemic (March 2020 to April 2021) on chiropodists' and podiatrists' clinical practices and foot care service delivery in Ontario, Canada. METHODS: A web-survey was completed by participating chiropodists and podiatrists registered with the College of Chiropodists of Ontario. The survey consisted of 31 multiple choice and open-ended items on clinical practice characteristics, foot care service delivery changes, perceived barriers during the pandemic, and its impact on clinicians. Descriptive statistics were used to characterize the sample and examine clinicians' responses, and qualitative content analysis was used to explore opened-ended items. RESULTS: Of the 773 eligible clinicians, 279 participated for a response rate of 36.1%. Most respondents reported a decline in patient volume, an increase in urgent foot health problems, a financial impact on their clinical practices, an emotional impact, and substantial changes to how they provided foot care services, such as incorporating telehealth/virtual care into patient care. Factors that impact clinicians' perception of future pandemic preparedness are identified. CONCLUSION: This study describes foot care service delivery in Ontario, Canada during the COVID-19 pandemic. The COVID-19 pandemic saw an increase in urgent foot health problems, decline in patient volume, and impacted clinicians' mental health and emotional well-being. Future studies should examine patients' experiences of foot care service delivery and maintaining their foot health during the pandemic, and further examination of factors that impact clinicians' perception of pandemic preparedness.