Habitually wearing high heels may improve user walking economy in any footwear.

The habitual use of high-heeled footwear may structurally remodel user leg muscle tendons, thereby altering their functional capabilities. High heels set users' ankles in relatively plantarflexed positions, causing calf muscle tendons to operate at relatively short lengths. Habitually operating muscle tendons at relatively short lengths induces structural remodeling that theoretically affects muscle metabolism. Because structural changes occur within the body, the user's locomotor metabolism may change in any footwear condition (e.g., conventional shoes, barefoot). Here, we studied the influence of habitual high-heel use on users' leg muscle-tendon structure and metabolism during walking in flat-soled footwear. We tested eight participants before and after 14 wk of agreeing to wear high heels as their daily shoes. Overall, participants who wore high heels >1,500 steps per day, experienced a 9% decrease in their net metabolic power during walking in flat-soled footwear (d = 1.66, P ≤ 0.049), whereas participants who took <1,000 daily steps in high heels did not (d = 0.44; P = 0.524). Across participants, for every 1,000 daily steps in high heels, net metabolic power during walking in flat-soled footwear decreased 5.3% (r = -0.73; P = 0.040). Metabolic findings were partially explained (r2 = 0.43; P = 0.478) by trending shorter medial gastrocnemius fascicle lengths (d = 0.500, P = 0.327) and increased Achilles tendon stiffness (d = 2.889, P = 0.088). The high-heel intervention did not alter user walking stride kinematics in flat-soled footwear (d ≤ 0.567, P ≥ 0.387). While our limited dataset is unable to establish the mechanisms underlying the high-heel-induced walking economy improvement, it appears that prescribing specific footwear use can be implemented to alter user muscle-tendon properties and augment their function in any shoes.NEW & NOTEWORTHY Habitually wearing high-heeled footwear structurally remodels leg muscle tendons and improves user walking economy, regardless of worn attire.

Pediatricians' focus of sight at pain assessment during a neonatal heel puncture.

OBJECTIVE: To evaluate the focus of pediatricians' gaze during the heel prick of neonates. METHODS: Prospective study in which pediatricians wearing eye tracker glasses evaluated neonatal pain before/after a heel prtick. Pediatricians scored the pain they perceived in the neonate in a verbal analogue numerical scale (0=no pain; 10=maximum pain). The outcomes measured were number and time of visual fixations in upper face, lower face, and hands, in two 10-second periods, before (pre) and after the puncture (post). These outcomes were compared between the periods, and according to pediatricians' pain perception: absent/mild (score: 0-5) and moderate/intense (score: 6-10). RESULTS: 24 pediatricians (31 years old, 92% female) evaluated 24 neonates. The median score attributed to neonatal pain during the heel prick was 7.0 (Interquartile range: 5-8). Compared to pre-, in the post-periods, more pediatricians fixed their gaze on the lower face (63 vs. 92%; p=0.036) and the number of visual fixations was greater on the lower face (2.0 vs. 5.0; p=0.018). There was no difference in the number and time of visual fixations according to the intensity of pain. CONCLUSIONS: At bedside, pediatricians change their focus of attention on the neonatal face after a painful procedure, focusing mainly on the lower part of the face.

Assessment of fore-, mid-, and rear-foot alignment and their association with knee symptoms and function in patients with knee osteoarthritis.

OBJECTIVE: Hallux valgus, flatfoot, and rearfoot eversion are well-known major complications of knee osteoarthritis (OA). However, there is no consensus on the association between these foot malalignments and knee symptoms or function. Thus, this study aimed to examine the association between foot alignment and knee symptoms or function in patients with knee OA. METHODS: Female patients aged ≥ 50 years with symptomatic knee OA participated in this study. Knee symptoms and function were assessed using the Knee Society Scoring System (KSS). Hallux valgus, navicular/foot ratio, and leg heel alignment were used as the forefoot, midfoot, and rearfoot alignment indices, respectively. The navicular/foot ratio was defined as the ratio of the navicular height to the total foot length. We performed multiple linear regression analysis to examine the associations between foot alignment and knee symptoms or function. RESULTS: Seventy-eight participants participated our study. KSS symptom score was significantly associated with navicular/foot ratio (regression coefficient [ß], -0.30; 95% confidence interval [CI], -109.2 to -20.5; P = 0.005), knee extensor strength (ß, 0.32; 95% CI, 0.02 to 0.09; P = 0.004), and age (ß, 0.24; 95% CI, 0.01 to 0.32; P = 0.036). KSS function score was not associated with foot alignments but with knee extensor strength (ß, 0.40; 95% CI, 0.10 to 0.33; P = 0.001) and body mass index (ß, -0.35; 95% CI, -2.82 to -0.66; P = 0.002). CONCLUSIONS: Knee symptoms were significantly associated with midfoot alignment in patients with medial knee OA. This suggests that lower navicular height in patients with medial knee OA may relate with the alleviation of knee symptoms. Key Points • In patients with medial knee OA, midfoot alignment was significantly associated with knee symptoms in patients with medial knee OA; however, knee function was not associated with foot alignment. • Lower navicular height in patients with medial knee OA may relate with the alleviation of knee symptoms.

Ultrasonography of heel entheses in axial spondyloarthritis patients: frequency and assessment of associated factors.

PURPOSE: Foot entheses involvement is a common manifestation of spondyloarthritis. The superiority of ultrasonography examination in foot entheses damages detection has been reported. We aimed to compare the ultrasonography findings of foot entheses between spondyloarthritis patients. and healthy controls and to identify factors associated with enthesitic heel involvement. METHODS: We conducted a cross-sectional study including 37 patients with axial spondyloarthritis (G1) and 37 healthy subjects matched by age and gender (G0). The following pro-inflammatory cytokines were measured: Interleukin (IL-)1, IL-6, IL-17, and IL-23. A blind ultrasonography of foot entheses was performed to examine calcaneal tendon (CT) and plantar fascia (PF). RESULTS: The mean age was 44.62 ± 12.31 years. Non-steroidal anti-inflammatory drugs were taken in 92% of patients. Clinical heel enthesopathy was noted in 10 patients (27%) of G1. No participant has enthesitic pain in G0. Ultrasonography changes in CT and PF were more frequent in G1 than G0 (p = 0.001 and p = 10-3, respectively). In the PF, tendon thickening was significantly higher in G1 than G0 (p = 0.03). Power Doppler in both enthesitic sites was exclusively observed in G1 (p = 10-3). Regarding associated factors, CT enthesophytes were less frequent in patients taking non-steroidal anti-inflammatory drugs continuously or having regular physical activity. PF structural damages were associated with higher erythrocyte sedimentation rate (p = 0.02), higher IL-23 level (p = 0.01), and higher disease activity (p = 0.04). CONCLUSION: Ultrasonography lesions of heel entheses were frequent in spondyloarthritis. Disease activity and inflammatory markers were higher in patients with heel enthesitis. Non-steroidal anti-inflammatory drugs intake and regular physical activity may prevent enthesophytes' occurrence.

Validity and Reliability of Criteria for Plantar Sensation Assessment Using Semmes-Weinstein Monofilament as a Clinically Usable Index.

There is no standard clinically adaptable criterion for assessing plantar sensation for pre- and post-intervention comparisons. Studies using Semmes-Weinstein monofilaments (SWMs) to investigate intervention effects on plantar sensation vary in procedure and do not consider measurement errors. This study aimed to develop a simple criterion using SWMs to assess plantar sensation, determine the measurement error range, and identify areas of low error. Six examiners assessed 87 healthy young adults in Experiment 1, while two examiners assessed 10 participants in Experiment 2. Filaments were graded from 1 to 20 based on increasing diameter. The smallest grade that could be perceived for three sequential stimuli was used as the criterion (smallest perceivable grade, SPG). The SPG was significantly smaller at the hallux and larger at the heel than at other sites. There were no significant differences between the SPG of the repeated tests performed by the same versus different examiners. The interquartile range of the differences was <±3 at all sites. Thus, our criteria were reliable in evaluating the effects of plantar sensation interventions, especially at the heel and the middle of the metatarsal heads and could contribute to the development of more effective treatments for plantar sensations.

Ground-Reaction-Force-Based Gait Analysis and Its Application to Gait Disorder Assessment: New Indices for Quantifying Walking Behavior.

Gait assessment is an important tool for determining whether a person has a gait disorder. Existing gait analysis studies have a high error rate due to the heel-contact-event-based technique. Our goals were to overcome the shortcomings of existing gait analysis techniques and to develop more objective indices for assessing gait disorders. This paper proposes a method for assessing gait disorders via the observation of changes in the center of pressure (COP) in the medial-lateral direction, i.e., COPx, during the gait cycle. The data for the COPx were used to design a gait cycle estimation method applicable to patients with gait disorders. A polar gaitogram was drawn using the gait cycle and COPx data. The difference between the areas inside the two closed curves in the polar gaitogram, area ratio index (ARI), and the slope of the tangential line common to the two closed curves were proposed as gait analysis indices. An experimental study was conducted to verify that these two indices can be used to differentiate between stroke patients and healthy adults. The findings indicated the potential of using the proposed polar gaitogram and indices to develop and apply wearable devices to assess gait disorders.

Assessment System for Predicting Maximal Safe Range for Heel Height by Using Force-Sensing Resistor Sensors and Regression Models.

Women often wear high-heeled shoes for professional or esthetic reasons. However, high-heeled shoes can cause discomfort and injury and can change the body's center of gravity when maintaining balance. This study developed an assessment system for predicting the maximal safe range for heel height by recording the plantar pressure of participants' feet by using force-sensing resistor (FSR) sensors and conducting analyses using regression models. Specifically, 100 young healthy women stood on an adjustable platform while physicians estimated the maximal safe height of high-heeled shoes. The collected FSR data combined with and without personal features were analyzed using regression models. The experimental results showed that the regression model based on the pressure data for the right foot had better predictive power than that based on data for the left foot, regardless of the module. The model with two heights had higher predictive power than that with a single height. Furthermore, adding personal features under the condition of two heights afforded the best predictive effect. These results can help wearers choose maximal safe high-heeled shoes to reduce injuries to the bones and lower limbs.

Assessment of Hindfoot Alignment: Intraoperative Fluoroscopy Versus Standing Radiograph.

Few intraoperative assessments are available for hindfoot alignment. In the current study, we demonstrated the feasibility of hindfoot alignment via intraoperative fluoroscopy. We retrospectively compared measurements of heel alignment obtained via intraoperative fluoroscopy with those acquired using standard radiographs. Two observers compared the heel alignment ratios and angles derived from 100 pairs of images. The effects of age, sex, laterality, and body mass index on the discrepancy between fluoroscopic images and radiographs were analyzed. The heel alignment ratio revealed a strong correlation between standing radiograph and intraoperative fluoroscopy, based on a correlation coefficient of 0.844 (p < .001). The heel alignment angle also showed significant correlation based on a correlation coefficient value of 0.667 (p < .001). None of the demographic factors showed any significant effect on the discrepancy between the 2 sets of images. Our study showed that the heel alignment determined via intraoperative fluoroscopy was comparable to that of a standard standing radiograph without any significant association with demographic factors.

MR-compatible loading device for assessment of heel pad internal tissue displacements under shearing load.

In the last decade, the role of shearing loads has been increasingly suspected to play a determinant impact in the formation of deep pressure ulcers. In vivo observations of such deformations are complex to obtain. Previous studies only provide global measurements of such deformations without getting the quantitative values of the loads that generate these deformations. To study the role that shearing loads have in the etiology of heel pressure ulcers, an MR-compatible device for the application of shearing and normal loads was designed. Magnetic resonance imaging is a key feature that allows to monitor deformations of soft tissues after loading in a non-invasive way. Measuring applied forces in an MR-environment is challenging due to the impossibility to use magnetic materials. In our device, forces are applied through the compression of springs made of polylactide. Shearing and normal loads were applied on the plantar skin of the human heel through a flat plate while acquiring MR images. The device materials did not introduce any imaging artifact and allowed for high quality MR deformation measurements of the internal components of the heel. The obtained subject-specific results are an original data set that can be used in validations for Finite Element analysis and therefore contribute to a better understanding of the factors involved in pressure ulcer development.

Cost-effectiveness of custom-made insoles versus usual care in patients with plantar heel pain in primary care: cost-effectiveness analysis of a randomised controlled trial.

OBJECTIVES: To evaluate the cost-effectiveness of custom-made insoles compared with general practitioner (GP)-led usual care after 26 weeks of follow-up in individuals with plantar heel pain (PHP) from a societal perspective. DESIGN: Cost-effectiveness analysis of a double-blinded randomised controlled trial. SETTING: General practice in the Netherlands. PARTICIPANTS: 116 participants with PHP for at least 2 weeks, aged 18-65 years and presenting to the GP. INTERVENTIONS: Participants were randomised to GP-led usual care (n=46) or referral to a podiatrist for treatment with a custom-made insole (n=70). Participant randomised to a sham insole (n=69) were excluded from this analysis. PRIMARY AND SECONDARY OUTCOMES: Outcomes comprised pain during rest and activity, and quality of life. Costs included healthcare and lost productivity costs. Statistical uncertainty was estimated using bootstrapping and presented using cost-effectiveness acceptability curves. RESULTS: Participants in the custom-made insole group experienced statistically significant more pain during activity at 26 weeks than participants in the usual care group (overall effect 1.06; 95% CI 0.36 to 1.75). There were no significant differences between groups in other outcomes. Total societal costs in the custom-made insole group were non-significantly higher than in the usual care group (mean difference €376; 95% CI -€1775 to €2038). The intervention with custom-made insoles was dominated by usual care by the GP (ie, more expensive and less effective) for pain during activity and quality of life outcomes. For the outcome pain at rest, the intervention was more expensive and more effective than usual care. However, the maximum probability of cost-effectiveness was only 0.59 at very high ceiling ratios. CONCLUSIONS: These findings show that that custom-made insoles are not cost-effective in comparison with GP-led usual care. Clinicians should be reserved in prescribing custom-made insoles for PHP as a primary intervention. TRIAL REGISTRATION NUMBER: NTR5346.

Biomechanical assessment of two types and two different locations of subtalar arthroereisis implants for flexible flatfoot: A cadaveric study.

BACKGROUND: Subtalar arthroereisis refers to the implantation of a sinus tarsi implant for the treatment of flexible flatfoot. The purpose of this study was to compare the ability to correct the flatfoot deformity and contact pressure of the posterior subtalar joint between two types of self-locking wedge implants and between two different positions for the same device in a cadaveric flatfoot model. METHODS: The flatfoot model was created in ten cadaver feet through ligament sectioning and cyclic loading. Three kinds of arthroereisis procedures were evaluated: Talar-Fit (type I self-locking wedge implant) anchored in the sinus portion of the tarsal sinus (T-sinus group), Talar-Fit in the canalis portion (T-canalis group), and HyProCure (type II) in the canalis portion (H group). Corrective ability in the sagittal and transverse planes were measured with clinometers. Contact pressure was measured with pressure-sensitive films. FINDINGS: T-canalis group provided more sagittal (mean difference for size 10 mm: 1.9°, P = 0.014; mean difference for size 11 mm: 3.1°, P = 0.037) and transverse (mean difference for size 8 mm: 1.8°, P = 0.049; mean difference for size 11 mm: 2.2°, P = 0.049) corrections than T-sinus group. The flattening process shifted the peak pressure of the posterior subtalar joint to the posteromedial side (P < 0.05) and arthroereisis helped the distribution of contact pressure restore uniformity (all P > 0.05). INTERPRETATION: A self-locking wedge implant inserted in the canalis portion of the tarsal sinus achieved better correction than an implant inserted in the sinus portion.

A waveform test for variance inequality, with a comparison of ground reaction force during walking in younger vs. older adults.

Various methods have been suggested for estimating the variability in biomechanical variables during gait. However, all current measures of variability are performed on discrete measurements extracted from the kinematic or kinetic waveforms, which provide no temporal information on where differences in variability occur. This study used a variance equality test to compare temporal differences in group variance along the entire ground reaction force waveform. The variance equality test used an F-statistic whose critical value was determined using the random field theory function within the one-dimensional statistical parametric mapping package. Twenty healthy younger and twenty older adults were included in the study and completed gait analysis as they walked along a level walkway at a self-selected pace. Variance for each group was calculated and compared at each interval along the waveform to produce the F-value. The F-value was compared against a calculated F-critical value to determine where in the waveform significant differences in ground reaction force variance occurred. Results suggest that younger individuals may exhibit greater ground reaction force variance during heel contact in the vertical and posterior directions, and that older individuals may exhibit greater variability in the mediolateral direction at toe-off. This study was able to identify differences in ground reaction force variance within the gait cycle between younger and older adults. The findings of this study warrant the use of the function as a suitable method to compare variance along the entire waveform between two groups.

Cost-Effectiveness of Two Dry Needling Interventions for Plantar Heel Pain: A Secondary Analysis of an RCT.

Plantar heel pain is a common cause of foot pain that affects patients' quality of life and represents a significant cost for the healthcare system. Dry needling and percutaneous needle electrolysis are two minimally invasive treatments that were shown to be effective for the management of plantar heel pain. The aim of our study was to compare these two treatments in terms of health and economic consequences based on the results of a published randomized controlled trial. For this, we evaluated the costs from the point of view of the hospital and we carried out a cost-effectiveness study using quality of life as the main variable according to the Eq-5D-5L questionnaire. The cost of the complete treatment with dry needling (DN) was €178.86, while the percutaneous needle electrolysis (PNE) was €200.90. The quality of life of patients improved and was translated into +0.615 quality-adjusted life years (QALYs) for DN and +0.669 for PNE. PNE presented an average incremental cost-effectiveness ratio (ICER) of €411.34/QALY against DN. These results indicate that PNE had a better cost-effectiveness ratio for the treatment of plantar heel pain than DN.

Assessment of the Shank-to-Vertical Angle While Changing Heel Heights Using a Single Inertial Measurement Unit in Individuals with Incomplete Spinal Cord Injury Wearing an Ankle-Foot-Orthosis.

Previous research showed that an Inertial Measurement Unit (IMU) on the anterior side of the shank can accurately measure the Shank-to-Vertical Angle (SVA), which is a clinically-used parameter to guide tuning of ankle-foot orthoses (AFOs). However, in this context it is specifically important that differences in the SVA are detected during the tuning process, i.e., when adjusting heel height. This study investigated the validity of the SVA as measured by an IMU and its responsiveness to changes in AFO-footwear combination (AFO-FC) heel height in persons with incomplete spinal cord injury (iSCI). Additionally, the effect of heel height on knee flexion-extension angle and internal moment was evaluated. Twelve persons with an iSCI walked with their own AFO-FC in three different conditions: (1) without a heel wedge (refHH), (2) with 5 mm heel wedge (lowHH) and (3) with 10 mm heel wedge (highHH). Walking was recorded by a single IMU on the anterior side of the shank and a 3D gait analysis (3DGA) simultaneously. To estimate validity, a paired t-test and intraclass correlation coefficient (ICC) between the SVAIMU and SVA3DGA were calculated for the refHH. A repeated measures ANOVA was performed to evaluate the differences between the heel heights. A good validity with a mean difference smaller than 1 and an ICC above 0.9 was found for the SVA during midstance phase and at midstance. Significant differences between the heel heights were found for changes in SVAIMU (p = 0.036) and knee moment (p = 0.020) during the midstance phase and in SVAIMU (p = 0.042) and SVA3DGA (p = 0.006) at midstance. Post-hoc analysis revealed a significant difference between the ref and high heel height condition for the SVAIMU (p = 0.005) and knee moment (p = 0.006) during the midstance phase and for the SVAIMU (p = 0.010) and SVA3DGA (p = 0.006) at the instant of midstance. The SVA measured with an IMU is valid and responsive to changing heel heights and equivalent to the gold standard 3DGA. The knee joint angle and knee joint moment showed concomitant changes compared to SVA as a result of changing heel height.

Agreement and consistency of five different clinical gait analysis systems in the assessment of spatiotemporal gait parameters.

BACKGROUND: Measuring gait function has become an essential tool in the assessment of mobility in aging populations for both, clinicians and researchers. A variety of systems exist that assess gait parameters such as gait cycle time, gait speed or duration of relative gait phases. Due to different measurement principles such as inertial or pressure sensors, accurate detection of spatiotemporal events may vary between systems. RESEARCH QUESTION: To compare the absolute agreement and consistency in spatiotemporal gait parameters among five different clinical gait analysis systems using different sensor technologies. METHODS: We compared two devices using inertial sensors (GaitUp & Mobility Lab), two devices using pressure sensor systems (GAITRite & Zebris) as well as one optical system (OptoGait). Twelve older adults walked at self-selected speed through a walkway integrating all of the above systems. Basic spatiotemporal parameters (gait cycle time, cadence, gait speed and stride length) as well as measures of relative phase (stance phase, swing phase, double stance phase, single limb support) were extracted from all systems. We used Intraclass Correlation Coefficients as measures of agreement and consistency. RESULTS: High agreement and consistency between all systems was found for basic spatiotemporal parameters, whereas parameters of relative phase showed poorer agreement and consistency. Overground measurement (GAITRite & OptoGait) showed generally higher agreement with each other as compared to inertial sensor-based systems. SIGNIFICANCE: Our results indicate that accurate detection of both, the heel-strike and toe-off event are crucial for reliable results. Systematic errors in the detection of one or both events may only have a small impact on basic spatiotemporal outcomes as errors remain consistent from step to step. Relative phase parameters on the other hand may be affected to a much larger extent as these differences lead to a systematic increase or reduction of relative phase durations.

Assessment of four pain scales for evaluating procedural pain in premature infants undergoing heel blood collection.

BACKGROUND: Procedural pain is underestimated in hospitalized preterm infants. The aim of this study was to assess the reliability, validity, and clinical utility of the Neonatal Facial Coding System (NFCS), Douleur Aiguë du Nouveau-né (DAN) scale, Neonatal Infant Pain Scale (NIPS), and Premature Infant Pain Profile (PIPP) in premature infants undergoing heel blood collection. We assume that the four scales were similar in reliablility and validity (but different in clinical utility). METHODS: The pain assessments were performed on 111 premature infants using the four scales. Internal consistency was determined by Cronbach's α, and the reliability was determined by the intraclass correlation coefficients. Concurrent validity was evaluated by Spearman's rank correlations. Bland-Altman plots were used to investigate the convergent validity. RESULTS: The internal consistency and their reliability of the scales were high (p < 0.001). Scores were significantly higher at the time of blood collection (p < 0.001). Mean scores of clinical utility of PIPP were significantly higher than NFCS and DAN (p < 0.05) but not higher than the NIPS (p > 0.05). CONCLUSIONS: The four scales were reliable and valid. This study suggests that the PIPP and NIPS has good clinical utility and are better choice for evaluating procedural pain in premature infants. IMPACT: The aim of this study was to assess the reliability, validity, and clinical utility of NFCS, DAN, NIPS, and PIPP in premature infants undergoing heel blood collection. The results showed that the four scales have high reliability and internal consistency; the PIPP and NIPS have good clinical utility and are better choice for evaluating procedural pain in premature infants. Our study results provided a reference for clinical workers in choosing pain assessment scales and conduction intervention.

A novel simplified biomechanical assessment of the heel pad during foot plantarflexion.

The heel pad (HP) which is located below the calcaneus comprises a composition of morphometrical and morphological arrangements of soft tissues that are influenced by factors such as gender, age and obesity. It is well known that HP pain and Achilles tendonitis consist of discomfort, pain and swelling symptoms that usually develop from excessive physical activities such as walking, jumping and running. The purpose of this study was to develop biomechanical techniques to evaluate the function and characteristics of the HP. Ten healthy participants (five males and five females) participated in this laboratory-based study, each performing a two-footed heel raise to mimic the toe-off phase during human locomotion. Twenty-six (3 mm) retroreflective markers were attached to the left and right heels (thirteen markers on each heel). Kinematic data was captured using three-dimensional motion analysis cameras synchronised with force plates. Descriptive and multivariate statistical tests were used in this study. In addition, a biomechanical technique that utilises only six markers from 26 markers to assess HP deformation and function has been developed and used in this study. Overall HP displacement was significantly higher in males on the most lateral part of the right heel (p < 0.05). No significant differences were evident when comparing the non-dominant and dominant heels during the baseline, unloading and loading phases (p > 0.05). Findings from this study suggested that biomechanical outputs expressed as derivatives from tracked HP marker movements can morphologically and morphometrically characterise HP soft tissue deformation changes. The outcome of this study highlights the importance of 3D motion analysis being used as a potential prospective intervention to quantify the function / characteristics of the heel pad soft tissues.

Correlation between goniometric and photogrammetric assessment of shank-forefoot alignment in athletes.

BACKGROUND: The shank-forefoot alignment (SFA) measurement has been previously developed to enhance the applicability of foot alignment measurement in sports preseason assessment because it is reliable and less time consuming. The use of SFA measurements in the clinical context, usually done with photogrammetry, may be simplified by using the universal goniometer and no longer requiring the image processing step that takes additional time and equipment. OBJECTIVE: Investigate the correlation between the goniometric and photogrammetric assessment of shank-forefoot alignment in athletes. PARTICIPANTS: Thirty volleyball athletes were recruited during a preseason assessment. METHODS: SFA measurements were assessed with a universal goniometer and photogrammetry. For both assessments the participants were positioned in prone with the rearfoot facing up and the ankle actively maintained in 90° of dorsiflexion. The examiner did not have access to the SFA outcome values from both measurements. A second examiner did the bi-dimensional analysis with SIMI MOTION (photogrammetric measure) and read the goniometer measures during the other SFA assessment. Data normality was tested using Shapiro-Wilk test and Pearson was used to determine the correlation between both measurements. RESULTS: A reliability study determined the Intraclass Correlation Coefficient (ICC3,3) for intra-rater reliability of 0.93 for photogrammetry and of 0.81 for goniometry assessment. The correlation (p < 0.001) between these two measurements was 0.71, which indicates a moderate relationship. CONCLUSIONS: This study describes a reliable and practical measurement procedure for shank-forefoot alignment using the universal goniometer that can be easily applied in clinical context.

Consensus for the Use of Weightbearing CT in the Assessment of Progressive Collapsing Foot Deformity.

RECOMMENDATION: There is evidence that the use of WEIGHTBEARING imaging aids in the assessment of progressive collapsing foot deformity (PCFD). The following WEIGHTBEARING conventional radiographs (CRs) are necessary in the assessment of PCFD patients: anteroposterior (AP) foot, AP or mortise ankle, and lateral foot. If available, a hindfoot alignment view is strongly recommended. If available, WEIGHTBEARING computed tomography (CT) is strongly recommended for surgical planning. When WEIGHTBEARING CT is obtained, important findings to be assessed are sinus tarsi impingement, subfibular impingement, increased valgus inclination of the posterior facet of the subtalar joint, and subluxation of the subtalar joint at the posterior and/or middle facet. LEVEL OF EVIDENCE: Level V, consensus, expert opinion.

Cost-effectiveness of multi-layered silicone foam dressings for prevention of sacral and heel pressure ulcers in high-risk intensive care unit patients: An economic analysis of a randomised controlled trial.

Pressure ulcer incidence is high in intensive care units. This causes a serious financial burden to healthcare systems. We evaluated the cost-effectiveness of multi-layered silicone foam dressings for prevention of sacral and heel pressure ulcers in addition to standard prevention in high-risk intensive care units patients. A randomised controlled trial to assess the efficacy of multi-layered silicone foam dressings to prevent the development of pressure ulcers on heels and sacrum among 422 intensive care unit patients was conducted. Direct costs for preventive dressings in the intervention group and costs for treatment of incident pressure ulcers in both groups were measured using a bottom-up approach. A cost-effectiveness analysis by calculating the incremental cost-effectiveness ratio using different assumptions was performed. Additional dressing and labour costs of €150.81 (€116.45 heels; €34.36 sacrum) per patient occurred in the intervention group. Treatment costs were €569.49 in the control group and €134.88 in the intervention group. The incremental cost-effectiveness ratio was €1945.30 per PU avoided (€8144.72 on heels; €701.54 sacrum) in the intervention group. We conclude that application of preventive dressings is cost-effective for the sacral area, but only marginal on heels for critically ill patients.