Effects of a Training Course for Andalusian Podiatrists on Antibiotic Management in Ingrown Toenail Infections: A Pilot Study.

BACKGROUND: The use of antibiotics (ABs) for the prevention and management of infections has been widespread for decades and, at this time, AB resistance is a global health crisis. The available evidence highlights the need to reduce the prophylactic and therapeutic use of ABs to avoid associated risks. METHODS: A preliminary study with a total sample of 56 Andalusian (Spain) podiatrists was surveyed. The purpose of this study was to identify whether there were changes in prescription habits from a situation before a subsequent training course on AB indications for the management of infections associated with ingrown toenails. An ad hoc questionnaire of 15 items related to therapeutic and prophylactic prescriptions of ABs was developed for this purpose, and the evaluation was carried out before and after the training course. RESULTS: The responses obtained before and after training were compared. The training activity led to improvements in the prescription habits of the participants, producing significant changes in the prescription pattern of the professionals in 10 of the 15 items. CONCLUSIONS: The results of this preliminary study show that the podiatrists surveyed improved the rational use of systemic AB therapy in ingrown toenails infections.

Management of Skin Lesions in Patients with Epidermolysis Bullosa by Topical Treatment: Systematic Review and Meta-Analysis.

Epidermolysis bullosa (EB) is the overarching term for a set of rare inherited skin fragility disorders that result from mutations in at least 20 different genes. Currently, there is no cure for any of the EB subtypes associated with various mutations. Existing therapies primarily focus on alleviating pain and promoting early wound healing to prevent potential complications. Consequently, there is an urgent need for innovative therapeutic approaches. The objective of this research was to assess the efficacy of various topical treatments in patients with EB with the goal of achieving wound healing. A secondary objective was to analyse the efficacy of topical treatments for symptom reduction. A literature search was conducted using scientific databases, including The Cochrane Library, Medline (Pubmed), Web of Science, CINHAL, Embase, and Scopus. The protocol review was registered in PROSPERO (ID: 418790), and inclusion and exclusion criteria were applied, resulting in the selection of 23 articles. Enhanced healing times were observed compared with the control group. No conclusive data have been observed on pain management, infection, pruritus episodes, and cure rates over time. Additionally, evidence indicates significant progress in gene therapies (B-VEC), as well as cell and protein therapies. The dressing group, Oleogel S-10, allantoin and diacerein 1%, were the most represented, followed by fibroblast utilisation. In addition, emerging treatments that improve the patient's innate immunity, such as calcipotriol, are gaining attention. However, more trials are needed to reduce the prevalence of blistering and improve the quality of life of individuals with epidermolysis bullosa.

Test de descenso del navicular / Navicular descent test

Objetivo: revisar críticamente la literatura sobre la validez y fiabilidad del test de descenso del navicular como herramienta clínica de evaluación de la pronación del pie. Método: Se ha realizado una revisión de la literatura existente sobre el tema en las principales bases de datos de ciencias de la salud. Para realizar la búsqueda se emplearon los terminos MeSH (navicular drop, pronation, foot) interconectados con los respectivos conectores booleanos. Resultados: Se seleccionaron finalmente un total de 38 artículos científicos en castellano e inglés sobre la fiabilidad y validez interna del test. Conclusiones: El test de descenso del navicular es una herramienta ampliamente utilizada en estudios de investigación. Sin embargo, con la evidencia disponible, podemos afirmar que la fiabilidad y validez interna del test es cuanto menos cuestionable para que este pueda ser usado con fines de investigación. (AU)

A Short-Term Evaluation of Foot Pronation Tendency in Healthy Recreational Runners.

Running is a highly physical activity, and it is related to injuries when there is an excessive pronation of the foot. This study evaluates, from a sample group of healthy recreational runners, if the foot tends to pronate after a period of running activity and when, with respect to a period of running compared to walking, evaluated during several phases: after 30, 45, and 60 min. This quasi-experimental study has been carried out on a total of 36 healthy recreational subjects. The subjects were evaluated during two different activities: running activity for a period of an hour with respect to normal walking activity. The main outcome measures were the foot posture index (FPI) and the navicular drop test (NDT), which were evaluated at p1 (the screening day), after 30 min of activity (p2), after 45 min of activity (p3), and finally after 60 min (p4) during running or walking activity. The analysis showed significant differences for the FPI and NDT variables in both groups and on both feet, comparing p1 and p4. These changes showed a significant relationship comparing p1 and p3 for the FPI variable, and for the NDT variable (p < 0.001) of the left foot and, with respect to the right foot, significance was shown to the FPI comparing the p1 and p2. A significant difference was found in the tendency to pronate the foot after a period of running compared to the same period of walking after 60 min of activity. Running produced an excessive pronation of the foot after 45 min of activity, evaluated with the FPI for both feet.

Evaluation of Gait Parameters on Subjects with Hallux Limitus Using an Optogait Sensor System: A Case-Control Study.

Background and Objetives: The foot is a part of the body's kinetic chain and needs to be efficient during the entire gait cycle. Electronic Sensor Gait analysis is useful and an important tool within the area of podiatry to assess the physical state of patients that helps the comprehensive intervention in situations where the daily activity is limited. The aim of this research is to evaluate if the presence of a hallux limitus (HL) can alter gait space-time parameters and consequently can affect the take-off phase of the gait and the limitation of the range of motion (ROM) of the hallux. Materials and Methods: A case-control study was designed to verify whether there are alterations in the spatiotemporal parameters of the gait cycle between subjects with structural HL compared to the group of subjects with a normal hallux range. A total of n = 138 participants, cases (68 HL subjects) and healthy controls (70 subjects) were studied using an OptoGait LED sensor system to identify gait imbalances using OptoGait photocell gait analysis sensors. Results: Significant differences were found between the two groups with respect to stride length, gait cycle duration in seconds (for both feet) and for total stride and load response (p < 0.05). Conclusions: The limitation of the Hallux ROM may alter the normal gait patterns measured with an Optogait system. The early identification and treatment of gait disturbances due to HL are important to achieve normal gait physical activity to maintain a healthy lifestyle.

Pilot Study: The Relationship between Foot Posture and Movement Quality in Non-Professional Male Football Players.

(1) Background: This study focusses on establishing the relationship between quality of movement (based on the functional movement screen, or FMS) and foot posture (based on the foot posture index, or FPI-6). We hypothesised that a poor FMS test score may be derived from the foot position in the space measured by FPI-6. (2) Methods: a quasi-experimental and cross-sectional study was designed to analyse foot posture in 30 healthy football players, using the foot posture index and the functional movement screen. (3) Results: No significant relationships were found between movement quality and foot posture. Poor movement quality is present in more than half of all foot positions, supination, pronation, and neutral. Good quality seems to be more associated with a neutral foot position (23.3%) and supinated (16.6%) than a pronated foot position (6.6%). (4) Conclusions: this study found no relationship between the two tests; therefore, we cannot demonstrate that foot posture is relevant in the quality of the movement of the football players studied.

Pilot Study: Effect of Morton's Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation.

This study focuses on the assessment of the mechanical effect produced by Morton's extension as an orthopedic intervention in patients with bilateral foot pronation posture, through a variation in hindfoot and forefoot prone-supinator forces during the stance phase of gait. A quasi-experimental and transversal research was designed comparing three conditions: barefoot (A); wearing footwear with a 3 mm EVA flat insole (B); and wearing a 3 mm EVA flat insole with a 3 mm thick Morton's extension (C), with respect to the force or time relational to the maximum time of supination or pronation of the subtalar joint (STJ) using a Bertec force plate. Morton's extension did not show significant differences in the moment during the gait phase in which the maximum pronation force of the STJ is produced, nor in the magnitude of the force, although it decreased. The maximum force of supination increased significantly and was advanced in time. The use of Morton's extension seems to decrease the maximum force of pronation and increase supination of the subtalar joint. As such, it could be used to improve the biomechanical effects of foot orthoses to control excessive pronation.

The Short-Term Effect of Dynamic Tape versus the Low-Dye Taping Technique in Plantar Fasciitis: A Randomized Clinical Trial.

BACKGROUND: Plantar fasciitis is a painful disorder that affects the plantar fascia of the foot, with a multifactorial aetiology. Dorsal flexion deficiency in the ankle is a risk factor for it. The provisional use of taping is described as part of conservative treatment. Dynamic Tape® is a type of tape that, adhered to muscles, allows for potential elastic energy to accumulate and dissipate later, optimizing its function. Therefore, it can offer immediate benefits while the patient awaits definitive treatment depending on the cause. OBJECTIVE: To verify the effectiveness of Dynamic Tape® and the low-dye taping technique on pain intensity, ankle range of motion, and foot posture index. METHOD: A randomised, double-blind clinical trial was conducted. A total of 57 subjects from the Clinical Podiatry Area of the University of Seville (Spain), clinically diagnosed with plantar fasciitis, were randomized into two groups. For one week, in the gastrocnemius-Achilles-plantar system, one group was treated with Dynamic Tape® and another group with low-dye taping. Pain, degrees of movement of dorsal flexion, and the foot posture index were measured in both groups before the intervention and one week after the intervention. A repeated-measures analysis of variance (ANOVA) was used to explore the differences between groups. RESULTS: Significant differences in the decrease in pain intensity using Dynamic Tape® were found when comparing the treatments (p = 0.015) and the foot posture index was more normal in low-dye taping (p < 0.001). In both cases, the treatment showed similar behaviour with respect to the dorsal flexion ankle movement. CONCLUSION: The effectiveness of Dynamic Tape®, compared to that of the low-dye taping, has a major benefit with regard to pain intensity from fasciitis, although it does not produce changes in the ankle range of motion and foot posture index. Consequently, Dynamic Tape® can be considered a taping technique with beneficial effects on pain intensity in the provisional approach to plantar fasciitis.

Evaluation of the Correlation Between Flamenco Dance and Ankle and Foot Posture.

BACKGROUND: The practice of flamenco dance involves great biomechanical demands, comparable with a high-performance sport. The technical movements of the footwork tap, the jumps, and the turns increase the prevalence of injuries and pathologic disorders of the foot and lower limb. Limited research has examined adaptation of the foot posture and dorsiflexion of the ankle in flamenco dancing. Therefore, the aim of this study was to evaluate whether the practice of flamenco dancing produces modifications in the ankle's dorsiflexion range of motion, Foot Posture Index, or pronation. METHODS: A cross-sectional observational study with intentional sampling was performed with 26 individuals (52 feet) in two groups: professional female flamenco dancers (n = 13) and nondancers (n = 13). The participants were assessed in a single session for ankle dorsiflexion, foot pronation (navicular drop test), and foot posture (Foot Posture Index). RESULTS: Significant differences were found between the two groups for left foot Foot Posture Index (P = .007) and right foot navicular drop test (P = .006). CONCLUSIONS: The results of this study indicate that flamenco dancing can produce modifications in the Foot Posture Index and foot pronation versus nondancers. Further research is required.

Comparison of the Psychological Impact of COVID-19 on Self-Employed Private Healthcare Workers with Respect to Employed Public Healthcare Workers: Three-Wave Study during the COVID-19 Pandemic in Spain.

(1) Background: Coronavirus disease, also called COVID-19, is a worldwide pandemic with a major impact on all aspects of the individual (health status, psychological, and economic aspects, among others). The perception of health professionals in this situation has been influenced by their economic and psychosocial situations. On the economic level, self-employed workers have no state subsidies, with the added disadvantage of not having sufficient means to cope with contagion. This could potentially have an impact on their health and indirectly on their family members, creating additional stress. The aim of this study was to determine whether there are differences in the level of anxiety of health professionals working in private practice compared to healthcare workers working in public institutions during the first three waves of COVID-19. (2) Methods: A cohort study on 517 subjects comparing anxiety between a group of health workers and a group of health professionals working in the public sector at three key moments during the pandemic was performed. (3) Results: Statistically significant differences were found between self-employed private health professionals compared to those working as public health workers. The perception of impact was worse in the self-employed; however, a higher level of anxiety was evident in public employees in all assessed domains (cognitive, physiological, and motor, p = 0.001). (4) Conclusions: There were significant changes when comparing the first phase between both groups; employed public healthcare workers manifested a sense of lower risk of COVID-19 contagion than privately employed professionals, who had a higher level of anxiety. In the second and third waves, negative feelings improved for both groups, and the fear of showing anxiety to the patient decreased over the course of the waves.

Relationship of the Use of Short Footwear with the Development of Hallux Valgus in a Sample of Andalusian Schoolchildren.

BACKGROUND: Several studies have shown the relationship between poor footwear fit and the risk of feet deformities. The available evidence seems to show that the development of hallux valgus deformity in the feet of schoolchildren may be related to the use of shoes that are poorly fitting in length. The objective of this cross-sectional study was to analyze the relationship between poor footwear fit in length and risk of developing hallux valgus. METHODS: Using an instrument that was designed and calibrated for this purpose, maximum foot length was obtained and compared to the inner length of the shoe in 187 schoolchildren. Hallux valgus angle (HVA) was measured on weight-bearing podogram image obtained from the longest foot in 188 schoolchildren. RESULTS: By default, the footwear was poorly fitting in length (too short or close-fitting) in 38.5% of the schoolchildren, with boys having the worst footwear fit; though no significant differences stood out. (p = 0.276). Regarding the HVA, no significant differences were recorded according to age or gender (p = 0.573). A strong correlation was observed between too-short footwear and the increase in HVA in 10-year-old boys (r = 0.817; p = 0.025) and in 9-year-old girls (r = 0.705; p = 0.005). CONCLUSIONS: Inadequate footwear fit in length may be a predisposing extrinsic risk factor for the development of hallux valgus in schoolchildren of both sexes. Results of the present study demonstrate the need to adapt the sizes of footwear to the rapid increase in foot-length that occur at puberty to avoid the risk of developing hallux valgus, especially at the ages of onset pubertal foot growth.

An Assessment of Balance through Posturography in Healthy about Women: An Observational Study.

The incidence of falls in adults constitutes a public health problem, and the alteration in balance is the most important factor. It is necessary to evaluate this through objective tools in order to quantify alterations and prevent falls. This study aims to determine the existence of alteration of balance and the influence of age in a population of healthy women. Static posturography was performed on 49 healthy adult women with no history of falls in four different situations using the Romberg test with the NedSVE/IBV® platform. The variables studied were the body sway area and the anteroposterior and mediolateral displacements. The situation of maximum instability occurred in RGC (p = 0.001), with a significant increase in anteroposterior oscillations regarding the ML (p < 0.001), with no correlation to age. Age alone does not influence the balance in the sample studied, other factors must come together to alter it. The joint cancellation of visual and somatosensory afferents could facilitate the appearance of falls, given that it is a situation of maximum instability. Proprioceptive training is interesting as a preventive strategy for falls.

Lived Experiences of African Migrants Crossing the Strait of Gibraltar to Europe: A Cross-Cultural Approach to Healthcare from a Qualitative Methodology.

BACKGROUND: The migratory flow from the African continent to Europe is intense and the European countries should apply a humanitarian, health and social response to this emerging problem. Migrants coming from Africa to Europe are a very vulnerable population. Healthcare professionals should be prepared for answering their needs from a transcultural approach, which requires a better understanding of this phenomenon. Thus, the aim of this study was to improve nursing and healthcare professionals' awareness and better understanding of migrant life experiences during the migration journey. An exploratory descriptive qualitative research was conducted. In-depth interviews were conducted involving four key informants and content analysis were performed with the transcriptions. RESULTS: Three themes merged: life situations in their countries of origin; motivations that led them to undertake the migratory journey; and experiences they lived during the migratory journey. The results described the dramatic experience and motivations for crossing the strait of Gibraltar from Africa to Europe, including feelings, fears, hopes and lived experiences. The determination of immigrants to fight for a better life opportunity and the physical damage and psychological consequences they suffer were revealed. CONCLUSIONS: This study would help healthcare professionals to better understand this complex reality and deliver culturally adapted care. Knowledge of the starting reality of these populations can help health professionals to incorporate a cross-cultural approach that improves the relational, ethical and affective competences to provide quality care to the migrant population, as well as the development of health measures to fight against inequalities suffered by these population groups.

International Multicenter Study on Drug Consumption in Nursing Students.

BACKGROUND: The prevalence of illicit drug use among young people is high, with many being highly vulnerable to substance abuse. The nursing profession is not immune to the impacts of substance misuse. Knowing the current levels of consumption of illicit drugs in nursing students will allow for the introduction of preventive actions. METHODS: Multi-center, descriptive, and cross-sectional study involving nursing schools from four different countries (Spain, Belgium, France, and Brazil). A total of seven centers participated. An adapted version of the Global School-based Student Health Survey (GSHS) was used as a tool, which selected only the module on illicit drugs. Standard logistic regression analysis was performed. RESULTS: A total of 496 nursing students participated in the study. Illicit drug shows positive representation among nursing students. A significant difference was observed between the gender and the age of first drug use, illicit drug consumption, cannabis use, and cocaine use ever in life, with higher use of illicit drugs by male, although at later ages than girls. The bivariate analysis, gender, problems as result of drugs, and nationality were significantly associated with the consumption of illicit drugs, cannabis, cocaine, and ecstasy ever in life. CONCLUSIONS: High rates of illicit drug use were found among nursing students, as well as factors that can influence consumption such as nationality or gender. These results can serve as a basis for the development of educational and policy interventions within nursing schools that are based on evidence, with significant implications for nurse educators, academic administrators, and practice.

A Case-Control Study of the Effects of Chronic Low Back Pain in Spatiotemporal Gait Parameters.

Chronic low back pain and biomechanical walking imbalances are closely related. It is relevant to identify if there are alterations in spatiotemporal gait patterns in subjects with CLBP (cases) versus healthy subjects (controls) to plan training interventions of motor control gait patterns, and thus allowing normal physical activity of the individual. This study is intended to identify if spatiotemporal alterations occur in the gait cycle in CLBP subjects (cases) compared with a control group (healthy patients) analyzed with an OptoGait LED sensors gait program. METHOD: A total of n = 147 participants: n = 75 cases (CLBP) and n = 72 healthy controls subjects were studied with OptoGait gait program. RESULTS: Significant differences were found between the two groups and both feet in foot stride, for the differences of the total stride and contact, for gait cadence and total stride length of the gait cycle (p < 0.05). CONCLUSIONS: CLBP may alter some normal gait patterns measured by OptoGait; this finding presents imbalances in gait cycle as an underlying factor. The gait is part of daily life of any individual and it is an important physical activity in relation to the maintenance of an optimal state of health. In addition, future studies are deemed necessary.

Custom-Made Foot Orthoses as Non-Specific Chronic Low Back Pain and Pronated Foot Treatment.

Excessive foot pronation has been reported as being related to chronic low back pain symptoms and risk factors in sports-specific pathologies. Compensating custom-made foot orthotics treatment has not been entirely explored as an effective therapy for chronic low back pain (CLBP). This study aims to observe the effects of custom-made foot orthoses, in subjects with foot pronation suffering from CLBP. A total of 101 patients with nonspecific CLBP and a pronated foot posture index (FPI) were studied. They were randomized in two groups: an experimental one (n = 53) used custom-made foot orthotics, and the control group (n = 48) were treated with non-biomechanical effect orthoses. The CLBP was measured using the Oswestry Disability Index (ODI) Questionnaire and a visual analogue scale (VAS), both for lower back pain. The symptoms were evaluated twice, at first when the subject was included in the study, and later, after 4 weeks of treatment. The analysis of outcomes showed a significant decrease in CLBP in the custom-made foot orthoses participants group (p < 0.001 ODI; p < 0.001 VAS). These findings suggest that controlling excessive foot pronation by using custom-made foot orthoses may significantly contribute to improving CLBP.

Clinical Manifestations of COVID-19 in the Feet: A Review of Reviews.

There is a lack of scientific evidence about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical manifestations are not thoroughly understood; classically, the virus manifests itself at the pulmonary level but can manifest at other levels. To the best of our knowledge, systematic reviews and non-systematic reviews about COVID-19 symptoms in the feet have not been published. The aim of this review of reviews was to analyze and synthesize the published reviews on manifestations of COVID-19 at the foot level. Methods: a review of reviews was conducted; the eligibility criteria included studies published in English or Spanish, involving children and adults with COVID-19, and reporting foot manifestations. PubMed, SciELO, Science Direct, Cochrane Database of Systematic Review, and Google Scholar were analyzed. Two authors independently performed the screening and quality assessment of the studies with AMSTAR 1, and finally, nine reviews were analyzed (one systematic and eight narratives studies). The main clinical manifestations at the foot level in patients with COVID-19 were vascular (edema, exanthems, chilblains, ischemia, and distal necrosis), dermatological (vesicular, maculopapular, papulosquamous, urticarial skin breakouts, and recurrent herpes), and neurological (muscular weakness in lower limbs, paresis, areflexias, ataxia, and difficulty walking). Erythema pernio or "COVID toes" was shown as the most characteristic lesion of this disease, especially in asymptomatic children and young people, so this typical manifestation may be considered important in patients who are positive for COVID-19. This finding does not allow for strong conclusions due to the scarce literature and methodological quality in this regard. Future studies are necessary.

A Cross-Sectional Study of Foot Growth and Its Correlation with Anthropometric Parameters in a Representative Cohort of Schoolchildren from Southern Spain.

Background: The relationship between growth of the foot and other anthropometric parameters during body development until puberty has been scarcely studied. Some studies propose that growth of the foot in length may be an early index of puberty. The objective of this cross-sectional study was to analyze the relationship between the growth of the foot in length and width with other anthropometric parameters, in prepubertal and early pubertal schoolchildren (Tanner stage II). Methods: Using an instrument that was designed and calibrated for this purpose, maximum foot length, width and height were obtained in 1005 schoolchildren. Results: The findings indicate that the age of onset of pubertal foot growth spur was 7-8 years in girls, and 8-9 years in boys. Growth in foot length stabilized in both sexes after 12 years of age. In boys, a strong correlation was found between height and foot length (r = 0.884; p < 0.047), and between body mass index (BMI) and forefoot width at 12 years of age (r = 0.935; p < 0.020). A strong correlation was found between height and forefoot width at 6 years in girls (r = 0.719; p < 0.001), as well as between BMI and metatarsal width in 10 years-old girls (r = 0.812; p <0.001). Conclusions: The average increase in foot length and width that precedes the onset of Tanner's stage II in both girls and boys can be considered as a useful biological indicator of the onset of puberty.

Assessment of Selected Spatio-Temporal Gait Parameters on Subjects with Pronated Foot Posture on the Basis of Measurements Using OptoGait. A Case-Control Study.

Walking is part of daily life and in asymptomatic subjects it is relatively easy. The physiology of walking is complex and when this complex control system fails, the risk of falls increases. As a result, gait disorders have a major impact on the older adult population and have increased in frequency as a result of population aging. Therefore, the OptoGait sensor is intended to identify gait imbalances in pronating feet to try to prevent falling and injury by compensating for it with treatments that normalize such alteration. This study is intended to assess whether spatiotemporal alterations occur in the gait cycle in a young pronating population (cases) compared to a control group (non-pronating patients) analyzed with OptoGait. METHOD: a total of n = 142 participants consisting of n = 70 cases (pronators) and n = 72 healthy controls were studied by means of a 30 s treadmill program with a system of 96 OptoGait LED sensors. RESULTS: Significant differences were found between the two groups and both feet in stride length and stride time, gait cycle duration and gait cadence (in all cases p < 0.05). CONCLUSIONS: pronating foot posture alters normal gait patterns measured by OptoGait; this finding presents imbalance in gait as an underlying factor. Prevention of this alteration could be considered in relation to its relationship to the risk of falling in future investigations.

Combined Chiropractic and Podiatric Treatment for Chronic Low Back Pain Concomitant With a Unilateral Pronated Foot: Protocol for a Multicenter Pilot Randomized Controlled Trial.

Objective: The purpose of this article is to describe a protocol to examine the feasibility of combining podiatric orthotic treatment with multimodal chiropractic treatment to treat chronic low back pain (CLBP) in those with a functional short leg on the same side as a unilateral pronated foot. Methods: This is a protocol for a multicenter feasibility 2-arm parallel randomized controlled trial. One hundred and thirty-two adults with CLBP and a functional short leg on the same side as a unilateral pronated foot are to be recruited in Melbourne, Australia, and Madrid and Seville, Spain. Forty-four participants at each site are to be randomized to multimodal chiropractic treatment including spinal manipulation or to multimodal chiropractic treatment also involving spinal manipulation, together with podiatric custom-made orthoses. Chiropractic visits are to comprise 12 treatments over 4 weeks. Outcome measures will be recruitment, compliance, costs, CLBP-related disability, and perceived low back pain. Results: Feasibility results will be reported in text format and the clinical data reported using descriptive statistics focusing on any clinically significant results. Conclusion: This protocol describes a feasibility study for assessing the combination of podiatric orthotic treatment with multimodal chiropractic treatment to treat CLBP in those with a functional short leg on the same side as a unilateral pronated foot.