An exploratory qualitative study of health professional perspectives on clinical outcomes in UK orthotic practice.

BACKGROUND: Despite potential savings to the National Health Service, the collection of data on outcomes of NHS orthotic services is patchy. Indeed, several reports into orthotic services in the UK have reported a lack of data relating to outcomes of care and highlighted the need to routinely measure outcomes to demonstrate efficacy of services. Whilst a previous study provided an overview of the use of outcome measures in orthotic practice and identified some barriers to their use, further questions emerged. Hence, this qualitative study aimed to explore orthotists' opinions and personal experiences on the influences on outcomes, how appropriate and relevant outcomes can be measured and also how barriers to the use of outcome measures can be overcome. METHODS: Following a review of the literature, an initial advisory group informed semi-structured questions. These were used to create dialogue in a focus group of 12 orthotists. Data from the focus group was transcribed verbatim and analysed using thematic analysis, creating themes and subthemes for discussion. RESULTS: The setting of realistic and agreed goals through managing expectations, compromise and patient education/information were seen as factors that could inform and improve outcomes. Barriers to the collection of outcome measures were associated with inadequate technology to manage the data, lack of time to complete them, lack of training in them and difficulties selecting appropriate outcome measures for patients with complex problems managed by different health professionals. The participants discussed ways of addressing these barriers, such as the use of 'snapshots' and delegation of data collection. CONCLUSIONS: This study has revealed that measuring outcomes is considered to be an important activity. In order to achieve good outcomes, it is important to address patient expectations, discuss and establish joint goals for care at the outset and inform and include patients in the decision-making process. The identified barriers to measuring outcomes can be overcome with the solutions revealed by these participants. Hence, this study has contributed to current knowledge which has relevance for clinical practice and may provide the theoretical basis for future research.

Efficacy of Nail Braces for Acute and Chronic Ingrown Toenails: A Prospective Study.

BACKGROUND: Nail braces are an alternative treatment for ingrown toenails. OBJECTIVE: This study aimed to prospectively examine the efficacy of nail braces for treatment of acute inflamed (AI)-type and chronic dystrophic-type ingrown toenails. MATERIALS AND METHODS: The authors conducted a prospective study of patients with ingrown toenails treated at Wan Fang Hospital between January 1, 2017, and July 31, 2018. Evaluation using physician global assessment scores and patient satisfaction questionnaires was performed at 1, 3, and 6 months after the start of treatment and during the final visit. Patient demographics, treatment courses, and outcomes were compared between the 2 types of ingrown toenails. RESULTS: Chronic dystrophic-type and AI-type ingrown toenails were observed in 25 (61 sides) and 28 patients (35 sides), respectively. Of the affected sides, 80.9%, 94.9%, and 100% achieved an excellent or fair result at 1, 3, and 6 months, respectively. Treatment duration and follow-up period were 179.2 ± 96.8 days and 281.6 ± 120.9, respectively. The recurrence rate was 7.4%. The treatment course and response were different between the 2 types of ingrown toenails. CONCLUSION: Ingrown toenails could be effectively treated with nail braces with excellent outcomes, favorable patient satisfaction, and low recurrence rates.

Cost-Effectiveness of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People: The REducing Falls with Orthoses and a Multifaceted Podiatry Intervention Trial Findings.

BACKGROUND: Falls are a major cause of morbidity among older people. Multifaceted interventions may be effective in preventing falls and related fractures. OBJECTIVE: To evaluate the cost-effectiveness alongside the REducing Falls with Orthoses and a Multifaceted podiatry intervention (REFORM) trial. METHODS: REFORM was a pragmatic multicentre cohort randomised controlled trial in England and Ireland; 1,010 participants (> 65 years) were randomised to receive either a podiatry intervention (n = 493), including foot and ankle strengthening exercises, foot orthoses, new footwear if required, and a falls prevention leaflet, or usual podiatry treatment plus a falls prevention leaflet (n = 517). PRIMARY OUTCOME: incidence of falls per participant in the 12 months following randomisation. SECONDARY OUTCOMES: proportion of fallers and quality of life (EQ-5D-3L) which was converted into quality-adjusted life years (QALYs) for each participant. Differences in mean costs and QALYs at 12 months were used to assess the cost-effectiveness of the intervention relative to usual care. Cost-effectiveness analyses were conducted in accordance with National Institute for Health and Clinical Excellence reference case standards, using a regression-based approach with costs expressed in GBP (2015 price). The base case analysis used an intention-to-treat approach on the imputed data set using multiple imputation. RESULTS: There was a small, non-statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73-1.05, p = 0.16). Participants allocated to the intervention group accumulated on average marginally higher QALYs than the usual care participants (mean difference 0.0129, 95% CI -0.0050 to 0.0314). The intervention costs were on average GBP 252 more per participant compared to the usual care participants (95% CI GBP -69 to GBP 589). Incremental cost-effectiveness ratios ranged between GBP 19,494 and GBP 20,593 per QALY gained, below the conventional National Health Service cost-effectiveness thresholds of GBP 20,000 to GBP 30,000 per additional QALY. The probability that the podiatry intervention is cost-effective at a threshold of GBP 30,000 per QALY gained was 0.65. The results were robust to sensitivity analyses. CONCLUSION: The benefits of the intervention justified the moderate cost. The intervention could be a cost-effective option for falls prevention when compared with usual care in the UK.

Normal foot loading parameters and repeatability of the Footscan® platform system.

BACKGROUND: The Footscan® platform system is one of the most commonly used clinical tools for the measurement of the foot pressure. The present study was designed to assess the repeatability of the system and identify the range of loading parameters observed in the normal foot. METHODS: Measurements were collected from 32 healthy participants, 15 females and 17 males, twice at an interval of 1 week. Peak pressure (PP), contact time (CT), contact area (CA), pressure-time integral (PTI), and maximum force (MaF) were recorded; these parameters were investigated in 10 areas of the foot: medial heel, lateral heel, midfoot, first to fifth metatarsals, hallux, and toes 2-5. The intra-session repeatability was evaluated by calculating the intraclass correlation coefficients (ICCs) and coefficients of variation (CVs) across the three repeated trials within the same session. The inter-session repeatability was assessed using the average of the three trials in each session to determine the ICCs and CVs. RESULTS: The ICCs showed moderate to good repeatability for every variable of interest, and the CVs were all <28%. The highest zones of PP were found under the second and third metatarsals, followed by the medial heel. The CT was 68.5-82.8% of the total stance time under the metatarsal heads. CA was highest under the midfoot, PTI was highest under the second metatarsal, and MaF was highest under the medial heel. CONCLUSIONS: Footscan® platform system was found to be repeatable. Thus, it can be used as a valuable tool in the assessment of plantar pressure distribution, and the normal values of the foot loading parameters identified in this study can be employed to provide a reference range for the gait analysis performed by the Footscan® system.

Custom-made foot orthoses: an analysis of prescription characteristics from an Australian commercial orthotic laboratory.

BACKGROUND: Foot orthoses are widely used in the prevention and treatment of foot disorders. The aim of this study was to describe characteristics of custom-made foot orthosis prescriptions from a Australian podiatric orthotic laboratory. METHODS: One thousand consecutive foot orthosis prescription forms were obtained from a commercial prescription foot orthosis laboratory located in Melbourne, Victoria, Australia (Footwork Podiatric Laboratory). Each item from the prescription form was documented in relation to orthosis type, cast correction, arch fill technique, cast modifications, shell material, shell modifications and cover material. Cluster analysis and discriminant function analysis were applied to identify patterns in the prescription data. RESULTS: Prescriptions were obtained from 178 clinical practices across Australia and Hong Kong, with patients ranging in age from 5 to 92 years. Three broad categories ('clusters') were observed that were indicative of increasing 'control' of rearfoot pronation. A combination of five variables (rearfoot cast correction, cover shape, orthosis type, forefoot cast correction and plantar fascial accommodation) was able to identify these clusters with an accuracy of 70%. Significant differences between clusters were observed in relation to age and sex of the patient and the geographic location of the prescribing clinician. CONCLUSION: Foot orthosis prescriptions are complex, but can be broadly classified into three categories. Selection of these prescription subtypes appears to be influenced by both patient factors (age and sex) and clinician factors (clinic location).

A randomised controlled trial of sensory awareness training and additional motor practice for learning scalpel skills in podiatry students.

BACKGROUND: The process of using a scalpel, like all other motor activities, is dependent upon the successful integration of afferent (sensory), cognitive and efferent (motor) processes. During learning of these skills, even if motor practice is carefully monitored there is still an inherent risk involved. It is also possible that this strategy could reinforce high levels of anxiety experienced by the student and affect student self-efficacy, causing detrimental effects on motor learning. An alternative training strategy could be through targeting sensory rather than motor processes. METHODS: Second year podiatry students who were about to commence learning scalpel skills were recruited. Participants were randomly allocated into sensory awareness training (Sensory), additional motor practice (Motor) or usual teaching only (Control) groups. Participants were then evaluated on psychological measures (Intrinsic Motivation Inventory) and dexterity measures (Purdue Pegboard, Grooved Pegboard Test and a grip-lift task). RESULTS: A total of 44 participants were included in the study. There were no baseline differences or significant differences between the three groups over time on the Perceived Competence, Effort/ Importance or Pressure/ Tension, psychological measures. All groups showed a significant increase in Perceived Competence over time (F1,41 = 13.796, p = 0.001). Only one variable for the grip-lift task (Preload Duration for the non-dominant hand) showed a significant difference over time between the groups (F2,41 = 3.280, p = 0.038), specifically, Motor and Control groups. CONCLUSIONS: The use of sensory awareness training, or additional motor practice did not provide a more effective alternative compared with usual teaching. Further research may be warranted using more engaged training, provision of supervision and greater participant numbers. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001428459 . Registered 13th October 2016. Registered Retrospectively.

Treatment of Ingrown Toenail with a Shape Memory Alloy Device.

BACKGROUND: We sought to report the clinical results of a new conservative treatment modality that uses a shape memory alloy device in patients with ingrown toenail. METHODS: A retrospective review was performed on 41 patients with ingrown toenail treated with the K-D device (S&C Biotech, Seoul, South Korea) between April 2013 and July 2014. Recurrence rate, cosmetic results, pain during the treatment period, and patient satisfaction were the major outcome measures. RESULTS: Patients were followed for at least 6 months (mean ± SD, 8.6 ± 2.1 months; range, 6-12 months). Recurrence was seen in eight patients (19.5%). Mean time to recurrence was 6.2 months (range, 3-10 months). Thirty-one patients (75.6%) were satisfied with the treatment. Thirty-five patients (85.4%) rated the application and treatment period as painless, and the remaining six (14.6%) noted pain particularly during shoe wearing. Thirty-one patients (75.6%) rated the cosmetic results as "excellent," four (9.8%) as "acceptable," and six (14.6%) as "poor." Satisfaction with the treatment, the cosmetic results, and pain were significantly worse in patients with recurrence (P = .0001 for all). All of the patients returned to their work immediately after application of the device. No complications occurred. CONCLUSIONS: The K-D device is a safe and effective treatment method for ingrown toenail. Although the recurrence rate is higher than for surgical treatment methods, the K-D device is a practical and painless method that provides immediate return to work and daily activities and excellent or acceptable cosmesis in most patients.

Normal Values of Pressures and Foot Areas Measured in the Static Condition.

BACKGROUND: Podiatric physicians are increasingly using pedobarographs to measure plantar pressure. However, normal values of static pedobarographic variables for healthy men and women are lacking, which makes it difficult to evaluate abnormal foot positioning in standing patients with low- or high-arched feet or painful feet. METHODS: During upright standing, a computerized pedobarograph measured the maximal (Pmax) and mean (Pmean) plantar pressures, total foot area, and forefoot and rearfoot areas in 84 healthy women and 84 healthy men, aged 18 to 83 years. After calibration of the pedobarograph, a correction factor was applied to area measurements, and data repeatability was assessed. RESULTS: The Pmax and Pmean values were not correlated with age but with weight, body mass index, and shoe size. Total foot area was significantly higher in male participants and correlated with body weight, body mass index, and shoe size but not with age. In both sexes, forefoot area was significantly lower than rearfoot area. Significant positive correlations were observed between forefoot and rearfoot areas and weight and shoe size. The forefoot-rearfoot area ratio did not vary with sex, weight, shoe size, and age. CONCLUSIONS: These data provide relationships between Pmax, Pmean, and foot areas and weight and shoe size and clearly indicate no age dependence of pedobarographic data. They also provide stable values of the forefoot-rearfoot area ratio. These data should help clinicians evaluate abnormal foot placement in standing patients.

A Novel Method of Quantifying Gait Deviations Using Plantar Pressure Patterns.

BACKGROUND: Comparing the dynamic pedobarographic patterns of individuals is common practice in basic and applied research. However, this process is often time-consuming and complex, and commercially available software often lacks powerful visualization and interpretation tools. METHODS: We propose a simple method for displaying pixel-level pedobarographic deviations over time relative to a so-called reference pedobarographic pattern. This novel method contains four distinct automated preprocessing stages: 1) normalization of pedobarographic fields (for foot length and width), 2) temporal normalization, 3) a pixel-level z-score-based calculation, and 4) color coding of the normalized pedobarographic fields. Group and patient-level comparisons were illustrated using an experimental data set including diabetic and nondiabetic patients. RESULTS: The automated procedure was found to be robust and quantified distinct temporal deviations in pedobarographic fields. CONCLUSIONS: The advantages of the novel method cover several domains, including visualization, interpretation, and education.

Estudio comparativo de las huellas plantares en jóvenes con síndrome de Down / Comparative study of plantar footprints in youth with Down syndrome

Introducción. Los trastornos musculoesqueléticos a nivel del pie son frecuentes en las personas con síndrome de Down (SD). Por ello el diagnóstico precoz mediante examen podológico de las huellas plantares puede ayudar a prevenir las manifestaciones ortopédicas. El objetivo es analizar, medir y clasificar la huella plantar mediante los índices podológicos (gold standard) en jóvenes con SD. Método. Estudio transversal comparativo; se analizaron 86 huellas plantares correspondientes a 2 grupos: 21 sujetos sin SD, 11 hombres de 20,45 (2,16) años y 10 mujeres de 20 (1,70) años; y 22 sujetos con SD, 11 hombres de 23,82 (3,12) años y 11 mujeres de 24,82 (6,81) años. Se registraron las huellas plantares en bipedestación estática mediante la utilización de un podoscopio óptico y una cámara digital. Los índices analizados son Hernández-Corvo, Chippaux-Smirak, Stahelli y ángulo de Clarke. Se compararon los resultados de ambas muestras y se analizó la concordancia entre los tipos de pies, derecho e izquierdo, mediante la prueba de Chi-cuadrado. Resultados. Los sujetos con SD se clasifican con pie plano y pronador en un 38,6% según el índice de Hernández-Corvo; Chippaux-Smirak 50%; Stahelli 70,4%; y ángulo de Clarke 59,1%. Los sujetos control presentan pies cavos en un 57,1% según el índice de Hernández-Corvo; Chippaux-Smirak 59,5%; Stahelli 81%; y como pie normal según el ángulo de Clarke en un 57,1%. Hay diferencia significativa (p < 0,01) en los índices Chippaux-Smirak, Stahelli y el ángulo de Clarke. La concordancia entre pie derecho e izquierdo no fue significativa. Conclusión. Los jóvenes con SD presentan más porcentaje de pie plano pronador y menos cavos que el grupo control (AU)

Introduction: Musculoskeletal disorders of the locomotive apparatus are common in young people with Down syndrome (DS), especially in the feet. Early diagnosis by examination of podiatric footprints can help prevent orthopaedic symptoms. Our objective was to analyze, measure and classify footprints on the basis of podiatric indices (gold standard) in young people with DS. Method: Cross-sectional study; 86 footprints were analyzed from 2 groups; there were 21 healthy subjects, 11 men 20.45 (2.16) years and 10 females 20.00 (1.70) years; and 22 subjects with DS, 11 men 23.82 (3.12) years and 11 females 24.82 (6.81) years. Footprints were recorded in standing position using an optical pedoscope and a digital camera system. We calculated the Hernández-Corvo index, Chippaux-Smirak index, Clarke’s angle and Stahelli index. We then compared the results of both samples and analyzed the concordance between types of feet and right and left feet by Chi-square test. Results: Footprints in individuals with DS showed flatfoot and/or pronated foot of 38.6% according to Hernández-Corvo index; 50%, to Chippaux-Smirak; 70.4%, to Stahelli; and 59.1%, to Clarke’s angle. In healthy subjects the rates of cavus foot were 57.1%, according to Hernández- Corvo index; 59.5%, to Chippaux-Smirak index; and 81%, to Stahelli index; while 57.1% showed a normal foot based on Clarke’s angle. Differences between the 2 groups were statistically significant (P < .01) in Chippaux-Smirak index, Stahelli index and Clarke’s angle. The correlation between the right and left foot was not significant. Conclusions: Young people with DS had a higher percentage of pronation and a lower percentage of cavus foot than the control group (AU)

Consequences of repetitive toenail cutting by podiatric physicians on force production, endurance to fatigue, and the electromyogram of the flexor digitorum superficialis muscles.

BACKGROUND: We hypothesized that the repetitive use of a toenail clipper by podiatric physicians could induce fatigue of the flexor digitorum superficialis (FDS) muscle, reducing the accuracy of toenail cutting. METHODS: We examined the consequences of cutting a plastic sheet, reproducing the resistance of thick toenails, with a podiatric medical clipper on the maximal handgrip force (Fmax) developed by the FDS muscle and an isometric handgrip sustained at 50% of Fmax, during which endurance to fatigue and changes in the power spectra of the surface FDS muscle electromyogram (root mean square and median frequency) were measured. The same participants randomly performed one or five runs of 30 successive cuttings, each on different days. RESULTS: After the first and fifth cutting runs, Fmax increased, suggesting a post-tetanic potentiation. During the handgrip sustained at 50% of Fmax, we measured a significant reduction in the tension-time index after the first cutting run. Moreover, after the fifth cutting run, the tension-time index decrease was significantly accentuated, and the decrease in FDS muscle median frequency was enhanced. No median frequency decline was measured during the cutting runs. CONCLUSIONS: These results suggest that the efficacy of occupational podiatric medical tasks progressively declines with the repetition of toenail cutting. We propose solutions to remedy this situation.

A novel device for standardizing marker placement at the calcaneus.

BACKGROUND: The determination of anatomical reference frames in the rearfoot during three-dimensional multisegment foot modeling has been hindered by a variety of factors. One of these factors is related to the difficulty in palpating, or the absence of, anatomical landmarks. A novel device (the Calcaneal Marker Device) aimed at standardizing marker placement at the calcaneus was, therefore, developed and evaluated for its reliability. METHODS: Throughout a random repeated-measures design, the repeatability of calcaneal marker placement was evaluated for two techniques: manual placement and placement using the Calcaneal Marker Device. Translational changes after marker placement and the clinical effect on intersegment angle calculation were quantified. RESULTS: Intraobserver variability was greater in therapist 2 (<5.3 mm) compared with therapist 1 (<2.9 mm). Intraobserver variability was also found to be less than 1.6 mm throughout use of the device. Interobserver variability was found to be significantly higher for the position of markers placed manually (5.8 mm), whereas with the Calcaneal Marker Device, the variability remained lower (<1.3 mm). The effect on the computed intersegment angles followed a similar trend, with variability of 0.4° to 4.0° and 1.0° to 8.7° for CMD and manual placement, respectively. CONCLUSIONS: These findings suggest that variations in marker placement are considerably reduced when the novel Calcaneal Marker Device is used, possibly toward the limits dictated by the fine motor skills of therapists and tissue artifacts.

Effectiveness of off-the-shelf footwear in reducing foot pain in Australian Department of Veterans' Affairs recipients not eligible for medical grade footwear: study protocol for a randomized controlled trial.

BACKGROUND: Foot pain is highly prevalent in older people, and in many cases is associated with wearing inadequate footwear. In Australia, the Department of Veterans' Affairs (DVA) covers the costs of medical grade footwear for veterans who have severe foot deformity. However, there is a high demand for footwear by veterans with foot pain who do not meet this eligibility criterion. Therefore, this article describes the design of a randomized controlled trial to evaluate the effectiveness of low cost, off-the-shelf footwear in reducing foot pain in DVA recipients who are currently not eligible for medical grade footwear. METHODS: One hundred and twenty DVA clients with disabling foot pain residing in Melbourne, Australia, who are not eligible for medical grade footwear will be recruited from the DVA database, and will be randomly allocated to an intervention group or a 'usual care' control group. The intervention group will continue to receive their usual DVA-subsidized podiatry care in addition to being provided with low-cost, supportive footwear (Dr Comfort®, Vasyli Medical, Labrador, Queensland, Australia). The control group will also continue to receive DVA-subsidized podiatry care, but will not be provided with the footwear until the completion of the study. The primary outcome measure will be pain subscale on the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8, 12 and 16 weeks. Secondary outcome measures measured at baseline and 16 weeks will include the function subscale of the FHSQ, the Manchester Foot Pain and Disability Index, the number of DVA podiatry treatments required during the study period, general health-related quality of life (using the Short Form 12® Version 2.0), the number of falls experienced during the follow-up period, the Timed Up and Go test, the presence of hyperkeratotic lesions (corns and calluses), the number of participants using co-interventions to relieve foot pain, and participants' perception of overall treatment effect. Data will be analyzed using the intention-to-treat principle. DISCUSSION: This study is the first randomized controlled trial to evaluate the effectiveness of off-the-shelf footwear in reducing foot pain in DVA recipients. The intervention has been pragmatically designed to ensure that the study findings can be implemented into policy and clinical practice if found to be effective. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12612000322831.

Matrixplasty for the treatment of severe incurved toenail with growth plate deformity.

BACKGROUND: Severely incurved toenails are accompanied by deformity of the toenail growth plate. In such a condition, partial removal of the nail and nail bed and simple unfolding of the nail itself frequently result in the recurrence of symptoms. We sought to design and develop a new technique for the treatment of incurved toenail with growth plate deformity and to report the results of treating this disease entity. METHODS: Forty consecutive patients (52 cases) underwent treatment of symptomatic incurved toenails with a new technique named matrixplasty. The mean ± SD patient age was 40.3 ± 18.9 years. Last follow-up was at a mean ± SD of 18.0 ± 1.3 months. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned, and patients were evaluated before treatment and at last follow-up. Patient satisfaction and the recurrence rate of the deformity were evaluated. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured before treatment and at last follow-up. The complication rate was also evaluated. RESULTS: All of the ingrown toenails healed, and the nail deformities were corrected within 3 weeks after the procedure. None of the incurved toenails had recurred by last follow-up. The mean pretreatment AOFAS forefoot hallux score was 72.9, and it improved to 99.6 by last follow-up (P < .001). Every patient was very satisfied or satisfied with the results of treatment. The mean ± SD center to edge angle of the toenail improved from 53.3° ± 9.5° to 15.3° ± 5.2° by last follow-up (P < .001). Minor paronychia, which was managed with local wound dressing and oral antibiotics, was identified in four cases. No other complication was identified. CONCLUSIONS: Matrixplasty showed excellent clinical results in the treatment of severe incurved toenail, and this newly developed procedure showed improvement of the deformed toenail and its growth plate.

Factores de riesgo novedosos en la fascitis plantar / Novel risk factors in the etiology of plantar fasciitis

Este estudio se plantea con el objetivo de analizar si el acortamiento de la musculatura posterior de la extremidad inferior y postura al dormir están relacionados con la fascitis plantar (FP). En una muestra de 100 extremidades inferiores de 100 sujetos se han realizado mediciones de la musculatura isquiotibial y musculatura de la pantorrilla mediante el test de elevación de la pierna recta (TEPR), ángulo poplíteo (AP), flexión dorsal del tobillo con la rodilla extendida (FDTRE) y flexión dorsal del tobillo con la rodilla flexionada (FDTR) respectivamente. La postura al dormir ha sido evaluada cualitativamente. Estas variables han sido comparadas entre un grupo de pies normales y otro formado por pies con fascitis plantar. Los resultados han desvelado diferencias significativas entre el grupo con FP y el grupo control (P = 0,001) para dichas variables, mostrando la consideración de la cortedad isquiotibial y la postura en decúbito prono/supino al dormir, como posibles factores de riesgo en la etiología de la FP. De los datos del estudio se puede concluir que el acortamiento de la musculatura posterior de la extremidad inferior y la posición en equino del pie durante el sueño están relacionados con la FP(AU)

This study is carried out with the aim of analyzing if shortening of the posterior muscles of the leg and sleeping position are associated with plantar fasciitis (PF). In a sample of 100 lower limbs of 100 subjects, We have made measurements of isquiotibial muscle and calf muscle through straight leg raising test (SLR), popliteal angle (PA), dorsiflexion ankle with the knee extended (FDTRE) and ankle dorsiflexion with the knee flexed (FDTRF) respectively. Sleep position has been assessed qualitatively. These variables were compared between a group of normal feet and another formed by foot with plantar fasciitis. The results revealed significant differences between the PF group and the control group (P = 0,001) for those variables, showing shortness of hamstrings and posture in prone/supine while sleeping, as potential risk factors in etiology of PF. From the data it can be concluded conclude that the shortening of posterior muscle of the lower extremity and ankle equinus while sleeping are related to the PF(AU)

Variations in foot posture and mobility between individuals with patellofemoral pain and those in a control group.

BACKGROUND: We sought to determine whether foot posture and foot mobility were increased in individuals with patellofemoral pain syndrome compared with individuals in a control group. METHODS: A nested case-control design was used with two controls matched to each patient by sex and age (±1 year). Participants included 43 individuals with a history of unilateral or bilateral patellofemoral pain syndrome and 86 participants in a control group. Data collected included height, weight, and five different measures of foot height and width in weightbearing and nonweightbearing that have been previously shown to have high levels of reliability. RESULTS: Individuals with patellofemoral pain syndrome were found to be four times more likely (odds ratio, 4.04; 95% confidence interval, 1.45-11.32) to have a larger-than-normal difference between nonweightbearing and weightbearing arch height compared with those in the control group. The mean values for difference in arch height and foot mobility magnitude were also statistically significant between the patient and control groups. Foot posture, as determined using the arch height ratio, was not significant between groups (odds ratio, 0.94; 95% confidence interval, 0.34-2.61). CONCLUSIONS: Although foot posture may not be different between individuals with patellofemoral pain syndrome and controls, foot mobility assessed using difference in arch height and foot mobility magnitude is different between the two groups.

A quantitative method for measuring forces applied by nail braces.

BACKGROUND: Nail bracing is a conservative method used for ingrown nails; however, lack of objective measurements limits its use for various nails. METHODS: Double-string nail braces with extra metal springs were applied to 12 patients with 21 chronic, thick, and overcurved ingrown nails. Force was measured with a force gauge meter. Treatment was stopped once patients stood on their tiptoes and walked in shoes pain free without braces. A force gauge meter was also used on a model nail to show the forces applied by various nail braces and to compare their pulling forces. RESULTS: After 6 to 10 months of treatment, all of the patients were pain free; 600 to 1,000 centi Newtons of force were applied to the nails. As the width of the nail increased, so did the force. CONCLUSIONS: Braces exert more force on larger nails, which may shorten treatment durations. By measuring forces, it may be possible to standardize force and duration of treatment according to variables such as nail thickness, nail width, angle of ingrown nail, and duration of symptoms.

Patología de los pies y características sociodemográficas de la población usuaria de los centros Sociales de mayores de Galicia / No disponible

La Universidad de A Coruña a través de la Escuela Universitaria de Enfermería y Podología realizó para la Xunta de Galicia y el Ministerio de Trabajo y Asuntos Sociales, un proyecto de intervención podológica denominado “Programa de Podología Itinerante para la atención a las personas mayores con dependencias 2005”, cuyo objetivo principal era prestar atención podológica a las personas mayores de 65 años que acuden a los centros sociales gestionados por la Vicepresidencia de Igualdad y Bienestar de la Xunta de Galicia. En este programa se realiza un estudio sobre una muestra de 815 personas seleccionadas por la Vicepresidencia de Igualdad y Bienestar y los responsables de cada uno de los 16 centros, para identificar las prioridades de atención podológica en ancianos, estableciendo una correlación entre sus características socio-demográficas y la aparición de patologías quiropodológicas. La mayoría de la población de estudio eran mujeres (72,2%), con una media de edad de 74 años con un rango de edad de 40 a 98 años, con pensión contributiva (91,4%), que vivían acompañadas (79,3%), y con un nivel de estudios básico (74,5%). Las patologías podológicas más frecuentes han sido las queratopatías (73,6%) hiperqueratosis (53,4%) y helomas (52%). Onicopatías (49,8%), onicogrifosis (22%), onicomicosis (18%), onicocriptosis (15%), hematomas subungueales (3,7%) otro tipo de onicopatías (2,8%). Según los datos del estudio, el sexo femenino es más proclive a padecer queratopatías [OR 2,33; IC 95% (1,67-3,26)], hiperqueratosis [OR 1,96; IC 95% (1,43- 2,67)] y helomas (OR 2,44; IC 95% [1,776-3,352]) en particular. Que las personas mayores no vivan solas disminuye la probabilidad de padecer queratopatías [OR 0,50-0,77]), en concreto helomas [OR 0,68 IC 95% [0,48-0,966]. Los ancianos con mayor nivel de estudios tienen menor probabilidad de padecer onicopatías (p=0,032) (OR 0,50; IC 95% [(0,29-0,86]). Mientras que los pensionistas son más proclives a padecer hiperqueratosis (p=0,011) (OR de 1,10 IC 95% [1,01-1,04])(AU)

The University of A Coruña, through the Podiatry and Nursing University, carried out for the Xunta de Galicia and the Spanish Work Ministry and Social Services, a podiatry project named “Itinerant Podiatry Program to assist elderly people with dependency during the year 2005”. Its main goal was to give podiatry care to people older than 65 who usually went to social centers that were managed by the Vice-presidency of Equality and Social Welfare. The total sample comprised 815 participants, selected by the Vice-Presidency of Equality and Social Welfare and the responsible of each one of the 16 centers. The aim was to identify the priorities of podiatry care in elderly people, by establishing a relationship between the socio-demographic characteristics and the podiatry pathologies. The majority of the participants were women (72.2%), aged 40 to 98 years, with a mean age of 74, received a contributory pension (91.4%) living with someone (79.3%) and had an elementary level of studies (74.5%). The most common podiatry pathologies were keratopathy (73.6%) hyperkeratosis (53.4%), callus (52%). Onycopathy (49.8%), onychogryphosis (22%), onychomycosis (18%), onichocriptosis (15%), (3, 7%) or other nail diseases (2,8%). According to the study, women are more prone to suffer keratopathy [OR 2.33; IC 95% (1.67-3.26)], hyperkeratosis (OR 1.96; IC 95% [1.43-2.67]) and callus [OR 2.44; IC 95% (1.776-3.352)]. Living with someone, diminishes the probability of suffering keratopathy (OR 0.50 [0.322-0.777]), primarily callus (OR 0.68 IC 95% [0.488-0.966]). Elderly people with higher level of studies have smaller probability of suffering nail diseases (p=0.032) (OR 0.50; IC 95% [(0.29-0.86]). Meanwhile, pensioners are more likely to have hyperkeratosis (p=0.011) (OR of 1.10 IC 95% [1.01-1.04](AU)

Normal pressure values and repeatability of the Emed® ST2 system.

OBJECTIVES: This study was designed to assess the repeatability of the Emed® ST2 system and identify the range of pressure values observed in the normal foot. METHODS: Measurements were taken from twenty-three healthy subjects, 14 females and 9 males, on two occasions 7 days apart. Begin of contact (BC), end of contact (EC), contact time (CT), peak pressure (PP), instant of peak pressure (IPP), contact area (CA) and pressure-time integral (PTI) were recorded. RESULTS: The coefficient of repeatability (CR) was less than 16.0% for all 63 parameters considered. In 87.3% of the parameters investigated (55 of 63) the CR (expressed as a percentage of the mean) was less than 10%. The highest areas of PP were found under the great toe and second metatarsal heads, with mean (S.D.) equal to 435 kPa (202) and 407 kPa (146), respectively, followed by the third metatarsal head 345 kPa (96) and the hindfoot 332 kPa (93). The CT (% ROP (range of pressure)) was in the range 74-85% under the metatarsal heads, and 71% under the great toe. CA was highest under the heel at 33.8 cm(2). CONCLUSION: Emed® ST2 system was found to be repeatable. The presented range of parameters compared very well to the results presented in the literature for the Emed® ST4 system.

Plantar pressures determinants in mild Hallux Valgus.

While podobarometric techniques have been applied to the study of pressures in Hallux Valgus (HV), little is known about its clinical and radiological determinants. So, the aim of the present study was to determine the plantar pressure pattern in participants with mild HV, comparing to a control group, and their clinical and anthropometric determinants. Biofoot/IBV(®) in-shoe system was used to evaluate 79 participants with mild HV. Computerized measurements of the 1st intermetatarsal angle (IMA) and the hallux abductus angle (HAA) were made on antero-posterior radiographs. The clinical outcome was assessed using the AOFAS score. The dependent baropodometric variables and the independent clinical and anthropometric variables were subjected to a multiple regression analysis. In both groups, the highest average pressure was in the 2nd metatarsal head (MTH). The mean pressure under the Hallux was significantly higher in HV group (controls, 146.5±92.5kPa; HV, 328.5±113.2kPa; p<0.001). An 18.6% of average pressure under the 1st MTH was accounted for pain, first ray alignment and total AOFAS score. Variations of the HAA explained 26.8% of the mean Hallux pressure. Women with mild HV present with pathologically increased pressure under the Hallux, which is caused by the altered alignment of the first ray. Pain and clinical result were associated with the pressure under the 1st MTH and the remaining variables were only moderate predictors of dynamic plantar pressures.