Does the Nonweightbearing Foot Position Replicate the Neutral Calcaneal Stance Position in an Adult Population?

BACKGROUND: The neutral calcaneal stance position (NCSP), despite its known issues, is currently used as an "ideal" measure compared with the resting stance position in clinical podiatric medicine. The nonweightbearing (NWB) foot position, as used in the foot mobility magnitude (FMM), can provide an alternative comparative position, which is partially validated, if a significant correlation between the NCSP and the NWB position exists. This study aimed to establish the correlation between the component measures of the FMM in the NCSP and the NWB foot position of the FMM. METHODS: Eighty participants were recruited. Measures of dorsal arch height (DAH) and midfoot width (MFW) were obtained at the 50% total foot length mark in the NCSP and the NWB position by two examiners using the apparatus described by McPoil et al. RESULTS: Reliability analysis with intraclass correlation coefficients (ICCs) indicated intrarater results of 0.90 to 0.99 for DAH and 0.96 to 0.99 for MFW and interrater results of 0.90 for DAH and 0.96 for MFW in the NWB position. Using a Pearson product moment correlation coefficient analysis, there was a significant correlation between the NCSP and the NWB position for DAH (r = 0.82) and MFW (r = 0.86). CONCLUSIONS: A significant correlation between the NCSP and the NWB position was evident when the measures of DAH and MFW were conducted. Therefore, clinically, the NWB position can potentially replace the NCSP as the ideal position for clinical treatment.

Identifying lower limb problems and the types of safety footwear worn in the Australian wine industry: a cross-sectional survey.

BACKGROUND: The Australian wine industry is a valuable part of the wider Australian economy worth approximately A$45 billion annually and employs 163,790 people either full time or part time. Australian agricultural industries are amongst the nation's most dangerous workplaces with joint, ligament, muscle and tendon injuries being commonplace along with wounds, lacerations and musculoskeletal diseases. It is therefore important to try and minimise the risk of injuries to workers. The aims of this study were to (1) identify whether lower limb problems occur in the Australian wine industry and (2) identify the types of safety footwear worn. METHODS: Participants were recruited from the Australian wine industry. The study was a cross-sectional anonymous survey of 82 questions with n = 207 respondents. Questions related to job role performed, types of lower limb problems experienced, level of pain, restriction of activities, types of footwear worn, general health and physical health. RESULTS: The main working roles were winery (73.4%), vineyard (52.2%), laboratory (39.6%), cellar door (32.4%) and office (8.2%), with 63.3% of participants working in more than one role. Lower back pain was the most commonly reported problem at 56% followed by foot pain (36.7%), knee pain (24.6%), leg pain (21.3%), ankle pain (17.9%), hip pain (15.5%), toe pain (13%) and heel pain (11.1%). The most popular footwear used by participants were elastic sided safety boots, followed by high cut lace up safety boots with side zip. Overall, although the pain experienced was moderate, it did not impact the workers ability to perform their duties and the majority self-reported as being in very good general and physical health. CONCLUSION: To date no data have been published on the types of lower limb problems or the types of safety footwear worn in the Australian wine industry. This study is the first to demonstrate that elastic sided safety boots were the most popular amongst respondents and that lower limb problems occur with workers. Therefore, further research into the safety footwear used in the Australian wine industry is needed to better support workers health while working in their varied roles and conditions.

Readiness for En Pointe Work in Young Ballet Dancers Are There Proven Screening Tools and Training Protocols for a Population at Increased Risk of Injury?

To progress to a high level in classical ballet, en pointe is a requirement. The aim of this literature review was to evaluate the available evidence relating to readiness for dancing en pointe, including injury rates in the adolescent dancer population, screening tools, and pre-pointe training methods. It has been emphasized that young dancers are a demographic at increased risk of injury, especially as they progress through the growth spurt and increase their training hours. Dancers are commonly screened at the pre-pointe level, but unfortunately the majority of evidence resulting from this process, as reported in the literature, is subjective in nature. Hence, there is large variance regarding an appropriate time or level to commence en pointe training, and it remains unclear what dance teachers should be looking for in making this decision. A further paucity of evidence is demonstrated with regard to pre-pointe training protocols or instruction; in this review, no published literature was found on the topic. As such, there is a clear need for further study of pre-pointe screening and en pointe training protocols.

Sever's disease: what does the literature really tell us?

BACKGROUND: Sever's disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series. METHODS: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever's disease. This information was then reviewed to present what is actually known about this condition. RESULTS: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition. CONCLUSION: The level of evidence for most of what we purport to know about Sever's disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment.

Effectiveness of Two Moisturizers in the Treatment of Foot Xerosis A Randomized Clinical Trial.

BACKGROUND:: Xerosis (dryness) of the foot is commonly encountered in clinical care and can lead to discomfort, pain, and predisposition to infection. Many moisturizing products are available, with little definitive research to recommend any particular formulation. METHODS:: We compared two commonly prescribed moisturizing products from different ends of the price spectrum (sorbolene and 25% urea cream) for their effectiveness in reducing xerosis signs using the Specified Symptom Sum Score. A randomized clinical trial of parallel design was conducted over 28 days (February-May 2015) on 41 participants with simple xerosis. Participants, therapists, assessors, and data entry personnel were blinded to treatment, and allocation was determined via a randomization table. RESULTS:: Thirty-four participants completed the study (19 urea and 15 sorbolene), with one reporting minor adverse effects. There were statistically significant improvements in both groups after 28 days. Mean differences between pre and post scores were 3.50 (95% confidence interval [CI], 2.80 to 4.20) for the urea group and 2.90 (95% CI, 2.00 to 3.80) for the sorbolene group. There was a slightly lower mean posttreatment score in the urea group (1.16; 95% CI, 0.67 to 1.64) than in the sorbolene group (1.80; 95% CI, 1.25 to 2.35), but this difference was not significant ( P ≤ .09). Effect size of difference was -0.48 (95% CI, -1.16 to 0.22). CONCLUSIONS:: In this study, there was no difference between using sorbolene or 25% urea cream to treat symptoms of foot xerosis. A recommendation, therefore, cannot be made based on efficacy alone; however, sorbolene treatments are invariably cheaper than urea-based ones.

Moisturisers for the treatment of foot xerosis: a systematic review.

BACKGROUND: Xerosis, literally dryness of the skin, of the foot is a common condition encountered clinically, which can lead to discomfort and predisposition to infection. Currently, there are no evidence-based recommendations on which moisturiser formulations best alleviate xerotic symptoms. The aim of this review was to guide clinical practice in the treatment of primary and diabetes related foot xerosis, by identifying from the existing literature the most effective ingredient or formulation of topical treatments for symptoms of primary foot xerosis in the general population. METHODS: A systematic review of published experimental trials was undertaken. Only studies pertaining to primary xerosis, classified within levels II - IV of the NHRMC hierarchy were reviewed. EMBASE, AMED, Cochrane, MEDLINE, CINAHL, Ageline and SCOPUS were searched using relevant search terms and keywords and pearling of reference lists was undertaken. Studies were evaluated for methodological quality using a critical appraisal tool. Individual active ingredients were identified from all studies, along with observed reported outcomes. A narrative synthesis was then conducted. RESULTS: A total of 22 experimental studies were included, from which 12 different active ingredients were identified. Study literature consisted of mainly comparative studies against other active interventions or controls, or pre-post-tests and was of a poor-to-moderate methodological quality as assessed by the Epidemiological Appraisal Instrument. Urea was the most researched active ingredient (14 studies), with ammonium lactate being next (7 studies). CONCLUSIONS: No conclusive recommendations were possible due to wide variation in study quality, methodologies and outcome measures. A synthesis of available literature suggests that treatments containing urea as a primary active ingredient have been the most researched. The poor quality of literature generally, however, precludes recommendation of any active ingredient over another.

The typically developing paediatric foot: how flat should it be? A systematic review.

BACKGROUND: All typically developing children are born with flexible flat feet, progressively developing a medial longitudinal arch during the first decade of their lives. Whilst the child's foot is expected to be flat, there is currently no consensus as to how flat this foot should be. Furthermore, whilst feet are observed to decrease in flatness with increasing age, it is not known how flat they should be at each age increment. The objective of this systematic review is to define the postural characteristics of the 'typically' developing paediatric foot. METHODS: The PRISMA protocol was applied to compare all data currently published describing the typical development of the paediatric foot. The Epidemiological Appraisal Instrument (EAI) was used to assess the risk of bias of the included studies. RESULTS: Thirty four epidemiological papers pertaining to the development of the paediatric foot were graphically compared. Sixteen different foot posture assessments were identified of which footprint based measures were the most reported outcome. CONCLUSION: Firstly, the use of the term normal in relation to foot posture is misleading in the categorisation of the paediatric foot, as indeed a flat foot posture is a normal finding at specific ages. Secondly, the foot posture of the developing child is indeed age dependent and has been shown to change over time. Thirdly, no firm conclusion could be reached as to which age the foot posture of children ceases to develop further, as no two foot measures are comparable, therefore future research needs to consider the development of consensus recommendations as to the measurement of the paediatric foot, using valid and reliable assessment tools.

The effect of footwear and foot orthoses on transverse plane knee motion during running - A pilot study.

OBJECTIVES: This study aimed to determine the immediate effects of footwear and foot orthoses on transverse plane rotation of the knee joint during the stance phase of jogging gait. DESIGN: An experimental, within subjects, repeated measures design. METHODS: Three-dimensional knee kinematics were estimated in the transverse plane by surface-mounted markers as 14 asymptomatic participants ran in four randomised conditions; neutral shoe, neutral shoe with customised orthoses, neutral shoe with prefabricated orthoses, and a stability shoe. Peak internal/external rotation joint angles and ranges of motion (ROM) during loading response, midstance and propulsion were determined. Immediate subjective comfort was also recorded for each condition using a 100 mm visual analogue scale. RESULTS: Significant main effects of condition were observed for all outcomes except transverse plane knee ROM during loading response (p < 0.05). All significant differences occurred between the stability shoe and another condition, with less knee internal rotation in the stability shoe (mean differences ranged between 1.7° and 6.1°) (p < 0.05). The neutral shoe with prefabricated orthoses was reported as more uncomfortable than all other testing conditions. CONCLUSIONS: The stability shoe reduced peak knee internal rotation throughout stance phase of jogging more than any other condition. Importantly, it was subjectively as comfortable as the other conditions. These results identify the ability for footwear alone to induce immediate proximal kinematic effects. The use of the kinematic theory behind foot orthoses therapy is also questioned.

Measurement of foot dorsiflexion: a modified Lidcombe template.

The Lidcombe template was introduced in 1991 for the nonweightbearing assessment of ankle joint dorsiflexion, and it has shown excellent reliability in impaired and unimpaired adult populations. We discuss limitations of the original template and test the reliability of a modified apparatus in an adolescent population. Intrarater and interrater reliability were assessed for 14 children (28 limbs) aged 7 to 14 years, returning intraclass correlation coefficient (1,1) results of greater than 0.99 for both aspects of reliability.

Criterion validation of four criteria of the foot posture index.

The Foot Posture Index is a new multidimensional and multiplanar tool aimed at quantifying the degree of pronation to supination of the foot, comprising eight criteria that sum to produce a final "score" of foot posture. In an initial study involving 31 subjects, angulations measured from dorsoplantar and lateral radiographs were compared with the corresponding Foot Posture Index criteria using Spearman's rho and the generalized linear model of analysis of variance. Eleven of the participants from Study 1 completed a second study in which wedges were used to alter foot position to determine whether changes to foot position were sensitively reflected in Foot Posture Index criterion scores and associated radiographic images. Study 1 demonstrated a significant correlation for only one criterion (talar head palpation), while Study 2 demonstrated intrasubject sensitivity to overall changes from supinated to pronated and supinated to resting positions but insensitivity to changes from resting to pronated positions. The results suggest that although the Foot Posture Index could be a useful tool to broadly classify foot postures, it is not sensitive to all small movements when assessed by this method.

Reliability of the foot posture index and traditional measures of foot position.

Repeatable measures are essential for clinicians and researchers alike. Both need baseline measures that are reliable, as intervention effects cannot be accurately identified without consistent measures. The intrarater and interrater reliability of the new Foot Posture Index and current podiatric measures of foot position were assessed using a same-subject, repeated-measures study design across three age groups. The Foot Posture Index total score showed moderate reliability overall, demonstrating better reliability than most other current measures, although navicular height (normalized for foot length) was the single most reliable measure in adults. None of the tested measures exhibited adequate reliability in young children, and, with less-than-desirable reliability being demonstrated, most measures need to be interpreted accordingly when repeated measures are involved.

Sever's disease: a prospective study of risk factors.

BACKGROUND: Sever's disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors. METHODS: Children with Sever's disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Sever's disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al-type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played. RESULTS: Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion. CONCLUSIONS: This study suggests that there is no evidence to support that weight and activity levels are risk factors for Sever's disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation.

Sever's disease--does it effect quality of life?

BACKGROUND: Sever's disease is a condition which has been described inconsistently in the literature with respect to pathology, aetiology and management. In particular, the impact of this condition has been overlooked, probably because it is usually self-limiting. METHOD: This study used a prospective comparative design study to determine the impact of Sever's disease on the quality of life of its sufferers. RESULTS: Three scales--Happiness, Satisfaction with symptoms and Pain/comfort scale--from the POSNA musculoskeletal questionnaire showed significant differences between the symptomatic and control groups. CONCLUSION: Although the condition may resolve with time, these results show that it has a considerable impact on children's lives.