Journal of Foot and Ankle Research最新文献

Background and aims: In 2023 the International Working Group of the Diabetic Foot (IWGDF) published definitions for the diagnosis, remission and relapse of active Charcot neuro-osteoarthropathy (CN). Until 2023 authors had used varied definitions to identify the stages of CN making comparisons difficult. The aim of the current study was to illustrate variation in definitions used before 2023 and to encourage consistent terminology in future publications.

Methods: Searches were conducted in OVID, Pubmed and CINAHL. Studies were included if they had a minimum of 10 participants and reported the outcomes of CN in conservative or pharmacological treatments in people with diabetes and CN. Included study designs were randomised controlled trials, cohort studies, non-randomised controlled trials, case-controls and case series. We excluded studies of surgical treatment of CN. Data collected included location of the study, study design and population. Definitions of each stage were compared to the IWGDF definitions through a scoring system.

Results: We screened 1758 titles, 143 abstracts and 63 full texts. We included 37 studies from 20 different countries. Scores comparing the studies' definitions to the published IWGDF guidelines for definitions ranged from a similarity of 17%-100%. Six studies scored 100% with 31 studies missing aspects of the IWGDF definitions.

Conclusion: Authors should use standardised definitions of the stages of CN to allow comparisons between studies to be accurately made. More work is needed to assess the variation in terminology within studies with CN treated surgically.

Introduction: This study investigates the proximity of the portals and nearby motor and sensory nerves in endoscopic release of the plantar fascia and the safety and efficacy of the addition of a novel third (plantar) portal to improve access to the calcaneal spur.

Methods: Nine fresh-frozen lower extremity cadavers were examined in this study. In addition to the conventional medial and lateral portals for endoscopic plantar fascia release, a third (plantar) portal was utilized to debride the calcaneal spur area. The fascia was released with the use of an obturator cannula. Each cadaver was carefully dissected, the distance of the nerves to the portals and the obturator cannula was measured with a digital caliper, and the adequacy of the plantar fascial cut was evaluated. The nerves were examined along their course to check for any injuries.

Result: The closest distance between the lateral plantar nerve and the plantar portal was 15.3 ± 1.47 mm, and the obturator cannula was 10.53 ± 1.50 mm. The closest distance between the first branch of the lateral plantar nerve (Baxter's nerve) and the obturator cannula was 10.02 ± 0.65 mm. The closest distance between Baxter's nerve and the calcaneal spur area was 8.21 ± 1.12 mm. There was no evidence of nerve or muscle injury in the dissected cadavers.

Conclusions: Using the plantar portal in conjunction with conventional portals in endoscopic plantar fasciitis surgery can be advantageous, as it provides easier access to the calcaneal spur and is safe in terms of its distance from the nearby neural structures.

Introduction: Volleyball is a sport that requires rapid changes in movements and high-intensity actions and skills. Ankle stability is a key factor in preventing injuries and enhance performance in volleyball players. This study evaluated the effects of prancing and galloping drills on ankle stability, agility, and fitness parameters in volleyball players.

Methods: Forty-two male volleyball players (mean age 23.67 ± 3.15 years) were randomly assigned to the prancing and galloping drills (POGO) training (PGT, n = 21) or conventional training (CT, n = 21) group. Over 6 weeks, the experimental group performed prancing and galloping drills, whereas the control group continued their routine warm-up. Outcome measures included ankle stability (Prokin system), vertical jump height (VJH), agility (CODAT), endurance (Cooper test), and dynamic balance (SEBT), assessed after implementing conventional and POGO drills.

Results: Significant improvements were observed in both groups, but the POGO training group demonstrated larger effects. Notably, the POGO training group showed substantial improvements in ankle instability (right ankle: t = 4.09 and p < 0.001; left ankle: t = 5.04 and p < 0.001) and dynamic balance (SEBT Right A: t = -4.20 and p < 0.001; SEBT Left A: t = -4.35 and p < 0.001).

Conclusions: Prancing and galloping drills effectively enhanced ankle stability and dynamic balance, offering a valuable addition to volleyball training programs for injury prevention and performance enhancement.

Background: Footwear influences performance and injury risk during change-of-direction (COD) movements. However, few studies have investigated how different shoe types influence COD biomechanics, particularly under ecologically valid conditions such as at sharp angles and under unanticipated conditions. This study examined the impact of barefoot, minimalist, and standard sport shoes on biomechanical and performance parameters during 90° COD tasks.

Methods: Forty-one participants (14 females and 27 males) completed a randomized crossover study, performing anticipated and unanticipated 90° COD tasks under three footwear conditions: barefoot, minimalist shoes, and habitual standard sport shoes. Kinematic, kinetic, and lower leg muscle activity data were collected using motion capture, force plates, and surface electromyography.

Results: Standard sport shoes resulted in faster COD completion times, significantly higher approach velocity, and greater braking and propulsion forces than minimalist and barefoot condition (p < 0.05). Minimalist and barefoot condition led to altered foot strike patterns, reduced knee flexion, and lower GRF magnitudes. Unanticipated trials increased neuromuscular demand, reducing approach velocity and altering GRF distribution across all footwear conditions. After controlling for approach velocity, footwear effects remained significant in most kinetic and kinematic measures.

Conclusion: These findings highlight the importance of footwear choice for performance and biomechanical outcomes during challenging COD tasks.

Objective: To systematically review the evidence for physical (for e.g. strengthening) and mechanical (for e.g. foot orthoses) therapies for lower limb problems in children with juvenile idiopathic arthritis (JIA).

Methods: Randomised clinical trials of physical and mechanical interventions for lower limb problems in children with JIA were included. The primary outcome was pain and secondary outcomes included disability, functional ability, and quality of life. Electronic databases were searched for eligible studies. Authors of included studies and researchers in the field were contacted to identify additional studies.

Results: Two authors independently screened 4876 titles and abstracts. Eleven randomised clinical trials were ultimately included. Four studies explored the effect of foot orthoses and seven physical therapies. Studies evaluating the effect of foot orthoses on foot and ankle pain were pooled in a meta-analysis. Results showed that foot orthoses were statistically and clinically significant in reducing both parent (-11.08 [-20.25, -1.90]) and child (-21.45 [-30.18, -12.73]) reported foot and ankle pain after 3 months compared to the control. This significant effect was sustained post 3 months. Physical therapies such as Pilates and underwater exercises were statistically and clinically significant in reducing lower limb pain after 3 months of intervention.

Conclusion: Foot orthoses can be prescribed to significantly reduce foot and ankle pain for children with JIA. Physical therapies appear to reduce pain during 3 months of intervention versus the control but are currently hampered by lack of blinding. Further research is also required to determine the effect of physical therapies past 3 months.

Background: The role and purpose of a clinical learning environment (CLE) is to help students become confident and independent practitioners. Exposure to clinical learning environments provides podiatry students with essential experiential learning opportunities and skills that are difficult to obtain elsewhere. Anecdotal evidence suggests that podiatry students encounter various obstacles in CLEs, although these obstacles have not been thoroughly described. This article, therefore, aims to understand and describe South African podiatry students' experiences of their clinical learning environment.

Methods: A qualitative research method was employed. A purposive sampling strategy was used to select undergraduate podiatry students from the University of Johannesburg to participate in a focus group discussion. Eight students took part in the focus group discussion, which was audio recorded and transcribed verbatim. Data were analysed using Giorgi's qualitative thematic analysis.

Results: Three main themes were identified: (i) Attitudes of supervising clinicians, (ii) Student confidence and (iii) Shortage of supervising clinicians.

Conclusion: Overall, the experiences of podiatry students in their clinical environment were negative. Understanding these obstacles may offer insight into the improvement of the clinical learning environment, and it may be possible to facilitate the development of competent and confident podiatrists.

Background: Lateral ankle sprains (LAS) result in chronic ankle instability (CAI), causing ongoing instability. Although peroneal muscle weakness is documented in CAI, surface electromyography shows similar activation patterns between CAI and healthy individuals, suggesting structural rather than neural deficits. Ultrasound imaging (USI) uniquely enables noninvasive assessment of muscle morphology and quality through cross-sectional area and echogenicity measurements. However, previous USI studies examined peroneals only in nonweight-bearing positions, potentially missing functional deficits. This study examines peroneal muscle characteristics in CAI versus healthy individuals specifically during weight-bearing functional positions using USI.

Methods: A case-control study was conducted with 58 participants (29 CAI and 29 healthy controls), aged 18-30 years. Cross-sectional area (CSA), echogenicity (grayscale analysis where higher values indicate fatty infiltration/fibrosis), and functional activation ratio (FAR) of the peroneal muscles were assessed using USI in nonweight-bearing (side lying) and weight-bearing (bilateral-leg standing (BLS) and single-leg standing (SLS)) positions. CSA images were averaged from three measurements for each position.

Results: The CAI group had significantly smaller CSA in BLS (p < 0.01) and SLS (p < 0.01) but not lying (p = 0.06), higher echogenicity indicating poorer muscle quality (69.7 ± 10.3 vs. 61.3 ± 7.0, p < 0.01), and lower FAR in both BLS (0.99 ± 0.13 vs. 1.13 ± 0.16, p < 0.01) and SLS (1.01 ± 0.17 vs. 1.12 ± 0.22, p = 0.03) compared to healthy controls.

Conclusion: Individuals with CAI showed reduced peroneal muscle CSA, lower activation, and poorer muscle quality specifically in weight-bearing positions compared to healthy controls. These findings suggest altered muscle function in CAI especially in functional weight-bearing positions. This demonstrates the need to assess peroneals in functional weight-bearing position compared to resting.

Introduction: A lower extremity amputation has traditionally been considered as a last resort treatment option for people with a diabetes-related foot ulcer (DFU). However, some people will opt for an earlier amputation to overcome the daily lifestyle challenges from ongoing conservative wound management. Even so, making the decision for non-emergency amputation is challenging due to the lack of clear recommendations or evidence-based resources. Therefore, this study aimed to gather recommendations from people with lived experience of a DFU or amputation, family members, health practitioners, and experts to guide decision-making for amputation due to diabetes.

Methods: Nominal group technique was used to gather and vote on recommendations to support people making decisions for amputation. This technique allows all voices to participate and inform ideas. Two separate cohorts were recruited, one group was comprised people with lived experience (of DFU or amputation due to diabetes) and family members (n = 4 participants). The other group consisted of health practitioners and experts (n = 5 participants). During these workshops, research findings from a previous scoping review (94 papers) and interviews with people with lived experience and health experts (n = 26) were presented to participants to gather iterative feedback. Recommendations were constructed using the previous findings and the participants' experience and expertise, which were voted on and later analysed using summative content analysis.

Results: A total of 13 recommendations were established by the people with lived experience and their family members, and 15 recommendations from health experts. Seven categories were established from these combined recommendations which described the priority considerations: 'Consider timing, with early discussions to move forward', 'Address every element of quality of life', 'Understand individual goals and priorities to make personalised decisions', 'Collaborate with support networks', 'Provide information and options', 'Communicate with respect and transparency', and 'Offer functional person-centred systems'.

Conclusions: The recommendations highlight the need for early and transparent discussions that prioritise individual goals, quality of life needs and collaboration with support networks, to enable person-centred and evidence-based decisions. These recommendations provide a foundation for the development of guidelines to support timely and informed collaborative decisions in the future.

Background: Longitudinal data on pregnancy-related changes in plantar loading and balance are limited, particularly among Asian populations. This study investigated trimester-specific alterations in plantar pressure, static and dynamic balance, and pain-related functional interference in pregnant Taiwanese women.

Methods: Eighty-eight pregnant women were prospectively assessed across six gestational time points (8-36 weeks). Plantar pressure distribution and static balance were measured using a pressure plate system (FOOTPLATEC), and dynamic balance was evaluated using the timed up and go (TUG) test. Pain severity and its interference with daily activities were recorded using the Brief Pain Inventory. Foot oedema was assessed using a standardised grading system to evaluate trimester-specific changes. Repeated-measures ANOVA and Pearson correlation analyses were conducted.

Results: Dynamic balance significantly declined across pregnancy, with TUG time increasing from 6.67 ± 1.11 s at 8-12 weeks to 7.24 ± 1.41 s at 33-36 weeks (p < 0.01, η² = 0.11). Medial midfoot pressure increased by 19% (from 102.56 ± 22.24 to 122.08 ± 29.93 kPa; p < 0.01). Mid-pregnancy foot pain was inversely correlated with hallux (r = -0.17) and lesser toe pressures (r = -0.18; both p < 0.05), whereas heel pressure in late pregnancy was positively associated with low back pain (r = 0.23, p < 0.05). TUG performance was consistently correlated with interference in daily activities throughout gestation (r = 0.20-0.26, p < 0.05).

Conclusion: Progressive redistribution of plantar loading and subtle balance changes were observed across gestation, which may contribute to discomfort and reduced mobility in some pregnant women. These findings support the importance of trimester-specific biomechanical monitoring in prenatal care.

Diabetes-related foot disease (DFD) affects an estimated 110,000 people in Aotearoa New Zealand (Aotearoa NZ) and is one of the leading causes of the national disease burden. While guideline-based care has been found to significantly reduce DFD burdens around the world, Aotearoa NZ lacks national DFD guidelines. Instead, Aotearoa NZ clinicians tend to use either international guidelines or fragmented regional pathways of varying quality which result in variability in clinical practice. Given the higher impacts of DFD on Māori and Pacific peoples, and those in socioeconomically deprived or rural areas, national DFD guidelines incorporating Indigenous knowledge are urgently needed in Aotearoa NZ. We call for the urgent development of Aotearoa NZ DFD guidelines and propose methods to co-develop evidence-based guidelines integrating clinical expertise with Indigenous perspectives. This approach will enhance consistency, improve health outcomes, and support equitable DFD care in Aotearoa NZ.