Journal of Foot and Ankle Research最新文献

Background: Chronic lower limb pain is common in children and adolescents and is frequently managed by podiatrists. Due to the complexities of understanding the cause of chronic pain, clinicians may experience uncertainty around the diagnosis, which in turn may impact their communication and management approaches. Limited research explores how podiatrists manage chronic lower limb pain in children, especially in the presence of diagnostic uncertainty. This study aimed to explore the management strategies including language that podiatrists report using to address the pain experience of children with chronic lower limb pain and to investigate if and how the reported management strategies used by podiatrists to address the pain experience of children with chronic lower limb pain vary based upon the level of diagnostic uncertainty.

Methods: Eight focus groups were conducted with a total of 48 podiatrists. Participants were presented with three vignettes, each describing a child with chronic lower limb pain. They were then asked to discuss their certainty in the child's diagnosis presented and their approaches to explain and manage the child's pain. Audio data were recorded, transcribed and analysed using thematic analysis. Three key themes were generated: Language strategies, non-verbal communication strategies and treatment strategies.

Results: Podiatrists were overall certain in the diagnosis presented in vignettes 1 (calcaneal apophysitis) and 2 (juvenile idiopathic arthritis); however, they expressed significant uncertainty in vignette 3, which was written to elicit uncertainty presenting a case with generalised lower limb pain. Many groups fixated on the Beighton score of 5/9 and interpreted this to mean hypermobility, which is inconsistent with the current clinical guidance. Podiatrists used similar language strategies across all 3 vignettes and supported their language strategies with non-verbal communication strategies. Podiatrists also discussed activity modification, passive and self-care strategies and building a team as the treatment strategies they would use.

Conclusions: This study highlights the variety of clinical management strategies used by approaches and highlights how their approach may change depending on their certainty in the diagnosis.

Introduction: The lateral longitudinal arch (LLA) is an essential structure of the foot. However, LLA evaluation methods remain underexplored compared to those of the medial longitudinal arch (MLA). This study sought to develop a method for measuring the cuboid height, the keystone of the LLA, using ultrasonography and to verify its correlation with radiography, as well as intrarater and interrater reliability.

Methods: This cross-sectional study included 21 university students (14 males and seven females). The cuboid height was measured using radiography and ultrasonography. The validity of ultrasonographic measurements was assessed through correlation with radiographic measurements and Bland-Altman analysis. Intrarater and interrater reliabilities were evaluated using intraclass correlation coefficients (ICCs).

Results: A strong correlation was observed between cuboid heights measured using radiography and ultrasonography (r = 0.98, p < 0.01). The Bland-Altman analysis revealed a fixed bias of -0.71 mm (95% confidence interval [95% CI]: -0.96 to -0.46 mm). Intrarater and interrater reliability for ultrasonographic measurements were almost perfect, with ICCs of 0.98 and 0.99, respectively.

Conclusions: Cuboid height measurements using ultrasonography demonstrated high validity and reliability. This method offers a noninvasive and cost-effective alternative to radiography, with potential clinical applications in the evaluation of LLA and related conditions such as cuboid syndrome and lateral foot injuries.

Introduction: Psychological factors are linked to pain and function in various musculoskeletal conditions, but their impact on hallux valgus is unclear. Health-related quality of life declines with increasing severity of hallux valgus, affecting not only foot pain and physical function, but also general health, vitality and mental health. Previous studies have reported inconsistent associations between psychological factors, such as anxiety and depression, and surgical outcomes, which might relate to variability in measurement approaches. Understanding the associations between psychological factors, including anxiety, depression, pain catastrophizing and kinesiophobia, and hallux valgus-related pain and function may inform more holistic pre-operative care. Therefore, we aimed to assess these associations in adults with hallux valgus pre-surgery.

Methods: A pre-operative cross-sectional study was conducted with 41 adults scheduled for hallux valgus surgery. Participants completed questionnaires measuring continuous psychological variables: depression, anxiety and stress (Depression Anxiety Stress Scale-21, a tool for general psychological distress), kinesiophobia (Tampa Scale for Kinesiophobia, which assesses fear of movement associated with pain) and pain catastrophizing (Pain Catastrophizing Scale, a tool used to evaluate maladaptive pain-coping strategies). Continuous outcomes were evaluated using the Manchester-Oxford Foot Questionnaire for foot function, pain and social interaction. Multiple linear regressions explored the associations between these psychological factors and the outcomes.

Results: When all exposure variables were considered simultaneously, pain catastrophizing emerged as a significant predictor of foot pain and foot function. A one-unit increase in the pain catastrophizing score was associated with a 1.41-point increase in foot pain (β = 1.41, 95% confidence intervals (CIs) 0.73-2.09 and p < 0.001) and a 1.83-point increase in worse foot function (β = 1.83, 95% CI 1.12-2.54 and p < 0.001).

Conclusion: Assessing pain catastrophising pre-operatively is recommended for individuals with hallux valgus, although more structured education may be needed to support health professionals in assessing psychological factors. Future research should evaluate the longitudinal impact of pain catastrophizing on post-operative outcomes and explore other contributing factors, such as comorbidities, lifestyle variables and sex differences, to refine screening and treatment strategies.

Introduction: Adult acquired flatfoot deformity (AAFD) is a disabling condition that may require complex surgical treatment. Little is known about the incidence of AAFD in the general population and specifically of AAFD requiring specialist care. We aimed to describe the incidence of AAFD referred to specialist care in the Swedish general population.

Methods: We conducted a nation-wide epidemiological register study to estimate the incidence of referred AAFD in the general population. We retrieved data from the Swedish National Patient Register. All individuals aged 16 years or older, with a first-time diagnosis of AAFD (ICD-10 code M214) between 2007 and 2018 were identified. Total incidences, change over time, and gender-specific and age-specific incidences per 100,000 person-years were calculated using population size data from Statistics Sweden. Incidences were compared using the Poisson test.

Results: The incidence rate of referred AAFD in the general population was 23.0 (95% CI 22.7-23.3) per 100,000 person-years. The incidence rate in women was 30.4 (95% CI 29.9-30.8) and in men was 15.4 (95% CI 15.1-15.8). The highest incidence rates were found in the age Group 61-75 years. The incidence rates varied significantly across the 21 regions in Sweden. The age-standardized and sex-standardized incidence rates ranged from 8.3 (95% CI 7.2-9.4) to 69.1 (95% CI 62.4-75.8).

Conclusion: AAFD requiring referral to specialist care is common in the general population. Women had nearly twice the incidence of AAFD compared to men. Large unexplained regional variations in the incidence rates exist.

Atrial fibrillation (AF) is a global health crisis affecting 33.5 million people, with costs projected to reach £75 billion by 2035. A significant concern is that 43-48% of cases are asymptomatic, increasing the risk of stroke and heart failure. While general population screening lacks strong support, targeted screening shows promise in reducing stroke occurrence and healthcare costs. Podiatrists, who frequently treat adults of advancing age, are uniquely positioned to detect AF in high-risk, asymptomatic individuals. This commentary advocates for opportunistic AF screening by podiatrists and other healthcare professionals, offering guidance for implementation. Early detection through defined referral pathways is crucial for timely diagnosis and management, potentially reducing AF-related strokes that can lead to early mortality. Further high-quality podiatry-led studies are recommended to build on this commentary paper.

Background: Health inequalities are a well-known and widespread phenomenon throughout health care settings. In particular, people of color experience higher rates of delayed and/or misdiagnosis contributing to poorer outcomes and an increased mortality risk. Research suggests that health care professionals find it more difficult to correctly diagnose dermatological conditions in the non-White patient demographic. Although podiatrists routinely examine and assess skin lesions, there is a paucity of research exploring their accuracy or confidence in recognizing skin pathologies. This study aims to investigate podiatry student's ability, confidence, approaches, and perceptions in diagnosing dermatology pathologies in different skin tones. A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

Methods: A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

Introduction: Charcot neuroarthropathy (CN) can result in fractures and dislocations of the foot and ankle in individuals with diabetes and neuropathy, leading to ulceration, amputation and a poor quality of life. Additional episodes of acute CN can lead to extended periods of physical and psychosocial distress. The aim of this scoping review was to identify and synthesise the evidence relating to factors associated with the development of recurrent and contralateral Charcot neuroarthropathy (CN) in individuals with diabetes.

Methods: A systematic search of four electronic databases was conducted from inception to February 06, 2023. All relevant study designs, except single case studies, that had been published in full in peer-reviewed journals were included. Studies were excluded if they were not published in English and did not provide data on individuals with diabetes.

Results: The search identified two studies that investigated factors associated with the development of recurrent CN, but none that related to the development of contralateral CN. Ten factors were investigated for association with recurrent CN development: age, body mass index, diabetes type and duration, glycated haemoglobin, anatomical site affected, duration of offloading applied to treat the primary CN episode, use of pharmacological intervention, severity of neuropathy, and skin temperature. However, no significant associations were reported.

Conclusions: There is an alarming lack of evidence-based findings in this research area to guide practice. Clearly, more research in the form of rigorous prospective studies is urgently required to identify risk factors for the development of recurrent and contralateral CN in individuals with diabetes.

Background: Plantar Heel Pain (PHP) can be a debilitating musculoskeletal condition from which only 50% recover within a year due to poor understanding of the mechanisms explaining severity and predicting outcomes specific to PHP.

Objective: To explore associations between biopsychosocial variables and the severity of people with PHP. Secondly, to determine what combination of self-reported factors distinguishes people with PHP from other foot pain (OFP).

Methods: We collected data from 235 participants, including 135 (%57) PHP (age 44 ± 12 years, 66% female) and 99 OFP (%43) (age 38 ± 11 years, 57% female) using 5 demographic, 13 biomedical, 8 psychological, 3 social and 8 activity-related factors. These were tested in linear and logistic regression models.

Results: Quality of life (QoL) (β = 0.35; p < 0.001), education (β = -0.22; p = 0.003), gender (β = -0.20; p = 0.007), morning pain duration (β = -0.18; p = 0.01) and disease duration (β = -0.15; p = 0.040) were significantly associated with severity of PHP. The second model, without QoL, showed that having sensitisation (β = -0.18; p = 0.002) and a higher level of morning pain (β = -0.20; p = 0.01) are associated with severity. The logistic regression results revealed that people with PHP tend to have a systemic disease (OR = 3.34; 1.53-7.76), express more kinesiophobia (OR = 1.02; 1.01-1.14), are less likely to have previous injuries (OR = 0.40; 0.19-0.81), worse morning pain (OR = 1.02; 1.01-1.03) and standing pain (OR = 2.60; 1.39-4.87) compared to people with OFP.

Conclusions: People with PHP have higher associated levels of a range of psychological, social and activity related factors than people with OFP. The findings highlight the importance of considering psychosocial assessments alongside physical examination.

Objectives: Insertional Achilles tendinopathy is a common and disabling condition. This trial aimed to determine the feasibility of conducting a parallel group randomised trial to evaluate the efficacy of heel lifts compared to a sham intervention for reducing pain intensity associated with insertional Achilles tendinopathy.

Methods: Twenty-six people with insertional Achilles tendinopathy were randomised to either the heel lift group or sham intervention group. Outcome measures were obtained at baseline, 4, 8 and 12 weeks. The primary outcome was feasibility, evaluated according to demand (recruitment rate and conversion rate), acceptability, adherence, adverse events and retention. Limited efficacy testing was conducted on secondary outcome measures including pain intensity, function, physical activity, health-related quality of life, use of co-interventions and global rating of change.

Results: Between August 25, 2023, and April 7, 2024, we recruited and tested 26 participants (aged 28-65 years, mean [SD] 51 [8]). The pre-determined thresholds were met for demand, acceptability, adherence, retention, pain intensity, function, quality of life and global rating of change and partly met for adverse events, physical activity and use of co-interventions. Between 47 and 241, participants will be needed for a fully powered randomised trial.

Conclusion: In its current form, a randomised trial of heel lifts compared to a sham intervention is feasible. However, future triallists may need to consider strategies to manage the risk of adverse events and plan to adjust the analyses to account for the use of co-interventions.

Trial registration: ACTRN12623000721606.

Background: The visual analogue scale (VAS) and the Foot Health Status Questionnaire (FHSQ) are patient-reported outcome measures that are frequently used to evaluate the management of plantar heel pain. This study aimed to re-calculate (i.e. revise) the minimal important differences (MIDs) of the VAS and the FHSQ when used for plantar heel pain to enhance the validity and precision of previous estimates.

Methods: This study used an anchor-based method to calculate MIDs and incorporated best-practice analyses to ensure credibility of the estimates. Data from 369 participants previously recruited from the community into four randomised controlled trials that evaluated interventions for plantar heel pain were used. VAS and FHSQ data from these participants at baseline and follow-up were pooled to calculate the MIDs (95% confidence intervals). A 15-point global rating of change Likert scale was used at follow-up as the transition scale, which was anchored to baseline. For the VAS, MIDs for two distinct types of pain were calculated: average pain and first-step pain. For the FHSQ, MIDs for two domains were calculated: foot pain and foot function.

Results: The revised MIDs for the 100 mm VAS were -8.5 mm (95% CI: -12.2 to -4.7) for average pain and -19.2 mm (95% CI: -24.7 to -13.8) for first-step pain, which represent improvements in pain. The MIDs for the FHSQ were 12.4 points (95% CI: 6.9 to 18.0) for foot pain and 6.4 points (95% CI: 0.9 to 11.9) for foot function, which represent improvements in foot health status.

Conclusions: The revised MIDs from this study for the VAS and the FHSQ when used for plantar heel pain have enhanced validity and precision compared to previous estimates. This is important for clinicians and researchers as it provides a better understanding of how much improvement is required by an individual before an important change is experienced. The revised MIDs will also assist researchers with prospective sample size calculations, so future clinical trials are appropriately powered from a statistical standpoint.