Journal of Foot and Ankle Research最新文献

Background: The dual influences of velocity and footwear on ankle-foot energetics are particularly relevant for clinical populations who rely on footwear during ambulation. Although walking velocity influences energetic demands of foot structures, footwear may modify these relationships by restricting joint motion. This study aimed to characterize ankle-foot energetics while participants walked at a wide range of velocities while wearing supportive shoes.

Methods: Eighteen healthy participants walked at four height-normalized velocities (0.4-1.0 statures/second) in supportive footwear while kinematic and kinetic data were collected. Ankle, midtarsal, and metatarsophalangeal (MTP) work was quantified and compared using repeated-measures ANOVAs with Holm pairwise tests.

Results: MTP positive and negative work increased with shod walking velocity, though negative work increased substantially more than positive work. Midtarsal positive work also increased while maintaining minimal negative work across all velocities. Ankle positive work significantly increased with velocity accompanied by small but significant increases in negative work.

Conclusions: At all velocities, the MTP joint functioned as a mechanical damper and its damping characteristics became more pronounced as velocity increased. The midtarsal joint functioned as a strut, with a small motor role which became more prominent as velocity increased. The ankle had mixed roles, primarily between strut and spring, with a small damper/motor role that traded off with velocity (less damper more motor as velocity increased). The presence of supportive footwear attenuated positive and negative work across velocities when compared to previous barefoot studies, with the largest difference in the midtarsal's negative work, suggesting footwear substantially modifies natural foot mechanics through increasing velocities.

Introduction: Foot skin xerosis is common, particularly in older people and people with diabetes. Efficacy of emollient treatment of xerosis can be measured using skin hydration measurement devices. None of the devices currently available, however, have been explicitly assessed for their suitability for use on the skin of the foot. The plantar skin has a morphology and composition disparate from non-plantar skin sites, with a stratum corneum (SC) 16 times thicker than non-plantar skin SC. The shallow measurement depth of hydration measurement devices (0.015 mm for the Corneometer CM825) could be collecting data from incommensurate locations within plantar and non-plantar skin. The aim of this study is to examine how data collected using three hydration measurement devices with different measurement depths (Corneometer CM825, MoistureMeter D and MoistureMeter SC) correlate with tissue characteristics known to vary with skin hydration (hardness, elasticity, surface texture and patient perception) to inform their future use.

Methods: Individuals aged 20-40 were recruited to attend the University of Salford Skin laboratory for data-collection. Following a 15-min acclimatisation period, measures were taken from four skin sites (plantar and non-plantar) using three hydration measurement devices, the SATRA STD 226 Durometer (SATRA Technology, Kettering, UK), Dermalab Elasticity probe (Cortex Technology, Hadsund, Denmark), Visioscan VC98 (Courage and Khazaka, Koln, Germany) and the Foot Skin health Questionnaire. Correlation analyses were conducted using SPSS (IBM SPSS Statistics Version 29.0.1.0).

Results: Thirty-two participants were recruited (mean age ± (SD):27.9 ± 4.8; 53% female). The Corneometer CM825 (n = 20) and MoistureMeter SC (n = 32) demonstrate consistent weak-moderate strength correlations with skin elasticity, hardness and texture for both plantar and non-plantar skin. The MoistureMeter D (n = 32), however, correlated stronger with the physical characteristics of plantar skin than non-plantar skin. The only device that found a statistically significant difference between self-perceived 'dry' or 'not dry' skin was the Corneometer CM825 (Mann-Whitney U test p = 0.009).

Conclusion: The skin site being measured should guide the selection of a hydration measurement device. Future work should include a similar assessment using low-cost devices that are accessible to health care practitioners and expansion of the work to include xerotic skin.

Background: Diabetic foot ulcers (DFUs) are a major complication of diabetes, leading to severe morbidity and high healthcare costs. Despite numerous studies on the prevalence of DFUs in Pakistan, the findings vary widely, making it difficult to obtain a clear estimate. To address this gap, we conducted a meta-analysis to determine the overall prevalence of DFUs among diabetic patients in Pakistan, providing a more comprehensive understanding of the burden of this condition.

Methods: A systematic search was conducted in PakMediNet, PubMed, Scopus, Web of Science, and Google Scholar without language or time restrictions. Two independent reviewers screened studies, extracted data, and assessed quality. Heterogeneity was evaluated using Cochran's Q and I². Subgroup analysis, meta-regression, and sensitivity analysis were performed. Publication bias was assessed via a funnel plot and Egger's test. The meta-analysis was conducted using a random-effects model in Stata 17.

Results: In this meta-analysis, 16 studies with a total of 15,333 participants were analyzed. The pooled prevalence of DFUs was estimated at 18%, with a prevalence of 19.4% in Punjab and 16.6% in other regions. The prevalence was reported as 20.8% in men and 14.9% in women. Sensitivity analysis indicated that the results were highly stable. Meta-regression revealed a significant increasing trend in the prevalence of DFUs from 1999 to 2022. Although statistical tests confirmed the presence of publication bias, the trim-and-fill method suggested that its impact was negligible.

Conclusion: This meta-analysis provides a comprehensive estimate of the prevalence of DFUs, highlighting regional and gender differences. The findings show a significant increasing trend over time, emphasizing the growing burden of this condition. These results highlight the need for targeted prevention strategies and improved management of DFUs.

Introduction: This conceptual review is the first work to explore the concept of footwear needs. The review draws upon multidisciplinary literature to synthesise and formulate the first iteration of conceptual understanding of footwear needs.

Methods: A systematic search was performed and through a screening process, 81 studies were included in this conceptual review. The included studies were analysed using the pragmatic utility meta-synthesis method to develop conceptual understanding and framework. The review process was further strengthened through expert consultation.

Results: The definition of footwear needs is defined as 'footwear requirements for the well-being of a person'. Preconditions of footwear needs include characteristics related to the person, product (footwear) and circumstances. Attributes of footwear needs encompass physical (fit for foot and fit for purpose), safety (footwear safety and financial safety), social (fit for person and fit for society) and emotional (increase positive emotions and decrease negative emotions) needs. Outcomes of footwear needs are related to physical, psychological and social aspects of a person. The conceptual framework of footwear needs illustrates the relationships between various factors underlying footwear needs. Footwear comfort is also identified as an allied concept and a potential outcome when footwear needs are achieved.

Conclusion: This conceptual review provides valuable insights into footwear needs, offering a foundation for future research and practical applications in footwear assessment, education and interventions.

Background: Chronic lateral ankle instability (CLAI) is frequently complicated by osteochondral lesion of the talus (OLT), which accelerate cartilage degeneration due to abnormal stress concentration and may progress to ankle osteoarthritis. However, in vivo biomechanical alterations in patients with concurrent CLAI and OLT remains unclear. This study aimed to characterize plantar pressure and stability deficits during single-leg stance (SLS) in patients with CLAI with and without OLT compared to healthy controls.

Methods: Eighty-eight participants were recruited: 29 healthy controls, 30 patients with CLAI, and 29 patients with CLAI + OLT (patients with CLAI and OLT). All participants underwent clinical assessments, including MRI-based ligament and cartilage evaluations. Plantar pressure parameters (normalized peak force [PF%]) and postural stability metrics (center of pressure [COP] and time-to-boundary [TTB]) were collected using a shoe-integrated sensor system during SLS. Among-group differences were analyzed using ANOVA and independent t-tests, with additional subgroup analyses based on gender, body mass index (BMI), and generalized joint hypermobility.

Results: Compared to control group, both CLAI (p = 0.028) and CLAI + OLT (p = 0.001) groups exhibited elevated medial midfoot PF% and patients with CLAI demonstrated higher PF% in third metatarsal region (p = 0.015). Patients with CLAI + OLT demonstrated reduced TTB (p = 0.032) and greater COP variance (p = 0.026) in the anterior-posterior direction. When the two sides were compared, the unaffected side in the CLAI + OLT group displayed lower PF% in the posterior heel (p = 0.012) and higher PF% in the fifth metatarsals (p = 0.030). Receiver operating characteristic curve analysis identified PF% in the third metatarsal as a moderate diagnostic marker for OLT (AUC = 0.700 and p = 0.026). Subgroup analyses revealed that patients with CLAI with males (p = 0.047), BMI < 25 (p = 0.010), and Beighton scores < 5 (p = 0.004) exhibited elevated PF% in the third metatarsal than CLAI + OLT, and the CLAI + OLT group with BMI ≥ 25 showed increased PF% in posterior heel (p = 0.043).

Conclusions: Patients with CLAI, particularly those with concomitant OLT, exhibited distinct biomechanical adaptations characterized by medial midfoot overload and impaired anterior-posterior stability. The implementation of early biomechanical screening of third metatarsal pressure in patients with CLAI and tailored rehabilitation for those with male sex, BMI < 25, and Beighton < 5 was necessary to mitigate osteoarthritis progression.

Background and purpose: Proficient ankle functioning provides a key contribution to everyday activities, such as walking and stair ascent and descent, where many falls occur. The up-on-the-toes stand test (UTTS), involves rising from standing to an up-on-the-toes position and holding it for 5 s, before lowering back to standing. Here, we explore whether the balance-related UTTS test scores differ between two groups with expected differences in ankle functioning, that is, between older adults with diabetic peripheral neuropathy (DPN) in comparison to young healthy adults.

Design: Case-control study.

Methods: On a force platform, 13 older adults with DPN and 14 young adults completed repeated UTTS. Outcome measures were the peak forwards and backwards centre of pressure (CoP) velocity when rising and lowering, the average CoP displacement and variability in CoP velocity when holding the up-on-the-toes position, and the time it was held.

Results: In older adults with DPN compared to young adults, the forwards CoP velocity and displacement when rising up-on-the-toes were reduced (p < 0.001), indicating a slower speed and range of movement; variability in CoP velocity when up-on-the-toes was greater, indicating reduced stability (p = 0.021); and time up-on-the-toes was shorter (p = 0.002), indicating a reduced ability to hold this position.

Conclusions: Findings indicate that older adults with DPN had poorer UTTS performance in comparison to young adults. This suggests the test might be useful for highlighting how deficits in ankle mobility and function can impact balance when moving up-on-the-toes. Future research should compare (a) older DPN patients with healthy older adults and (b) young adults with older adults, to determine whether UTTS test can validly assess age-related decline. In addition, case-control designs within the same age group are necessary to determine whether UTTS test can distinguish disease-specific balance deficits.

Background: Current care provided by health professionals for individuals with osteoarthritis (OA) is inconsistent with clinical guideline recommendations. Although OA guidelines have been developed for more commonly studied joints such as the knee and hip, foot OA remains comparatively underrepresented. Despite its high prevalence and significant impact on functional ability, foot OA lacks standardised classification criteria. The absence of clinical guidelines for foot OA underscores its importance as a research priority. Understanding current assessment and management strategies is crucial before designing clinical trials. This study aims to assess New Zealand (NZ) podiatrists' knowledge of foot OA, their assessment practices and their management strategies. Although foot OA is both highly prevalent and functionally disabling, the absence of standardised classification criteria persists.

Methods: A qualitative descriptive approach was employed for data collection and analysis. Using purposive sampling, semistructured interviews were conducted with 10 NZ registered podiatrists. An interview schedule guided discussions on diagnosing and managing foot OA. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify key meanings and patterns within the data.

Results: Five key themes were derived regarding the assessment of foot OA: (1) chief complaint versus incidental finding; (2) obtaining patient history through subjective interviews; (3) targeted objective assessments for foot OA; (4) determining individual biomechanical factors and (5) further investigations. Five themes were identified relating to the management of foot OA: (1) knowledge and language used to provide education about OA; (2) clinical uncertainty necessitates an iterative approach; (3) podiatry administered treatments; (4) referral pathways to other health professionals and (5) management influences.

Conclusion: New Zealand podiatrists utilise a comprehensive diagnostic approach, integrating symptom history, joint mobility assessment and radiographic imaging particularly in the absence of formal diagnostic criteria. Management strategies align with international guidelines, emphasising education, exercise and weight management alongside podiatrist-led interventions such as foot orthoses and footwear modifications. However, the study highlights several challenges: limited evidence-based guidance, uncertainty around optimal orthotic strategies and a disconnect between evolving OA knowledge and its application into clinical practice.

Background: Deltoid ligament (DL) injuries are increasingly recognized in chronic ankle instability (CAI), drawing clinical attention to rotational ankle instability (RAI). Cadaveric studies have shown that RAI can increase ankle rotation; however, current examination methods for RAI remain limited. As they neither provide adequate insight into ligamentous structural damage nor clearly characterize the rotational instability. This study aimed to evaluate the characteristic rotational instability of RAI and, based on this indicator, investigate which postural control parameters best represent rotational instability and how these parameters can be quantified to assess diagnostic utility using postural control parameters and establish quantitative diagnostic thresholds.

Methods: We included 32 patients with CAI who underwent a postural control assessment, combining center of pressure (COP) analysis with the sensory organization test (SOT). Talar tilt angle and medial clear space were also measured via anteroposterior radiographs and magnetic resonance imaging (MRI) to assess DL injuries. Final diagnoses of RAI or CAI were made in the DL based on arthroscopic findings. Receiver operating characteristic (ROC) curves were constructed to determine the diagnostic performance of each indicator.

Results: In RAI, the ratio of coronal-plane sway to sagittal-plane sway amplitude during motion was significantly elevated, a phenomenon we term "coronal instability." Coronal instability emerged as a strong predictor of RAI, with an area under the ROC curve (AUC) of 0.95 (95% CI, 0.810-0.996; p < 0.0001). Its optimal cutoff value of 0.81 yielded a sensitivity of 83.33% and a specificity of 100%, surpassing imaging-based measures such as radiography and MRI (AUC = 0.567-0.844).

Conclusion: Coronal instability, measured through a noninvasive postural control assessment, demonstrates high sensitivity and specificity for diagnosing RAI. This method offers a valuable clinical tool for accurately identifying RAI and may complement or outperform traditional imaging techniques in certain cases.

Background: Ankle-foot orthoses (AFOs) are commonly prescribed to manage lower limb impairments, especially foot drop in neurological disorders. With the evolution of 3D technology, digital acquisition using 3D scanning and modelling using computer aided design software is becoming more commonplace to produce AFOs. Our previous systematic review in 2019 identified an emerging field of 3D printed AFOs and we highlighted biomechanical effects, mechanical properties and self-reported outcomes such as comfort. To cover the rapidly growing literature on the effects of 3D printed AFOs in clinical populations, the aim of this systematic review was to update an earlier review from 2019 to determine the feasibility and effect of 3D printed AFOs on biomechanical and satisfaction outcomes.

Method: Seven electronic databases were searched from 1985 to July 2025. Original research papers of any design from healthy or clinical populations of any age were eligible for inclusion. Studies must have investigated the effect of 3D printed AFOs in healthy or pathological populations. The quality of the evidence was assessed using QualSyst.

Results: Twenty-eight papers were included in the updated systematic review. The use of 3D printing methods and materials varied markedly, where fused deposition modelling was more prevalent in recent literature than selective laser sintering, and Nylon 12 was most tested. The sample sizes were all smaller than 12. Walking speed and step length of people wearing 3D printed AFOs were mostly improved compared to those with other AFOs and shod or barefoot only. 3D printed AFOs generally had similar or higher satisfaction scores than traditional AFOs. Although levels of evidence were all lower than four, 10 papers had excellent study quality.

Conclusion: The use of additive manufacturing in AFO fabrication has rapidly increased in the past few years. The novel designed 3D printed AFOs might have potential benefits over traditional designs in terms of biomechanical outcomes. 3D printed AFOs have been further proven to be comparable to traditional ones. Further research is encouraged to conduct with more specific condition characteristics such as cerebral palsy within a specific GMFCS level, longitudinal clinical trials and testing in a home or natural environment. Establishing a standard for AFO evaluation and reporting is also recommended.

Background: Multiple healthcare professions are involved in the management of plantar heel pain (PHP). Professional diversity can lead to varied practice and treatment choices. Understanding PHP management can aid clinical benchmarking, inform knowledge mobilisation strategies, and may support shared decision making between patients and referrers. This study explored the management of plantar heel pain by United Kingdom (UK) registered healthcare professionals.

Methods: A cross-sectional, online survey using the Jisc Online Surveys platform. The survey was distributed to UK healthcare practitioners via digital channels, including professional bodies, special interest groups and social media.

Results: Four hundred and six professionals responded, predominantly podiatrists (181; 44.6%) and physiotherapists (144; 36.5%). The remaining 18% comprised orthotists, osteopaths, orthopaedic surgeons, General Practitioners (GPs), nurses, rheumatologists, sport and exercise rehabilitation specialists, and a consultant in sport and exercise medicine. Most respondents (247; 60.8%) did not commonly use imaging to guide PHP management. The majority (359; 88.4%) provided physical interventions: strengthening (88%), stretching (85.5%) and balance (65.2%) were frequently used. Prefabricated orthoses (56.3%) were more frequently used than custom orthoses (24.2%). Treatments employed by podiatrists and physiotherapists were similar. Advice on nonsteroidal anti-inflammatory drugs (NSAIDs) (226; 83%), and simple analgesics (e.g., paracetamol) (221; 81%) to manage pain was commonly provided. Only 6.4% frequently performed steroid injections. Patient information was commonly provided (359; 88%); however, most practitioners (297; 83%) lacked resources in languages other than English.

Conclusion: Healthcare professionals in the UK favour exercise and prefabricated orthoses when managing PHP.