Journal of Foot and Ankle Research最新文献

Introduction: We developed a smartphone application capable of automatically measuring the hallux valgus angle (HVA) and various intermetatarsal angles by capturing radiographic images displayed on a monitor. This study aimed to evaluate the accuracy of these measurements using the application.

Methods: Three users-a board-certified orthopedic surgeon, a resident, and a nonhealthcare professional (Users 1, 2, and 3)-independently used the application to measure angles on 92 radiographs from 92 consecutive patients. Mean absolute errors (MAEs) between the application-based measurements and the median of manual measurements performed by three experienced foot and ankle surgeons using a DICOM viewer were calculated for each user. To evaluate whether the measurement errors were acceptably small, one-sided t-tests were conducted to determine whether the MAEs were significantly less than 3°. Differences in MAEs among the three users were also assessed using analysis of variance.

Results: The MAEs of HVA by the three users were 1.1°, 1.3°, and 1.4°, respectively, all significantly below the 3° threshold (95% CI upper limit; 1.2°, 1.5°, and 1.5°). Comparable accuracy was observed for intermetatarsal angles, which have slightly greater variability for more lateral metatarsals. All measurements met the accuracy criterion of < 3°, except for the intermetatarsal angles between the first and fifth metatarsals measured by the nonhealthcare user. No significant difference in MAE was found among users for HVA (p = 0.13), whereas significant differences were noted for some intermetatarsal angles.

Conclusions: The developed smartphone application accurately measured the HVA and various intermetatarsal angles, with performance comparable to that of experienced foot and ankle surgeons. Importantly, sufficient accuracy was achieved even when used by individuals without clinical training. The application may be useful as a practical tool in clinical and research settings.

Multisegment foot models have become increasingly important in biomechanical research and clinical gait analysis but often face limitations in defining joint positions. Often, they rely on simplified methods, such as using the midpoint between two markers to represent a joint, which lacks functional verification. In contrast, phenomenological angles, such as the medial arch angle, bypass joint center calculations, and offer sensitive, radiologically aligned indicators of foot mechanics. The Heidelberg functional foot model (HFFM) integrates functionally verified joint positions in combination with clinically relevant phenomenological measures, thereby enhancing clinical interpretability in gait analysis. The marker placement of the HFFM is based on the Heidelberg foot measurement method (HFMM). A four-segment model (shank, hindfoot, forefoot, and hallux) is defined. Anatomical coordinate systems are established via regression formulas derived from functional joint parameter determination. Kinematic angles are compared with radiological measures. Additionally, six clinically relevant angles of the HFMM are integrated into the HFFM. The method is applied to cavovarus (CV, 19 feet), equinovarus (EV, 31 feet), and typically developed feet (TD, 88 feet). EV feet show more pronounced hindfoot varus and forefoot adduction than CV and TD feet. Within the parameters adopted from the HFMM, EV feet exhibit increased subtalar inversion and a stronger medial arch than CV. Significant correlations are identified between hindfoot/shank flexion, forefoot/hindfoot flexion and medial arch, and radiological angles. The HFFM is sensitive for analyzing equinvarus and cavovarus deformities without applying static offsets due to the functional approach. It enables calculating kinetics to better understand the biomechanics of foot deformities.

Background: Diabetes-related foot ulceration (DFU) represents a significant and increasing cause of morbidity and economic burden to health services. Surgical offloading has shown great effectiveness in the prevention and healing of DFU. The objective of this review is to assess the effectiveness of submetatarsal plantar fat pad modulation in preventing DFU and to characterise the different biomaterials used to this end.

Methods: The study was registered on PROSPERO. A search strategy of the PubMed, CINAHL and Cochrane biomedical databases was conducted. Any study which explored the modulation of the plantar submetatarsal fat pad for the prevention or treatment of DFU in adults was included. The main outcome was the occurrence of ulceration following intervention.

Results: Of the 3162 retrieved studies, 10 studies met inclusion criteria, describing outcomes for 76 participants with 112 ulcers or pre-ulcerative areas. Four studies report results of injectable liquid silicone in 55 participants, four studies included the use of an acellular allograft in eight participants, two studies included autolipotransplantation in 11 participants and one study reports on the use of injectable collagen in two participants. Only one randomised control trial was identified while the remainder of the studies were observational, case-series, or case-reports. The overall ulcer occurrence was 27/112 over an average follow-up of 32.4 months.

Discussion: While plantar fat pad modulation shows promise as a surgical offloading strategy for DFU, insufficient high-quality trial data preclude meaningful interpretation of its merits. This is further complicated by heterogeneity in the biomaterial employed for modulation.

Background: Dermal temperature differentials between limbs are used to monitor disease progression and support safe withdrawal of immobilisation in Charcot neuro-osteoarthropathy (CNO). Despite the wide clinical use of dermal thermometry, there is a lack of evidence on the optimal temperature stabilisation period after removal of immobilisation devices, such as total contact casts (TCCs). This study aimed to investigate the optimal time period to achieve temperature stabilisation post removal of TCC for assessing dermal temperatures in active CNO.

Methods: Over a 2-year period, this within-subjects repeated measures study recruited 12 adults with active CNO treated with TCC from a metropolitan high-risk foot service in Melbourne, Australia. Participants were excluded if they had bilateral CNO, an active foot ulcer, an inflammatory foot condition (e.g., gout), peripheral artery disease or major lower limb amputation. In a temperature-controlled room, dermal temperatures were recorded using an infrared thermometer after removal of TCC and contralateral footwear. Temperatures were recorded at 10-min intervals from baseline to 90 min at 10 anatomical locations on each foot. Paired samples t-tests or Wilcoxon signed-rank tests explored temperature stabilisation at each anatomical site across the 10 time points.

Results: Mean age was 55.1 (SD, 8.9) years, 75.0% were male and 83.3% had type 2 diabetes. All participants had peripheral neuropathy and a large proportion had history of foot ulceration (75.0%). The average duration of CNO was 2.9 (SD, 1.7) months, with most classified as stage 1 (91.7%), affecting the tarsometatarsal joints (58.3%) and midtarsal joints (83.3%). Overall, dermal temperatures had stabilised by 40 min for the Charcot (casted) foot and contralateral (non-casted) foot.

Conclusions: This is the first study to explore the optimal time period to achieve temperature stabilisation when assessing dermal temperatures in active CNO. Forty minutes appears to be an appropriate resting time to reach thermal equilibrium. Although this approach may improve the accuracy of dermal thermometry, the time period may not always be feasible in clinical practice.

Background: Chronic ankle instability (CAI) disrupts postural stability after ankle sprains and inadequate treatment. Gait initiation (GI), governed by central nervous system (CNS) patterns, is used to evaluate stability. Muscle synergy, which reflects coordinated activations, reveals neuromuscular control. This study investigates lower limb muscle synergies during GI in individuals with and without CAI to understand their neuromuscular strategies.

Design: Cross-sectional study.

Setting: Laboratory.

Method: This study involved 20 participants, 10 healthy men and 10 patients with CAI. Six electrodes were applied per the SENIAM guidelines, and markers were set according to the cluster model. The participants initiated gait after an auditory cue was presented on a force plate. OpenSim simulated a musculoskeletal model using kinematic and muscle activity data. Muscle synergies were analyzed via HALS in MATLAB. Statistical tests, including Wilcoxon and one-way ANOVA, were conducted in SPSS with p < 0.05 as the significance threshold.

Results: The number of muscle synergies was not significantly different between the healthy and CAI groups (p > 0.05). However, muscle weight differed significantly between synergies 1 and 2 (p < 0.05). In synergy 1, the TA had greater weighting in the CAI group, whereas synergy 2 had higher RF and GM_L weightings in the CAI group. Synergy 3 revealed greater PL weight in the control group (p < 0.05).

Conclusion: In CAI, PL muscle weakness is offset by the TA, RF, and GM_L muscles resulting in altered ankle strategies during gait instability. This compensation disrupts motor chains, increases movement complexity, and involves the CNS, framing CAI as a global movement issue rather than a localized problem.

Changes in tendon morphometry around first-row bones are linked to the hallux valgus (HV) development. However, there are very limited studies examining the relationship between the connection status of the tibialis posterior (TP) tendon to the adductor hallucis (ADH) and flexor hallucis brevis (FHB) tendons and the development of HV. This study aimed to investigate the association between these tendon connections and the occurrence of HV. The study included 24 formalin-fixed adult cadavers and amputee feet (10 female, 14 male). The attachment sites and connections between the ADH, FHB, and TP tendons were recorded. Feet were classified into three groups: no connection between the three tendons (Group I), connection between TP and FHB (Group II), and connection between TP, FHB, and ADH (Group III). HV angle values and subgroups (normal, mild, and moderate-severe) were defined to assess the degree of HV. Feet were grouped based on tendon attachment status, and the distribution of HV subgroups was statistically analyzed. HV angles in Group III were significantly larger than in Groups I and II (= 0.000, p = 0.024). While tendon connection was detected in only 20% (1/5) of feet without HV, tendon connection was detected in 64% (7/11) of mild HV and in all feet with moderate-severe HV. HV occurred in 93.8% (15/16) of feet with tendon connections (vs. 50% without). The study revealed that HV can develop in feet with and without tendon attachments. However, HV is more frequent in cases where the TP tendon is attached to the FHB and ADH tendons. Additionally, moderate-severe HV increases when TP is attached to ADH.

Background: Recalcitrant plantar fasciitis (PF) refers to persistent heel pain lasting ≥ 6 months despite appropriate conservative management, including physical therapy, orthotics, and pharmacological interventions. This study aimed to compare the clinical efficacy and safety of corticosteroid injection (CI), radiofrequency ablation (RFA), and their combination in patients with recalcitrant PF.

Methods: In this retrospective study, a total of 156 patients with ultrasonographically confirmed plantar fasciitis, experiencing heel pain for at least 6 months and unresponsive to ≥ 3 months of standard conservative therapy, were included; 52 received RFA, 50 received CI, and 54 underwent combined therapy. Pain intensity (visual analog scale [VAS]), functional status (Foot Function Index [FFI], Roles and Maudsley score [RMS]), plantar fascia thickness (PFT), and relapse rates at 12 months were assessed. Within-group and between-group differences were assessed using appropriate nonparametric tests, and relapse rates were compared accordingly.

Results: All treatment modalities improved VAS, FFI, RMS, and PFT at 6 months (p < 0.001). VAS declined from 6.73 to 6.81 at baseline to 1.62 in the RFA group and 1.83 in the combined group, whereas remaining at 6.56 in the CI group. FFI dropped from ∼52 to 21.50 and 17.57 in the RFA and combined groups but remained at 46.62 in the CI. PFT decreased from ∼6.2 mm to 3.29, 2.71, and 2.95 mm, respectively. Relapse occurred in 12 (23.1%), 19 (38.0%), and 8 (14.8%) patients in the RFA, CI, and combined groups. Between-group differences were significant at 6 months (p < 0.001). No major adverse events were observed.

Conclusion: Both CI and RFA are effective in recalcitrant PF, but their combination provides superior and more durable improvements in pain, function, and fascia morphology, with the lowest relapse rates. Ultrasound-guided combined therapy suggests a safe, practical, and effective treatment option for patients unresponsive to conservative measures.

Podiatric surgery is a registered specialty in Australia, supported by nationally accredited training programs and decades of safe, effective practice. Despite this, podiatric surgeons are excluded from public hospitals and government-funded services, eliminating their ability to contribute to high-demand areas of surgical care. This commentary explores systemic barriers to the integration of podiatric surgeons within the Australian health system. It draws on national regulatory frameworks, clinical audit data, and international comparisons including interprofessional agreements in the United Kingdom and United States, to examine how a well-trained but vastly underutilised specialist surgical workforce remains siloed outside public care. Structural reforms would allow podiatric surgeons to participate in multidisciplinary teams, reduce surgical waiting times, and support patients with complex foot and ankle conditions, especially those with conditions such as diabetic foot disease, that are known to deteriorate with time, and patients from marginalised and remote demographics. International examples show that enabling access and removing funding exclusions improve service equity, alleviate surgical bottlenecks, and bring Australia in line with global best practice.