Journal of Foot and Ankle Research最新文献

Background: Diabetes-related foot ulceration (DFU) is often related to footwear fit. People with diabetes often have wider feet than in those without diabetes. Standards for evaluating footwear width in those at risk are therefore important.

Methods: We performed a systematic search with a narrative review to assess consensus in quantitative methods used to assess footwear width for people at risk of DFU within research studies, and how often footwear is considered too narrow or wide. Search terms included diabet*, footwear, fit, size and width. This returned 1397 results, with 16 studies included after full paper review.

Results: Three standards emerged, defining incorrectly fitting footwear as (1) one shoe size or (2) one width fitting larger or smaller than feet (4-7 mm) or (3) measured shoe width not equal to foot width. Footwear that was too narrow by one shoe size or width fitting was common (31.0%-78.0%) but too wide was rare (2 studies: 1.0% too wide where 100% had DM or 64.6% where 9% had DM). DFU was more likely in older people who wore either incorrect size or inappropriate footwear (n = 219, 100.0% DM, OR 1.7, p = 0.001) or incorrect length or width footwear (n = 440, 58.4% DM, OR 5.1, p = 0.02), but not in those with incorrect shoe width (n = 65, 9.0% DM, OR 0.75, p = 1.0).

Conclusions: It is unclear how much space the at-risk forefoot requires. Standardised methods are needed to establish the accuracy and reliability of foot and footwear measuring tools, and to evaluate footwear fit, given their relationship with the clinical outcome.

Introduction: Intrinsic foot muscles and the plantar fascia are crucial for foot health, which diminishes with age and conditions such as chronic plantar fasciitis (PF). Ultrasound (US) is an accessible and cost-effective method for evaluating these structures. This study aims to assess the repeatability, reliability, and validity of plantar fascia thickness and flexor digitorum brevis (FDB) muscle measurements using US compared with MRI in individuals with and without PF.

Methods: Foot muscle volume and plantar fascia thickness were measured via US and MRI in 28 participants with and without PF. Subsequently, the plantar fascia thickness and FDB volume were calculated using the OsiriX semiauto volume segmenter software for MRI and the truncated cone formula for both MRI and US. Intraclass correlation coefficients (ICCs), Pearson product correlations (r), minimal detectable differences (MDD), and standard error of measurement (SEm) were calculated.

Results: High ICCs (r = 0.988-0.990) indicated excellent repeatability for all measurement techniques of the plantar fascia and FDB muscle. Reliability for plantar fascia and FDB measurements ranged from 3.98% to 5.50% and 5.06%-9.84%, respectively, across both groups. Validity was high with correlation values between 0.94 and 0.99 and Bland-Altman limits of agreement ranging from 2.6% to 9.2%.

Conclusions: US provides repeatable, reliable, and valid measurements of plantar fascia thickness and FDB muscle volume compared with MRI. It offers a cost-effective and accessible alternative for assessing foot health in clinical and research settings.

Background: Approximately one-third of the adult population is affected by hallux valgus (HV). Surgical interventions are successful in reducing deformity; however, postoperative complications are common. There is growing evidence for prehabilitation and rehabilitation strategies in orthopaedic surgeries. However, the effectiveness of such strategies in HV surgery is currently unknown. This systematic review aimed to synthesise and determine the quality of evidence for the effectiveness of physical and mechanical prehabilitation and postoperative rehabilitation interventions for improving outcomes following HV surgery.

Methods: Electronic databases: MEDLINE, Cochrane, CINAHL, Scopus, EMBASE and AMED were searched from inception until 19th May 2025, following the PRISMA guidelines. Randomised controlled trials were included to determine the effectiveness of preoperative and postoperative physical and mechanical therapies for improving outcomes in adults undergoing HV surgery. The evidence from individual studies was narratively synthesised, and data were not pooled because of the heterogeneity of interventions, methods and outcomes measures.

Results: A total of 8166 titles and abstracts were screened, and 66 full-text papers were reviewed. Five studies met the eligibility criteria and were included in this review. No randomised controlled trials examined the effectiveness of eligible preoperative physical or mechanical interventions. Postoperative early weight-bearing, dynamic metatarsal splinting and transcutaneous ultrasound appeared to improve patient outcomes, whereas rigid-soled footwear improved patient satisfaction.

Conclusion: There is currently no evidence to support the effectiveness of preoperative physical and mechanical interventions for improving outcomes in HV surgery, and limited evidence supports postoperative interventions. Future trials should consider incorporating validated outcome measures.

Introduction: Understanding foot joint loading during different dynamic activities is essential information for guiding exercise progression in rehabilitation. While walking and running biomechanics are well studied, joint-specific kinetic data during a single leg drop and hop task, often used in rehabilitation, are lacking. This study aimed to evaluate (1) the kinetic behavior of the ankle, Chopart, Lisfranc, and MTP-1 joints during a drop-hop task under different visual constraints and (2) to contextualize these findings by comparing them with heel-strike running, to assess the relative loading demands of the drop-hop task.

Methods: Seventeen recreationally active male adults performed a single-leg drop and hop under two visual focus conditions: central (focusing on the landing spot) and peripheral (focusing straight ahead). Kinematics, moments, and power were analyzed using a four-segment foot model with statistical parametric mapping. Additionally, peak plantarflexion moments and power outputs were compared with existing data from heel-strike running data from a mixed-sex sample (4 males, 3 females) collected in a separate study using the same setup.

Results: Findings revealed no differences between central and peripheral focus conditions. Heel-strike running shows similar joint loading, but higher power generation (p < 0.001) at the ankle and Chopart joint, higher absorption (p < 0.001) at the Chopart and MTP-1 (p < 0.05) joint and lower power absorption (p < 0.001) at the ankle and Lisfranc joint.

Conclusion: Visual input does not influence foot biomechanics during a single-leg drop and hop. This task produces similar joint loading patterns similar to heel-strike running but with reduced power generation at the ankle and midfoot. Contrary to global belief, the single leg drop-hop task is not excessively more demanding in terms of foot joint loading, supporting the earlier use of drop-hop exercises in rehabilitation programs. They offer a controlled way to reintroduce loading while avoiding the full propulsion demands of running, independent of visual focus.

Background: Fatty infiltration-or fatty atrophy-of the abductor digiti minimi (ADM) muscle of the foot on magnetic resonance imaging (MRI) has been attributed to entrapment of the first branch of the lateral plantar nerve (i.e., Baxter's neuropathy), a condition associated with plantar heel pain (PHP). The aim of this study was to investigate the evidence relating to the association between fatty infiltration of ADM and Baxter's neuropathy.

Methods: This systematic review conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from 20^th June 2023 to 19^th of March 2024. Peer-reviewed articles of retrospective, cross-sectional observational, or cohort studies written in English that investigated the prevalence or frequency of fatty infiltration of ADM on MRI in adult participants were included. Study quality and risk of bias were assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies.

Results: Four studies (1052 participants) were identified and included in the review. Two studies were retrospective studies and two studies were cross-sectional observational studies. Only one study was rated 'good' on quality assessment. The reported prevalence of fatty infiltration of ADM on MRI was reported to be between 4% and 11% in the general population. Prevalence was also reported to be similar in people with and without generalised foot pain (approximately 8% and 6%, respectively). No studies reported prevalence in specific populations with PHP or with Baxter's neuropathy.

Conclusion: The association between fatty infiltration of ADM on MRI and entrapment of the first branch of the lateral plantar nerve as part of PHP still remains unknown due to the lack of robust evidence. Additional high-quality studies investigating the association between PHP and fatty infiltration of ADM on MRI would be worthwhile to improve our understanding of the diagnostic value of MRI for this condition, which may aid decision-making for the treatment of PHP, particularly surgical treatment of Baxter's neuropathy.

Introduction: Foot health and lower extremity function are important issues for people with multiple sclerosis (MS). However, relatively little is known about foot health among people with MS. The potential association between foot health and lower extremity function in particular has seldom been studied. Therefore, this study aimed to analyse the level of self-reported foot health and lower extremity function in people with MS and to identify possible associating factors.

Methods: A cross-sectional survey study design was applied. The data were collected online April-May 2024 from members of a national patient association with the Self-administered Foot Health Assessment Instrument, the Lower Extremity Functional Scale (LEFS) as well as a background information form. The data were analysed with descriptive and inferential statistics.

Results: The participants (n = 969, response rate 23%) had many foot problems of which dry skin (73%), cold feet (65%), leg cramps (61%), foot pain (59%) and thickened toe nails (51%) were the most common. Participants experienced mild to moderate lower extremity-related functional limitation (mean 51, SD 22, range 0-80). Foot health among people with MS associated with gender, being on sick leave due to foot problems, perceived knowledge levels of foot self-care, and self-evaluated level of foot health. Moreover, weak but significant correlation between foot health and lower extremity function was found, indicating that a poorer foot health was associated with more difficulties in performing lower extremity-related actions.

Conclusion: The results suggest that not only are foot problems among people with MS extremely prevalent, but they also impact functional ability. People with MS could benefit from regular rehabilitative care that includes access to podiatric care. Future research is needed to develop and evaluate strategies to support self-care in lower extremity health among people with MS.

Objective: This study aims to investigate whether alterations in the lower extremity kinematics, kinetics, and muscle activity of individuals with chronic ankle instability (CAI) occur during landing with expected and unexpected inversion perturbations.

Methodology: PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were searched for relevant studies up to November 30, 2024. Comparative studies investigating the characteristics of lower extremity kinematics, kinetics, and muscle activity in individuals with CAI compared with healthy controls were included. Two independent reviewers extracted the data. Certainty of the evidence was assessed using the Newcastle-Ottawa Scale (NOS) approach.

Synthesis: Thirteen studies involving 207 patients with CAI and 215 healthy controls were included. Individuals with CAI exhibited increased activity of the tibialis anterior muscle before landing (SMD = 0.28 and 95% CI: 0.03-0.54). The delayed activation of the peroneus longus muscle (SMD = 1.35 and 95% CI: 0.90-1.80) and increased co-contraction index in the sagittal plane (SMD = 0.41 and 95% CI: 0.06-0.77), ankle inversion angle (SMD = 0.56 and 95% CI: 0.30-0.81), ankle inversion range of motion (SMD = 0.83 and 95% CI: 0.42-1.24), and knee extension moment (SMD = 0.71 and 95% CI: 0.32-1.11) were observed after landing. Besides, subgroup analysis revealed that the anticipation of perturbations influenced muscle activation patterns, with significant differences in peroneus longus latency and coactivation indices.

Conclusion: Patients with CAI may present differences in lower extremity biomechanics during expected and unexpected inversion-perturbed landings compared with healthy controls. The results of this work may have clinical implications in the development of more effective and targeted rehabilitation programs for individuals with CAI.

Trial registration: PROSPERO registration number: CRD42024615006.

Introduction: Foot disease is a leading cause of national disease burdens and is driven by diabetes. General practitioners (GPs) play a gatekeeper role in many national healthcare systems. Yet, national foot disease management by GPs has not been explored. We explored the management of foot disease by Australian GPs in people with and without diabetes.

Methods: We analysed 16 years of annual, cross-sectional, GP encounter data from the nationally representative Australian Bettering the Evaluation and Care of Health study in which a foot disease problem was managed. Factors independently associated with foot disease encounters by GPs were assessed using multivariable logistic regression.

Results: Foot disease management rates increased from 11.6 per 1000 GP encounters (95% CI: 10.8-12.5) in 2000-2001 to 14.4 (13.3-15.4) in 2015-2016 and 6.1 (5.7-6.6) to 8.7 (8.1-9.3) per 100 Australian people. The rate of GP foot disease management was 2.4-fold higher in people with diabetes compared to those without diabetes (31.5 [26.4-36.6] vs. 12.9 [11.8-14.0]). Foot disease encounters were positively associated with diabetes, male patients, older patients, English-speaking backgrounds and having healthcare concession cards (all, p < 0.05); for patients with diabetes, only males were positively associated. Most frequent management actions used were medications, procedures and pathology with referrals, counselling and imaging least frequent.

Conclusions: Australian GP management rates for foot disease are higher than many more well-known health conditions and increasing. GPs frequently manage foot disease with medications and procedures, but relatively rarely counsel or refer. Future strategies to improve GP foot disease management and referrals are needed.

Background: Acute Charcot neuroarthropathy (CN) is a rare but serious complication of diabetes that requires timely diagnosis and evidence-based management to prevent long-term disability. In regional or rural settings, delivering evidence-based care is particularly challenging due to systemic and contextual barriers.

Objective: To explore the perceptions of patients and health professionals about assessment, diagnosis and management of acute CN in a regional Victorian health service.

Method: This study used a qualitative research design, utilising thematic analysis of semi-structured interviews with patients with previous acute CN and focus groups with health professionals (orthopaedic surgeons, podiatrists and prosthetists and orthotists) involved in the assessment and management of patients with acute CN. Two assessors used inductive thematic analysis to identify key themes related to acute CN care delivery.

Results: Four overarching themes were identified: (1) barriers to evidence-based care, including delayed diagnosis, limited access to skilled clinicians and diagnostic tools and the burden of treatment; (2) enablers, such as timely access to knowledgeable clinicians and resources; (3) mitigating factors, including patient engagement, empathetic communication and multidisciplinary support and (4) strategies for improvement, such as public and professional education, upskilling of health professionals and integration of psychological and person-centred support.

Conclusion: Improving outcomes for people with acute CN in regional or rural settings requires a multifaceted approach. Enhancing awareness, building workforce capacity and embedding patient-centred care practices are essential to ensure timely diagnosis, equitable access to treatment and improved quality of life.

Background: Midfoot osteoarthritis (OA) affects one in eight people over 50, yet its impact on foot and lower limb kinematics remains poorly understood. This study compared foot and lower limb kinematics during level walking and stair climbing between people with and without symptomatic radiographic midfoot OA.

Methods: Symptomatic radiographic midfoot OA was defined as midfoot pain in the last 4 weeks and radiographic OA in one or more midfoot joints. Cases aged ≥ 45 years were matched 1:1 for sex and age (± 5 years) to controls. A 10-camera motion analysis system was used to capture foot and lower limb kinematics during level walking and stair climbing, which were analysed with a validated multi-segmental lower limb model. Group differences were analysed using independent samples t-tests and effect sizes for discrete angles, whereas statistical parametric mapping compared kinematic patterns between groups.

Results: We included 24 midfoot OA cases (mean age 64.4, SD 9.5) matched to 24 controls (mean age 65.2, SD 10.1). During level walking, people with midfoot OA walked slower and displayed absolute joint angles that showed less hip extension throughout stance, less knee flexion in early and late stance, less ankle dorsiflexion throughout stance (medium to large effects), greater subtalar pronation in late stance, and greater tarsometatarsal supination during early stance (medium effects). There were few differences during stair ascent and descent.

Conclusion: People with midfoot OA walk slower and demonstrate medium to large differences in sagittal plane hip, knee, and ankle kinematics, and medium differences in subtalar and tarsometatarsal kinematics. These findings offer insights into the walking patterns of people with midfoot OA and the mechanisms that may contribute to or result from the condition. Prospective studies are needed to clarify the temporal relationship between these factors and midfoot OA development.