Journal of Foot and Ankle Research最新文献

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.

Introduction: Diabetes-related foot disease (DFD) is a significant and costly complication of diabetes in Australia and Aotearoa New Zealand (NZ). Diabetes footcare education is considered a cornerstone of DFD prevention and management, with podiatrists playing a key role in education provision. This systematic review evaluated the nature and composition of diabetes footcare education provided by podiatrists to people living with diabetes in Australia and NZ.

Methods: Medline, EBSCO, Megafile Ultimate and Cochrane library databases were conducted from inception until January 31, 2024 to identify studies reporting on the mode of delivery and composition, including frequency, of diabetes footcare education provided to people with diabetes by podiatrists in Australia and NZ.

Results: From a total of 226 abstracts screened, 4 studies with 878 participants were included. Three studies were from Australia and 1 from NZ. Studies included podiatrists in both private and public health sectors and used cross-sectional web-based surveys or observation. Components of diabetes footcare education included education on neuropathy and vascular foot health, footwear and general foot health/hygiene. This education was provided by podiatrists from both countries routinely. Verbal education was the most frequently used method of delivery. There was no significant difference between content, mode of delivery and frequency of diabetes footcare education between private and public practitioners in either country. No studies reported on culturally responsive content or education delivery methods.

Conclusion: There are little available data on the composition or mode of delivery of diabetes footcare education provided by podiatrists in Australia and NZ to people living with diabetes. A range of footcare education is provided, most frequently verbally. Further qualitative research is required to conclusively establish the composition and delivery methods used for diabetes footcare education provided by podiatrists. In addition, the provision of culturally responsive diabetes footcare education and availability of related culturally responsive supporting resources is yet to be established.

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.

Introduction: The fifth metatarsal fracture is a foot injury that occurs in sports activities. This fracture has been associated with risk factors based on intrinsic variables such as type of feet (flatfoot or cavus foot), foot pathologies, and bone density among others. Extrinsic variables associated with fifth metatarsal fractures include sports maneuvers, the type of sports practice, and contact surface. Although this injury has been investigated over the years, there is no consensus on the most relevant risk factors that cause this injury. An increase in the number of people with fractures makes it a relevant topic of research. The objective of this review was to identify an overview of the risk factors for producing the fifth metatarsal fracture based on intrinsic and extrinsic variables in sports activities. Furthermore, this review aimed to clarify what is known and what is needed on the risk factors that can influence the appearance of the fracture.

Methods: A search in electronic databases, such as Scopus (n = 87), PubMed (n = 187), and Web of Science (n = 173) was conducted. The initial search yielded 447 titles and abstracts, from which 31 papers were selected for detailed analysis after screening all citations against the eligibility criteria.

Results: After screening the manuscripts, it was found that the fifth metatarsal fracture can be produced by multiple factors. However, most of the studies focus on one or two specific risk factors. It was found that soccer (38.7%) is the sports activity that presents a higher risk of getting a fifth metatarsal fracture compared to other sports activities. The second risk factor was the performance of critical maneuvers (22.5%) and the third one was the biomechanics of the foot (22.5%).

Conclusion: It is paramount to identify the most critical risk factors linked to the fifth metatarsal fracture to be able to implement effective treatments and prevention strategies.

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.

Background: Collective evaluation of studies assessing students' self-perceived cultural capability following clinical placement is required to help inform future cultural capability training for both university and healthcare service environments. Therefore, the aim of this systematic review was to evaluate studies investigating health professional students' self-perceived cultural capability following participation in a clinical placement with First Nations Peoples.

Methods: Electronic database searchers were conducted in MEDLINE, EMBASE, AMED, PsychINFO, Pubmed, CINAHL and Informit. Hand Searches of grey literature were conducted including Lowitja institute, Australian Indigenous HealthInfoNet, Menzies School of Health Research, Services for Australian Rural and Remote Allied Health, and the Australian Institute of Health and Welfare. Studies published in English that investigated health professional students' self-perceived cultural capability before and after clinical placement undertaken with First Nations people in Australia were eligible for inclusion. Two authors independently screened potentially eligible studies and performed quality appraisal and data extraction.

Results: A total of 14 studies were included (n = 307 participants). Studies included undergraduate students from podiatry, medicine, nursing, pharmacy, and mixed health professions. The results of this systematic review suggest that clinical placements in health services or settings for Aboriginal and Torres Strait Islander Peoples that involve elements of co-design are effective in increasing aspects of health professional students' self-perceived cultural capability. This outcome was consistent across studies regardless of the location of clinical placements (urban or rural), type of clinical placement (health setting or Community), or length of placement.

Conclusions: The findings from this systematic review suggest that clinical placement in health services or settings for Aboriginal and Torres Strait Islander Peoples may contribute to increased self-perceived cultural capability in health professions graduates. However, the impact of the placements on the cultural safety of student-led care, from a First Nations perspective, remains to be established.

Background: In podiatry, there are a variety of clinical tasks that require precision and skill and it is expected that clinicians will obtain these skills during their training. Simulation is a dynamic teaching tool used in healthcare to enhance skill and knowledge acquisition. Currently, the extent and nature of the research on the use of simulation in podiatry teaching and learning are not clear.

Aim: A scoping review was conducted to identify the extent and nature of research activity on the use of simulation in podiatry teaching and learning and identify gaps in the existing literature.

Methods: Any research relating to simulation use in podiatry teaching including various designs and focusing on simulations aimed at improving podiatry teaching or learning were eligible for inclusion. A systematic search was conducted on February 14, 2024 of the following databases: Embase (via Embase.com), MEDLINE (via PubMed), CINAHL, and the Web of Science. Additional papers were identified via bibliographies of included studies. Content analysis of content relating to podiatry teaching and learning was performed and grouped into broad themes, then further narrowing to six themes.

Results: A total of 21 research studies were deemed eligible for inclusion focusing on diverse aspects of podiatry simulation utilized in high-income countries exclusively. Conducted between 1997 and 2023, these studies were categorized into six key themes: skill improvement, communication and professionalism, clinical competencies and patient safety, educational enhancement, and anatomy and histology education. The simulations, carried out by or assessed for podiatry professionals, staff, or students, ranged from high-fidelity medical mannequins to low-fidelity simulations such as a grapefruit model of a diabetes-related foot ulcer.

Conclusion: Overall, the findings suggest that simulation teaching in podiatry, whether through direct skill enhancement or through educational impact assessments, holds potential in improving competency, confidence, and educational outcomes in podiatry practice. This scoping review identified a small yet diverse evidence base for simulation modalities in podiatry education, demonstrating gaps in long-term effects and comparative effectiveness studies. It highlights the urgent need for research focused on longitudinal impacts, evaluating various simulation technologies and standardizing best practices to improve podiatry education and align with clinical and patient care needs.

Introduction: Falls are one of the most frequent difficulties in patients with Parkinson's disease. The objective of this study was to determine the relationship between foot pain and the risk of falls in participants with Parkinson's disease compared to a group of participants without Parkinson's disease.

Materials and methods: The subjects (124) were divided into two groups, cases (n = 62) and controls (n = 62). They completed the Downton scale that collects the following 5 dimensions: previous falls, medications, sensory deficit, mental state, and ambulation.

Results: Analyzing the Downton scale using dimensions, a significant difference was observed between both groups in all dimensions except mental state. Regarding the global result of risk of falls, the participants who had a diagnosis of Parkinson's disease presented a high risk of falls, 40.3% compared to 3.2% of the non-Parkinson's disease group, with statistically significant differences (p < 0.05). For the numerical value of the Downton scale, there was a clear statistically significant difference between groups (2.65 ± 0.96 vs. 1.31 ± 1.19).

Conclusion: This research confirms further evidence that people with Parkinson's disease who suffer from foot pain are at high risk of falling, regardless of gender.

Background: Podiatry enrolments at Australian and New Zealand universities have decreased by 17.3% since 2015, which threatens the profession's sustainability and the health and wellbeing of Australian and New Zealand people and communities. Reasons for this decline remain unclear due to insufficient evidence on factors influencing career choices. The overarching aim of this study was to identify motivators and barriers for studying podiatry in Australia and New Zealand.

Methods: This study used a convergent mixed methods design. Students enrolled in (i) podiatry and (ii) relevant non-podiatry health, sport or science programs at nine Australian and one New Zealand university, were invited to participate in an online survey. First-year podiatry students were also invited to participate in an online workshop. Quantitative data were analysed using descriptive statistics and linear/logistic regression models. Three independent assessors used inductive thematic analysis for the qualitative data.

Results: Overall, 278 podiatry students (mean age 24.9 ± 8.5 years, 65.1% female) and 553 non-podiatry students (mean age 24.8 ± 8.2 years, 75.4% female; 32.2% from physiotherapy and 29.1% from occupational therapy) responded to the survey. Interest in a health-related career, wanting to make a difference to people's health, and opportunity to care for people from different backgrounds/age groups were key motivating factors among podiatry students. Barriers to studying podiatry were encountered by 28.1% of podiatry students. Thematic analysis identified seven themes concerning career choice, which are as follows: (i) awareness of profession and scope of practice; (ii) stereotypes and negative perceptions of the profession; (iii) awareness of career pathways; (iv) job prospects and earning potential; (v) working with people and building relationships; (vi) podiatry is not the first preference; and (vii) barriers which limit student enrolment.

Conclusions: There are a variety of factors that motivate and influence students to study podiatry, however, altruistic reasons are most highly rated. Allied health students have limited understanding of the scope of practice and career opportunities in podiatry. Additionally, the podiatry profession often faces negative stereotypes. Further work is required to reverse the negative stereotypes and perceptions of podiatry and build knowledge of the profession's scope of practice, career pathways/opportunities, job prospects and earning potential.