BACKGROUND:Diabetic foot ulcers (DFUs) are a serious complication of diabetes, with a lifetime risk of up to 34%. Despite preventive guidelines, gaps remain in the care chain. This study aimed to identify and prioritise improvements in DFU prevention, care, and self-care in the Region Västra Götaland, Sweden. METHODS:A participatory action research design was used as part of a larger observational co-design study. Patients with diabetes, healthcare professionals, and researchers participated. Data were collected through Concept Mapping to generate and cluster ideas, followed by a workshop to prioritise improvements. The improvements were assessed regarding feasibility and importance ranging from 0 to 7, with exceptions that some participants scored ideas > 7. RESULTS:Thirty-one participants contributed and based on 83 ideas five clusters were generated: (1) Examination of the feet by healthcare professionals, (2) Exchange of knowledge/Exchange of experiences, (3) Access to podiatry, (4) Economy/Equal care, and (5) Other/Support for self-care. In a workshop with 22 participants, the three prioritised ideas were: (1) Having access to podiatry if problems occur, (2) Getting help when problems arise, and (3) Information from the healthcare about the importance of good foot healthcare. These ideas got 80% or more of all votes within each of the five clusters and were scored > 5 for feasibility and of > 7 for importance. Other prioritised ideas involved enhancing individual self-care capabilities and maintaining personalised interactions despite digitalisation. CONCLUSIONS:Timely access to podiatry, increased foot health awareness among healthcare professionals, and rapid intervention when problems arise were identified as key priorities for improving DFU care and patient outcomes.
PURPOSE:This study investigated foot muscle and plantar fascia size measurements and their relationship with static balance dysfunction in stroke patients. METHODS:This cross-sectional study included 90 stroke patients (3-12 months post-stroke) and 95 healthy controls. Ultrasound imaging quantified thickness and cross-sectional area (CSA) of intrinsic foot muscles (e.g., flexor hallucis brevis), extrinsic foot muscles (e.g., tibialis anterior, peroneus longus), and plantar fascia segments. Force platform measured center-of-pressure (CoP) parameters during 30-s static standing under eyes-open and eyes-closed conditions. RESULTS:Stroke patients exhibited significantly reduced peroneus longus (d = 1.14, p < 0.001) and tibialis anterior (d = 0.70, p < 0.001) muscle sizes, reduced flexor hallucis brevis muscle thickness (d = 0.76, p < 0.001), and increased plantar fascia thickness in middle and posterior segments (d = 0.74, p < 0.001; d = 0.71, p < 0.001). In healthy controls, foot muscle parameters strongly correlated with balance metrics, with flexor hallucis brevis thickness showing significant correlation with mediolateral displacement under eyes-closed conditions (r = -0.52, p < 0.001). However, no significant correlations between structural parameters and balance metrics were observed in stroke patients after false discovery rate correction, indicating structural-functional dissociation. CONCLUSION:Although stroke patients exhibited mixed size changes in foot-ankle structures, the dissociation between structural changes and balance function suggests that dysfunction is primarily attributable to central nervous system damage rather than to peripheral structural alterations. This implies that rehabilitation should focus on neuromuscular control training rather than on isolated muscle strengthening.
INTRODUCTION:Up to one in two individuals who have a history of an ankle injury will develop chronic ankle instability, which subsequently increases the risk of osteoarthritis development. Although lateral ankle ligament injuries are the most common, recent research shows that concomitant injuries to the deltoid (medial collateral) ligament complex may be more prevalent than previously recognised. However, the anatomy and biomechanics of the deltoid ligament complex are reported inconsistently in the literature. This systematic review will summarise current evidence on the anatomy and biomechanics of the deltoid ligament complex in healthy adult ankles. METHODS:Searches will be conducted in Scopus, MEDLINE, Embase, CINAHL and SPORTDiscus. Our search strategy will cover terms associated with 'deltoid ligament', 'anatomy' and 'biomechanics'. We will only include dissection and imaging studies published in English that report any of the listed clinically relevant properties of the deltoid ligament in healthy adult human ankles. Two reviewers will independently perform screening and assess study quality using the anatomical quality assessment (AQUA) tool. One reviewer will extract relevant data, which will be independently verified by co-authors. Primary outcomes include band prevalence, length, width, cross-sectional area, maximum and/or failure load and elastic modulus. If three or more studies report a primary outcome, we will conduct a meta-analysis and report findings as pooled means with 95% confidence intervals. If a meta-analysis is not feasible, outcomes will be summarised as a narrative analysis. Measures will be taken during data synthesis to address anticipated methodological heterogeneity across included studies, and pooled estimates will be interpreted with caution. DISCUSSION:This protocol details a systematic review that aims to summarise the anatomy and biomechanics of the deltoid ligament complex. Our findings will inform computational modelling, clinical management and biomechanics for ankle pathologies, as well as identifying research gaps and directions for future research. TRIAL REGISTRATION:PROSPERO: CRD420251142867.
INTRODUCTION:Off-road activities such as trail running and hiking have undergone a significant surge in global popularity over the last 2 decades, but this engagement also raises the potential for musculoskeletal injuries, which are prevalent and comparable to rates reported in road running. Footwear is critical in these dynamic environments, incorporating features such as aggressive outsole patterns and structural stability elements to accommodate varied and rugged terrain. METHODS:Given the limited synthesis and fragmented nature of the literature, this scoping review systematically mapped and summarised existing research on the influence of footwear in hiking and trail running. The review was guided by three research questions that examined key outcome domains and methodological approaches, using the Arksey and O'Malley framework, and was reported in accordance with PRISMA-ScR guidelines. RESULTS:A search across four databases identified 16 eligible studies. Thirteen studies (81%) focused on trail running, exploring various footwear types, including advanced footwear technology, minimalist designs, and specific midsole characteristics. Biomechanical outcomes were the most frequently investigated (62% of studies), while physiological outcomes, performance, injury, and comfort were addressed in 25%-31% of studies each. CONCLUSION:Although methodological strengths include an increasing commitment to ecological validity by leveraging wearable sensors in combined lab and field protocols, persistent limitations include frequent use of small sample sizes and the underrepresentation of female participants in many controlled trials. A significant evidence gap remains regarding the chronic effects of prolonged footwear use and the interaction of footwear with fatigue. Future research requires methodological standardisation and longitudinal studies to advance toward individualised, evidence-based footwear solutions.
INTRODUCTION:Diabetes-related foot ulceration (DFU) is a serious complication, serving as a leading cause of amputation, disability, hospitalisation and a significant contributor to healthcare costs. Deficiencies in vitamin C and other micronutrients are common in DFU. Emerging evidence suggests vitamin C supplementation may enhance wound healing; however, high-quality randomised controlled trials are lacking. Therefore, the aim of this study is to investigate the efficacy of oral vitamin C supplementation (1 g/day) for 8 weeks on wound healing in people with DFU. METHODS:This is a multi-site, parallel group, randomised, placebo-controlled, double-blind trial. Eighty adults with DFU will be recruited and randomly assigned to either placebo or vitamin C supplementation (500 mg twice daily). Ulcer measurements will be obtained at baseline, 2, 4, 6 and 8 weeks with all other measures collected at baseline and 8 weeks. The primary outcome measure is the percentage reduction in ulcer size (ulcer volume in mm3) at 8 weeks, compared to baseline. Secondary outcomes are changes in plasma vitamin C, time to 50% ulcer healing, time to complete ulcer healing, rate of healing of ulcers and adverse events. Exploratory outcomes include changes to glycaemic status, blood lipids, blood pressure, peripheral arterial perfusion, mental health and well-being, scurvy signs and symptoms and oxidative stress. DISCUSSION:The findings from this research will provide high-quality evidence on the efficacy of vitamin C for wound healing in people with DFU and help to inform clinical practice regarding vitamin C supplementation alongside current standard care to aid in the healing of DFUs. TRIAL REGISTRATION:Australian and New Zealand Clinical Trials Registry (ACTRN12624000675527). Universal Trial Number (UTN) U1111-1308-1050.
Orthotic interventions are commonly used in the management of first metatarsophalangeal (MTP) joint osteoarthritis, yet recent systematic review evidence suggests that their average treatment effects are small and unlikely to represent clinically meaningful benefit for the average patient. This has led to a growing perception that orthotics may have limited clinical value. However, such conclusions risk oversimplifying the evidence by conflating a lack of average treatment effect with a lack of utility for individual patients. This commentary explores this tension through critical appraisal of the current evidence base and consideration of treatment effect heterogeneity. It argues that responder heterogeneity, combined with the biomechanical specificity of first MTP osteoarthritis, may explain why orthotics provide substantial benefit for some patients despite weak average effects in trials. The discussion further highlights a mismatch between current osteoarthritis guidelines, which emphasise exercise as a core treatment, and the limited capacity for exercise to meaningfully influence joint loading in distal joints such as the first MTP. Drawing on evidence from hip osteoarthritis, including the CLEAT trial, the commentary contrasts capacity-based and load-modifying interventions and proposes a shift towards more mechanistically informed and individualised treatment strategies.
INTRODUCTION:Therapeutic orthoses, such as medical shoes and custom insoles, are used to prevent diabetic foot ulcer (DFU) recurrence. This systematic review with narrative synthesis aimed to evaluate the effectiveness of orthoses in preventing DFU recurrence compared to standard care. METHODS:We followed PRISMA guidelines for a systematic review. Searches were conducted in PubMed, Cochrane, and Web of Science. RCTs on orthoses for preventing DFU recurrence were included. Risk of bias was assessed using Cochrane tools. Due to heterogeneity, narrative synthesis was used. RESULTS:An initial search of 4166 articles identified ten randomized controlled trials (RCTs) that met the inclusion criteria and were included in this review, focusing on patients living with diabetes at risk of DFU recurrence compared to usual care. Narrative synthesis of the 10 RCTs, involving 1686 participants, showed that custom orthoses reduced recurrence in several studies (e.g., Bus 2013 reported 9.9% recurrence vs. 25% in controls), though the evidence was heterogeneous due to variability in orthosis types and follow-up periods. CONCLUSION:Orthoses can prevent diabetic foot ulcer recurrence, and we recommend their use where feasible. Further research is needed to optimize their clinical application.
INTRODUCTION:This study compared the cross-sectional areas (CSA) of key intrinsic foot muscles in people with and without plantar heel pain (PHP). METHODS:Seventy-five adults participated in the study: 50 participants with PHP and 25 age-, sex-, and body mass index (BMI)-matched participants without PHP (control group). Cross-sectional images were generated using 3.0T magnetic resonance imaging (MRI). CSAs of four intrinsic foot muscles-abductor hallucis, quadratus plantae, flexor digitorum brevis and abductor digiti minimi-were measured. The difference in CSA of each muscle was compared between the groups using independent samples t-tests and Cohen's d effect sizes were calculated. RESULTS:Participants were well matched: mean age 49.1 and 48.9 years, women accounted for 58% and 56%, and BMI 30.6 kg/m2 and 30.2 kg/m2 in the PHP and control groups, respectively. There were no significant differences in mean CSAs for all four muscles (p > 0.05) between the PHP and control groups, and effect sizes were tiny or very small. CONCLUSION:This study found no differences in muscle CSAs of key intrinsic muscles of the foot in people with and without PHP, indicating that people with PHP do not have key intrinsic foot muscle size deficits. As such, intrinsic muscle size does not appear to be a logical therapeutic target for PHP. Clinicians translating our findings into practice should, therefore, consider whether strengthening interventions targeting intrinsic muscles in PHP are warranted.
BACKGROUND:Learning anatomy is an essential part of the process of becoming a podiatrist. Anatomical knowledge underpins the assessment, diagnosis and management of lower limb pathology and competent professional practice. However, anatomy remains a challenging subject for students and educators. We have therefore developed an application to aid students in their continued learning and revision of anatomy in podiatric undergraduate training. METHODS:This qualitative exploration sought the experiences and perceptions of six undergraduate podiatry students as they used the application alongside their traditional studies. Participants were provided with an iPad, a stylus and the necessary application and given 6 months to use the app. We convened a focus group to collect data on their experiences and opinions for how the app could be improved. Data were analysed using a reflexive, thematic approach. RESULTS:Results were organised into two main themes: Engagement, and Improvements and Implementation and 5 sub-themes: "Learning control and personalisation: a change from the norm" "Applicability to clinical practice" "Beyond anatomy" "Desired improvements, training and timing" and "Not just for independent learning". These themes illustrated participants' positive experience with the app from an educational perspective as well as their suggestions for improvement. CONCLUSIONS:Participants engaged well with the note-taking application and found learning from it enhanced their understanding of musculoskeletal practice in particular. They were positive about the independent learning opportunity it provided and could see uses beyond anatomy for future development. This project has enabled us to understand students' approaches to learning better and therefore be in position to develop the application more effectively for future use.
BACKGROUND:Ongoing colonisation of the land now known of Australia includes Western hegemony in biomedical knowledge systems dominating healthcare provision. Racism remains structurally entrenched in Australian systems of health and wellbeing. This has serious implications for First Nations foot health outcomes. The purpose of this work is to empower First Nations-led codesign of ways of working in foot health research to investigate challenges to attending, and barriers to providing, good foot care with and for First Nations Peoples. METHODS:Aboriginal Participatory Action Research ways of working in this study are documented in previous publication; 'Working right ways in foot health with and for First Nations Peoples: research method guided and governed by First Nations ways of knowing, being, and doing in cross-sectional qualitative study design'. First Nations-led study design used decolonised language in semi-structured interviewing to talk with consenting participants. Data analysis included all transcripts being anonymised and transcribed verbatim by researchers manually. First Nations-led ways of doing thematic analysis was agreed upon by all authors. RESULTS:Two talking points discussed First Nations and non-Indigenous health practitioners' perspectives of providing good foot care with and for First Nations Peoples: (1) What challenges exist in attending individual/organisational services? (2) What are barriers to providing good foot care? In interviews, themes emerged of relationships, disempowerment, education, and clinical governance. Additionally, racism, distance, and funding were perceived as influencing foot care provision. Although not themed, the constructs of time and their importance, were interwoven through results. CONCLUSION:Participants described relationships which were not culturally centred, nor longer term, and which therefore limited trust, as being a challenge to attending foot health services. This research identified service barriers to providing good foot care with and for First Nations Peoples as distance and funding. Compounding barriers was lack of health professional cultural capability education impacting clinical services; this being dependant on individuals' behaviours and knowledges, and services' governance. Further work needs to centre the cultures and leadership of First Nations individuals, families, and Communities in working with and for them to keep feet strong.
BACKGROUND:Footwear fit advice for patients and people with diabetes varies significantly. A review of the strength of evidence for footwear fit standards developed in peer-reviewed studies is urgently needed both to inform future research and guidelines. METHODS:We performed a systematic review to summarise and evaluate strength of evidence (GRADE) and risk of bias (Newcastle-Ottawa Scale) of footwear fit standards in peer-reviewed research studies involving people with diabetes through a search of Medline, Scopus, Embase and Web of Science databases. RESULTS:Wearing incorrect shoe size increased DFU risk by up to 10 times (OR 1.7, p = 0.001 to OR 10.4, p < 0.001) based on 4 studies (risk of bias: poor (n = 3) to good (n = 1), but GRADE strength of evidence was Low to Moderate). GRADE strength of evidence for recommended footwear length, width and depth were very low to low. No studies were found examining DFU risk or in-shoe pressure in shoelace alternatives, varying toe box shapes, heel width or height. CONCLUSION:Strength of evidence for current footwear fit guidelines is limited. Footwear fit guidance should currently be based on assessing adequate shoe size, with further research required to determine quantitative ranges for toe gaps, etc.
BACKGROUND:Ultrasonography is commonly used to evaluate ligament injuries following acute lateral ankle sprain. However, the clinical significance of structural changes in ligament thickness during the healing process remains unclear. This study aimed to evaluate whether changes in anterior talofibular ligament (ATFL) thickness are associated with functional clinical outcomes. METHODS:This study was a retrospective analysis of prospectively collected cohort data involving 32 patients with acute lateral ankle sprain enrolled between January 2024 and March 2025. All patients underwent conservative treatment and were followed for up to 12 weeks after injury. Patients were excluded if they had a history of prior ankle sprain, fracture, deformity, previous surgery involving the foot or ankle, or avulsion-type ATFL injury. Standardized ultrasound examinations were performed at baseline and at 3, 6, and 12 weeks after injury. ATFL thickness was measured bilaterally at the ligament midpoint, and an injured-to-healthy thickness ratio was calculated. Functional outcomes were assessed at 12 weeks using the visual analog scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, and Cumberland Ankle Instability Tool (CAIT). Temporal changes were analyzed using repeated-measures ANOVA, and correlations were assessed using Pearson correlation analysis. RESULTS:The ATFL thickness ratio decreased significantly over time (p < 0.05), suggesting progressive structural remodeling during healing. Clinical outcomes improved significantly (all p < 0.001). However, no significant associations were detected between the ATFL thickness ratio and functional outcome measures at any time point (all p > 0.05). CONCLUSIONS:Although serial ultrasonography demonstrated progressive morphological remodeling of the ATFL following acute lateral ankle sprain, the present study did not detect a significant association between the ATFL thickness ratio and short-term functional outcomes. These findings suggest that ultrasonographic thickness alone may not fully reflect clinical recovery.
INTRODUCTION:First metatarsophalangeal (MTP) joint osteoarthritis (OA) is a common and disabling condition that causes substantial pain and impairs quality of life. Cushioned insoles have the potential to lower plantar pressures beneath the hallux and possibly reduce pain, but their clinical effectiveness has not been investigated. This study describes the protocol for a randomised controlled trial (RCT) assessing whether daily use of cushioned insoles produces greater reductions in first MTP joint walking pain, and other symptoms, over 12 weeks than sham insoles. METHODS AND ANALYSIS:This two-arm, parallel group, superiority RCT will recruit 108 community-dwelling adults aged 45 years and older with symptomatic radiographic first MTP joint OA. Participants will be randomised to receive three pairs of either cushioned insoles (6 mm low-density ethyl vinyl acetate (EVA)) or visually similar thin sham insoles (2 mm high-density EVA), to be worn for 12 weeks. The primary outcome is the 12-week change in first MTP joint pain during walking, assessed using an 11-point numerical rating scale (0-10, higher scores worse pain). Secondary outcomes include 12-week changes in physical function, other measures of first MTP joint pain, health-related quality of life, physical activity, and fear of movement. Global ratings of change in pain and function will also be assessed at 12 weeks. Other measures will also be collected. Analyses will include all participants as randomised using linear and log-binomial regression adjusted for baseline values. Prespecified sensitivity and moderator analyses will also be conducted. ETHICS AND DISSEMINATION:This study has been approved by the University of Melbourne Greater than Low Risk Human Research Ethics Committee. Findings will provide the first evidence regarding the efficacy of cushioned insoles for the management of first metatarsophalangeal joint OA. Results will be disseminated via peer-reviewed journals, scientific conferences, information on our website and lay summaries for participants. TRIAL REGISTRATION:Prospectively registered on the 14 of December 2023 with the Australian New Zealand Clinical Trials Registry, reference ACTRN12623001304628.
BACKGROUND:Tarsal tunnel syndrome (TTS) is a relatively uncommon compressive neuropathy of the posterior tibial nerve that is often underdiagnosed due to variable presentation and overlap with other conditions. As patients increasingly turn to YouTube for health information, concerns have arisen about the reliability and comprehensibility of such content. METHODS:On December 23, 2024, YouTube was queried using the terms "tarsal tunnel syndrome," "tarsal tunnel release," and "tarsal tunnel injection." After excluding duplicates, unrelated, non-English, and short (< 30 seconds) videos, 88 were reviewed and the 50 most-viewed were analyzed. Each was evaluated using three tools: the Journal of the American Medical Association (JAMA) benchmark criteria (0-4) for reliability, a 4-point Likert scale for comprehensibility, and a 19-point Tarsal Tunnel Syndrome-Specific Score (TTS-SS) for educational content. Video source, content type, and video power index (VPI) were also recorded. The Shapiro-Wilk test assessed normality, and Kruskal-Wallis and Wilcoxon rank sum tests compared group with Holm adjustment. RESULTS:The median TTS-SS educational content score was 5.2 (IQR 3.0-8.0). Mean JAMA and comprehensibility scores were 2.0 and 2.6, respectively. Only 10% of videos met all four JAMA criteria, and fewer than 20% were rated as highly comprehensible. Disease-specific videos had the highest TTS-SS (mean = 6.8), while non-surgical management scored lowest (mean = 2.8, p = 0.025). Videos by trainers and physical therapists had higher VPI (mean = 338.4) than those by physicians (mean = 0.26, p < 0.001), despite lower educational value. Surgical technique videos were least comprehensible (mean = 1.4) compared with other types (p < 0.05). CONCLUSION:Among the most-viewed English-language YouTube videos sampled at a single time point, content related to TTS demonstrated generally low educational completeness, reliability, and comprehensibility. While healthcare professionals produce more accurate content, their videos attract less engagement than those by non-physicians. Improving visibility of evidence-based videos is necessary to ensure patients receive accurate information for this underrecognized condition.
PURPOSE:Chronic lateral ankle instability (CLAI), categorized by repetitive ankle sprains, has previously been studied utilizing either questionnaires or ankle sprain simulators. However, a quantitative tool that safely creates an unexpected ankle sprain during gait has not been proposed. This study aimed to determine if a novel ankle sprain simulator differentiates between CLAI and healthy controls and compare findings to known measures of impaired function. METHODS:Thirty-two feet were assigned to the CLAI group or the control group. Participants walked on a treadmill wearing boots designed to induce unexpected ankle inversion. To do so, the device was triggered randomly during swing to induce instability during loading response. Maximal inversion velocities (MIV) were measured immediately after initial contact. A Ratio MIV was determined by dividing the MIV of the simulated sprain by the average MIV of the 5 steps preceding the simulated sprain. Also, Identification of Functional Ankle Instability (IdFAI) and the Foot Ankle Ability Measurement (FAAM) questionnaires were collected. RESULTS:Mean MIV in the CLAI and Control groups were 213.5 ± 54.7°/s and 177.0 ± 64.2°/s (p = 0.02), while mean Ratio MIV were 1.22 ± 0.13 and 1.08 ± 0.08 (p < 0.001), respectively. The area under the curve to predict CLAI was 0.83 (95% CI; [0.73; 0.93]) for Ratio MIV with a value greater than 1.15 showing 68% sensitivity and 93.8% specificity. Ratio MIV was moderately correlated with IdFAI (ρ = 0.50; p < 0.0001) and weakly correlated with impairments in activities of daily living (ρ = -0.45; p < 0.001) and sports (ρ = -0.43; p < 0.001). CONCLUSION:Inversion velocities caused by the ankle sprain simulator differentiated CLAI from healthy controls. Ratio MIV was associated with measurements of functional CLAI, impairments in ADLs and sports.
BACKGROUND:Accurate knowledge of the supramalleolar anatomy of the tibial nerve is essential for safe ultrasound-guided procedures and proximal nerve interventions in the foot and ankle. However, quantitative in vivo ultrasound reference data describing its positional anatomy at this level remain scarce. METHODS:An in vivo ultrasound anatomical study was conducted in 100 healthy volunteers to evaluate the supramalleolar position of the tibial nerve. Measurements included the distance from the medial border of the tibial cortex to the center of the nerve, nerve depth from the skin surface, nerve perimeter, and the anatomical relationship between the tibial nerve and the posterior tibial artery. Associations with sex and anthropometric variables were analyzed using appropriate inferential statistical tests. RESULTS:Ultrasound imaging demonstrated a stable and predictable anatomical configuration of the tibial nerve at the supramalleolar level, with bifurcation observed in only 1% of cases. Men showed a greater distance between the tibial nerve and the medial tibial cortex compared with women (p = 0.009), whereas women exhibited greater nerve depth (p = 0.003). The tibial nerve-tibial cortex distance was positively correlated with body weight (p < 0.001), body mass index (p = 0.001), and malleolar circumference (p = 0.004). No significant associations were observed between anthropometric variables and the anatomical relationship between the tibial nerve and the posterior tibial artery (p > 0.05). CONCLUSIONS:The tibial nerve at the supramalleolar level exhibits a stable in vivo anatomical arrangement with minimal branching variability. These ultrasound-based reference values provide clinically relevant information that may enhance diagnostic assessment and support ultrasound-guided procedural planning in the foot and ankle.
BACKGROUND:Lateral wedge insoles (LWIs) are a non-surgical adjunct treatment for knee osteoarthritis (OA) that has been shown to reduce the knee adduction moment-a biomechanical risk factor for knee OA disease progression. Though worn in one's shoes, little is known of the effects of LWIs use on the foot or ankle. Importantly, it unknown whether their use enhances foot symptoms in people with knee OA and concomitant foot pain, thus questioning the general appropriateness of their use in this subgroup. METHODS:We conducted a pilot, feasibility randomized controlled trial to assess study approaches and general effects of LWIs use in people with knee OA and foot pain. 30 individuals with foot pain and radiographically-confirmed knee OA were randomized to a 12-week intervention using either standalone 6-degree LWIs or LWIs integrated with custom foot and arch support. Feasibility outcomes included: recruitment and retention outcomes; insoles usage, reporting, and comfort; and adverse events. We also examined foot (Foot Function Index pain and difficulty subscales) and knee symptoms (Knee Osteoarthritis Outcomes Severity Score pain and daily function subscales), and gait biomechanics (knee adduction and flexion moment peaks and impulses, ankle/subtalar eversion peaks) before and after the 12-week intervention. RESULTS:All feasibility criteria were met, and no major adverse events were reported. Participants found the insoles moderately comfortable (7/10), and most weeks (278/336, 83%) met the acceptable 30 min per day wear time threshold. Though no statistical comparisons were made, changes in clinical and biomechanical outcomes were consistent with previous research; specifically, trends toward improvement in knee pain and function, as well as knee adduction moment magnitudes, in both groups. CONCLUSION:Lateral wedge insoles, with or without support, appear safe for people with knee OA and concomitant foot pain. Given positive feasibility and efficacy observations, future research in this area is warranted.
INTRODUCTION:Thinning of fat pads may elevate the risk of developing plantar foot ulcers potentially resulting in lower-extremity amputations. Evaluating whether fat pad thickness is associated with plantar foot ulceration could aid in early risk detection. This study therefore aims to compare fat pad thickness between type 2 diabetes mellitus (T2DM) patients with and without plantar foot ulcers using MRI. METHODS:This retrospective cross-sectional study included patients diagnosed with T2DM of whom a nonweight bearing MRI of the ankle or foot was available. The thickness of the calcaneal fat pad was measured in the sagittal plane, measuring perpendicularly from the lowest cortex of the calcaneal bone to and including the skin. Calcaneal fat pad thickness was compared between T2DM patients with and without plantar foot ulceration. RESULTS:In total, 42 patients were included of which 16 in the T2DM group with plantar foot ulceration. The calcaneal fat pad was significantly thinner in T2DM patients with plantar foot ulceration compared to those without plantar foot ulceration (15.7 ± 3.2 mm vs. 18.6 ± 2.8 mm, p = 0.004). CONCLUSION:This study established an initial association between fat pad thickness and plantar foot ulceration in T2DM patients. Our findings suggest that a reduction in calcaneal fat pad thickness may decrease the shock-absorbing ability of the plantar fat pads, making the underlying tissue more vulnerable to injury, increasing the risk of developing plantar foot ulcers. The initial association between fat pad thickness and foot ulceration should be further explored to discover its potential in clinical practice.
ABSTRACT Introduction To evaluate whether a 3D‐printed shoe sole can passively replicate toe‐out gait biomechanics and reduce the knee adduction moment (KAM) and knee adduction angular impulse (KAAI), addressing limitations of traditional gait retraining. Methods Custom shoe soles were 3D‐printed using gyroid infill structures to create a rotational hind‐sole and a variable stiffness fore‐sole (‘RVS’ shoes). Twenty‐one healthy adults completed three baseline gait trials in control shoes, followed by randomised biofeedback‐based gait retraining at toe‐out angles of 5°, 10° and 15°. After each retraining session, motion capture was used during overground walking. Participants then walked wearing RVS shoes for three trials. Gait biomechanics were analysed using repeated measures ANOVA and multiple linear regression. Results Compared to baseline, KAM's second peak was significantly reduced after toe‐out retraining: 5° (13.6%, p = 0.002), 10° (20.2%, p < 0.001) and 15° (31.7%, p < 0.001). RVS shoes alone reduced it by 16.3% (p < 0.001), and KAAI by 8.6% (p < 0.001)—a reduction not achieved by retraining. Regression analysis showed that changes in KAM were strongly predicted (95%) by knee centre‐of‐pressure offset and mediolateral ground reaction force. Conclusion 3D‐printed RVS shoes passively replicated or exceeded the biomechanical effects of active toe‐out gait retraining, offering a promising, low‐effort intervention for managing knee osteoarthritis.
INTRODUCTION:People at risk of diabetes-related foot ulcers are recommended to always use therapeutic footwear when weight-bearing, to help prevent ulcers. These recommendations are supported by good quality evidence, yet adherence by patients to using this footwear is low. One reason may be because these recommendations do not consider that footwear use is highly contextual to the physical or sociocultural environments it is intended to be used. In this paper, we propose and discuss a contextual approach to considering therapeutic footwear solutions. CONTEXTUAL APPROACH TO THERAPEUTIC FOOTWEAR:Recommending patients to use the same therapeutic footwear solution in vastly different contexts seems at odds with person-centred care principles and is likely a reason for patients not fully adhering to such recommendations. We discuss seven contexts in which using therapeutic footwear is particularly challenging: the home, workplaces, social occasions, places-of-worship, water-related activities, hotter climates and holidays. We outline how a contextual approach to therapeutic footwear might lead to more appropriate footwear solutions. This approach typically involves a trade-off between functional benefits and adherence and may lead to novel designs for different contexts. We also propose six different footwear solutions that incorporate features that may be more aesthetically pleasing, cooler, lighter, cheaper or waterproof, yet still providing protection and functional offloading. We suggest outcomes of such an approach may be more favourable for the patient's overall adherence and foot health than the current somewhat unrealistic recommended practice of prescribing a "one shoe fits all" solution. CONCLUSION:A contextual approach as proposed in this paper may lead to novel therapeutic footwear solutions that better address patients' needs for adequate footwear. If these footwear solutions are implemented, this may in future lead to higher patient adherence to using appropriate footwear and lower ulceration rates.
