Objective To examine hospitalisations caused by diabetes-related foot disease (DFD) at the largest tertiary hospital in Aotearoa New Zealand.Methods We analysed hospital admission data for DFD-caused hospitalisations from Auckland City Hospital (ACH), from 1 July 2014 to 30 June 2019, for people 15 years or older, using ICD10-AM discharge codes and amputation procedure codes. DFD-caused hospitalisations were defined where DFD was the principal reason for admission. Demographic variables and length of stay were also collected.Results During the study period, out of the total 11,222 hospitalisations in persons with diabetes, 1605 (14.3%) were DFD-caused hospitalisations, which included 265 (16.5%) minor amputations and 94 (5.9%) major amputations. There were a total of 71,033 hospital bed days in persons with diabetes, of which 16,992 (23.9%) hospital bed days were due to DFD. Median length of stay in days was 4 (IQR: 1-8) for persons with diabetes; 7 (3-14) for DFD-caused hospitalisations, 13 (8-22) for minors and 17 (13-26) for major amputations. The DFD-caused hospitalisation rate per 1000 persons with diabetes increased by 86% from 6.2 (95% CI: 5.2, 7.2) in 2014/15 to 11.5 (10.2, 12.8) in 2018/19 and combined minor and major amputation rates increased 82% from 1.1 (0.7, 1.5) to 2.0 (1.4, 2.5). The rate of first DFD-caused hospitalisation was highest for M & amacr;ori at 7.5 (5.8 9.5), followed by Pacific at 5.3 (4.5, 6.2) and lowest for European/Other at 3.7 (3.3, 4.1) per 1000 person-years with diabetes.Conclusion DFD-caused hospitalisations and amputations made up nearly a quarter of all hospital bed days used by people with diabetes and nearly doubled over 5 years. The highest rates were found in adults of M & amacr;ori and Pacific ethnicity. Most DFD-caused hospitalisations did not involve amputations (78%). The high and increasing burden of DFD-caused hospitalisations suggest surveillance could monitor necessary changes to preventative foot care services.
Objectives: Heel fat pad syndrome (HFPS) is a common but under-investigated cause of plantar heel pain. No randomized controlled trials (RCTs) have evaluated targeted treatments. This study evaluated the immediate and short-term effects of novel loop taping on pain, function, and fat pad thickness in adults with HFPS. Design: Two-period crossover pilot RCT. Interventions: Participants completed two taping conditions (loop and control) in randomized order, separated by a 4-to-7-day washout, with each participant serving as their own control. Outcome Measures: The primary outcome was immediate change in heel pain during the most painful weightbearing activity [0-10 numeric pain rating scale (NPRS)]. Secondary outcomes at 3 days post-taping included changes in Foot Health Status Questionnaire (FHSQ) Pain and Function scores [0 (worst)-100 (best)] and in average 24-h heel pain (NPRS). Mechanistic outcomes included heel fat pad thickness and pressure pain threshold (PPT). Linear mixed effects models estimated between-condition differences. Results: Among 16 paired observations, loop taping produced a small, non-significant between-condition difference in change in immediate activity-related pain (mean difference 0.8; 95% CI: -0.1 to 1.7; p = 0.10); 63% (loop) versus 25%-31% (control) met minimal clinically important difference (MCID) thresholds. Between-condition differences favored loop taping for FHSQ Pain (20.7 points; 95% CI: 4.5 to 36.8; p = 0.02) and Function (11.3 points; 95% CI: -1.0 to 23.6; p = 0.09), exceeding MCIDs of 12.4 and 6.4 points. Fat pad thickness increased by 1.7 mm (95% CI: 1.2 to 2.3; p < 0.001) and correlated with improvement in FHSQ Pain. PPT did not differ between conditions. Conclusions: Loop taping showed favorable trends for reducing pain and improving function and significantly increased heel fat pad thickness. Although underpowered for definitive conclusions, several outcomes exceeded MCIDs. Findings support the potential of loop taping and inform primary outcome selection and design considerations for future, larger trials of this low-cost, pathomechanics-based intervention.
ABSTRACT Introduction Weak intrinsic foot muscles may lead to foot pain, altered foot posture, single‐leg balance issues, and altered gait. Short foot exercises can strengthen intrinsic foot muscles, which can improve foot posture and single‐leg balance. This study tested the efficacy of a training device designed to strengthen intrinsic foot muscles, the FootCore MAX, for decreasing pain, improving single‐leg balance, improving foot posture, and increasing comfortable walking speed. Methods Thirteen participants with chronic foot pain (10 female; 25.4 ± 4.3 yrs; body mass index 26.7 ± 6.8) performed 6 weeks of at‐home short foot exercise using the FootCore MAX training device. Pre‐ and post‐training visits included questionnaires, single‐leg balance testing, foot posture measures, and comfortable and fast walking speeds. Participants also rated their foot pain before and after each lab visit. Results Foot and Ankle Outcome Score pain subscore decreased 30% (37 ± 18 to 26 ± 15, p = 0.040) after 6 weeks of training. Foot and Ankle Disability Index scores decreased 25% (4 ± 4 to 4 ± 3, p = 0.032), indicating disability decreased. Foot and Ankle Ability Measure total scores improved by 14% (72 ± 15 to 82 ± 16 p = 0.015), indicating ability improvement. Visual analog pain rating scores showed a significant interaction between both the beginning and end of lab visits as well as pre‐ and post‐training ( p = 0.002), suggesting pain scores were influenced by the training, as pain scores significantly increased from the beginning to the end of the pre‐training lab visit (12 ± 11 to 27 ± 14, p = 0.001), but not from beginning to end of the post‐training lab visit (14 ± 13 to 16 ± 18, p = 0.314). Preferred gait speed significantly increased with training (1.06 ± 0.33 to 1.16 ± 0.20, p = 0.008). Neither fast walking speed, balance, or foot postural measurements changed from pre‐ to post‐training ( p > 0.05). Conclusion Six weeks of short foot exercise training with the FootCore MAX can improve foot pain and increase comfortable gait speed.
ABSTRACT Background Prolonged standing is common in manufacturing and assembly‐line work and is associated with musculoskeletal discomfort, especially in the lower limbs and spine. The influence of foot posture, morphology, and plantar loading patterns on this discomfort remains unclear. Objective To analyze the associations between foot posture, plantar pressure, and 3D foot morphology with work‐related musculoskeletal discomfort in standing workers and to examine the role of BMI and the potential modifying role of sex. Methods A cross‐sectional study was conducted among 240 assembly‐line workers (129 women, 53.8%). Musculoskeletal discomfort was assessed using the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). Foot posture (FPI‐6), baropodometry (FreeMed), and 3D foot morphology (DOMESCAN) were evaluated under standardized conditions. Participants were classified as having low (CMDQ ≤ 10) or moderate–high (≥ 11) discomfort. Firth‐penalized logistic regression analyzed associations between overall CMDQ discomfort, foot posture, sex, and BMI, including an FPI × sex interaction term. Results All workers reported at least one musculoskeletal discomfort response, with the feet, neck, and lumbar region accounting for the largest proportions of reported discomfort. Among women, pronated foot posture was associated with higher odds of moderate–high overall CMDQ discomfort (OR = 2.91, 95% CI 1.10–7.28). Overweight/obesity status was associated with higher odds of foot and hip/gluteal discomfort, whereas, among women, pronated foot posture was associated with greater odds of lumbar discomfort. The pronation–discomfort association was stronger in women and attenuated in men. Conclusions Among women, pronated foot posture was associated with greater overall work‐related musculoskeletal discomfort during prolonged standing and with greater odds of lumbar discomfort, whereas overweight/obesity status was associated with greater odds of foot and hip/gluteal discomfort. The pronation–discomfort association was attenuated in men. From an occupational‐health perspective, incorporating foot‐posture and BMI assessment into ergonomic evaluations may help identify workers who could benefit from more individualized preventive strategies, particularly women with pronated feet.
ABSTRACT Introduction Squamous cell carcinoma (SCC) is a malignant tumour arising from epidermal keratinocytes and is the second most common form of skin cancer globally. Although relatively rare on the foot, SCC and its variants may occur in people with diabetes and can mimic common diabetes‐related foot ulcerations. This diagnostic overlap presents a risk of delayed recognition and treatment. The aim of this review was to synthesise published case reports of SCC occurring in the diabetic foot and to describe patient characteristics, clinical presentation, and outcomes. Methods A review of case reports was conducted in accordance with the PRISMA guidelines. Electronic databases (Medline, CINAHL, SPORTDiscus and SCOPUS) were searched up to September 2025 using relevant terms for SCC and its variants. Studies describing clinical cases of SCC arising on the foot in individuals with diabetes were included. Results Thirty‐one cases from 13 countries were included. The mean age of patients was 62 years, with a predominance of males (71.0%) and type 2 diabetes (64.5%). Lesions most affected the right foot (64.5%) and were frequently located on the toes or plantar surfaces. The mean lesion duration prior to diagnosis was 61.9 months (range 2–360; n = 25). Initial misdiagnosis was most commonly as a foot ulcer (54.8%), followed by a wart (19.4%) and osteomyelitis (12.9%). Final diagnoses included SCC (51.7%), verrucous carcinoma (35.5%), and Marjolin's ulcer (12.9%). Pain was reported in 58.1% of cases despite neuropathy being present in 45.2%. Recurrence occurred in 16.1% of cases. Conclusions Squamous cell carcinoma in people with diabetes‐related foot disease is rare but frequently misdiagnosed, resulting in prolonged lesion duration prior to diagnosis. Clinicians should maintain a high index of suspicion for malignancy in atypical or non‐healing foot lesions, particularly those with unusual features or persistence despite treatment. Early biopsy is essential for timely diagnosis and optimising outcomes.
