INTRODUCTION:Charcot neuroarthropathy (CN) can result in severe destruction of the foot and the ankle. Additional episodes of acute CN in the same or contralateral foot cause additional burden. This study aimed to explore Australian high-risk foot podiatrists' understanding of recurrent and contralateral CN in individuals with diabetes. METHODS:Semi-structured online interviews were conducted. Interviews were audio-recorded and transcribed. Thematic content analysis was used. RESULTS:Five themes were identified in relation to recurrent and contralateral CN-two were related to potential risk factors: patients and systems and addressing clinical complexity, two were related to preventive interventions: protection as prevention and knowledge and surveillance and one was related to barriers to implementing preventive interventions: financial and personal endurance. The most reported risk factors were reduced adherence to management and lack of knowledge. Many preventive interventions were reported, but there was a lack of consensus on standardised care, and due to significant barriers, these interventions were not frequently used. CONCLUSION:This study found that participants perceived a range of potential risk factors for recurrent and contralateral CN. They also reported a variety of preventive interventions; however, due to associated barriers, these were not frequently applied. Further rigorous research is needed to develop evidence-based guidelines.

INTRODUCTION:Falls are a major concern for older women and can result in significant injury. Footwear has been shown to improve or impair balance performance in older women, contingent upon footwear design features. Balance-enhancing shoes may reduce the risk of falling but their acceptability is unknown. Acceptability is important because it influences the level of adherence to the intervention. The aim of this trial protocol is to describe the methodology of a randomised crossover trial to compare the acceptability of balance-enhancing outdoor shoes versus minimalist outdoor shoes in older women and compare the effects of these two interventions on the perceived risk of falling and balance performance. METHODS:The trial will use a randomised two-period crossover trial methodology. We will recruit 44 community-dwelling women aged 65 years or older who will be randomised to receive a pair of minimalist shoes (Basic Lace Up Canvas Shoes, Kmart Australia Ltd, Mulgrave, Australia) or a pair of balance-enhancing shoes (Balla Balance Leather Lace Up Boots, Ziera Australia, Abbotsford, Australia), which encompass key features known to be beneficial for balance such as adequate fixation, a firm heel counter, high heel collar, firm midsole and textured insole. The order of the interventions will be randomised. Cross-over to the second shoe condition will occur at 6 weeks. Outcome measures will be collected at baseline, six and 12 weeks; the primary endpoint for assessing footwear acceptability for each shoe condition will be 6 weeks. The primary outcome measure will be footwear acceptability, evaluated using a modified version of the Monitor Orthopaedic Shoes Questionnaire. Secondary outcome measures include perceived risk of falling (the Falls Efficacy Scale International) and balance performance (upper body stability when walking, using the GyKo wearable sensor). DISCUSSION:This trial will evaluate the acceptability, perceived risk of falling and balance performance of minimalist shoes versus balance-enhancing shoes. The findings will provide much-needed evidence as to the acceptability of these two shoe types in older women. Such information may support footwear design to increase balance performance and reduce risk of falling. TRIAL REGISTRATION:Australian and New Zealand Clinical Trial Registry (ACTRN12624001496505).

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.

Objectives First metatarsophalangeal (MTP) joint osteoarthritis (OA) is a common and disabling foot condition, but the relationship between localised joint changes with pain severity is poorly understood. This study aimed to investigate the association between joint changes on magnetic resonance imaging (MRI) with pain severity in individuals with first MTP joint OA. Methods This cross-sectional study used baseline data from 80 participants aged 36 to 74 years (mean [SD] = 57.5 [8.8]) with first MTP joint OA enrolled in two randomised trials. MRI atlas features assessed included osteophytes, bone marrow lesions, bone cysts, effusion-synovitis, cartilage loss, and joint space narrowing. Pain severity was measured using a visual analogue scale. Regression analyses included linear, multivariable models, with exploratory stepwise forward-selection analyses to identify MRI features associated with pain severity. Results Osteophytes, joint space narrowing, bone marrow lesions in the proximal phalanx and sesamoids, cysts, and effusion-synovitis were not associated with pain severity in unadjusted or adjusted analyses. In contrast, first metatarsal head bone marrow lesions (involving >66% of the first metatarsal head) were significantly associated with pain severity in adjusted (p = 0.025) and subsequent stepwise analyses (p = 0.039). Cartilage loss was additionally associated with pain severity in the stepwise analysis (p = 0.047). Conclusion MRI-detected bone marrow lesions in the first metatarsal head and cartilage loss are associated with pain severity in first MTP joint OA. These findings provide insights into local mechanisms contributing to pain severity in the first MTP joint OA and may support the development of targeted interventions. Further research is needed to clarify the temporal relationship between MRI-detected pathology and symptoms

ABSTRACT Background Fatty infiltration, or fatty atrophy, of the abductor digiti minimi (ADM) muscle of the foot is proposed to be associated with entrapment of the first branch of the lateral plantar nerve (i.e., Baxter's neuropathy) as part of plantar heel pain (PHP). However, this association has not been rigorously investigated. The aim of this study was to determine if there is an association between PHP and fatty infiltration of ADM. Methods This cross‐sectional observational study compared 50 participants with PHP to a control group of 25 participants without PHP who were matched at recruitment for age (± 5 years), sex and body mass index (BMI) (± 10%). Fatty infiltration of ADM was assessed on all participants using magnetic resonance imaging (MRI). Prior to assessment, four grading scales of fatty infiltration were investigated for reliability by two independent assessors using Kappa or weighted Kappa and the most reliable scale was chosen for the primary data analysis. Following this, participant characteristics were compared between the PHP and the no‐PHP groups using Chi‐squared, Mann‐Whitney U or independent samples t‐tests to ensure there were no significant differences between the two groups in characteristics that could have confounded the findings. The association between PHP and fatty infiltration was analysed using the Chi‐square test (χ2). Results In the PHP and no‐PHP groups, respectively, the mean age was 49.1 and 48.9 years, women comprised 58% and 56%, and the mean BMI was 30.6 and 30.2 kg/m2. A four‐point grading scale was found to be the most reliable scale (0.87 and 0.92 for inter‐ and intra‐rater reliability, respectively). There were no significant differences (p > 0.05) for important participant characteristics (e.g., age, sex and BMI). There was some fatty infiltration (grades 1–3) in 78% and 96% of participants in the PHP and no‐PHP groups respectively. No significant association was found (χ2 = 6.176, df = 3, p = 0.103) between PHP and fatty infiltration according to the four‐point grading scale. Conclusions After accounting for age, sex and BMI, there was no association between PHP and fatty infiltration of ADM. These findings suggest that adults with PHP do not have a greater predisposition for or amount of fatty infiltration of ADM compared to adults without PHP. Therefore, fatty infiltration of ADM is likely to be an incidental finding on MRI rather than a diagnostic sign of PHP, where Baxter's neuropathy may be present. Accordingly, clinicians should not focus on fatty infiltration of ADM on MRI to diagnose Baxter's neuropathy, or view it as a proxy marker, particularly when surgery for PHP is being considered.

BACKGROUND:Midfoot osteoarthritis is common and results in pain and disability. We compared the effects of an arch contouring foot orthosis and a flat sham insert on plantar loading in people with midfoot osteoarthritis. METHODS:Plantar loading was collected while walking with: (i) shoe-only, and either (ii) a flat sham insert or (iii) an arch contouring orthosis. Differences within groups were tested using paired samples t-tests, and differences between groups were tested using analyses of covariance. Effect sizes for within-group comparisons were calculated using Cohen's d. FINDINGS:Forty-two adults were analysed (38 women and 4 men, mean ± SD age 66.3 ± 6.7 years). The arch contouring orthosis significantly increased contact area (adjusted mean difference [MD] 3.0 cm2, 95% confidence interval [95% CI] 0.0 to 5.9; p = 0.047) and maximum force (MD 30.3 N, 95% CI 16.0 to 44.7; p < 0.001) at the medial midfoot, decreased maximum force at the lateral forefoot (MD -28.2 N, 95% CI -42.9 to -13.5; p < 0.001), decreased peak pressure at the heel (MD -36.2 kPa, 95% CI -65.1 to -7.4; p = 0.015) and increased peak pressure at the medial midfoot (MD 19.8 kPa, 95% CI 7.0 to 32.5; p = 0.003). Within the arch contouring orthosis group, increases in maximum force and peak pressure at the medial midfoot were large and very large (d = 0.90 and 1.21, respectively). INTERPRETATION:The arch contouring orthosis increased plantar loading at the medial midfoot and decreased loading at the heel. Further studies are required to investigate if these effects are related to symptomatic improvements.

The absence of agreed methods to diagnose Achilles tendinopathy impedes research and clinical practice. This gap results in heterogeneous and/or poorly described study samples, making it challenging to apply findings in clinical practice. The aim of this Delphi study was to define consensus on (1) diagnostic domains; (2) differential diagnoses; and (3) conditions requiring further medical attention, when assessing for Achilles tendinopathy.We conducted a sequential three-stage process which included: (1) identifying diagnostic domains, differential diagnoses and conditions requiring further medical attention based on existing scoping reviews and clinical practice guidelines; (2) developing Delphi survey questions; and (3) administering a five-round Delphi online survey. Consensus was defined as ≥70% agreement.52 participants completed the surveys. Four diagnostic domains were deemed essential and reached consensus (pain location (93%); pain during activity (97%); tests that provoke pain (87%); palpation to assess pain (83%)). 15 differential diagnoses reached consensus: 2 for both midportion and insertional (partial tear (80%); posterior ankle impingement (78%)), 6 for midportion (plantaris tendinopathy (84%); tibialis posterior or flexor hallucis longus tendinopathy/tenosynovitis (72%); flexor digitorum longus tendinopathy (77%); accessory soleus muscle (74%); paratendinopathy (86%); sural nerve neuropathy (81%)) and 7 for insertional (superficial (88%) and retrocalcaneal bursitis (86%); Haglund's/calcaneal exostosis (80%), intratendinous calcifications (73%); Sever's disease (78%); calcaneal stress reaction/fracture (80%); subtalar/ankle pain (71%)). Six conditions requiring further medical attention reached consensus: (Achilles tendon rupture (83%); systemic inflammatory joint disease (86%); metabolic syndrome (75%); familial hypercholesterolaemia (77%); endocrine and hormonal disorders (80%); drug reactions (77%)).This consensus identified essential diagnostic domains, differential diagnoses and conditions requiring further medical attention that should be considered when assessing for Achilles tendinopathy.

OBJECTIVE: To evaluate the efficacy of heel lifts in people with midportion Achilles tendinopathy. DESIGN: This was a parallel-group randomized, sham-controlled, participant- and assessor-blinded trial conducted at a single center (Victoria University, Institute for Health and Sport, Melbourne, Australia). METHODS: One hundred and eight participants (38 females and 70 males; mean age, 48 years; standard deviation, 10 years) with midportion Achilles tendinopathy, diagnosed clinically and confirmed by ultrasound, were randomly allocated to either a heel lift (n = 54) or sham intervention (n = 54) group. The primary outcome was pain intensity (11-point numerical rating scale) at 12 weeks. Differences between groups were analyzed using an intention-to-treat approach with analysis of covariance. RESULTS: There was 100% follow-up of participants at 12 weeks. Pain intensity reduced by a mean of 3.7 points in the heel lifts group and 2.5 points in the sham intervention group. On average, there was a significant between-group difference in favor of heel lifts for reducing pain intensity (adjusted mean difference, -0.9; 95% confidence interval [CI]: -1.7, -0.2; P = .02), which approximated, but did not meet the predetermined minimum important difference of 1.5 points. The primary analysis was not robust to sensitivity analysis when controlling for expectation (adjusted mean difference -0.7; 95% CI: -1.5, 0.0; P = .06). CONCLUSION: In adults with midportion Achilles tendinopathy, heel lifts demonstrated greater efficacy than a sham intervention for reducing pain intensity at 12 weeks, but this benefit was small and may not be clinically meaningful. These results do not support the use of heel lifts for the primary management of Achilles tendinopathy. J Orthop Sports Phys Ther 2025;55(9):1-10. Epub 1 August 2025. doi:10.2519/jospt.2025.13422.

Objective:Intra-articular corticosteroid injections are commonly used in the management of foot and ankle OA. Although current clinical guidelines advocate the judicious use of corticosteroid injection as an adjunct therapy, none of these recommendations are specific to the foot and ankle. Therefore, the aim of this review is to examine the effectiveness of intra-articular corticosteroid injections in people with foot or ankle OA. Methods:Four databases (Cumulative Index to Nursing and Allied Health Literature [CINAHL], MEDLINE, EMBASE and CENTRAL) and one clinical trial register (International Clinical Trials Registry Platform [ICTRP]) were searched from inception to June 2024 for randomized control trials (RCTs) and quasi-RCTs evaluating corticosteroid injection in the treatment of foot or ankle OA on pre-specified outcomes: pain, function, quality of life, safety (adverse events) and/or cost-effectiveness. Two independent reviewers conducted record screening, data extraction (Cochrane data extraction tool) and assessment of methodological quality (Cochrane Risk of Bias tool [RoB 2.0]). Results:From 1711 citations, two RCTs (57 participants, 49% males) were identified. There were no differences in pain or function over 8 weeks after a single injection of intra-articular corticosteroid compared with prolotherapy for treatment of first metatarsal joint OA. Pain and function significantly improved in people having three corticosteroid injections combined with hyaluronic acid compared with corticosteroid injections alone for treatment of post-traumatic subtalar OA. Methodological quality was graded as some concerns in both trials. Conclusion:There is insufficient evidence to guide the use of intra-articular corticosteroid injections for OA of the foot or ankle. Future robust research is needed to provide reliable evidence for this commonly performed treatment.

Abstract Introduction Work‐readiness is linked to health professional graduates' job performance, satisfaction, engagement and retention. However, there is currently no podiatry‐specific graduate employer work‐readiness survey tool that has been developed with employers of graduate podiatrists. The aim of this study was to conduct a modified Delphi survey to achieve consensus among employers of podiatry graduates on the key capabilities required for podiatry graduates. Methods A Delphi method of consensus development was used, comprising three online survey rounds. Purposive sampling was used to recruit individuals with extensive experience and knowledge in mentoring and managing graduate podiatrists in Australia or New Zealand. In Round 1, participants were asked to rate agreement/disagreement with 71 items across seven domains relating to capabilities required of podiatry graduates that were extracted from a literature search and steering committee input. Participants were also asked to contribute further ideas in relation to these items, which were incorporated as new items (n = 7) in Round 2. In Rounds 2 and 3, participants re‐appraised their ratings in view of the group consensus. Consensus was defined as ≥75% agreement. In Round 3, participants were also asked to rate the importance of each item as either ‘essential’ or ‘optional’. Results Twenty‐five participants (mean [SD] of 14.9 [5.7] years of experience in managing podiatry graduates in clinical practice in Australia or New Zealand) completed Round 1, 24 in Round 2, and 23 in Round 3. Of the 78 items presented to our expert panel, 61 (78.2%) achieved consensus and were accepted, and 17 (21.8%) were excluded. Of the 61 items that achieved consensus, thirty‐nine (63.9%) were rated as ‘essential’ by 75% of more respondents. Conclusion Consensus among employers of podiatry graduates was established on the key capabilities required for podiatry graduates. Sixty‐one items were identified across seven domains, and of these, 39 items were rated as ‘essential’. The findings of this study have the potential to inform the creation of a podiatry‐specific graduate employer work‐readiness tool to provide feedback to podiatry education program providers and new graduates in the workplace.

Narrow fitting footwear is a modifiable risk factor for the development of hallux valgus (HV). Despite this, the pressure that footwear exerts at the medial forefoot has not been fully evaluated in people with HV. Therefore, the objective of this study was to determine whether the toe box of footwear habitually worn by women with HV is associated with pressure exerted on the medial forefoot. In-shoe peak pressure and maximum force at the medial forefoot (distal and proximal sites) were recorded from 28 women (mean age 60.7 years, SD 10.7) with moderate or severe HV using the pedar pad pressure system (Novel GmbH, Germany). The shape (width and area) of the participants' most symptomatic foot and toe-box of their usual footwear was determined using an INFOOT 3D laser scanner (I-Ware Laboratory, Japan) and hand tracing, respectively. The difference between the foot and corresponding footwear measurements as well as differences in the magnitude and timing of peak pressure and maximum force between the proximal and distal forefoot were determined using independent t-tests. Correlations between forefoot pressures with toe-box differential were determined using Spearman's ρ analyses. Peak pressure and maximum force were significantly greater (mean difference [MD] = 33.0 ± 15.4 kPa; p < 0.001 and 12.8 ± 7.3 N; p = 0.001) and occurred slightly later in the stance phase at the distal forefoot compared to the proximal forefoot (MD = 6.0 ± 6.9%; p = 0.083 and 6.9 ± 6.8%; p = 0.045, respectively). There were no significant correlations between toe-box differential and medial forefoot pressures, with all correlations less than 0.35 (p > 0.05). Toe-box shape and fit of footwear typically worn by older women with painful HV was not associated with increased medial forefoot pressures in this study sample. Therefore, changing the toe-box width and area of the usual footwear worn by older women with painful, moderate or severe HV may not necessarily reduce medial forefoot pressures where footwear does not appear to play a role.

Midfoot osteoarthritis (OA) is a common and disabling condition, yet lacks clinical guidelines for its assessment and management. This study aimed to investigate strategies used by Australian podiatrists to assess and manage midfoot OA. An exploratory cross-sectional survey of podiatrists working in Australia was conducted. Respondents were invited through professional organisations to complete an online questionnaire on their usual assessment and management practices for midfoot OA, based on a vignette. Between November 2022 and July 2023, 103 participants (52% women, mean age 40 years) with an average of 15 years of clinical experience responded. Physical assessments (including history taking and musculoskeletal assessments) (96%) and medical imaging (90%) were commonly used diagnostic methods, with palpation (96%), passive movement testing (95%) and x-ray imaging (62%) frequently reported. Associated impairments were assessed with range of motion testing of the midfoot (96%), gait analysis (95%), functional tests (83%), muscle strength (72%), and observation of static alignment (71%), including foot posture (69%). Most participants assessed comorbidities (93%), body composition (66%) and cognitive/psychosocial impairments (62%). Treatment approaches included footwear advice (97%), orthotic therapy (85%), strapping/taping (81%), education (79%), and exercise therapy (75%). One-third (34%) expected a ‘satisfactory’ treatment response within two months, and 36% would refer to another healthcare practitioner for co-management between two and three months if treatment was ineffective. A wide range of approaches are used to assess and manage midfoot OA. These findings have potential to inform the design of future studies in developing valid assessment approaches and effective interventions for this condition.

OBJECTIVE:To investigate whether self-reported exercise adherence to a 12-week calf exercise program is associated with pain and function in individuals with Achilles tendinopathy. METHODS:A secondary analysis of a randomised controlled trial, examining self-reported exercise adherence data in 127 participants with Achilles tendinopathy performing a 12-week rehabilitation program. Exercise adherence measures - frequency, volume, and intensity along with patient outcomes - VISA-A and pain, were collected via self-report questionnaires at 6 and 12 weeks. RESULTS:Completion rates were high (91 %-95 %) for adherence assessments and reported outcome measures. Adherence to frequency (78 %-58 %) reduced from 6 to 12 weeks, but adherence to sets (83 %-79 %) and repetitions was stable over this period (59 %-63 %). Pain and function (VISA-A) scores significantly improved over time. Linear mixed modelling revealed adherence to sets (p = 0.04), repetitions (p = 0.013), and added weight (p = 0.002), were significantly associated with higher VISA-A, and adherence to repetitions (p = 0.014) were significantly associated with lower pain, whilst also controlling for potential confounders. Adherence to frequency was not associated with either outcome. CONCLUSION:Although adherence to frequency of exercise is commonly assessed in the literature, it was not associated with clinical outcomes in people with Achilles tendinopathy performing a 12-week rehabilitation program. However, using more weight and doing higher volume may have some relationship with improvement in clinical outcomes. This study highlights the need for researchers to improve their measurement and reporting of exercise adherence in Achilles tendinopathy.

BACKGROUND:The decline in podiatry student enrolments at universities across Australia and New Zealand presents a workforce crisis that threatens the profession's sustainability and the delivery of essential healthcare services to communities. Recent data highlight a limited understanding of the podiatry profession among allied health students. There is now a clear need for strategies to address negative stereotypes and to build knowledge of the profession's scope of practice, career opportunities, job prospects and earning potential. As part of a larger research initiative, this study explored student perspectives on marketing the podiatry profession to increase student enrolments. METHODS:A convergent mixed methods study design was employed. Participants included students enrolled in (i) podiatry and (ii) relevant 'non-podiatry' health, sport or science programs at nine Australian universities and one New Zealand university. Data were collected via an online survey (278 podiatry students and 553 non-podiatry students responding) and two online workshops with nine first-year podiatry students. Quantitative data were analysed using descriptive statistics and regression models, while qualitative data underwent inductive thematic analysis by three independent assessors. We integrated the data by exploring the connections between the quantitative and qualitative findings. RESULTS:Findings revealed that over 40% of podiatry students had initial concerns about their course and 34.2% had considered leaving. Instagram and Facebook were identified as the most influential social media platforms for sourcing information about courses and careers. Four over-arching themes emerged as important marketing strategies for increasing student enrolments: (i) enhance the visibility, perception and advocacy of podiatry; (ii) emphasise holistic and diverse practice in podiatry; (iii) enable early exposure and experience of podiatry practice and (iv) improve course entry pathways and flexibility. CONCLUSIONS:An evidence-based approach is required to enhance the visibility and appeal of podiatry as a career. Strategies should focus on addressing misconceptions about the discipline, expanding promotional efforts to broader audiences, leveraging relevant media platforms, reducing financial and academic barriers for prospective students, and improving study flexibility. Strengthening enrolments and reducing attrition are fundamental to ensuring the sustainability and growth of the podiatry profession in Australia and New Zealand.

OBJECTIVE:To conduct a bibliographic analysis of English language, non-surgical research pertaining to foot osteoarthritis (OA). DESIGN:A Scopus® database search was conducted to identify all non-surgical foot OA articles published in English up until December 2023. Bibliometric analysis was performed using an open-source tool based on the R language. Citations, journals, authors, institutions, and countries were described. Publications were manually categorised according to research type and funding source. RESULTS:The search strategy yielded 121 eligible articles, which received a total of 4531 citations and were published by 372 authors in 55 journals. The highest publication output occurred in the past decade. The most frequent journals were Arthritis Care & Research, Osteoarthritis and Cartilage, Journal of the American Podiatric Medical Association, Annals of the Rheumatic Diseases, Foot & Ankle International and Journal of Foot and Ankle Research. The most published institutions were Keele University, La Trobe University, the University of Leeds, the University of Melbourne and the University of North Carolina. Of the 106 articles that could be classified, most were focused on aetiology (n=52, 49%), followed by evaluation of treatments and therapeutic interventions (n=28, 26%), detection, screening and diagnosis (n=17, 16%), health and social care services research (n=6, 6%) and underpinning research (3, 3%). Fifty-one articles (42%) reported no research funding. CONCLUSION:Foot OA research has increased significantly in the past decade. There is a need, however, to improve our understanding of the condition and to address the relatively small number of clinical trials that have been conducted.

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.

BACKGROUND:Footwear, orthoses, and insoles have been shown to influence balance in older adults; however, it remains unclear which features, singular or in combination, are considered optimal. The aim of this scoping review was to identify and synthesise the current evidence regarding how footwear, orthoses, and insoles influence balance in older adults. Four electronic databases (MEDLINE, CINAHL, Embase, and AMED) were searched from inception to October 2023. Key terms such as "shoe*," "orthoses," "postural balance" and "older people" were employed in the search strategy. Studies meeting the following criteria were included: (i) participants had a minimum age ≥60 years, and were free of any neurological, musculoskeletal, and cardiovascular diseases; (ii) an active intervention consisting of footwear, foot orthoses, or insoles was evaluated; and (iii) at least one objective outcome measure of balance was reported. SUMMARY:A total of 56 studies from 17 different countries were included. Three study designs were utilised (cross-sectional study, n = 44; randomised parallel group, n = 6; cohort study n = 6). The duration of studies varied considerably, with 41 studies evaluating immediate effects, 14 evaluating effects from 3 days to 12 weeks, and 1 study having a duration of 6 months. Seventeen different interventions were evaluated, including/consisting of textured insoles (n = 12), heel elevation (n = 8), non-specific standardised footwear and changes in sole thickness or hardness (n = 7 each), sole geometry or rocker soles, contoured or custom insoles and high collar height (n = 6 each), insole thickness or hardness and vibrating insoles (n = 5 each), outsole tread (n = 4), minimalist footwear and slippers (n = 3 each), balance-enhancing shoes, footwear fit, socks, and ankle-foot orthoses (n = 2 each), and eversion insoles, heel cups, and unstable footwear (n = 1 each). Twenty-three different outcomes were assessed, and postural sway was the most common (n = 20), followed by temporo-spatial gait parameters (n = 17). There was uncertainty regarding intervention effectiveness. Overall, features such as secure fixation, a textured insole, a medium-to-hard density midsole and a higher ankle collar, in isolation, were able to positively impact balance. Conversely, footwear with an elevated heel height and the use of socks and slippers impaired balance. KEY MESSAGES:There is a substantial body of literature exploring the effects of footwear, orthoses, and insoles on balance in older adults. However, considerable uncertainty exists regarding the efficacy of these interventions due to variability in methodological approaches. Further high-quality research is necessary to determine whether a singular intervention or a combination of interventions is most effective for enhancing balance in older adults.

OBJECTIVE: To describe and compare pain maps reported during Achilles tendon loading exercises with recall pain location, in people with pain on palpation in their Achilles tendon and tendon pathology on imaging. DESIGN: Cross-sectional analysis of baseline RCT. METHOD: Participants were recruited from a larger Achilles tendinopathy clinical trial. Inclusion criteria were at least 2-month self-reported history of Achilles tendinopathy, midtendon palpation pain, and pathology on ultrasound tissue characterization. Participants were asked to identify their Achilles tendon pain location on a pain map with 8 prespecified locations while at rest prior to loading (recall pain), and subsequently during tendon loading exercises (loading pain). Participants could select multiple locations or select "other" if the locations did not represent their pain. RESULTS: Ninety-three participants were included (93% of participants from a clinical trial). The locations of pain on loading were diverse; all 8 pain locations (and an "other" option) were represented within this sample. Twenty-five percent of participants did not report pain with loading (n = 23 of 93). Of the 70 participants with loading pain, recall pain location differed to loading pain location in 40% (n = 28 of 70) of the participants. CONCLUSION: Palpation pain location, recall pain location, or location of pathology on imaging were not valid proxies for load-related pain in the Achilles tendon. How different pain locations respond to treatment is unknown. Some pathologies (eg, plantaris) have clear pain locations (eg, medial tendon), and assessing pain location may assist differential diagnosis. J Orthop Sports Phys Ther 2024;54(1):86-94. Epub 7 December 2023. doi:10.2519/jospt.2023.12131

AbstractBackgroundPodiatry 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.MethodsThis 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.ResultsOverall, 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.ConclusionsThere 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.