Journal Of Foot And Ankle Research[JOURNAL]
Sun
200 papers
Long-Term Use of Anti-Pronation Insoles Enhances Inter-Joint Coordination in Individuals With Flat Feet.
Soltani N, Majlesi M, Fatahi A
J Foot Ankle Res · 2026 Mar · PMID 41513595 · Full text
BACKGROUND: Flatfoot alters lower limb biomechanics and can negatively affect interjoint coordination during gait. Antipronation insoles are commonly prescribed to correct excessive foot pronation, yet their long-term ef...
BACKGROUND: Flatfoot alters lower limb biomechanics and can negatively affect interjoint coordination during gait. Antipronation insoles are commonly prescribed to correct excessive foot pronation, yet their long-term effects on interjoint coordination remain unclear. This study aimed to examine whether prolonged use of antipronation insoles improves interjoint coordination in individuals with flat feet. METHODS: Twenty-four participants (12 with flat feet and 12 with normal arches) were included. Spatiotemporal and interjoint coordination parameters were evaluated under four gait conditions: normal gait (NG), posttest normal gait (PNG), walking with shoes (SH), and posttest walking with shoes (PSH). Gait kinematics and kinetics were recorded using a motion capture system and force plates. All participants completed a baseline gait assessment, after which the flat foot group (FFG) underwent a 6-week intervention with antipronation insoles. A follow-up gait assessment was conducted for both groups to determine the long-term effects of insole use. Interjoint coordination was analyzed using the vector coding technique. RESULTS: Following 6 weeks of insole use, the flat-foot group showed phase-dependent changes in ankle-hip coordination, with lower coupling angles than controls during loading response and swing and higher angles during push-off under the normal-gait condition (p ≤ 0.01 and ηp = 0.28-0.33). Changes in ankle-knee and knee-hip coordination were smaller and generally limited to specific gait phases. Insoles produced an overall increase in coupling angles across conditions, reflecting these phase-specific effects. Spatiotemporal analysis showed longer single-support times in controls, longer double-support times in the flat-foot group with insoles, greater baseline stride length in controls, and no between-group difference in walking speed. CONCLUSION: Long-term use of antipronation insoles improves interjoint coordination in distal lower limb joints and may contribute to a more conservative or steadier gait pattern in individuals with flat feet as reflected by phase-specific changes in spatiotemporal parameters. However, their limited influence on proximal joints underscores the need for complementary interventions, such as targeted rehabilitation exercises.
Dynamic Step-Down Tasks Reveal Altered Lower Limb Biomechanics in Chronic Ankle Instability.
Farahpour N, Yaghoubi UM, Robbins S … +2 more , Allard P, Moisan G
J Foot Ankle Res · 2026 Mar · PMID 41513591 · Full text
BACKGROUND: Accurate knowledge about biomechanical alterations in chronic ankle instability (CAI) during dynamic movements may inform rehabilitation strategies. OBJECTIVE: To identify movement patterns associated with CA...
BACKGROUND: Accurate knowledge about biomechanical alterations in chronic ankle instability (CAI) during dynamic movements may inform rehabilitation strategies. OBJECTIVE: To identify movement patterns associated with CAI injury during a step-down task. METHOD: Seventeen participants with CAI and 17 healthy controls performed a step-down task from heights of 20 and 40 cm. Lower limb joint angles, range of motion (ROM), moments, and power were measured. The one-dimensional statistical parametric mapping (SPM) test compared groups across the entire task (0%-100%). RESULTS: At 20 cm height, the CAI group exhibited greater hip abduction angles (0%-2%, p = 0.024 and 21%-77%, p = 0.014) but smaller hip abduction (7%-13%, 19%-20%, and 47%-64% (p < 0.05)), hip external rotation (8%-12% and p = 0.04), knee abduction (7%-30%, p = 0.001 and 49%-53%, p = 0.024), and ankle external rotation moments (7%-42% and p = 0.001). At 40 cm height, the CAI group showed greater hip abduction (44%-100% and p = 0.005), reduced ankle eversion (4%-12% and p = 0.012) angles, and smaller hip abduction, hip external rotation, knee abduction, ankle plantarflexion, and external rotation moments (all p < 0.05). No between-group differences were observed for the ROMs and power (p > 0.05). CONCLUSION: CAI individuals exhibited greater hip abduction, less ankle eversion, and smaller muscle moments, which are associated with an increased risk of injury. Rehabilitation should emphasize strengthening the hip muscles to mitigate the risk of injury.
Modified Star Excursion Balance Test Performance in Individuals With Chronic Ankle Instability: A Participant-Level Analysis.
Forsyth L, Simpson J, Pourkazemi F … +8 more , Torp DM, Burcal C, Koldenhoven RM, Donovan L, Jaffri A, Al Adal S, Mitchell A, Childs CR
J Foot Ankle Res · 2026 Mar · PMID 41501607 · Full text
INTRODUCTION: For 1 in 5 individuals, an initial ankle sprain results in chronic ankle instability (CAI). Research is inconclusive as to whether individuals with CAI display decreased stability performance. This study co...
INTRODUCTION: For 1 in 5 individuals, an initial ankle sprain results in chronic ankle instability (CAI). Research is inconclusive as to whether individuals with CAI display decreased stability performance. This study conducted a participant-level analysis to determine normative values for modified Star Excursion Balance Test (mSEBT) performance in a CAI population. DESIGN: Participant-level analysis. METHODS: Ten datasets of mSEBT data were combined and participants categorised into one of three groups: individuals with CAI, Copers and Healthy participants. Maximal reach distances were analysed in the anterior (ANT), posterolateral (PL), posteromedial (PM) and composite (COMP) directions. The CAI and Healthy groups were sub-categorised into 4 groups depending on the stance position and whether the average or best scores were reported. RESULTS: The final pooled data consisted of 429 participants (202 CAI; 181 Healthy; 46 Coper). The 4 CAI sub-groups recorded a mean reach of 66.53%-76.42% (ANT), 54.67%-87.16% (PM), 44.55%-83.01% (PL) and 55.25%-82.19% (COMP). Smaller reach distances were reported in Group 1's ANT, PL and COMP reaches and Group 2's ANT reach (p < 0.05) compared to the Healthy group. Copers exceeded CAI and Healthy reaches for all reaches. Reach distances in the ANT direction were generally the smallest for the CAI group and ANT and PL directions for the Healthy and Coper groups. CONCLUSION: Reduced mSEBT reach was performed in specific directions for specific sub-groups only for the CAI population compared to both Healthy and Coper. The normative data can inform clinical practice and aid decision-making regarding dynamic balance for assessment and rehabilitation purposes.
Automated Optical 3d Scanner to Assess Postoperative Edema Following Forefoot Surgery.
Beldame J, Civinini A, Munoz MA … +4 more , Sacco R, Hamza A, Lalevee M, Melone MA
J Foot Ankle Res · 2026 Mar · PMID 41466088 · Full text
BACKGROUND: Postoperative edema is a common and often underestimated consequence of forefoot surgery, potentially affecting wound healing, patient comfort, and recovery time. Traditional measurement techniques, such as w...
BACKGROUND: Postoperative edema is a common and often underestimated consequence of forefoot surgery, potentially affecting wound healing, patient comfort, and recovery time. Traditional measurement techniques, such as water displacement and circumferential taping, have limitations in the immediate postoperative period due to infection risk and operator dependence. This study aimed to quantify and monitor with a 3D optical scanner the postoperative edema following forefoot surgery and to identify risk factors associated with increased edema volume. METHODS: In this prospective, single-center observational study, 108 patients undergoing forefoot surgery were evaluated using the UPOD-S 3D optical scanner. Each patient underwent serial volume assessments of both feet at baseline (Day 0, preoperatively), and postoperatively at Days 8, 21, 45, and 3 months. Patients were classified into three groups based on the type of surgery: isolated first ray procedures, combined first ray and lesser rays procedures, and isolated lesser ray procedures. A mixed-effects multivariate model was used to evaluate the impact of sex, age, BMI, surgical type, and postoperative footwear on volume changes. RESULTS: The operated foot showed a significant increase in volume compared to baseline at all postoperative timepoints (p < 0.001), peaking at Day 21 (+78 cm; +9%). Also, when compared to Day 8 postoperative, foot volume increased by 25 cm at Day 21 (p = 0.008) and decreased by 27 cm at 3 months (p = 0.003). Male sex (+169 cm, p < 0.001) and elevated BMI (BMI 26-30: +59 cm; BMI > 30; +109 cm; p < 0.01) were independent predictors of increased edema. Surgery involving combined hallux and lesser rays led to greater volume increases (p > 0.001). Age and type of postoperative footwear had no significant impact. CONCLUSION: We monitored forefoot surgery postoperative edema using 3D optical scanning. Male sex, elevated BMI, and multiple forefoot procedures were found to be key risk factors for prolonged or increased edema, which typically peaked at Day 21 and decreased thereafter in our study.
Diabetic Foot Ulcers in Pakistan: A Silent Epidemic?-A Meta-Analysis of Observational Studies.
Ghanei Gheshlagh R, Esmaeelzadeh M, Asmat K … +1 more , Sharafi S
J Foot Ankle Res · 2025 Dec · PMID 41448152 · Full text
BACKGROUND: Diabetic foot ulcers (DFUs) are a major complication of diabetes, leading to severe morbidity and high healthcare costs. Despite numerous studies on the prevalence of DFUs in Pakistan, the findings vary widel...
BACKGROUND: Diabetic foot ulcers (DFUs) are a major complication of diabetes, leading to severe morbidity and high healthcare costs. Despite numerous studies on the prevalence of DFUs in Pakistan, the findings vary widely, making it difficult to obtain a clear estimate. To address this gap, we conducted a meta-analysis to determine the overall prevalence of DFUs among diabetic patients in Pakistan, providing a more comprehensive understanding of the burden of this condition. METHODS: A systematic search was conducted in PakMediNet, PubMed, Scopus, Web of Science, and Google Scholar without language or time restrictions. Two independent reviewers screened studies, extracted data, and assessed quality. Heterogeneity was evaluated using Cochran's Q and I. Subgroup analysis, meta-regression, and sensitivity analysis were performed. Publication bias was assessed via a funnel plot and Egger's test. The meta-analysis was conducted using a random-effects model in Stata 17. RESULTS: In this meta-analysis, 16 studies with a total of 15,333 participants were analyzed. The pooled prevalence of DFUs was estimated at 18%, with a prevalence of 19.4% in Punjab and 16.6% in other regions. The prevalence was reported as 20.8% in men and 14.9% in women. Sensitivity analysis indicated that the results were highly stable. Meta-regression revealed a significant increasing trend in the prevalence of DFUs from 1999 to 2022. Although statistical tests confirmed the presence of publication bias, the trim-and-fill method suggested that its impact was negligible. CONCLUSION: This meta-analysis provides a comprehensive estimate of the prevalence of DFUs, highlighting regional and gender differences. The findings show a significant increasing trend over time, emphasizing the growing burden of this condition. These results highlight the need for targeted prevention strategies and improved management of DFUs.
Safety and Feasibility of the Plantar Portal Technique in the Surgical Management of Plantar Fasciitis: A Cadaveric Study.
Yilmaz E, Yozgatli TK, Aktekin A … +3 more , Ozturk O, Aktekin M, Kocaoglu B
J Foot Ankle Res · 2025 Dec · PMID 41422369 · Full text
INTRODUCTION: This study investigates the proximity of the portals and nearby motor and sensory nerves in endoscopic release of the plantar fascia and the safety and efficacy of the addition of a novel third (plantar) po...
INTRODUCTION: This study investigates the proximity of the portals and nearby motor and sensory nerves in endoscopic release of the plantar fascia and the safety and efficacy of the addition of a novel third (plantar) portal to improve access to the calcaneal spur. METHODS: Nine fresh-frozen lower extremity cadavers were examined in this study. In addition to the conventional medial and lateral portals for endoscopic plantar fascia release, a third (plantar) portal was utilized to debride the calcaneal spur area. The fascia was released with the use of an obturator cannula. Each cadaver was carefully dissected, the distance of the nerves to the portals and the obturator cannula was measured with a digital caliper, and the adequacy of the plantar fascial cut was evaluated. The nerves were examined along their course to check for any injuries. RESULT: The closest distance between the lateral plantar nerve and the plantar portal was 15.3 ± 1.47 mm, and the obturator cannula was 10.53 ± 1.50 mm. The closest distance between the first branch of the lateral plantar nerve (Baxter's nerve) and the obturator cannula was 10.02 ± 0.65 mm. The closest distance between Baxter's nerve and the calcaneal spur area was 8.21 ± 1.12 mm. There was no evidence of nerve or muscle injury in the dissected cadavers. CONCLUSIONS: Using the plantar portal in conjunction with conventional portals in endoscopic plantar fasciitis surgery can be advantageous, as it provides easier access to the calcaneal spur and is safe in terms of its distance from the nearby neural structures.
Comparison of Up-on-the-Toes Stand Test Performance in Young Adults and Older Adults With Diabetic Peripheral Neuropathy.
Buckley JG, Sabouni A, Rodacki ALF … +2 more , Brown S, Reeves ND
J Foot Ankle Res · 2025 Dec · PMID 41409000 · Full text
BACKGROUND AND PURPOSE: Proficient ankle functioning provides a key contribution to everyday activities, such as walking and stair ascent and descent, where many falls occur. The up-on-the-toes stand test (UTTS), involve...
BACKGROUND AND PURPOSE: Proficient ankle functioning provides a key contribution to everyday activities, such as walking and stair ascent and descent, where many falls occur. The up-on-the-toes stand test (UTTS), involves rising from standing to an up-on-the-toes position and holding it for 5 s, before lowering back to standing. Here, we explore whether the balance-related UTTS test scores differ between two groups with expected differences in ankle functioning, that is, between older adults with diabetic peripheral neuropathy (DPN) in comparison to young healthy adults. DESIGN: Case-control study. METHODS: On a force platform, 13 older adults with DPN and 14 young adults completed repeated UTTS. Outcome measures were the peak forwards and backwards centre of pressure (CoP) velocity when rising and lowering, the average CoP displacement and variability in CoP velocity when holding the up-on-the-toes position, and the time it was held. RESULTS: In older adults with DPN compared to young adults, the forwards CoP velocity and displacement when rising up-on-the-toes were reduced (p < 0.001), indicating a slower speed and range of movement; variability in CoP velocity when up-on-the-toes was greater, indicating reduced stability (p = 0.021); and time up-on-the-toes was shorter (p = 0.002), indicating a reduced ability to hold this position. CONCLUSIONS: Findings indicate that older adults with DPN had poorer UTTS performance in comparison to young adults. This suggests the test might be useful for highlighting how deficits in ankle mobility and function can impact balance when moving up-on-the-toes. Future research should compare (a) older DPN patients with healthy older adults and (b) young adults with older adults, to determine whether UTTS test can validly assess age-related decline. In addition, case-control designs within the same age group are necessary to determine whether UTTS test can distinguish disease-specific balance deficits.
Experiences of New Zealand Podiatrists Providing Podiatry Care to People With Foot Osteoarthritis.
Molyneux P, Ma M, Bowen C … +3 more , Ellis RF, Rome K, Carroll MR
J Foot Ankle Res · 2025 Dec · PMID 41408912 · Full text
BACKGROUND: Current care provided by health professionals for individuals with osteoarthritis (OA) is inconsistent with clinical guideline recommendations. Although OA guidelines have been developed for more commonly stu...
BACKGROUND: Current care provided by health professionals for individuals with osteoarthritis (OA) is inconsistent with clinical guideline recommendations. Although OA guidelines have been developed for more commonly studied joints such as the knee and hip, foot OA remains comparatively underrepresented. Despite its high prevalence and significant impact on functional ability, foot OA lacks standardised classification criteria. The absence of clinical guidelines for foot OA underscores its importance as a research priority. Understanding current assessment and management strategies is crucial before designing clinical trials. This study aims to assess New Zealand (NZ) podiatrists' knowledge of foot OA, their assessment practices and their management strategies. Although foot OA is both highly prevalent and functionally disabling, the absence of standardised classification criteria persists. METHODS: A qualitative descriptive approach was employed for data collection and analysis. Using purposive sampling, semistructured interviews were conducted with 10 NZ registered podiatrists. An interview schedule guided discussions on diagnosing and managing foot OA. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify key meanings and patterns within the data. RESULTS: Five key themes were derived regarding the assessment of foot OA: (1) chief complaint versus incidental finding; (2) obtaining patient history through subjective interviews; (3) targeted objective assessments for foot OA; (4) determining individual biomechanical factors and (5) further investigations. Five themes were identified relating to the management of foot OA: (1) knowledge and language used to provide education about OA; (2) clinical uncertainty necessitates an iterative approach; (3) podiatry administered treatments; (4) referral pathways to other health professionals and (5) management influences. CONCLUSION: New Zealand podiatrists utilise a comprehensive diagnostic approach, integrating symptom history, joint mobility assessment and radiographic imaging particularly in the absence of formal diagnostic criteria. Management strategies align with international guidelines, emphasising education, exercise and weight management alongside podiatrist-led interventions such as foot orthoses and footwear modifications. However, the study highlights several challenges: limited evidence-based guidance, uncertainty around optimal orthotic strategies and a disconnect between evolving OA knowledge and its application into clinical practice.
Osteochondral Lesion of the Talus Amplifies Plantar Pressure Alterations and Postural Instability in Chronic Lateral Ankle Instability: A Cross-Sectional Study Based on a Wearable Smart Plantar Pressure System.
Zhu T, Chen R, Kang H … +4 more , Ding F, Guo R, Wu X, Jiang D
J Foot Ankle Res · 2025 Dec · PMID 41405502 · Full text
BACKGROUND: Chronic lateral ankle instability (CLAI) is frequently complicated by osteochondral lesion of the talus (OLT), which accelerate cartilage degeneration due to abnormal stress concentration and may progress to...
BACKGROUND: Chronic lateral ankle instability (CLAI) is frequently complicated by osteochondral lesion of the talus (OLT), which accelerate cartilage degeneration due to abnormal stress concentration and may progress to ankle osteoarthritis. However, in vivo biomechanical alterations in patients with concurrent CLAI and OLT remains unclear. This study aimed to characterize plantar pressure and stability deficits during single-leg stance (SLS) in patients with CLAI with and without OLT compared to healthy controls. METHODS: Eighty-eight participants were recruited: 29 healthy controls, 30 patients with CLAI, and 29 patients with CLAI + OLT (patients with CLAI and OLT). All participants underwent clinical assessments, including MRI-based ligament and cartilage evaluations. Plantar pressure parameters (normalized peak force [PF%]) and postural stability metrics (center of pressure [COP] and time-to-boundary [TTB]) were collected using a shoe-integrated sensor system during SLS. Among-group differences were analyzed using ANOVA and independent t-tests, with additional subgroup analyses based on gender, body mass index (BMI), and generalized joint hypermobility. RESULTS: Compared to control group, both CLAI (p = 0.028) and CLAI + OLT (p = 0.001) groups exhibited elevated medial midfoot PF% and patients with CLAI demonstrated higher PF% in third metatarsal region (p = 0.015). Patients with CLAI + OLT demonstrated reduced TTB (p = 0.032) and greater COP variance (p = 0.026) in the anterior-posterior direction. When the two sides were compared, the unaffected side in the CLAI + OLT group displayed lower PF% in the posterior heel (p = 0.012) and higher PF% in the fifth metatarsals (p = 0.030). Receiver operating characteristic curve analysis identified PF% in the third metatarsal as a moderate diagnostic marker for OLT (AUC = 0.700 and p = 0.026). Subgroup analyses revealed that patients with CLAI with males (p = 0.047), BMI < 25 (p = 0.010), and Beighton scores < 5 (p = 0.004) exhibited elevated PF% in the third metatarsal than CLAI + OLT, and the CLAI + OLT group with BMI ≥ 25 showed increased PF% in posterior heel (p = 0.043). CONCLUSIONS: Patients with CLAI, particularly those with concomitant OLT, exhibited distinct biomechanical adaptations characterized by medial midfoot overload and impaired anterior-posterior stability. The implementation of early biomechanical screening of third metatarsal pressure in patients with CLAI and tailored rehabilitation for those with male sex, BMI < 25, and Beighton < 5 was necessary to mitigate osteoarthritis progression.
Feasibility of Designing, Manufacturing and Delivering 3D Printed Ankle-Foot Orthoses: An Updated Systematic Review.
Wang JZ, Wojciechowski EA, Paine T … +2 more , Burns J, Cheng TL
J Foot Ankle Res · 2025 Dec · PMID 41363222 · Full text
BACKGROUND: Ankle-foot orthoses (AFOs) are commonly prescribed to manage lower limb impairments, especially foot drop in neurological disorders. With the evolution of 3D technology, digital acquisition using 3D scanning...
BACKGROUND: Ankle-foot orthoses (AFOs) are commonly prescribed to manage lower limb impairments, especially foot drop in neurological disorders. With the evolution of 3D technology, digital acquisition using 3D scanning and modelling using computer aided design software is becoming more commonplace to produce AFOs. Our previous systematic review in 2019 identified an emerging field of 3D printed AFOs and we highlighted biomechanical effects, mechanical properties and self-reported outcomes such as comfort. To cover the rapidly growing literature on the effects of 3D printed AFOs in clinical populations, the aim of this systematic review was to update an earlier review from 2019 to determine the feasibility and effect of 3D printed AFOs on biomechanical and satisfaction outcomes. METHOD: Seven electronic databases were searched from 1985 to July 2025. Original research papers of any design from healthy or clinical populations of any age were eligible for inclusion. Studies must have investigated the effect of 3D printed AFOs in healthy or pathological populations. The quality of the evidence was assessed using QualSyst. RESULTS: Twenty-eight papers were included in the updated systematic review. The use of 3D printing methods and materials varied markedly, where fused deposition modelling was more prevalent in recent literature than selective laser sintering, and Nylon 12 was most tested. The sample sizes were all smaller than 12. Walking speed and step length of people wearing 3D printed AFOs were mostly improved compared to those with other AFOs and shod or barefoot only. 3D printed AFOs generally had similar or higher satisfaction scores than traditional AFOs. Although levels of evidence were all lower than four, 10 papers had excellent study quality. CONCLUSION: The use of additive manufacturing in AFO fabrication has rapidly increased in the past few years. The novel designed 3D printed AFOs might have potential benefits over traditional designs in terms of biomechanical outcomes. 3D printed AFOs have been further proven to be comparable to traditional ones. Further research is encouraged to conduct with more specific condition characteristics such as cerebral palsy within a specific GMFCS level, longitudinal clinical trials and testing in a home or natural environment. Establishing a standard for AFO evaluation and reporting is also recommended.
To Assess the Variation in the Definitions Used to Describe the Stages of Acute Charcot Neuro-Osteoarthropathy (Diagnosis, Remission and Relapse): A Systematic Review.
Patel D, Gooday C, Gray K … +1 more , Dhatariya K
J Foot Ankle Res · 2025 Dec · PMID 41359315 · Full text
BACKGROUND AND AIMS: In 2023 the International Working Group of the Diabetic Foot (IWGDF) published definitions for the diagnosis, remission and relapse of active Charcot neuro-osteoarthropathy (CN). Until 2023 authors h...
BACKGROUND AND AIMS: In 2023 the International Working Group of the Diabetic Foot (IWGDF) published definitions for the diagnosis, remission and relapse of active Charcot neuro-osteoarthropathy (CN). Until 2023 authors had used varied definitions to identify the stages of CN making comparisons difficult. The aim of the current study was to illustrate variation in definitions used before 2023 and to encourage consistent terminology in future publications. METHODS: Searches were conducted in OVID, Pubmed and CINAHL. Studies were included if they had a minimum of 10 participants and reported the outcomes of CN in conservative or pharmacological treatments in people with diabetes and CN. Included study designs were randomised controlled trials, cohort studies, non-randomised controlled trials, case-controls and case series. We excluded studies of surgical treatment of CN. Data collected included location of the study, study design and population. Definitions of each stage were compared to the IWGDF definitions through a scoring system. RESULTS: We screened 1758 titles, 143 abstracts and 63 full texts. We included 37 studies from 20 different countries. Scores comparing the studies' definitions to the published IWGDF guidelines for definitions ranged from a similarity of 17%-100%. Six studies scored 100% with 31 studies missing aspects of the IWGDF definitions. CONCLUSION: Authors should use standardised definitions of the stages of CN to allow comparisons between studies to be accurately made. More work is needed to assess the variation in terminology within studies with CN treated surgically.
Acute Change of Footwear Limits Performance and Alters Foot Strike Patterns During Anticipated and Unanticipated 90° Change of Direction.
Siegel SD, Sproll M, Warneke K … +2 more , Mason J, Zech A
J Foot Ankle Res · 2025 Dec · PMID 41340215 · Full text
BACKGROUND: Footwear influences performance and injury risk during change-of-direction (COD) movements. However, few studies have investigated how different shoe types influence COD biomechanics, particularly under ecolo...
BACKGROUND: Footwear influences performance and injury risk during change-of-direction (COD) movements. However, few studies have investigated how different shoe types influence COD biomechanics, particularly under ecologically valid conditions such as at sharp angles and under unanticipated conditions. This study examined the impact of barefoot, minimalist, and standard sport shoes on biomechanical and performance parameters during 90° COD tasks. METHODS: Forty-one participants (14 females and 27 males) completed a randomized crossover study, performing anticipated and unanticipated 90° COD tasks under three footwear conditions: barefoot, minimalist shoes, and habitual standard sport shoes. Kinematic, kinetic, and lower leg muscle activity data were collected using motion capture, force plates, and surface electromyography. RESULTS: Standard sport shoes resulted in faster COD completion times, significantly higher approach velocity, and greater braking and propulsion forces than minimalist and barefoot condition (p < 0.05). Minimalist and barefoot condition led to altered foot strike patterns, reduced knee flexion, and lower GRF magnitudes. Unanticipated trials increased neuromuscular demand, reducing approach velocity and altering GRF distribution across all footwear conditions. After controlling for approach velocity, footwear effects remained significant in most kinetic and kinematic measures. CONCLUSION: These findings highlight the importance of footwear choice for performance and biomechanical outcomes during challenging COD tasks.
A Cross-Sectional Study Exploring the Suitability of Skin Hydration Measurement Devices for Use on the Foot.
Andrews J, Nester C, Price C … +1 more , Hashmi F
J Foot Ankle Res · 2025 Dec · PMID 41313744 · Full text
INTRODUCTION: Foot skin xerosis is common, particularly in older people and people with diabetes. Efficacy of emollient treatment of xerosis can be measured using skin hydration measurement devices. None of the devices c...
INTRODUCTION: Foot skin xerosis is common, particularly in older people and people with diabetes. Efficacy of emollient treatment of xerosis can be measured using skin hydration measurement devices. None of the devices currently available, however, have been explicitly assessed for their suitability for use on the skin of the foot. The plantar skin has a morphology and composition disparate from non-plantar skin sites, with a stratum corneum (SC) 16 times thicker than non-plantar skin SC. The shallow measurement depth of hydration measurement devices (0.015 mm for the Corneometer CM825) could be collecting data from incommensurate locations within plantar and non-plantar skin. The aim of this study is to examine how data collected using three hydration measurement devices with different measurement depths (Corneometer CM825, MoistureMeter D and MoistureMeter SC) correlate with tissue characteristics known to vary with skin hydration (hardness, elasticity, surface texture and patient perception) to inform their future use. METHODS: Individuals aged 20-40 were recruited to attend the University of Salford Skin laboratory for data-collection. Following a 15-min acclimatisation period, measures were taken from four skin sites (plantar and non-plantar) using three hydration measurement devices, the SATRA STD 226 Durometer (SATRA Technology, Kettering, UK), Dermalab Elasticity probe (Cortex Technology, Hadsund, Denmark), Visioscan VC98 (Courage and Khazaka, Koln, Germany) and the Foot Skin health Questionnaire. Correlation analyses were conducted using SPSS (IBM SPSS Statistics Version 29.0.1.0). RESULTS: Thirty-two participants were recruited (mean age ± (SD):27.9 ± 4.8; 53% female). The Corneometer CM825 (n = 20) and MoistureMeter SC (n = 32) demonstrate consistent weak-moderate strength correlations with skin elasticity, hardness and texture for both plantar and non-plantar skin. The MoistureMeter D (n = 32), however, correlated stronger with the physical characteristics of plantar skin than non-plantar skin. The only device that found a statistically significant difference between self-perceived 'dry' or 'not dry' skin was the Corneometer CM825 (Mann-Whitney U test p = 0.009). CONCLUSION: The skin site being measured should guide the selection of a hydration measurement device. Future work should include a similar assessment using low-cost devices that are accessible to health care practitioners and expansion of the work to include xerotic skin.
Functional Assessment of Peroneal Muscles Using Ultrasound Imaging in Chronic Ankle Instability.
Jaffri A
J Foot Ankle Res · 2025 Dec · PMID 41249869 · Full text
BACKGROUND: Lateral ankle sprains (LAS) result in chronic ankle instability (CAI), causing ongoing instability. Although peroneal muscle weakness is documented in CAI, surface electromyography shows similar activation pa...
BACKGROUND: Lateral ankle sprains (LAS) result in chronic ankle instability (CAI), causing ongoing instability. Although peroneal muscle weakness is documented in CAI, surface electromyography shows similar activation patterns between CAI and healthy individuals, suggesting structural rather than neural deficits. Ultrasound imaging (USI) uniquely enables noninvasive assessment of muscle morphology and quality through cross-sectional area and echogenicity measurements. However, previous USI studies examined peroneals only in nonweight-bearing positions, potentially missing functional deficits. This study examines peroneal muscle characteristics in CAI versus healthy individuals specifically during weight-bearing functional positions using USI. METHODS: A case-control study was conducted with 58 participants (29 CAI and 29 healthy controls), aged 18-30 years. Cross-sectional area (CSA), echogenicity (grayscale analysis where higher values indicate fatty infiltration/fibrosis), and functional activation ratio (FAR) of the peroneal muscles were assessed using USI in nonweight-bearing (side lying) and weight-bearing (bilateral-leg standing (BLS) and single-leg standing (SLS)) positions. CSA images were averaged from three measurements for each position. RESULTS: The CAI group had significantly smaller CSA in BLS (p < 0.01) and SLS (p < 0.01) but not lying (p = 0.06), higher echogenicity indicating poorer muscle quality (69.7 ± 10.3 vs. 61.3 ± 7.0, p < 0.01), and lower FAR in both BLS (0.99 ± 0.13 vs. 1.13 ± 0.16, p < 0.01) and SLS (1.01 ± 0.17 vs. 1.12 ± 0.22, p = 0.03) compared to healthy controls. CONCLUSION: Individuals with CAI showed reduced peroneal muscle CSA, lower activation, and poorer muscle quality specifically in weight-bearing positions compared to healthy controls. These findings suggest altered muscle function in CAI especially in functional weight-bearing positions. This demonstrates the need to assess peroneals in functional weight-bearing position compared to resting.
Motors and Dampers: The Energetic Tradeoffs in the Shod Foot With Increasing Walking Velocity.
Henderson A, Bruening D, Arch E
J Foot Ankle Res · 2025 Dec · PMID 41217273 · Full text
BACKGROUND: The dual influences of velocity and footwear on ankle-foot energetics are particularly relevant for clinical populations who rely on footwear during ambulation. Although walking velocity influences energetic...
BACKGROUND: The dual influences of velocity and footwear on ankle-foot energetics are particularly relevant for clinical populations who rely on footwear during ambulation. Although walking velocity influences energetic demands of foot structures, footwear may modify these relationships by restricting joint motion. This study aimed to characterize ankle-foot energetics while participants walked at a wide range of velocities while wearing supportive shoes. METHODS: Eighteen healthy participants walked at four height-normalized velocities (0.4-1.0 statures/second) in supportive footwear while kinematic and kinetic data were collected. Ankle, midtarsal, and metatarsophalangeal (MTP) work was quantified and compared using repeated-measures ANOVAs with Holm pairwise tests. RESULTS: MTP positive and negative work increased with shod walking velocity, though negative work increased substantially more than positive work. Midtarsal positive work also increased while maintaining minimal negative work across all velocities. Ankle positive work significantly increased with velocity accompanied by small but significant increases in negative work. CONCLUSIONS: At all velocities, the MTP joint functioned as a mechanical damper and its damping characteristics became more pronounced as velocity increased. The midtarsal joint functioned as a strut, with a small motor role which became more prominent as velocity increased. The ankle had mixed roles, primarily between strut and spring, with a small damper/motor role that traded off with velocity (less damper more motor as velocity increased). The presence of supportive footwear attenuated positive and negative work across velocities when compared to previous barefoot studies, with the largest difference in the midtarsal's negative work, suggesting footwear substantially modifies natural foot mechanics through increasing velocities.
Physical and Mechanical Therapies for Lower Limb Problems in Children With Juvenile Idiopathic Arthritis: A Systematic Review With Meta-Analysis.
Fellas A, Hawke F, Maarj M … +3 more , Singh-Grewal D, Santos D, Coda A
J Foot Ankle Res · 2025 Dec · PMID 41189076 · Full text
OBJECTIVE: To systematically review the evidence for physical (for e.g. strengthening) and mechanical (for e.g. foot orthoses) therapies for lower limb problems in children with juvenile idiopathic arthritis (JIA). METHO...
OBJECTIVE: To systematically review the evidence for physical (for e.g. strengthening) and mechanical (for e.g. foot orthoses) therapies for lower limb problems in children with juvenile idiopathic arthritis (JIA). METHODS: Randomised clinical trials of physical and mechanical interventions for lower limb problems in children with JIA were included. The primary outcome was pain and secondary outcomes included disability, functional ability, and quality of life. Electronic databases were searched for eligible studies. Authors of included studies and researchers in the field were contacted to identify additional studies. RESULTS: Two authors independently screened 4876 titles and abstracts. Eleven randomised clinical trials were ultimately included. Four studies explored the effect of foot orthoses and seven physical therapies. Studies evaluating the effect of foot orthoses on foot and ankle pain were pooled in a meta-analysis. Results showed that foot orthoses were statistically and clinically significant in reducing both parent (-11.08 [-20.25, -1.90]) and child (-21.45 [-30.18, -12.73]) reported foot and ankle pain after 3 months compared to the control. This significant effect was sustained post 3 months. Physical therapies such as Pilates and underwater exercises were statistically and clinically significant in reducing lower limb pain after 3 months of intervention. CONCLUSION: Foot orthoses can be prescribed to significantly reduce foot and ankle pain for children with JIA. Physical therapies appear to reduce pain during 3 months of intervention versus the control but are currently hampered by lack of blinding. Further research is also required to determine the effect of physical therapies past 3 months.
Using Nominal Group Technique to Gather Recommendations in the Decision-Making for Amputation Due to Diabetes.
Ong EKM, Murray C, Hillier S … +1 more , Causby R
J Foot Ankle Res · 2025 Dec · PMID 41184217 · Full text
INTRODUCTION: A lower extremity amputation has traditionally been considered as a last resort treatment option for people with a diabetes-related foot ulcer (DFU). However, some people will opt for an earlier amputation...
INTRODUCTION: A lower extremity amputation has traditionally been considered as a last resort treatment option for people with a diabetes-related foot ulcer (DFU). However, some people will opt for an earlier amputation to overcome the daily lifestyle challenges from ongoing conservative wound management. Even so, making the decision for non-emergency amputation is challenging due to the lack of clear recommendations or evidence-based resources. Therefore, this study aimed to gather recommendations from people with lived experience of a DFU or amputation, family members, health practitioners, and experts to guide decision-making for amputation due to diabetes. METHODS: Nominal group technique was used to gather and vote on recommendations to support people making decisions for amputation. This technique allows all voices to participate and inform ideas. Two separate cohorts were recruited, one group was comprised people with lived experience (of DFU or amputation due to diabetes) and family members (n = 4 participants). The other group consisted of health practitioners and experts (n = 5 participants). During these workshops, research findings from a previous scoping review (94 papers) and interviews with people with lived experience and health experts (n = 26) were presented to participants to gather iterative feedback. Recommendations were constructed using the previous findings and the participants' experience and expertise, which were voted on and later analysed using summative content analysis. RESULTS: A total of 13 recommendations were established by the people with lived experience and their family members, and 15 recommendations from health experts. Seven categories were established from these combined recommendations which described the priority considerations: 'Consider timing, with early discussions to move forward', 'Address every element of quality of life', 'Understand individual goals and priorities to make personalised decisions', 'Collaborate with support networks', 'Provide information and options', 'Communicate with respect and transparency', and 'Offer functional person-centred systems'. CONCLUSIONS: The recommendations highlight the need for early and transparent discussions that prioritise individual goals, quality of life needs and collaboration with support networks, to enable person-centred and evidence-based decisions. These recommendations provide a foundation for the development of guidelines to support timely and informed collaborative decisions in the future.
Changes in Foot Biomechanics During Pregnancy: Associations With Plantar Pressure, Low Back Pain and Daily Function in Taiwanese Women.
Gau ML, Hsu HM, Chen LL … +2 more , Chen TL, Pan WL
J Foot Ankle Res · 2025 Dec · PMID 41182687 · Full text
BACKGROUND: Longitudinal data on pregnancy-related changes in plantar loading and balance are limited, particularly among Asian populations. This study investigated trimester-specific alterations in plantar pressure, sta...
BACKGROUND: Longitudinal data on pregnancy-related changes in plantar loading and balance are limited, particularly among Asian populations. This study investigated trimester-specific alterations in plantar pressure, static and dynamic balance, and pain-related functional interference in pregnant Taiwanese women. METHODS: Eighty-eight pregnant women were prospectively assessed across six gestational time points (8-36 weeks). Plantar pressure distribution and static balance were measured using a pressure plate system (FOOTPLATEC), and dynamic balance was evaluated using the timed up and go (TUG) test. Pain severity and its interference with daily activities were recorded using the Brief Pain Inventory. Foot oedema was assessed using a standardised grading system to evaluate trimester-specific changes. Repeated-measures ANOVA and Pearson correlation analyses were conducted. RESULTS: Dynamic balance significantly declined across pregnancy, with TUG time increasing from 6.67 ± 1.11 s at 8-12 weeks to 7.24 ± 1.41 s at 33-36 weeks (p < 0.01, η = 0.11). Medial midfoot pressure increased by 19% (from 102.56 ± 22.24 to 122.08 ± 29.93 kPa; p < 0.01). Mid-pregnancy foot pain was inversely correlated with hallux (r = -0.17) and lesser toe pressures (r = -0.18; both p < 0.05), whereas heel pressure in late pregnancy was positively associated with low back pain (r = 0.23, p < 0.05). TUG performance was consistently correlated with interference in daily activities throughout gestation (r = 0.20-0.26, p < 0.05). CONCLUSION: Progressive redistribution of plantar loading and subtle balance changes were observed across gestation, which may contribute to discomfort and reduced mobility in some pregnant women. These findings support the importance of trimester-specific biomechanical monitoring in prenatal care.
Reducing the Diabetes Footprint: A Call for Aotearoa New Zealand Diabetic Foot Guidelines.
Jepson H, Garrett M, Lazzarini PA … +1 more , Carroll MR
J Foot Ankle Res · 2025 Dec · PMID 41182561 · Full text
Diabetes-related foot disease (DFD) affects an estimated 110,000 people in Aotearoa New Zealand (Aotearoa NZ) and is one of the leading causes of the national disease burden. While guideline-based care has been found to...
Diabetes-related foot disease (DFD) affects an estimated 110,000 people in Aotearoa New Zealand (Aotearoa NZ) and is one of the leading causes of the national disease burden. While guideline-based care has been found to significantly reduce DFD burdens around the world, Aotearoa NZ lacks national DFD guidelines. Instead, Aotearoa NZ clinicians tend to use either international guidelines or fragmented regional pathways of varying quality which result in variability in clinical practice. Given the higher impacts of DFD on Māori and Pacific peoples, and those in socioeconomically deprived or rural areas, national DFD guidelines incorporating Indigenous knowledge are urgently needed in Aotearoa NZ. We call for the urgent development of Aotearoa NZ DFD guidelines and propose methods to co-develop evidence-based guidelines integrating clinical expertise with Indigenous perspectives. This approach will enhance consistency, improve health outcomes, and support equitable DFD care in Aotearoa NZ.
Assessing Rotational Ankle Instability Through Postural Control Testing: Coronal Instability Outperforms Conventional Imaging.
Mei N, Jiang Z, Zhong Z … +7 more , Ruan Y, Liu H, Kurokawa H, Miyamoto T, Taniguchi A, Tanaka Y, Chang F
J Foot Ankle Res · 2025 Dec · PMID 41120821 · Full text
BACKGROUND: Deltoid ligament (DL) injuries are increasingly recognized in chronic ankle instability (CAI), drawing clinical attention to rotational ankle instability (RAI). Cadaveric studies have shown that RAI can incre...
BACKGROUND: Deltoid ligament (DL) injuries are increasingly recognized in chronic ankle instability (CAI), drawing clinical attention to rotational ankle instability (RAI). Cadaveric studies have shown that RAI can increase ankle rotation; however, current examination methods for RAI remain limited. As they neither provide adequate insight into ligamentous structural damage nor clearly characterize the rotational instability. This study aimed to evaluate the characteristic rotational instability of RAI and, based on this indicator, investigate which postural control parameters best represent rotational instability and how these parameters can be quantified to assess diagnostic utility using postural control parameters and establish quantitative diagnostic thresholds. METHODS: We included 32 patients with CAI who underwent a postural control assessment, combining center of pressure (COP) analysis with the sensory organization test (SOT). Talar tilt angle and medial clear space were also measured via anteroposterior radiographs and magnetic resonance imaging (MRI) to assess DL injuries. Final diagnoses of RAI or CAI were made in the DL based on arthroscopic findings. Receiver operating characteristic (ROC) curves were constructed to determine the diagnostic performance of each indicator. RESULTS: In RAI, the ratio of coronal-plane sway to sagittal-plane sway amplitude during motion was significantly elevated, a phenomenon we term "coronal instability." Coronal instability emerged as a strong predictor of RAI, with an area under the ROC curve (AUC) of 0.95 (95% CI, 0.810-0.996; p < 0.0001). Its optimal cutoff value of 0.81 yielded a sensitivity of 83.33% and a specificity of 100%, surpassing imaging-based measures such as radiography and MRI (AUC = 0.567-0.844). CONCLUSION: Coronal instability, measured through a noninvasive postural control assessment, demonstrates high sensitivity and specificity for diagnosing RAI. This method offers a valuable clinical tool for accurately identifying RAI and may complement or outperform traditional imaging techniques in certain cases.
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