Journal Of Foot And Ankle Research[JOURNAL]
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200 papers
Understanding Footwear Needs: A Conceptual Review.
Tunprasert T, Morrison SC, Joseph LH … +1 more , Kersten P
J Foot Ankle Res · 2025 Dec · PMID 41075291 · Full text
INTRODUCTION: This conceptual review is the first work to explore the concept of footwear needs. The review draws upon multidisciplinary literature to synthesise and formulate the first iteration of conceptual understand...
INTRODUCTION: This conceptual review is the first work to explore the concept of footwear needs. The review draws upon multidisciplinary literature to synthesise and formulate the first iteration of conceptual understanding of footwear needs. METHODS: A systematic search was performed and through a screening process, 81 studies were included in this conceptual review. The included studies were analysed using the pragmatic utility meta-synthesis method to develop conceptual understanding and framework. The review process was further strengthened through expert consultation. RESULTS: The definition of footwear needs is defined as 'footwear requirements for the well-being of a person'. Preconditions of footwear needs include characteristics related to the person, product (footwear) and circumstances. Attributes of footwear needs encompass physical (fit for foot and fit for purpose), safety (footwear safety and financial safety), social (fit for person and fit for society) and emotional (increase positive emotions and decrease negative emotions) needs. Outcomes of footwear needs are related to physical, psychological and social aspects of a person. The conceptual framework of footwear needs illustrates the relationships between various factors underlying footwear needs. Footwear comfort is also identified as an allied concept and a potential outcome when footwear needs are achieved. CONCLUSION: This conceptual review provides valuable insights into footwear needs, offering a foundation for future research and practical applications in footwear assessment, education and interventions.
Effect of Prancing and Galloping Drills on Fitness and Ankle Joint Stability in Volleyball Players: A Randomized Trial.
Choudhary S, Sharma A, Zaidi Z … +2 more , Sami W, Rizvi MR
J Foot Ankle Res · 2025 Dec · PMID 41075290 · Full text
INTRODUCTION: Volleyball is a sport that requires rapid changes in movements and high-intensity actions and skills. Ankle stability is a key factor in preventing injuries and enhance performance in volleyball players. Th...
INTRODUCTION: Volleyball is a sport that requires rapid changes in movements and high-intensity actions and skills. Ankle stability is a key factor in preventing injuries and enhance performance in volleyball players. This study evaluated the effects of prancing and galloping drills on ankle stability, agility, and fitness parameters in volleyball players. METHODS: Forty-two male volleyball players (mean age 23.67 ± 3.15 years) were randomly assigned to the prancing and galloping drills (POGO) training (PGT, n = 21) or conventional training (CT, n = 21) group. Over 6 weeks, the experimental group performed prancing and galloping drills, whereas the control group continued their routine warm-up. Outcome measures included ankle stability (Prokin system), vertical jump height (VJH), agility (CODAT), endurance (Cooper test), and dynamic balance (SEBT), assessed after implementing conventional and POGO drills. RESULTS: Significant improvements were observed in both groups, but the POGO training group demonstrated larger effects. Notably, the POGO training group showed substantial improvements in ankle instability (right ankle: t = 4.09 and p < 0.001; left ankle: t = 5.04 and p < 0.001) and dynamic balance (SEBT Right A: t = -4.20 and p < 0.001; SEBT Left A: t = -4.35 and p < 0.001). CONCLUSIONS: Prancing and galloping drills effectively enhanced ankle stability and dynamic balance, offering a valuable addition to volleyball training programs for injury prevention and performance enhancement.
South African Podiatry Students' Experiences of Their Clinical Learning Environment.
Melissa M, Simiso N
J Foot Ankle Res · 2025 Dec · PMID 41075288 · Full text
BACKGROUND: The role and purpose of a clinical learning environment (CLE) is to help students become confident and independent practitioners. Exposure to clinical learning environments provides podiatry students with ess...
BACKGROUND: The role and purpose of a clinical learning environment (CLE) is to help students become confident and independent practitioners. Exposure to clinical learning environments provides podiatry students with essential experiential learning opportunities and skills that are difficult to obtain elsewhere. Anecdotal evidence suggests that podiatry students encounter various obstacles in CLEs, although these obstacles have not been thoroughly described. This article, therefore, aims to understand and describe South African podiatry students' experiences of their clinical learning environment. METHODS: A qualitative research method was employed. A purposive sampling strategy was used to select undergraduate podiatry students from the University of Johannesburg to participate in a focus group discussion. Eight students took part in the focus group discussion, which was audio recorded and transcribed verbatim. Data were analysed using Giorgi's qualitative thematic analysis. RESULTS: Three main themes were identified: (i) Attitudes of supervising clinicians, (ii) Student confidence and (iii) Shortage of supervising clinicians. CONCLUSION: Overall, the experiences of podiatry students in their clinical environment were negative. Understanding these obstacles may offer insight into the improvement of the clinical learning environment, and it may be possible to facilitate the development of competent and confident podiatrists.
Plantar Heel Pain Management: A Survey of UK Registered Healthcare Professionals.
Drake C, Chapman L, Burnett C … +5 more , Halstead J, Redmond A, Roddy E, Wilkins R, Keenan AM
J Foot Ankle Res · 2025 Dec · PMID 41075286 · Full text
BACKGROUND: Multiple healthcare professions are involved in the management of plantar heel pain (PHP). Professional diversity can lead to varied practice and treatment choices. Understanding PHP management can aid clinic...
BACKGROUND: Multiple healthcare professions are involved in the management of plantar heel pain (PHP). Professional diversity can lead to varied practice and treatment choices. Understanding PHP management can aid clinical benchmarking, inform knowledge mobilisation strategies, and may support shared decision making between patients and referrers. This study explored the management of plantar heel pain by United Kingdom (UK) registered healthcare professionals. METHODS: A cross-sectional, online survey using the Jisc Online Surveys platform. The survey was distributed to UK healthcare practitioners via digital channels, including professional bodies, special interest groups and social media. RESULTS: Four hundred and six professionals responded, predominantly podiatrists (181; 44.6%) and physiotherapists (144; 36.5%). The remaining 18% comprised orthotists, osteopaths, orthopaedic surgeons, General Practitioners (GPs), nurses, rheumatologists, sport and exercise rehabilitation specialists, and a consultant in sport and exercise medicine. Most respondents (247; 60.8%) did not commonly use imaging to guide PHP management. The majority (359; 88.4%) provided physical interventions: strengthening (88%), stretching (85.5%) and balance (65.2%) were frequently used. Prefabricated orthoses (56.3%) were more frequently used than custom orthoses (24.2%). Treatments employed by podiatrists and physiotherapists were similar. Advice on nonsteroidal anti-inflammatory drugs (NSAIDs) (226; 83%), and simple analgesics (e.g., paracetamol) (221; 81%) to manage pain was commonly provided. Only 6.4% frequently performed steroid injections. Patient information was commonly provided (359; 88%); however, most practitioners (297; 83%) lacked resources in languages other than English. CONCLUSION: Healthcare professionals in the UK favour exercise and prefabricated orthoses when managing PHP.
Clinical Outcomes of First Metatarsophalangeal Joint Arthrodesis Using the BOFAS Registry: A Prospective Cohort Study.
Jadhakhan F, Nilesh M, Lyndon M … +2 more , Paul H, Alison R
J Foot Ankle Res · 2025 Dec · PMID 41025702 · Full text
BACKGROUND: This study investigated the quality and clinical outcomes of the British Orthopaedic Foot and Ankle Society (BOFAS) registry first metatarsophalangeal joint (MTPJ) arthrodesis pathway. METHODS: A prospective...
BACKGROUND: This study investigated the quality and clinical outcomes of the British Orthopaedic Foot and Ankle Society (BOFAS) registry first metatarsophalangeal joint (MTPJ) arthrodesis pathway. METHODS: A prospective cohort study using data derived from the BOFAS registry. Adults aged ≥ 18 years with a record of undergoing first MTPJ arthrodesis in the UK from 29/08/2014 to 31/10/2019. The pre- and post-treatment pathway was evaluated by analysing Patient Reported Outcome Measures (PROMs) at baseline, 6 months and 12 months intervals. Consistency of data capture and completeness were explored using means, SD, medians and IQR for continuous variables and frequencies for categorical variables. RESULTS: The mean age of the study population (n = 459) was 64.1 (± 12.1) years and 98.9% of the study cohort were female. Completeness of data collection was low for some items (e.g., medication 46%, surgical procedures 52%). Baseline completion of PROMs was moderate with 52.5% of participants providing MOXFQ (Manchester-Oxford Foot Questionnaire) pain and walking/standing scores at baseline. However, follow-up response rates declined substantially to 27.2% at 6 months and 15.7% at 12 months. Improvement in PROMs by 12 months following surgery was statistically and clinically significant (p < 0.001), with median scores of 10 [IQR: 0-20] for MOXFQ pain, 5.5 [0-21] for walking/standing, 0 [0-19] for social interaction, 5 [1-31] for NRS pain and 0.8 [0.7-1.0] for EQ-5D-5L. CONCLUSION: The analysis highlights the clinical benefits of first metatarsophalangeal joint (first MTPJ) fusion surgery, with improvements in pain intensity, walking/standing ability, social interaction and quality of life. The BOFAS registry serves as a valuable tool for collecting patient-reported outcome measure (PROM) data, providing important insights into treatment effectiveness and participant well-being. Strengthening the data collection capabilities of the BOFAS registry could further enhance our understanding of the benefits of first MTPJ fusion and inform future treatment strategies.
Foot Health and Lower Extremity Function in People With Multiple Sclerosis: A Cross-Sectional Survey Study.
Stolt M, Eränen M, Katajisto J … +1 more , Rosio R
J Foot Ankle Res · 2025 Sep · PMID 40968415 · Full text
INTRODUCTION: Foot health and lower extremity function are important issues for people with multiple sclerosis (MS). However, relatively little is known about foot health among people with MS. The potential association b...
INTRODUCTION: Foot health and lower extremity function are important issues for people with multiple sclerosis (MS). However, relatively little is known about foot health among people with MS. The potential association between foot health and lower extremity function in particular has seldom been studied. Therefore, this study aimed to analyse the level of self-reported foot health and lower extremity function in people with MS and to identify possible associating factors. METHODS: A cross-sectional survey study design was applied. The data were collected online April-May 2024 from members of a national patient association with the Self-administered Foot Health Assessment Instrument, the Lower Extremity Functional Scale (LEFS) as well as a background information form. The data were analysed with descriptive and inferential statistics. RESULTS: The participants (n = 969, response rate 23%) had many foot problems of which dry skin (73%), cold feet (65%), leg cramps (61%), foot pain (59%) and thickened toe nails (51%) were the most common. Participants experienced mild to moderate lower extremity-related functional limitation (mean 51, SD 22, range 0-80). Foot health among people with MS associated with gender, being on sick leave due to foot problems, perceived knowledge levels of foot self-care, and self-evaluated level of foot health. Moreover, weak but significant correlation between foot health and lower extremity function was found, indicating that a poorer foot health was associated with more difficulties in performing lower extremity-related actions. CONCLUSION: The results suggest that not only are foot problems among people with MS extremely prevalent, but they also impact functional ability. People with MS could benefit from regular rehabilitative care that includes access to podiatric care. Future research is needed to develop and evaluate strategies to support self-care in lower extremity health among people with MS.
The Heidelberg Functional Foot Model-Application to Cavovarus and Equinovarus Feet.
Campos S, Salami F, Chen Q … +3 more , Putz C, Tsitlakidis S, Wolf SI
J Foot Ankle Res · 2025 Sep · PMID 40954514 · Full text
Multisegment foot models have become increasingly important in biomechanical research and clinical gait analysis but often face limitations in defining joint positions. Often, they rely on simplified methods, such as usi...
Multisegment foot models have become increasingly important in biomechanical research and clinical gait analysis but often face limitations in defining joint positions. Often, they rely on simplified methods, such as using the midpoint between two markers to represent a joint, which lacks functional verification. In contrast, phenomenological angles, such as the medial arch angle, bypass joint center calculations, and offer sensitive, radiologically aligned indicators of foot mechanics. The Heidelberg functional foot model (HFFM) integrates functionally verified joint positions in combination with clinically relevant phenomenological measures, thereby enhancing clinical interpretability in gait analysis. The marker placement of the HFFM is based on the Heidelberg foot measurement method (HFMM). A four-segment model (shank, hindfoot, forefoot, and hallux) is defined. Anatomical coordinate systems are established via regression formulas derived from functional joint parameter determination. Kinematic angles are compared with radiological measures. Additionally, six clinically relevant angles of the HFMM are integrated into the HFFM. The method is applied to cavovarus (CV, 19 feet), equinovarus (EV, 31 feet), and typically developed feet (TD, 88 feet). EV feet show more pronounced hindfoot varus and forefoot adduction than CV and TD feet. Within the parameters adopted from the HFMM, EV feet exhibit increased subtalar inversion and a stronger medial arch than CV. Significant correlations are identified between hindfoot/shank flexion, forefoot/hindfoot flexion and medial arch, and radiological angles. The HFFM is sensitive for analyzing equinvarus and cavovarus deformities without applying static offsets due to the functional approach. It enables calculating kinetics to better understand the biomechanics of foot deformities.
Preoperative and Postoperative Physical and Mechanical Rehabilitation Interventions in Hallux Valgus: A Systematic Review.
Gumuskaya O, Peterson B, Donnelly H … +3 more , Unver B, Lafferty D, Tehan P
J Foot Ankle Res · 2025 Sep · PMID 40936159 · Full text
BACKGROUND: Approximately one-third of the adult population is affected by hallux valgus (HV). Surgical interventions are successful in reducing deformity; however, postoperative complications are common. There is growin...
BACKGROUND: Approximately one-third of the adult population is affected by hallux valgus (HV). Surgical interventions are successful in reducing deformity; however, postoperative complications are common. There is growing evidence for prehabilitation and rehabilitation strategies in orthopaedic surgeries. However, the effectiveness of such strategies in HV surgery is currently unknown. This systematic review aimed to synthesise and determine the quality of evidence for the effectiveness of physical and mechanical prehabilitation and postoperative rehabilitation interventions for improving outcomes following HV surgery. METHODS: Electronic databases: MEDLINE, Cochrane, CINAHL, Scopus, EMBASE and AMED were searched from inception until 19th May 2025, following the PRISMA guidelines. Randomised controlled trials were included to determine the effectiveness of preoperative and postoperative physical and mechanical therapies for improving outcomes in adults undergoing HV surgery. The evidence from individual studies was narratively synthesised, and data were not pooled because of the heterogeneity of interventions, methods and outcomes measures. RESULTS: A total of 8166 titles and abstracts were screened, and 66 full-text papers were reviewed. Five studies met the eligibility criteria and were included in this review. No randomised controlled trials examined the effectiveness of eligible preoperative physical or mechanical interventions. Postoperative early weight-bearing, dynamic metatarsal splinting and transcutaneous ultrasound appeared to improve patient outcomes, whereas rigid-soled footwear improved patient satisfaction. CONCLUSION: There is currently no evidence to support the effectiveness of preoperative physical and mechanical interventions for improving outcomes in HV surgery, and limited evidence supports postoperative interventions. Future trials should consider incorporating validated outcome measures.
Validity of MRI and Ultrasound Volume Measurements of Foot Muscles and Plantar Fascia Cross-Sectional Area Within Older Adults With and Without Chronic Plantar Fasciitis.
Swanson DA, Sponbeck JK, Swanson DC … +2 more , Allen SP, Johnson AW
J Foot Ankle Res · 2025 Sep · PMID 40931567 · Full text
INTRODUCTION: Intrinsic foot muscles and the plantar fascia are crucial for foot health, which diminishes with age and conditions such as chronic plantar fasciitis (PF). Ultrasound (US) is an accessible and cost-effectiv...
INTRODUCTION: Intrinsic foot muscles and the plantar fascia are crucial for foot health, which diminishes with age and conditions such as chronic plantar fasciitis (PF). Ultrasound (US) is an accessible and cost-effective method for evaluating these structures. This study aims to assess the repeatability, reliability, and validity of plantar fascia thickness and flexor digitorum brevis (FDB) muscle measurements using US compared with MRI in individuals with and without PF. METHODS: Foot muscle volume and plantar fascia thickness were measured via US and MRI in 28 participants with and without PF. Subsequently, the plantar fascia thickness and FDB volume were calculated using the OsiriX semiauto volume segmenter software for MRI and the truncated cone formula for both MRI and US. Intraclass correlation coefficients (ICCs), Pearson product correlations (r), minimal detectable differences (MDD), and standard error of measurement (SEm) were calculated. RESULTS: High ICCs (r = 0.988-0.990) indicated excellent repeatability for all measurement techniques of the plantar fascia and FDB muscle. Reliability for plantar fascia and FDB measurements ranged from 3.98% to 5.50% and 5.06%-9.84%, respectively, across both groups. Validity was high with correlation values between 0.94 and 0.99 and Bland-Altman limits of agreement ranging from 2.6% to 9.2%. CONCLUSIONS: US provides repeatable, reliable, and valid measurements of plantar fascia thickness and FDB muscle volume compared with MRI. It offers a cost-effective and accessible alternative for assessing foot health in clinical and research settings.
Characteristics of Lower Extremity Kinematics, Kinetics, and Muscle Activity in Individuals With Chronic Ankle Instability During Landing With Expected and Unexpected Inversion Perturbations: A Systematic Review and Meta-Analysis.
Gong Y, Xu M, Chen P … +3 more , Hu X, Zhou W, Wang L
J Foot Ankle Res · 2025 Sep · PMID 40922104 · Full text
OBJECTIVE: This study aims to investigate whether alterations in the lower extremity kinematics, kinetics, and muscle activity of individuals with chronic ankle instability (CAI) occur during landing with expected and un...
OBJECTIVE: This study aims to investigate whether alterations in the lower extremity kinematics, kinetics, and muscle activity of individuals with chronic ankle instability (CAI) occur during landing with expected and unexpected inversion perturbations. METHODOLOGY: PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were searched for relevant studies up to November 30, 2024. Comparative studies investigating the characteristics of lower extremity kinematics, kinetics, and muscle activity in individuals with CAI compared with healthy controls were included. Two independent reviewers extracted the data. Certainty of the evidence was assessed using the Newcastle-Ottawa Scale (NOS) approach. SYNTHESIS: Thirteen studies involving 207 patients with CAI and 215 healthy controls were included. Individuals with CAI exhibited increased activity of the tibialis anterior muscle before landing (SMD = 0.28 and 95% CI: 0.03-0.54). The delayed activation of the peroneus longus muscle (SMD = 1.35 and 95% CI: 0.90-1.80) and increased co-contraction index in the sagittal plane (SMD = 0.41 and 95% CI: 0.06-0.77), ankle inversion angle (SMD = 0.56 and 95% CI: 0.30-0.81), ankle inversion range of motion (SMD = 0.83 and 95% CI: 0.42-1.24), and knee extension moment (SMD = 0.71 and 95% CI: 0.32-1.11) were observed after landing. Besides, subgroup analysis revealed that the anticipation of perturbations influenced muscle activation patterns, with significant differences in peroneus longus latency and coactivation indices. CONCLUSION: Patients with CAI may present differences in lower extremity biomechanics during expected and unexpected inversion-perturbed landings compared with healthy controls. The results of this work may have clinical implications in the development of more effective and targeted rehabilitation programs for individuals with CAI. TRIAL REGISTRATION: PROSPERO registration number: CRD42024615006.
Patient and Health Professional Perceptions of the Assessment, Diagnosis and Management of Acute Charcot Neuro-Osteoarthropathy at a Regional Australian Health Service.
Diacogiorgis D, Perrin BM, MacDonald E … +1 more , Kingsley MIC
J Foot Ankle Res · 2025 Sep · PMID 40913780 · Full text
BACKGROUND: Acute Charcot neuroarthropathy (CN) is a rare but serious complication of diabetes that requires timely diagnosis and evidence-based management to prevent long-term disability. In regional or rural settings,...
BACKGROUND: Acute Charcot neuroarthropathy (CN) is a rare but serious complication of diabetes that requires timely diagnosis and evidence-based management to prevent long-term disability. In regional or rural settings, delivering evidence-based care is particularly challenging due to systemic and contextual barriers. OBJECTIVE: To explore the perceptions of patients and health professionals about assessment, diagnosis and management of acute CN in a regional Victorian health service. METHOD: This study used a qualitative research design, utilising thematic analysis of semi-structured interviews with patients with previous acute CN and focus groups with health professionals (orthopaedic surgeons, podiatrists and prosthetists and orthotists) involved in the assessment and management of patients with acute CN. Two assessors used inductive thematic analysis to identify key themes related to acute CN care delivery. RESULTS: Four overarching themes were identified: (1) barriers to evidence-based care, including delayed diagnosis, limited access to skilled clinicians and diagnostic tools and the burden of treatment; (2) enablers, such as timely access to knowledgeable clinicians and resources; (3) mitigating factors, including patient engagement, empathetic communication and multidisciplinary support and (4) strategies for improvement, such as public and professional education, upskilling of health professionals and integration of psychological and person-centred support. CONCLUSION: Improving outcomes for people with acute CN in regional or rural settings requires a multifaceted approach. Enhancing awareness, building workforce capacity and embedding patient-centred care practices are essential to ensure timely diagnosis, equitable access to treatment and improved quality of life.
Comparative Effectiveness of Ultrasound-Guided Corticosteroid Injection, Radiofrequency Ablation, and Their Combination for Recalcitrant Plantar Fasciitis: A Retrospective Cohort Study.
Aktan Ç, Aktan C
J Foot Ankle Res · 2025 Sep · PMID 40908556 · Full text
BACKGROUND: Recalcitrant plantar fasciitis (PF) refers to persistent heel pain lasting ≥ 6 months despite appropriate conservative management, including physical therapy, orthotics, and pharmacological interventions. Thi...
BACKGROUND: Recalcitrant plantar fasciitis (PF) refers to persistent heel pain lasting ≥ 6 months despite appropriate conservative management, including physical therapy, orthotics, and pharmacological interventions. This study aimed to compare the clinical efficacy and safety of corticosteroid injection (CI), radiofrequency ablation (RFA), and their combination in patients with recalcitrant PF. METHODS: In this retrospective study, a total of 156 patients with ultrasonographically confirmed plantar fasciitis, experiencing heel pain for at least 6 months and unresponsive to ≥ 3 months of standard conservative therapy, were included; 52 received RFA, 50 received CI, and 54 underwent combined therapy. Pain intensity (visual analog scale [VAS]), functional status (Foot Function Index [FFI], Roles and Maudsley score [RMS]), plantar fascia thickness (PFT), and relapse rates at 12 months were assessed. Within-group and between-group differences were assessed using appropriate nonparametric tests, and relapse rates were compared accordingly. RESULTS: All treatment modalities improved VAS, FFI, RMS, and PFT at 6 months (p < 0.001). VAS declined from 6.73 to 6.81 at baseline to 1.62 in the RFA group and 1.83 in the combined group, whereas remaining at 6.56 in the CI group. FFI dropped from ∼52 to 21.50 and 17.57 in the RFA and combined groups but remained at 46.62 in the CI. PFT decreased from ∼6.2 mm to 3.29, 2.71, and 2.95 mm, respectively. Relapse occurred in 12 (23.1%), 19 (38.0%), and 8 (14.8%) patients in the RFA, CI, and combined groups. Between-group differences were significant at 6 months (p < 0.001). No major adverse events were observed. CONCLUSION: Both CI and RFA are effective in recalcitrant PF, but their combination provides superior and more durable improvements in pain, function, and fascia morphology, with the lowest relapse rates. Ultrasound-guided combined therapy suggests a safe, practical, and effective treatment option for patients unresponsive to conservative measures.
AI-Powered Smartphone Application for Measuring Hallux Valgus Angle From Radiographs Displayed on a Monitor.
Takeda R, Ando S, Iidaka T … +6 more , Makabe K, Kasai T, Omata Y, Yoshimura N, Tanaka S, Matsumoto T
J Foot Ankle Res · 2025 Sep · PMID 40906587 · Full text
INTRODUCTION: We developed a smartphone application capable of automatically measuring the hallux valgus angle (HVA) and various intermetatarsal angles by capturing radiographic images displayed on a monitor. This study...
INTRODUCTION: We developed a smartphone application capable of automatically measuring the hallux valgus angle (HVA) and various intermetatarsal angles by capturing radiographic images displayed on a monitor. This study aimed to evaluate the accuracy of these measurements using the application. METHODS: Three users-a board-certified orthopedic surgeon, a resident, and a nonhealthcare professional (Users 1, 2, and 3)-independently used the application to measure angles on 92 radiographs from 92 consecutive patients. Mean absolute errors (MAEs) between the application-based measurements and the median of manual measurements performed by three experienced foot and ankle surgeons using a DICOM viewer were calculated for each user. To evaluate whether the measurement errors were acceptably small, one-sided t-tests were conducted to determine whether the MAEs were significantly less than 3°. Differences in MAEs among the three users were also assessed using analysis of variance. RESULTS: The MAEs of HVA by the three users were 1.1°, 1.3°, and 1.4°, respectively, all significantly below the 3° threshold (95% CI upper limit; 1.2°, 1.5°, and 1.5°). Comparable accuracy was observed for intermetatarsal angles, which have slightly greater variability for more lateral metatarsals. All measurements met the accuracy criterion of < 3°, except for the intermetatarsal angles between the first and fifth metatarsals measured by the nonhealthcare user. No significant difference in MAE was found among users for HVA (p = 0.13), whereas significant differences were noted for some intermetatarsal angles. CONCLUSIONS: The developed smartphone application accurately measured the HVA and various intermetatarsal angles, with performance comparable to that of experienced foot and ankle surgeons. Importantly, sufficient accuracy was achieved even when used by individuals without clinical training. The application may be useful as a practical tool in clinical and research settings.
Single Leg Drop and Hop: Insight Into Multisegment Foot Kinematics, Kinetics and the Role of Visual Focus in Healthy Young Adult Males.
Haelewijn N, Staes F, Vereecke E … +2 more , Rosseel S, Deschamps K
J Foot Ankle Res · 2025 Sep · PMID 40890940 · Full text
INTRODUCTION: Understanding foot joint loading during different dynamic activities is essential information for guiding exercise progression in rehabilitation. While walking and running biomechanics are well studied, joi...
INTRODUCTION: Understanding foot joint loading during different dynamic activities is essential information for guiding exercise progression in rehabilitation. While walking and running biomechanics are well studied, joint-specific kinetic data during a single leg drop and hop task, often used in rehabilitation, are lacking. This study aimed to evaluate (1) the kinetic behavior of the ankle, Chopart, Lisfranc, and MTP-1 joints during a drop-hop task under different visual constraints and (2) to contextualize these findings by comparing them with heel-strike running, to assess the relative loading demands of the drop-hop task. METHODS: Seventeen recreationally active male adults performed a single-leg drop and hop under two visual focus conditions: central (focusing on the landing spot) and peripheral (focusing straight ahead). Kinematics, moments, and power were analyzed using a four-segment foot model with statistical parametric mapping. Additionally, peak plantarflexion moments and power outputs were compared with existing data from heel-strike running data from a mixed-sex sample (4 males, 3 females) collected in a separate study using the same setup. RESULTS: Findings revealed no differences between central and peripheral focus conditions. Heel-strike running shows similar joint loading, but higher power generation (p < 0.001) at the ankle and Chopart joint, higher absorption (p < 0.001) at the Chopart and MTP-1 (p < 0.05) joint and lower power absorption (p < 0.001) at the ankle and Lisfranc joint. CONCLUSION: Visual input does not influence foot biomechanics during a single-leg drop and hop. This task produces similar joint loading patterns similar to heel-strike running but with reduced power generation at the ankle and midfoot. Contrary to global belief, the single leg drop-hop task is not excessively more demanding in terms of foot joint loading, supporting the earlier use of drop-hop exercises in rehabilitation programs. They offer a controlled way to reintroduce loading while avoiding the full propulsion demands of running, independent of visual focus.
On podiatric surgery.
Edwards SR
J Foot Ankle Res · 2025 Sep · PMID 40890880 · Full text
Podiatric surgery is a registered specialty in Australia, supported by nationally accredited training programs and decades of safe, effective practice. Despite this, podiatric surgeons are excluded from public hospitals...
Podiatric surgery is a registered specialty in Australia, supported by nationally accredited training programs and decades of safe, effective practice. Despite this, podiatric surgeons are excluded from public hospitals and government-funded services, eliminating their ability to contribute to high-demand areas of surgical care. This commentary explores systemic barriers to the integration of podiatric surgeons within the Australian health system. It draws on national regulatory frameworks, clinical audit data, and international comparisons including interprofessional agreements in the United Kingdom and United States, to examine how a well-trained but vastly underutilised specialist surgical workforce remains siloed outside public care. Structural reforms would allow podiatric surgeons to participate in multidisciplinary teams, reduce surgical waiting times, and support patients with complex foot and ankle conditions, especially those with conditions such as diabetic foot disease, that are known to deteriorate with time, and patients from marginalised and remote demographics. International examples show that enabling access and removing funding exclusions improve service equity, alleviate surgical bottlenecks, and bring Australia in line with global best practice.
A Systematic Review of Submetatarsal Fat Pad Augmentation for the Treatment and Prevention of Diabetes-Related Foot Ulceration.
Ashmore C, Virdee J, Culmer P … +4 more , Edwards J, Siddle H, Warren J, Russell D
J Foot Ankle Res · 2025 Sep · PMID 40887711 · Full text
BACKGROUND: Diabetes-related foot ulceration (DFU) represents a significant and increasing cause of morbidity and economic burden to health services. Surgical offloading has shown great effectiveness in the prevention an...
BACKGROUND: Diabetes-related foot ulceration (DFU) represents a significant and increasing cause of morbidity and economic burden to health services. Surgical offloading has shown great effectiveness in the prevention and healing of DFU. The objective of this review is to assess the effectiveness of submetatarsal plantar fat pad modulation in preventing DFU and to characterise the different biomaterials used to this end. METHODS: The study was registered on PROSPERO. A search strategy of the PubMed, CINAHL and Cochrane biomedical databases was conducted. Any study which explored the modulation of the plantar submetatarsal fat pad for the prevention or treatment of DFU in adults was included. The main outcome was the occurrence of ulceration following intervention. RESULTS: Of the 3162 retrieved studies, 10 studies met inclusion criteria, describing outcomes for 76 participants with 112 ulcers or pre-ulcerative areas. Four studies report results of injectable liquid silicone in 55 participants, four studies included the use of an acellular allograft in eight participants, two studies included autolipotransplantation in 11 participants and one study reports on the use of injectable collagen in two participants. Only one randomised control trial was identified while the remainder of the studies were observational, case-series, or case-reports. The overall ulcer occurrence was 27/112 over an average follow-up of 32.4 months. DISCUSSION: While plantar fat pad modulation shows promise as a surgical offloading strategy for DFU, insufficient high-quality trial data preclude meaningful interpretation of its merits. This is further complicated by heterogeneity in the biomaterial employed for modulation.
Foot Disease Management by General Practitioners in People With and Without Diabetes: An Analysis of Nationally Representative Primary Care Data in Australia.
Lazzarini PA, Menz HB, Williams CM … +3 more , Gordon J, Cramb S, Harrison C
J Foot Ankle Res · 2025 Sep · PMID 40877921 · Full text
INTRODUCTION: Foot disease is a leading cause of national disease burdens and is driven by diabetes. General practitioners (GPs) play a gatekeeper role in many national healthcare systems. Yet, national foot disease mana...
INTRODUCTION: Foot disease is a leading cause of national disease burdens and is driven by diabetes. General practitioners (GPs) play a gatekeeper role in many national healthcare systems. Yet, national foot disease management by GPs has not been explored. We explored the management of foot disease by Australian GPs in people with and without diabetes. METHODS: We analysed 16 years of annual, cross-sectional, GP encounter data from the nationally representative Australian Bettering the Evaluation and Care of Health study in which a foot disease problem was managed. Factors independently associated with foot disease encounters by GPs were assessed using multivariable logistic regression. RESULTS: Foot disease management rates increased from 11.6 per 1000 GP encounters (95% CI: 10.8-12.5) in 2000-2001 to 14.4 (13.3-15.4) in 2015-2016 and 6.1 (5.7-6.6) to 8.7 (8.1-9.3) per 100 Australian people. The rate of GP foot disease management was 2.4-fold higher in people with diabetes compared to those without diabetes (31.5 [26.4-36.6] vs. 12.9 [11.8-14.0]). Foot disease encounters were positively associated with diabetes, male patients, older patients, English-speaking backgrounds and having healthcare concession cards (all, p < 0.05); for patients with diabetes, only males were positively associated. Most frequent management actions used were medications, procedures and pathology with referrals, counselling and imaging least frequent. CONCLUSIONS: Australian GP management rates for foot disease are higher than many more well-known health conditions and increasing. GPs frequently manage foot disease with medications and procedures, but relatively rarely counsel or refer. Future strategies to improve GP foot disease management and referrals are needed.
Muscle Synergies of the Lower Extremities During Gait Initiation in Individuals With and Without Chronic Ankle Instability.
Zivari S, Yousefi M, Pezeshk AF … +1 more , Caderby T
J Foot Ankle Res · 2025 Sep · PMID 40855601 · Full text
BACKGROUND: Chronic ankle instability (CAI) disrupts postural stability after ankle sprains and inadequate treatment. Gait initiation (GI), governed by central nervous system (CNS) patterns, is used to evaluate stability...
BACKGROUND: Chronic ankle instability (CAI) disrupts postural stability after ankle sprains and inadequate treatment. Gait initiation (GI), governed by central nervous system (CNS) patterns, is used to evaluate stability. Muscle synergy, which reflects coordinated activations, reveals neuromuscular control. This study investigates lower limb muscle synergies during GI in individuals with and without CAI to understand their neuromuscular strategies. DESIGN: Cross-sectional study. SETTING: Laboratory. METHOD: This study involved 20 participants, 10 healthy men and 10 patients with CAI. Six electrodes were applied per the SENIAM guidelines, and markers were set according to the cluster model. The participants initiated gait after an auditory cue was presented on a force plate. OpenSim simulated a musculoskeletal model using kinematic and muscle activity data. Muscle synergies were analyzed via HALS in MATLAB. Statistical tests, including Wilcoxon and one-way ANOVA, were conducted in SPSS with p < 0.05 as the significance threshold. RESULTS: The number of muscle synergies was not significantly different between the healthy and CAI groups (p > 0.05). However, muscle weight differed significantly between synergies 1 and 2 (p < 0.05). In synergy 1, the TA had greater weighting in the CAI group, whereas synergy 2 had higher RF and GM_L weightings in the CAI group. Synergy 3 revealed greater PL weight in the control group (p < 0.05). CONCLUSION: In CAI, PL muscle weakness is offset by the TA, RF, and GM_L muscles resulting in altered ankle strategies during gait instability. This compensation disrupts motor chains, increases movement complexity, and involves the CNS, framing CAI as a global movement issue rather than a localized problem.
Association of Baxter's Neuropathy and Fatty Infiltration of the Abductor Digiti Minimi Muscle on Magnetic Resonance Imaging: A Systematic Review.
Chen JSC, Abbott M, Landorf KB
J Foot Ankle Res · 2025 Sep · PMID 40836398 · Full text
BACKGROUND: Fatty infiltration-or fatty atrophy-of the abductor digiti minimi (ADM) muscle of the foot on magnetic resonance imaging (MRI) has been attributed to entrapment of the first branch of the lateral plantar nerv...
BACKGROUND: Fatty infiltration-or fatty atrophy-of the abductor digiti minimi (ADM) muscle of the foot on magnetic resonance imaging (MRI) has been attributed to entrapment of the first branch of the lateral plantar nerve (i.e., Baxter's neuropathy), a condition associated with plantar heel pain (PHP). The aim of this study was to investigate the evidence relating to the association between fatty infiltration of ADM and Baxter's neuropathy. METHODS: This systematic review conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from 20 June 2023 to 19 of March 2024. Peer-reviewed articles of retrospective, cross-sectional observational, or cohort studies written in English that investigated the prevalence or frequency of fatty infiltration of ADM on MRI in adult participants were included. Study quality and risk of bias were assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. RESULTS: Four studies (1052 participants) were identified and included in the review. Two studies were retrospective studies and two studies were cross-sectional observational studies. Only one study was rated 'good' on quality assessment. The reported prevalence of fatty infiltration of ADM on MRI was reported to be between 4% and 11% in the general population. Prevalence was also reported to be similar in people with and without generalised foot pain (approximately 8% and 6%, respectively). No studies reported prevalence in specific populations with PHP or with Baxter's neuropathy. CONCLUSION: The association between fatty infiltration of ADM on MRI and entrapment of the first branch of the lateral plantar nerve as part of PHP still remains unknown due to the lack of robust evidence. Additional high-quality studies investigating the association between PHP and fatty infiltration of ADM on MRI would be worthwhile to improve our understanding of the diagnostic value of MRI for this condition, which may aid decision-making for the treatment of PHP, particularly surgical treatment of Baxter's neuropathy.
Anatomical Study of the Tibialis Posterior Tendon's Connections to the Plantar Muscles and Its Relationship With the Severity of Hallux Valgus.
Koç T, Kurtoğlu Olgunus Z, Çiçek F … +1 more , Bobuş Örs A
J Foot Ankle Res · 2025 Sep · PMID 40804734 · Full text
Changes in tendon morphometry around first-row bones are linked to the hallux valgus (HV) development. However, there are very limited studies examining the relationship between the connection status of the tibialis post...
Changes in tendon morphometry around first-row bones are linked to the hallux valgus (HV) development. However, there are very limited studies examining the relationship between the connection status of the tibialis posterior (TP) tendon to the adductor hallucis (ADH) and flexor hallucis brevis (FHB) tendons and the development of HV. This study aimed to investigate the association between these tendon connections and the occurrence of HV. The study included 24 formalin-fixed adult cadavers and amputee feet (10 female, 14 male). The attachment sites and connections between the ADH, FHB, and TP tendons were recorded. Feet were classified into three groups: no connection between the three tendons (Group I), connection between TP and FHB (Group II), and connection between TP, FHB, and ADH (Group III). HV angle values and subgroups (normal, mild, and moderate-severe) were defined to assess the degree of HV. Feet were grouped based on tendon attachment status, and the distribution of HV subgroups was statistically analyzed. HV angles in Group III were significantly larger than in Groups I and II (= 0.000, p = 0.024). While tendon connection was detected in only 20% (1/5) of feet without HV, tendon connection was detected in 64% (7/11) of mild HV and in all feet with moderate-severe HV. HV occurred in 93.8% (15/16) of feet with tendon connections (vs. 50% without). The study revealed that HV can develop in feet with and without tendon attachments. However, HV is more frequent in cases where the TP tendon is attached to the FHB and ADH tendons. Additionally, moderate-severe HV increases when TP is attached to ADH.
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