Journal Of Foot And Ankle Research[JOURNAL]
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200 papers
Exploring Patient and Podiatrist Perspectives of the 'In-Remission' Status in Diabetes-Related Foot Disease.
Donaldson G, Hendry G, Barn R
J Foot Ankle Res · 2025 Jun · PMID 40356413 · Full text
BACKGROUND: The term 'in-remission' has been historically associated with the disease status in cancer. In diabetes foot care, the term was introduced into risk stratification systems in order to support patient communic...
BACKGROUND: The term 'in-remission' has been historically associated with the disease status in cancer. In diabetes foot care, the term was introduced into risk stratification systems in order to support patient communication and healthcare prevention strategies post-ulceration. However, despite the inclusion of an 'in-remission' category into risk stratification systems, the adoption and perception of the terminology in clinical practice remains unknown. The aim of this study is to explore patient and clinician perceptions of the term 'in-remission' in the context of diabetes foot disease management. METHODS: Semi-structured focus groups or interviews were conducted to identify the perceptions and impact of the term 'in-remission' on end users. Participants included patients classified as 'in-remission' as well as podiatrists who routinely work with people who have diabetes. Recruitment occurred via social media adverts, posters and snowball sampling. All focus groups and interviews were recorded and transcribed verbatim. Data were analysed for themes. RESULTS: The study included n = 9 people with diabetes classified as in-remission and n = 12 podiatrists. One online focus group was held with n = 5 podiatrists, whereas individual telephone interviews were conducted with the remaining n = 7 podiatrists and all n = 9 participants with diabetes. Three overarching themes were identified with several sub-themes in each group. Perceptions and implementation of the term 'in-remission' were highly variable whereby podiatrists tend to avoid using the term directly with patients and instead focus on patient education and held mixed views of the impact on patients. People with diabetes were largely unaware of their 'in-remission' status and had varied opinions on what 'in-remission' means and how it may impact on foot care. CONCLUSION: Awareness and implementation of the term 'in-remission' into podiatry practice are inconsistent. Despite the intention of the term to increase patient awareness and access to services, themes were identified regarding applicability and suitability resulting in avoidance by clinicians and confusion and fear from people with diabetes. These findings suggest that the term is not having the intended effect and further work is required to more fully explore the adoption of this terminology.
Knowledge-Behavior Relationships and Technology Adoption Among Patients With Diabetes: A Mixed-Methods Analysis of Smart Foot Care Technology.
Yeh TT, Huang JS, Chou YC
J Foot Ankle Res · 2025 Jun · PMID 40347486 · Full text
BACKGROUND: Although recent systematic reviews indicate low adherence to foot care practices among patients with type 2 diabetes compared to other self-management behaviors, smart healthcare technologies offer potential...
BACKGROUND: Although recent systematic reviews indicate low adherence to foot care practices among patients with type 2 diabetes compared to other self-management behaviors, smart healthcare technologies offer potential solutions for improving foot care management. The smart diabetic foot screening system represents an innovative approach to diabetic foot care. However, the factors influencing its adoption, particularly the relationship between knowledge, behavior, and technology acceptance, remain poorly understood. METHODS: A mixed-methods design was employed, integrating quantitative and qualitative data. Quantitative data were collected from 80 patients with type 2 diabetes using validated instruments: the foot care knowledge questionnaire, diabetic foot self-management behavior scale, and the unified theory of acceptance and use of technology questionnaire. Pearson correlation and regression analyses examined relationships between knowledge, behavior, and technology adoption intention. In-depth, semistructured interviews with 20 participants explored adoption factors. Thematic analysis was conducted on qualitative data. RESULTS: Despite high levels of foot care knowledge (86.2% correct response rate), actual self-management behaviors remained suboptimal, with a modest correlation between knowledge and behavior (r = 0.31 and p < 0.01). Regression analysis identified attitude and facilitating conditions as significant predictors of smart system adoption intention, explaining 57% of the variance. Qualitative analysis revealed three main themes: technology acceptance perceptions, implementation support system, and self-management patterns, highlighting the complex interplay between knowledge, attitudes, and behavioral factors. CONCLUSIONS: This study reveals that despite improved knowledge levels compared to previous decades, the knowledge-behavior gap in diabetic foot care persists. The findings suggest that successful implementations of smart healthcare technologies require addressing both attitudinal factors and facilitating conditions, rather than focusing solely on knowledge enhancement. These insights contribute to understanding technology adoption in chronic disease self-management and inform the development of more effective implementation strategies.
Exploring the lived experiences of individuals living with Charcot neuro-osteoarthropathy in Australia: A qualitative research study.
Chapman NM, Tehan PE
J Foot Ankle Res · 2025 Jun · PMID 40312126 · Full text
AIM: Charcot neuro-osteoarthropathy (CNO) is a rare but serious inflammatory process in individuals with peripheral polyneuropathy leading to the development of fractures, dislocations and permanent foot deformity. Most...
AIM: Charcot neuro-osteoarthropathy (CNO) is a rare but serious inflammatory process in individuals with peripheral polyneuropathy leading to the development of fractures, dislocations and permanent foot deformity. Most commonly, CNO occurs in individuals with diabetes and the progression of significant foot deformity can predispose the individual to pressure-related ulcerations and increased risk of lower limb amputation. The lived experience of the individual with CNO is largely unknown. This study aims to explore the lived experience of individuals affected by active CNO and CNO in remission in Australia. METHODS: This was a qualitative study using semi-structured interviews of a heterogeneous purposeful sample of individuals with CNO from a high-risk foot service in Australia. Interview questions were related to the physical, financial, social and emotional impacts of CNO and were developed based on the validated SF-36 outcome measure tool. A reflexive thematic analysis approach was used to analyse the dataset. RESULTS: Fourteen participants were recruited including seven males, seven females with age ranging from 36 to 74 years. Four themes were derived: (1) A burden to family and caregivers and feeling isolated and alone. (2) A lack of certainty relating to outcomes leading to increased anxiety. (3) Adaptive health behaviour changes made as a result of the CNO diagnosis. and (4) Limited access to healthcare information and healthcare support systems. CONCLUSIONS: The burden of CNO extends beyond the physical limitations of living with a significant foot deformity and the associated increased risk for further limb threatening complications. Individuals with CNO report feelings of increased anxiety, a loss of independence and feel they are a burden to their family impacting on their individual roles at home, including the ability to provide financially. This should be considered when managing individuals with CNO, with more holistic approaches to care required. This research highlights that increased engagement with mental health support services, social work and peer-group support along with greater access to evidence-based information on the management of CNO may better support the psycho-social needs of this population.
Reconciling Differences Between Podiatric and Orthopaedic Surgeons in the United Kingdom: The Memorandum of Understanding and Its Implications for the Future of Podiatric Surgery.
Kannegieter E, Nazir K, Nancarrow SA … +1 more , Borthwick AM
J Foot Ankle Res · 2025 Jun · PMID 40302126 · Full text
Interprofessional conflict has long characterised the relationship between UK podiatric surgeons and orthopaedic surgeons, stemming from overlapping professional boundaries and differing regulatory frameworks. This comme...
Interprofessional conflict has long characterised the relationship between UK podiatric surgeons and orthopaedic surgeons, stemming from overlapping professional boundaries and differing regulatory frameworks. This commentary focuses upon the recent memorandum of understanding (MoU) between the Royal College of Podiatry (RCPod) and the British Orthopaedic Foot and Ankle Society (BOFAS), which aims to address key areas of agreement and disagreement while fostering collaboration. It provides a contextual backdrop by illuminating the historical interprofessional conflict preceding the MoU and highlights the potential of the MoU to enhance patient outcomes, improve workforce sustainability and bridge historical divides. It is clear that achieving lasting progress will require continued dialogue and mutual recognition of each profession's contributions to modern healthcare. These issues also hold broader relevance for interprofessional relations and healthcare policy worldwide.
Shear Wave Tensiometry in the Evaluation of Achilles Tendon Loading: A Cross-Sectional Study on Conservatively Treated Tendons After Rupture.
Schneebeli A, Filardo G, Testa E … +6 more , Riegger M, Falla D, Sangiorgio A, Cescon C, Soldini E, Barbero M
J Foot Ankle Res · 2025 Jun · PMID 40289551 · Full text
PURPOSE: The aim of this study was to quantify differences in the shear wave speed (SWS) between a conservatively treated Achilles tendon (AT) after rupture and the unaffected contralateral tendon. METHODS: Twenty-nine p...
PURPOSE: The aim of this study was to quantify differences in the shear wave speed (SWS) between a conservatively treated Achilles tendon (AT) after rupture and the unaffected contralateral tendon. METHODS: Twenty-nine participants who received conservative treatment following Achilles tendon rupture (ATR) were enrolled. Measurements were taken during a single follow-up visit, which occurred between 1 and 7 years after the rupture. Tendon load was assessed using a shear wave tensiometer comprising a set of four accelerometers attached to the tendon. Stiffness, thickness, and cross-sectional area (CSA) were also assessed using MyotonPRO and ultrasound imaging. RESULTS: No significant differences in SWS were found between the affected AT and the unaffected side when analyzing the entire group (p > 0.05). However, significant differences between sides were observed at 3.5 Nm and 7 Nm (p = 0.001 and p = 0.020) for participants that experienced a lesion of the mid tendon. Higher plantar flexor strength was found for the unaffected side (320 ± 99.5 Nm) compared to the affected side (261 ± 80 Nm; p = 0.001). Thickness and CSA in the proximal and distal part of the tendon were significantly higher in the affected tendon compared to the unaffected side (p < 0.001). CONCLUSION: There is no difference in SWS values between the affected and the unaffected AT in the longer term after the rupture. However, differences in SWS were detected at specific contraction levels in participants with a mid-tendon lesion. Moreover, tendon thickness and the cross-sectional area, as well as plantar flexor strength, remain different between the affected and the unaffected AT.
Patients' Perspectives on Participation in an Effectiveness Study on Footwear Modification for the First Metatarsophalangeal Joint Osteoarthritis: A Qualitative Study.
Braam C, Kloprogge S, Schiphof D … +3 more , van Meurs JBJ, Bierma-Zeinstra SMA, van Middelkoop M
J Foot Ankle Res · 2025 Jun · PMID 40269334 · Full text
BACKGROUND: The effectiveness of footwear modifications for the first metatarsophalangeal (MTP) joint osteoarthritis (OA) compared to usual general practitioner (GP) care has never been studied. Understanding patients' p...
BACKGROUND: The effectiveness of footwear modifications for the first metatarsophalangeal (MTP) joint osteoarthritis (OA) compared to usual general practitioner (GP) care has never been studied. Understanding patients' perspectives is essential for assessing the feasibility of a randomized controlled trial (RCT) on this topic. Our objective is to explore experiences, expectations, beliefs, and opinions of patients with the first MTP joint OA regarding symptoms and limitations, healthcare management, footwear intervention, and research participation for designing a successful future effectiveness trial. METHOD: A qualitative research design was embedded within a feasibility pilot study for the recruitment of participants diagnosed with the first MTP joint OA. Qualitative data from semistructured interviews were categorized analyzed. RESULTS: All participants (n = 10) experienced limitations on the activity and participation level due to pain symptoms in the first MTP joint. Patients experienced varying approaches and treatment outcomes in primary and secondary healthcare, leading to both positive and negative perspectives. Most participants highlighted the importance of the cosmetic appearance of modified footwear, indicating that this is crucial for compliance with the intervention. Participants showed willingness to participate in an RCT, with strong preference for randomization into an intervention group with a modified footwear alongside usual GP care rather than GP care alone. CONCLUSION: Our study identified key considerations for designing a successful future trial, including recruiting incident cases, offering the deferred footwear intervention to the control group, providing clear information during recruitment and randomization phase, and the significance of the cosmetic appearance of modified footwear for patients with the first MTP joint OA.
Correlation Between Hallux Valgus Severity and the Prevalence of Metatarsus Adductus in Hallux Valgus.
Chen YS, Liang CH, Shih HT … +3 more , Tu KC, Tang SC, Wang SP
J Foot Ankle Res · 2025 Jun · PMID 40252214 · Full text
INTRODUCTION: Hallux valgus (HV) is a common foot deformity, with metatarsus adductus (MA) identified as a potential predisposing factor. MA has been shown to negatively affect surgical outcomes for HV, particularly in s...
INTRODUCTION: Hallux valgus (HV) is a common foot deformity, with metatarsus adductus (MA) identified as a potential predisposing factor. MA has been shown to negatively affect surgical outcomes for HV, particularly in severe cases. This study aims to clarify the prevalence of MA in the HV population using different metatarsus adductus angle (MAA) measurement methods and assess whether MAAs are influenced by HV severity. MATERIALS AND METHODS: This retrospective study included 294 feet from 147 participants. Patients were classified into non-HV (normal) and HV subgroups, with HV severity graded as mild, moderate, or severe based on the hallux valgus angle (HVA) measured on dorsoplantar weight-bearing radiographs. The prevalence of MA was assessed using four radiographic measurements: Sgarlato's MAA (MAA4), modified Sgarlato's MAA (MAA5), modified Engel's angle, and the calcaneo-second metatarsal angle (rearfoot-MT2). The interclass correlation coefficient was used to evaluate the reliability of the measurements. The correlation between HVA and MAA was analyzed using Spearman's Rho coefficient, and the prevalence of MA was compared using various measures. RESULTS: After excluding 87 feet, 207 feet (146 HV and 61 non-HV) from 147 participants were analyzed. All four MAA measurements showed excellent reliability, with the modified Engel's angle demonstrating the highest interobserver reliability and strongest correlation with HVA. HVA was significantly higher in the MA (+) group compared to the MA (-) group (32.21 vs. 24.78° and p = 0.001). The overall prevalence of MA in the cohort was 19.3% (MAA4), 24.2% (MAA5), 18.4% (modified Engel's angle), and 8.2% (rearfoot-MT2). MA was significantly more prevalent in the HV group compared to the normal group (24.0% vs. 4.9%) when using the modified Engel's angle, with MA prevalence increasing as HV severity worsened. CONCLUSIONS: MA is common among patients with HV, with its prevalence increasing in parallel with HV severity. The modified Engel's angle is a reliable and sensitive method for detecting MA associated with HV, particularly in severe cases, and its use can help tailor surgical plans to improve outcomes. Surgeons should be mindful of the presence of concomitant MA when planning HV surgery, as it may negatively affect surgical outcomes and increase the risk of recurrence.
Primary Care and Linked Secondary Care Encounters for Foot and Ankle Problems in Children and Young People: A Population-Based Cohort Study in England.
Rezel-Potts E, Bowen C, Dunn KM … +3 more , Jones CI, Gulliford MC, Morrison SC
J Foot Ankle Res · 2025 Jun · PMID 40235039 · Full text
BACKGROUND: In the United Kingdom, foot and ankle problems in children and young people are typically seen by the general practitioner in primary care and referred to secondary care or community services for specialist a...
BACKGROUND: In the United Kingdom, foot and ankle problems in children and young people are typically seen by the general practitioner in primary care and referred to secondary care or community services for specialist assessment and intervention. Following initial presentation to primary care, we have described the secondary care services accessed by children and young people with foot and ankle problems. We have also explored the sociodemographic variables associated with referrals to secondary care. METHOD: This was a population-based cohort study using the UK Clinical Practice Research Datalink (CPRD) Aurum primary care database and linked Hospital Episode Statistics (HES) Outpatient database. We extracted data for all children and young people up to 18 years of age with a consultation for a foot and ankle problem from 1st January 2015 to 31st December 2021 (CPRD) and included those with linked data in secondary care (HES database) in our analyses. RESULTS: 346,454 children and young people aged 0-18 years were identified in CPRD and eligible for linkage; 5030 had at least one referral within 18 weeks. The most common reason for referral was musculoskeletal or unspecified pain and 2935 had a referral to trauma and orthopaedics, 1314 for paediatric services, 678 for physiotherapy and 274 for diagnostic imaging. Odds for referrals were higher among younger age groups (odds ratio (OR) 1.29 and 95% confidence interval (CI) 1.25-1.33). Those in other (OR 0.77 and 95%CI 0.72-0.82), Asian (OR 0.81 and 95%CI 0.77-0.86) and Black (OR 0.85 and 95%CI 0.8-0.91) ethnic groups had lower odds of referral compared to those in the White group. CONCLUSION: These findings represent the first analyses of secondary care referrals for children and young people with foot and ankle problems. We have identified that musculoskeletal symptoms were most common reason for referral and the most common speciality involved in assessing foot and ankle problems was trauma and orthopaedics. We have reported sociodemographic differences in secondary care referrals and these findings could be indicative of inequalities in access to care and should be a priority for further research.
Footwear Toe-Box Shape and Medial Forefoot Pressures in Women With Hallux Valgus.
Bajraszewski KJ, Lim PQX, Buldt AK … +7 more , Hurn SE, Mickle KJ, Roddy E, Wluka AE, Erbas B, Munteanu SE, Menz HB
J Foot Ankle Res · 2025 Jun · PMID 40220280 · Full text
BACKGROUND: Narrow fitting footwear is a modifiable risk factor for the development of hallux valgus (HV). Despite this, the pressure that footwear exerts at the medial forefoot has not been fully evaluated in people wit...
BACKGROUND: Narrow fitting footwear is a modifiable risk factor for the development of hallux valgus (HV). Despite this, the pressure that footwear exerts at the medial forefoot has not been fully evaluated in people with HV. Therefore, the objective of this study was to determine whether the toe box of footwear habitually worn by women with HV is associated with pressure exerted on the medial forefoot. METHODS: In-shoe peak pressure and maximum force at the medial forefoot (distal and proximal sites) were recorded from 28 women (mean age 60.7 years, SD 10.7) with moderate or severe HV using the pedar pad pressure system (Novel GmbH, Germany). The shape (width and area) of the participants' most symptomatic foot and toe-box of their usual footwear was determined using an INFOOT 3D laser scanner (I-Ware Laboratory, Japan) and hand tracing, respectively. The difference between the foot and corresponding footwear measurements as well as differences in the magnitude and timing of peak pressure and maximum force between the proximal and distal forefoot were determined using independent t-tests. Correlations between forefoot pressures with toe-box differential were determined using Spearman's ρ analyses. RESULTS: Peak pressure and maximum force were significantly greater (mean difference [MD] = 33.0 ± 15.4 kPa; p < 0.001 and 12.8 ± 7.3 N; p = 0.001) and occurred slightly later in the stance phase at the distal forefoot compared to the proximal forefoot (MD = 6.0 ± 6.9%; p = 0.083 and 6.9 ± 6.8%; p = 0.045, respectively). There were no significant correlations between toe-box differential and medial forefoot pressures, with all correlations less than 0.35 (p > 0.05). CONCLUSION: Toe-box shape and fit of footwear typically worn by older women with painful HV was not associated with increased medial forefoot pressures in this study sample. Therefore, changing the toe-box width and area of the usual footwear worn by older women with painful, moderate or severe HV may not necessarily reduce medial forefoot pressures where footwear does not appear to play a role.
Muscle Strengthening Exercises for the Foot and Ankle: A Scoping Review Exploring Adherence to Best Practice for Optimizing Musculoskeletal Health.
Osborne JWA, Menz HB, Whittaker GA … +2 more , Cotchett M, Landorf KB
J Foot Ankle Res · 2025 Jun · PMID 40178827 · Full text
BACKGROUND: Foot and ankle muscle strengthening exercises are common interventions for many musculoskeletal conditions that are associated with pain and limited function in the lower limb. The scientific literature has a...
BACKGROUND: Foot and ankle muscle strengthening exercises are common interventions for many musculoskeletal conditions that are associated with pain and limited function in the lower limb. The scientific literature has a multitude of strengthening exercises recommended, and they have been criticized for not adhering to best practice and for being poorly reported. The aims of this scoping review were to (i) describe what foot and ankle strengthening exercises have been recommended in the scientific literature, (ii) compare the prescription of these exercises to best practice recommendations, and (iii) assess the completeness of the reporting of these exercises and exercise programs. METHODS: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A systematic search of peer-review journal articles was conducted on 23 February 2023. Study designs that were included were experimental, quasi-experimental, feasibility, pilot studies, and observational. For each study included in the review, study design and participant details such as age, sex, and conditions treated were noted. To describe the foot and ankle strengthening exercises, each exercise was noted, which included its name, the number of sets and repetitions recommended, the load type and its magnitude, and whether there were any progression strategies. Exercises were grouped according to primary movement and a general exercise descriptor. To compare to best practice, each program's prescription parameters of frequency, intensity, and time were compared to the American College of Sports Medicine's (ACSM) guidelines. To assess completeness of reporting, each study was assessed with the Consensus on Exercise Reporting Template (CERT). RESULTS: The search yielded 1511 documents, and 87 were included after full-text screening. Of the included studies, most were randomized controlled trials, and the most common participants were healthy adults (mean age range: 18-83 years). Across all studies, a total of 300 foot and ankle exercises were prescribed. The most common strengthening exercise category involved ankle plantar flexion (25% of 300 exercises), followed by plantar foot intrinsics (16%). The most common prescription of strengthening exercises included 3 sets (37%) of 10 repetitions (38%) performed 3 times per week (34%), often without a prescribed load (66%). Prescribed sets per muscle group met ACSM recommendations for novice lifters in 93% of studies. In contrast, load intensity (for increasing muscle strength) was prescribed at the recommended dose of 60% of 1 repetition maximum or greater in only 2% of exercises. The median score for completeness of reporting according to the CERT checklist was 31% of all items. CONCLUSIONS: This scoping review found that the studies predominantly included ankle plantar flexion and plantar foot intrinsic muscle strengthening exercises, typically prescribed at 3 sets of 10 repetitions, 3 times per week. When compared to best practice recommendations, load intensity in exercise prescription is commonly less than recommended or is not reported. In addition, the review highlights deficiencies in the reporting of exercise programs. We propose using established best-practice exercise prescription guidelines like those from the ACSM and the adoption of CERT for reporting exercises in the scientific literature.
Custom Foot Orthoses: A Retrospective Analysis of 1000 Prescriptions From New Zealand Podiatrists.
Jackson A, Sheerin K, Reid D … +3 more , Ganley T, Lamb B, Carroll MR
J Foot Ankle Res · 2025 Jun · PMID 40178762 · Full text
BACKGROUND: Podiatrists frequently prescribe foot orthoses to manage a range of musculoskeletal complaints. This study aimed to understand what characteristics were included in the design of custom foot orthoses, how sym...
BACKGROUND: Podiatrists frequently prescribe foot orthoses to manage a range of musculoskeletal complaints. This study aimed to understand what characteristics were included in the design of custom foot orthoses, how symmetrically these were applied and whether there was an association between these features and the clinical diagnosis. METHODS: One thousand orthotic prescriptions were obtained from two commercial orthotic labs in New Zealand. Twenty-six prescription characteristics were analysed. Descriptive data detailed the frequency of included characteristics. The symmetry feature was derived according to the characteristics of both feet and analysed considering the number of times the left foot differed from the right foot. Clinical diagnoses were grouped, and for the most common four (plantar heel pain, pes planus, posterior tibial tendon and ankle sprain), associations between the prescription characteristics selected and diagnosis were analysed using cross tabulations and chi-squared tests. RESULTS: The most common prescription characteristics were a Polyamide 11 shell (80%), a shell thickness of 3 mm (54%), modified root shell style (61%) and varus cast correction (64%). Additionally, deep heel cups (36%), medial rearfoot (Kirby) skives (36%) and lateral forefoot wedges (22%) were the most prescribed modifications. Fifty-eight percent of prescriptions were identical between the left and right sides. The most common diagnosis was plantar heel pain (11%). Plantar heel pain was associated with the characteristics of plantar fascia groove (p < 0.001), forefoot lateral wedge (p < 0.001) and heel cushion (p < 0.001). CONCLUSION: Strong associations between orthotic design characteristics and diagnoses indicate consistency in prescription variables amongst New Zealand podiatrists when prescribing custom foot orthoses. Plantar heel pain and pes planus are the two clinical diagnoses for which podiatrists prescribe the most custom foot orthoses. The high degree of similarity and symmetry in the prescription of orthoses raises questions regarding the specificity of prescriptions and opens a potential for future research on the topic.
The association of sarcopenia and frailty in diabetes-related foot disease: A 3-year prospective evaluation.
Hon KY, Bain M, Edwards S … +3 more , Pena G, McMillan N, Fitridge R
J Foot Ankle Res · 2025 Mar · PMID 40119820 · Full text
AIM: To prospectively evaluate the association of various markers of sarcopenia and frailty with clinical outcomes in diabetes-related foot disease (DRFD), namely wound healing, amputation-free survival, and death over 3...
AIM: To prospectively evaluate the association of various markers of sarcopenia and frailty with clinical outcomes in diabetes-related foot disease (DRFD), namely wound healing, amputation-free survival, and death over 3 years. METHODS: This was an observational study of patients with DRFD at a quaternary multidisciplinary diabetic foot service. Initial assessment includes classification of DRFDs using WIfI classification, assessment of frailty using the FRAIL scale, and measurement of handgrip strength (HGS) using a dynamometer. Muscle mass was ascertained by measuring the psoas muscle area at the level of L3 vertebrae on computed tomography. Patients were followed up for 3 years and primary outcomes were wound healing, amputation-free survival, and death. RESULTS: One hundred patients with a median age of 71 were included in the analysis. The majority of the patients were male (75%). Forty-seven percent of patients were considered as frail, with 37 patients recorded to have low HGS. Patients with high HGS had significantly higher odds of wound healing by 3.83 times when compared to those with low HGS (odds ratio = 3.83. 95% CI 1.35-10.92). Patients with low psoas muscle index (PMI) and low HGS were observed to have a higher risk of death based on the following hazard ratios: HGS (high vs. low), HR = 0.46, 95% CI: 0.22-0.997; PMI (low vs. high), HR = 2.15, 95% CI: 1.17-3.96. CONCLUSION: There was a significant prevalence of frailty and reduced HGS among our patients with DRFD. Low HGS was associated with poor wound healing and increased mortality in patients with DRFD. Additionally, low muscle mass was associated with increased mortality in this population. This research highlights the need for more precise tests and future studies of the links between sarcopenia, frailty, and outcomes in DRFD.
How Can Podiatrists and Other Health Care Professionals Support the Detection of Atrial Fibrillation?
Lewis JEA, Tozer J, Lobban T … +3 more , Evans A, Banner M, Ambrose L
J Foot Ankle Res · 2025 Mar · PMID 40050249 · Full text
Atrial fibrillation (AF) is a global health crisis affecting 33.5 million people, with costs projected to reach £75 billion by 2035. A significant concern is that 43-48% of cases are asymptomatic, increasing the risk of...
Atrial fibrillation (AF) is a global health crisis affecting 33.5 million people, with costs projected to reach £75 billion by 2035. A significant concern is that 43-48% of cases are asymptomatic, increasing the risk of stroke and heart failure. While general population screening lacks strong support, targeted screening shows promise in reducing stroke occurrence and healthcare costs. Podiatrists, who frequently treat adults of advancing age, are uniquely positioned to detect AF in high-risk, asymptomatic individuals. This commentary advocates for opportunistic AF screening by podiatrists and other healthcare professionals, offering guidance for implementation. Early detection through defined referral pathways is crucial for timely diagnosis and management, potentially reducing AF-related strokes that can lead to early mortality. Further high-quality podiatry-led studies are recommended to build on this commentary paper.
Navigating diagnostic uncertainty in children's chronic lower limb pain: A qualitative study of management strategies using vignette-based focus groups.
Coventry J, Welch JJ, Pacey V … +4 more , Ta B, Sturgiss E, Smith M, Williams CM
J Foot Ankle Res · 2025 Mar · PMID 40042426 · Full text
BACKGROUND: Chronic lower limb pain is common in children and adolescents and is frequently managed by podiatrists. Due to the complexities of understanding the cause of chronic pain, clinicians may experience uncertaint...
BACKGROUND: Chronic lower limb pain is common in children and adolescents and is frequently managed by podiatrists. Due to the complexities of understanding the cause of chronic pain, clinicians may experience uncertainty around the diagnosis, which in turn may impact their communication and management approaches. Limited research explores how podiatrists manage chronic lower limb pain in children, especially in the presence of diagnostic uncertainty. This study aimed to explore the management strategies including language that podiatrists report using to address the pain experience of children with chronic lower limb pain and to investigate if and how the reported management strategies used by podiatrists to address the pain experience of children with chronic lower limb pain vary based upon the level of diagnostic uncertainty. METHODS: Eight focus groups were conducted with a total of 48 podiatrists. Participants were presented with three vignettes, each describing a child with chronic lower limb pain. They were then asked to discuss their certainty in the child's diagnosis presented and their approaches to explain and manage the child's pain. Audio data were recorded, transcribed and analysed using thematic analysis. Three key themes were generated: Language strategies, non-verbal communication strategies and treatment strategies. RESULTS: Podiatrists were overall certain in the diagnosis presented in vignettes 1 (calcaneal apophysitis) and 2 (juvenile idiopathic arthritis); however, they expressed significant uncertainty in vignette 3, which was written to elicit uncertainty presenting a case with generalised lower limb pain. Many groups fixated on the Beighton score of 5/9 and interpreted this to mean hypermobility, which is inconsistent with the current clinical guidance. Podiatrists used similar language strategies across all 3 vignettes and supported their language strategies with non-verbal communication strategies. Podiatrists also discussed activity modification, passive and self-care strategies and building a team as the treatment strategies they would use. CONCLUSIONS: This study highlights the variety of clinical management strategies used by approaches and highlights how their approach may change depending on their certainty in the diagnosis.
Psychological factors associated with pain and function in adults with hallux valgus.
Kak A, Batra M, Erbas B … +7 more , Sadler S, Chuter V, Jenkins J, Ozcan H, Lafferty D, Amir O, Cotchett M
J Foot Ankle Res · 2025 Mar · PMID 40024905 · Full text
INTRODUCTION: Psychological factors are linked to pain and function in various musculoskeletal conditions, but their impact on hallux valgus is unclear. Health-related quality of life declines with increasing severity of...
INTRODUCTION: Psychological factors are linked to pain and function in various musculoskeletal conditions, but their impact on hallux valgus is unclear. Health-related quality of life declines with increasing severity of hallux valgus, affecting not only foot pain and physical function, but also general health, vitality and mental health. Previous studies have reported inconsistent associations between psychological factors, such as anxiety and depression, and surgical outcomes, which might relate to variability in measurement approaches. Understanding the associations between psychological factors, including anxiety, depression, pain catastrophizing and kinesiophobia, and hallux valgus-related pain and function may inform more holistic pre-operative care. Therefore, we aimed to assess these associations in adults with hallux valgus pre-surgery. METHODS: A pre-operative cross-sectional study was conducted with 41 adults scheduled for hallux valgus surgery. Participants completed questionnaires measuring continuous psychological variables: depression, anxiety and stress (Depression Anxiety Stress Scale-21, a tool for general psychological distress), kinesiophobia (Tampa Scale for Kinesiophobia, which assesses fear of movement associated with pain) and pain catastrophizing (Pain Catastrophizing Scale, a tool used to evaluate maladaptive pain-coping strategies). Continuous outcomes were evaluated using the Manchester-Oxford Foot Questionnaire for foot function, pain and social interaction. Multiple linear regressions explored the associations between these psychological factors and the outcomes. RESULTS: When all exposure variables were considered simultaneously, pain catastrophizing emerged as a significant predictor of foot pain and foot function. A one-unit increase in the pain catastrophizing score was associated with a 1.41-point increase in foot pain (β = 1.41, 95% confidence intervals (CIs) 0.73-2.09 and p < 0.001) and a 1.83-point increase in worse foot function (β = 1.83, 95% CI 1.12-2.54 and p < 0.001). CONCLUSION: Assessing pain catastrophising pre-operatively is recommended for individuals with hallux valgus, although more structured education may be needed to support health professionals in assessing psychological factors. Future research should evaluate the longitudinal impact of pain catastrophizing on post-operative outcomes and explore other contributing factors, such as comorbidities, lifestyle variables and sex differences, to refine screening and treatment strategies.
Incidence of Adult Acquired Flatfoot Deformity Referred to Specialist Care in Sweden.
Osbeck I, Cöster M, Atroshi I
J Foot Ankle Res · 2025 Mar · PMID 40013869 · Full text
INTRODUCTION: Adult acquired flatfoot deformity (AAFD) is a disabling condition that may require complex surgical treatment. Little is known about the incidence of AAFD in the general population and specifically of AAFD...
INTRODUCTION: Adult acquired flatfoot deformity (AAFD) is a disabling condition that may require complex surgical treatment. Little is known about the incidence of AAFD in the general population and specifically of AAFD requiring specialist care. We aimed to describe the incidence of AAFD referred to specialist care in the Swedish general population. METHODS: We conducted a nation-wide epidemiological register study to estimate the incidence of referred AAFD in the general population. We retrieved data from the Swedish National Patient Register. All individuals aged 16 years or older, with a first-time diagnosis of AAFD (ICD-10 code M214) between 2007 and 2018 were identified. Total incidences, change over time, and gender-specific and age-specific incidences per 100,000 person-years were calculated using population size data from Statistics Sweden. Incidences were compared using the Poisson test. RESULTS: The incidence rate of referred AAFD in the general population was 23.0 (95% CI 22.7-23.3) per 100,000 person-years. The incidence rate in women was 30.4 (95% CI 29.9-30.8) and in men was 15.4 (95% CI 15.1-15.8). The highest incidence rates were found in the age Group 61-75 years. The incidence rates varied significantly across the 21 regions in Sweden. The age-standardized and sex-standardized incidence rates ranged from 8.3 (95% CI 7.2-9.4) to 69.1 (95% CI 62.4-75.8). CONCLUSION: AAFD requiring referral to specialist care is common in the general population. Women had nearly twice the incidence of AAFD compared to men. Large unexplained regional variations in the incidence rates exist.
Development of a Lateral Longitudinal Arch Evaluation Method for the Foot Using Ultrasonography: Validation With Radiography and Verification of Intrarater and Interrater Reliability.
Kawamura D, Komatsu T, Suto M … +4 more , Narita H, Umezaki Y, Takahashi S, Shinohara H
J Foot Ankle Res · 2025 Mar · PMID 39999351 · Full text
INTRODUCTION: The lateral longitudinal arch (LLA) is an essential structure of the foot. However, LLA evaluation methods remain underexplored compared to those of the medial longitudinal arch (MLA). This study sought to...
INTRODUCTION: The lateral longitudinal arch (LLA) is an essential structure of the foot. However, LLA evaluation methods remain underexplored compared to those of the medial longitudinal arch (MLA). This study sought to develop a method for measuring the cuboid height, the keystone of the LLA, using ultrasonography and to verify its correlation with radiography, as well as intrarater and interrater reliability. METHODS: This cross-sectional study included 21 university students (14 males and seven females). The cuboid height was measured using radiography and ultrasonography. The validity of ultrasonographic measurements was assessed through correlation with radiographic measurements and Bland-Altman analysis. Intrarater and interrater reliabilities were evaluated using intraclass correlation coefficients (ICCs). RESULTS: A strong correlation was observed between cuboid heights measured using radiography and ultrasonography (r = 0.98, p < 0.01). The Bland-Altman analysis revealed a fixed bias of -0.71 mm (95% confidence interval [95% CI]: -0.96 to -0.46 mm). Intrarater and interrater reliability for ultrasonographic measurements were almost perfect, with ICCs of 0.98 and 0.99, respectively. CONCLUSIONS: Cuboid height measurements using ultrasonography demonstrated high validity and reliability. This method offers a noninvasive and cost-effective alternative to radiography, with potential clinical applications in the evaluation of LLA and related conditions such as cuboid syndrome and lateral foot injuries.
Key capabilities required for podiatry graduates: A Delphi consensus study.
Munteanu SE, Cotchett M, Oates MJ … +6 more , Frescos N, Chuter V, Frecklington M, Butler MT, Haley NW, Menz HB
J Foot Ankle Res · 2025 Mar · PMID 39979786 · Full text
INTRODUCTION: Work-readiness is linked to health professional graduates' job performance, satisfaction, engagement and retention. However, there is currently no podiatry-specific graduate employer work-readiness survey t...
INTRODUCTION: Work-readiness is linked to health professional graduates' job performance, satisfaction, engagement and retention. However, there is currently no podiatry-specific graduate employer work-readiness survey tool that has been developed with employers of graduate podiatrists. The aim of this study was to conduct a modified Delphi survey to achieve consensus among employers of podiatry graduates on the key capabilities required for podiatry graduates. METHODS: A Delphi method of consensus development was used, comprising three online survey rounds. Purposive sampling was used to recruit individuals with extensive experience and knowledge in mentoring and managing graduate podiatrists in Australia or New Zealand. In Round 1, participants were asked to rate agreement/disagreement with 71 items across seven domains relating to capabilities required of podiatry graduates that were extracted from a literature search and steering committee input. Participants were also asked to contribute further ideas in relation to these items, which were incorporated as new items (n = 7) in Round 2. In Rounds 2 and 3, participants re-appraised their ratings in view of the group consensus. Consensus was defined as ≥75% agreement. In Round 3, participants were also asked to rate the importance of each item as either 'essential' or 'optional'. RESULTS: Twenty-five participants (mean [SD] of 14.9 [5.7] years of experience in managing podiatry graduates in clinical practice in Australia or New Zealand) completed Round 1, 24 in Round 2, and 23 in Round 3. Of the 78 items presented to our expert panel, 61 (78.2%) achieved consensus and were accepted, and 17 (21.8%) were excluded. Of the 61 items that achieved consensus, thirty-nine (63.9%) were rated as 'essential' by 75% of more respondents. CONCLUSION: Consensus among employers of podiatry graduates was established on the key capabilities required for podiatry graduates. Sixty-one items were identified across seven domains, and of these, 39 items were rated as 'essential'. The findings of this study have the potential to inform the creation of a podiatry-specific graduate employer work-readiness tool to provide feedback to podiatry education program providers and new graduates in the workplace.
Comparing perioperative outcomes after transmetatarsal amputation in patients with or without peripheral vascular disease.
Plantz MA, Bergman R, Gerlach E … +3 more , Mutawakkil M, Patel M, Kadakia AR
J Foot Ankle Res · 2025 Mar · PMID 39924627 · Full text
BACKGROUND: Transmetatarsal amputation (TMA) is a commonly performed procedure for gangrene in the setting of diabetes or peripheral vascular disease. The purpose of this study is to investigate the incidence of and risk...
BACKGROUND: Transmetatarsal amputation (TMA) is a commonly performed procedure for gangrene in the setting of diabetes or peripheral vascular disease. The purpose of this study is to investigate the incidence of and risk factors for reoperation and perioperative complications after TMA in patients undergoing surgery for primarily infectious/diabetic wounds versus peripheral vascular disease. METHODS: Patients undergoing TMA between January 1, 2015 and December 31, 2020 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. The indication for surgery was reported using the International Classification of Disease 9/10 codes. Patients were categorized into two groups: patients undergoing surgery for primarily infectious/diabetic wounds versus peripheral vascular disease. The incidence of 30-day mortality, readmission, reoperation, nonhome discharge, and various medical and surgical complications was reported. Outcome measures were compared between the diabetic and peripheral vascular disease groups. Logistic regression was used to identify independent risk factors for each outcome measure of interest. RESULTS: 3392 patients were included in the final cohort. There was a 30-day mortality rate of 2.9%, reoperation rate of 13.8%, readmission rate of 16.8%, surgical complication rate of 22.2%, and medical complication rate of 15.8%. Patients undergoing surgery for a vascular indication had a higher rate of mortality, reoperation, hospital readmission, nonhome discharge, and various medical complications (p < 0.05). Patients undergoing surgery for infectious/diabetic wounds had a higher rate of deep surgical site infection and systemic sepsis (p < 0.05). A vascular surgical indication was independently associated with reoperation and overall medical complications (p < 0.05). Various factors, including age, body mass index, medical comorbidities, and the presence of preoperative sepsis were associated with poor outcomes. CONCLUSION: Significant rates of mortality, reoperation, and hospital readmission were reported after TMA. The presence of peripheral vascular disease was independently associated with reoperation and medical complications. Patients undergoing TMA, particularly for peripheral vascular disease, should be counseled about perioperative risks and indicated for surgery carefully.
The use of computer-aided design and manufacture for foot orthoses: A cross-sectional study of orthotic services in the UK.
Barr L, Richards J, Chapman GJ
J Foot Ankle Res · 2025 Mar · PMID 39909864 · Full text
OBJECTIVE: This study aimed to identify how computer aided design and manufacture (CAD/CAM) technologies are currently being used for insole production by UK orthotic services in the National Health Service (NHS), includ...
OBJECTIVE: This study aimed to identify how computer aided design and manufacture (CAD/CAM) technologies are currently being used for insole production by UK orthotic services in the National Health Service (NHS), including any variation in the specific processes and identify barriers to implementation. DESIGN: A cross-sectional study was undertaken using freedom of information requests sent to all 214 NHS Trusts and Health Boards (HBs) across the UK. The request comprised 22 questions relating to CAD/CAM for insole production by UK NHS orthotic services during the 2021/22 financial year. OUTCOME MEASURES: Analysis was undertaken and presented in terms of response rate to individual questions. Where free text responses were provided, thematic analysis was conducted. RESULTS: Responses were received from 186 (86.9%) Trusts/HBs, those who did not have an orthotic service were excluded, and 131 responses were included in the final analysis. 70.5% (91/129) of Trusts/HBs used CAD/CAM to manufacture bespoke insoles. The most common workflow associated with CAD/CAM insole production was foot-shape capture with a foam box impression cast (86.8% (79/91)); casts transported to another site (90.8% (79/87)); foam boxes scanned into a CAD/CAM system (81.6% (71/87)); insoles designed by a technician (73.6% (67/91)) and insole produced with reduction milling (59.1% (SD 37.92)). The greatest barriers to the use of CAD/CAM were those of equipment costs and staff experience and training. CONCLUSIONS: UK orthotic services have widely adopted CAD/CAM insole production, but fully-digital workflow is uncommon. Hybrid-digital workflow involves physical casts and their transportation, generating waste and impacting sustainability. Further research is required to understand how hybrid-digital and fully-digital workflow affect patient treatment outcomes, costs and sustainability. Barriers to CAD/CAM including costs and staff training which should be considered alongside the growing body of research around CAD/CAM technologies.
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