Journal Of Foot And Ankle Research[JOURNAL]
Sun
200 papers
Relation Between Calcaneal Fat Pad Thickness and Plantar Foot Ulceration in Patients With Type 2 Diabetes Mellitus.
van den Nieuwenhof SJ, Heijmans MHM, van der Reijden JJ … +2 more , Bakker CD, Vaes RHD
J Foot Ankle Res · 2026 Sep · PMID 42400935 · Full text
INTRODUCTION: Thinning of fat pads may elevate the risk of developing plantar foot ulcers potentially resulting in lower-extremity amputations. Evaluating whether fat pad thickness is associated with plantar foot ulcerat...
INTRODUCTION: Thinning of fat pads may elevate the risk of developing plantar foot ulcers potentially resulting in lower-extremity amputations. Evaluating whether fat pad thickness is associated with plantar foot ulceration could aid in early risk detection. This study therefore aims to compare fat pad thickness between type 2 diabetes mellitus (T2DM) patients with and without plantar foot ulcers using MRI. METHODS: This retrospective cross-sectional study included patients diagnosed with T2DM of whom a nonweight bearing MRI of the ankle or foot was available. The thickness of the calcaneal fat pad was measured in the sagittal plane, measuring perpendicularly from the lowest cortex of the calcaneal bone to and including the skin. Calcaneal fat pad thickness was compared between T2DM patients with and without plantar foot ulceration. RESULTS: In total, 42 patients were included of which 16 in the T2DM group with plantar foot ulceration. The calcaneal fat pad was significantly thinner in T2DM patients with plantar foot ulceration compared to those without plantar foot ulceration (15.7 ± 3.2 mm vs. 18.6 ± 2.8 mm, p = 0.004). CONCLUSION: This study established an initial association between fat pad thickness and plantar foot ulceration in T2DM patients. Our findings suggest that a reduction in calcaneal fat pad thickness may decrease the shock-absorbing ability of the plantar fat pads, making the underlying tissue more vulnerable to injury, increasing the risk of developing plantar foot ulcers. The initial association between fat pad thickness and foot ulceration should be further explored to discover its potential in clinical practice.
Advancing Conservative Treatment of Knee Osteoarthritis: 3D-Printed Shoe Soles for Passive Toe-Out Gait Modification.
Jiang Z, Studer PB, Zäh M … +4 more , Kryenbühl C, Reichenbach S, Taylor WR, Zhang Q
J Foot Ankle Res · 2026 Jun · PMID 42332343 · Full text
INTRODUCTION: To evaluate whether a 3D-printed shoe sole can passively replicate toe-out gait biomechanics and reduce the knee adduction moment (KAM) and knee adduction angular impulse (KAAI), addressing limitations of t...
INTRODUCTION: To evaluate whether a 3D-printed shoe sole can passively replicate toe-out gait biomechanics and reduce the knee adduction moment (KAM) and knee adduction angular impulse (KAAI), addressing limitations of traditional gait retraining. METHODS: Custom shoe soles were 3D-printed using gyroid infill structures to create a rotational hind-sole and a variable stiffness fore-sole ('RVS' shoes). Twenty-one healthy adults completed three baseline gait trials in control shoes, followed by randomised biofeedback-based gait retraining at toe-out angles of 5°, 10° and 15°. After each retraining session, motion capture was used during overground walking. Participants then walked wearing RVS shoes for three trials. Gait biomechanics were analysed using repeated measures ANOVA and multiple linear regression. RESULTS: Compared to baseline, KAM's second peak was significantly reduced after toe-out retraining: 5° (13.6%, p = 0.002), 10° (20.2%, p < 0.001) and 15° (31.7%, p < 0.001). RVS shoes alone reduced it by 16.3% (p < 0.001), and KAAI by 8.6% (p < 0.001)-a reduction not achieved by retraining. Regression analysis showed that changes in KAM were strongly predicted (95%) by knee centre-of-pressure offset and mediolateral ground reaction force. CONCLUSION: 3D-printed RVS shoes passively replicated or exceeded the biomechanical effects of active toe-out gait retraining, offering a promising, low-effort intervention for managing knee osteoarthritis.
One Shoe Doesn't Fit All: A Contextual Approach to Therapeutic Footwear for People at Risk of Diabetes-Related Foot Ulceration.
Jarl G, Lazzarini PA, Srisawasdi G … +1 more , van Netten JJ
J Foot Ankle Res · 2026 Jun · PMID 42310478 · Full text
INTRODUCTION: People at risk of diabetes-related foot ulcers are recommended to always use therapeutic footwear when weight-bearing, to help prevent ulcers. These recommendations are supported by good quality evidence, y...
INTRODUCTION: People at risk of diabetes-related foot ulcers are recommended to always use therapeutic footwear when weight-bearing, to help prevent ulcers. These recommendations are supported by good quality evidence, yet adherence by patients to using this footwear is low. One reason may be because these recommendations do not consider that footwear use is highly contextual to the physical or sociocultural environments it is intended to be used. In this paper, we propose and discuss a contextual approach to considering therapeutic footwear solutions. CONTEXTUAL APPROACH TO THERAPEUTIC FOOTWEAR: Recommending patients to use the same therapeutic footwear solution in vastly different contexts seems at odds with person-centred care principles and is likely a reason for patients not fully adhering to such recommendations. We discuss seven contexts in which using therapeutic footwear is particularly challenging: the home, workplaces, social occasions, places-of-worship, water-related activities, hotter climates and holidays. We outline how a contextual approach to therapeutic footwear might lead to more appropriate footwear solutions. This approach typically involves a trade-off between functional benefits and adherence and may lead to novel designs for different contexts. We also propose six different footwear solutions that incorporate features that may be more aesthetically pleasing, cooler, lighter, cheaper or waterproof, yet still providing protection and functional offloading. We suggest outcomes of such an approach may be more favourable for the patient's overall adherence and foot health than the current somewhat unrealistic recommended practice of prescribing a "one shoe fits all" solution. CONCLUSION: A contextual approach as proposed in this paper may lead to novel therapeutic footwear solutions that better address patients' needs for adequate footwear. If these footwear solutions are implemented, this may in future lead to higher patient adherence to using appropriate footwear and lower ulceration rates.
Prevalence and Radiographic Morphology of Hallux Valgus in Adolescent Athletes.
Ikuta Y, Nakasa T, Toriyama M … +5 more , Ito H, Yamakawa R, Ochi M, Mikami Y, Adachi N
J Foot Ankle Res · 2026 Jun · PMID 42304191 · Full text
INTRODUCTION: Hallux valgus (HV) can shift plantar loading, impair hallux function, and affect athletic performance in adolescent athletes. Although previous studies have focused mainly on dance-related sports, limited d...
INTRODUCTION: Hallux valgus (HV) can shift plantar loading, impair hallux function, and affect athletic performance in adolescent athletes. Although previous studies have focused mainly on dance-related sports, limited data exist regarding the prevalence and radiographic morphology of HV across broader athletic populations. In particular, the role of hallux interphalangeal alignment and proximal phalanx morphology in deformity severity remains unclear. We aimed to determine HV prevalence among adolescent athletes across various sports and to identify radiographic morphological factors associated with deformity severity. METHODS: This cross-sectional study included 280 adolescent athletes (188 males and 92 females; mean age, 13.7 ± 1.6 years) across 18 sports. Weight-bearing foot radiographs were obtained. Radiographic parameters included the HV angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), hallux interphalangeal angle (HIA), proximal-distal phalanx articular angle (PDPAA), Meary angle, calcaneal pitch angle, and medial cuneiform-fifth metatarsal height. Multivariable linear regression analyses were performed separately for dominant and nondominant feet to identify factors associated with combined deformity severity (sum of HVA and HIA). RESULTS: HV was identified in 42.9% of athletes when defined as HVA ≥ 15° in either foot and was more prevalent in female than male athletes (59.8% vs. 34.6%, p < 0.001). In contrast, 93.6% of athletes had an HIA ≥ 10° in either foot, based on the conventional adult-derived threshold, with no significant sex difference. In this multi-sport adolescent athlete population, distal first metatarsal morphology (DMAA) and proximal phalanx articular morphology (PDPAA) showed the strongest independent associations with combined deformity severity. IMA and female sex were also significant factors, whereas sagittal plane alignment, body mass index, and ankle activity score were not. CONCLUSION: This multi-sport study extends previous findings on adolescent hallux deformity by demonstrating that deformity severity is associated not only with metatarsal structural factors but also with proximal phalanx articular morphology. These findings support a broader radiographic characterization of adolescent HV, although their clinical significance requires further study.
Measuring In-Shoe Plantar Strain Outcomes in the Presence of Callus: A Preliminary Study Using the STAMPS3D Measurement System.
Sairally F, Russell DA, Siddle HJ … +3 more , Trinca D, Brockett C, Culmer PR
J Foot Ankle Res · 2026 Jun · PMID 42287691 · Full text
INTRODUCTION: Diabetes-related foot ulcers (DFU) are growing in prevalence, driven by the global rise in diabetes. Plantar callus has been identified as a risk factor for DFU formation, with its presence considered highl...
INTRODUCTION: Diabetes-related foot ulcers (DFU) are growing in prevalence, driven by the global rise in diabetes. Plantar callus has been identified as a risk factor for DFU formation, with its presence considered highly predictive for ulceration. Preventative strategies, such as debridement and offloading aim to reduce the thickness of localised hard skin formed through repetitive high pressure and shear stress. Although several studies have looked at the quantitative effects of callus and its removal in the neuropathic foot, assessments have relied solely on pressure measurements, neglecting the contribution of shear stress. A lack of in-shoe measurement devices capable of measuring shear, either independently or alongside pressure, limits our understanding of how the foot behaves in the presence of callus or responds as a result of debridement. METHODS: This proof-of-concept study investigates the use of the STAMPS3D system to capture cumulative 3D plantar strain data across the foot in the presence of simulated callus in healthy participants. By introducing multi-layer silicone inserts that replicate key mechanical features of callus at the 1 metatarsal head and heel regions, this study explores plantar strain responses in healthy participants. RESULTS: The simulated callus produced subtle redistribution of strain across the foot with distinct local changes at the callus sites. CONCLUSION: Findings may inform future approaches to objective callus assessment, guide debridement practices and contribute to DFU prevention strategies.
The Effect of Limited Ankle Dorsiflexion During Emergency Stop-Jump Movements on Lower Limb Biomechanics.
Zhou Y, Yang N, Wang Q … +5 more , Wu Y, Shi H, Zhang S, Ren S, Huang H
J Foot Ankle Res · 2026 Jun · PMID 42287683 · Full text
OBJECTIVE: The stop-jump task is a key movement in sports such as basketball and volleyball, with landing biomechanics closely linked to injury risk. Restricted ankle dorsiflexion (DF) alters lower-extremity mechanics an...
OBJECTIVE: The stop-jump task is a key movement in sports such as basketball and volleyball, with landing biomechanics closely linked to injury risk. Restricted ankle dorsiflexion (DF) alters lower-extremity mechanics and increases the risk of lower-limb joint injuries; however, its effects on the full stop-jump cycle remain unclear. This study examined how restricted DF influences lower-extremity biomechanics during the stop-jump task and explored the mechanisms underlying a stiff landing strategy and its potential injury risks. METHODS: Participants underwent static ankle dorsiflexion range of motion (DF ROM) testing and functional squat assessment. Eligible participants completed walking and stop-jump tasks, with biomechanical data collected synchronously using motion capture and force plates. Based on peak ankle dorsiflexion angle during walking, 44 participants were categorized into restricted (RADF, n = 22) and unrestricted (unRADF, n = 22) groups. Group differences in lower-extremity biomechanics across stop-jump phases were analyzed using ANCOVA with sex as a covariate, with post hoc power reported. RESULTS: The RADF group demonstrated significantly greater peak vertical ground reaction force (GRF) and posterior loading rates (LRs) compared with the unRADF group (p < 0.05). During the horizontal landing phase, ankle plantarflexion and internal rotation angles were significantly increased in the RADF group (p < 0.05). At the moment of peak GRF during the vertical landing phase, the RADF group exhibited significantly reduced ankle dorsiflexion angle (p < 0.001) and significantly greater knee abduction angle (p < 0.05). Additionally, leg stiffness was significantly higher in the RADF group during this phase (p < 0.05). CONCLUSION: Individuals with restricted DF adopt a stiff landing strategy during stop-jump, with increased impact loads and abnormal joint kinetics that may impair shock absorption and elevate lower-extremity injury risk.
Risk Factors for Foot-Related Hospitalisations in Adults With and Without Diabetes: A Systematic Review.
Weerasuriya SR, Alahakoon C, Karunathilaka N … +3 more , Zhang Y, Cramb SM, Lazzarini PA
J Foot Ankle Res · 2026 Jun · PMID 42260297 · Full text
INTRODUCTION: Foot-related conditions are a leading cause of all hospitalisations and amputations worldwide. Half of these foot-related hospitalisations are in people without diabetes. Yet, few studies seem to have explo...
INTRODUCTION: Foot-related conditions are a leading cause of all hospitalisations and amputations worldwide. Half of these foot-related hospitalisations are in people without diabetes. Yet, few studies seem to have explored risk factors for foot-related hospitalisations in populations with or without diabetes. This study aimed to systematically review studies investigating risk factors for hospitalisations caused by any foot-related conditions amongst any general community-dwelling adult populations (with or without diabetes). METHODS: PubMed and Embase databases were searched for studies related to risk factors, foot-related conditions and hospitalisations published since 1st January 2000. Search results were screened for eligibility by two independent authors. Risk of bias was assessed using the Quality in Prognostic Studies tool, and data were extracted using a customised data extraction tool. RESULTS: Fourteen studies from 7824 screened studies were included. Twelve studies investigated diabetes populations and two general (with and without diabetes) populations. All 14 studies investigated only for foot disease-related hospitalisation outcomes. Seven studies were rated as low risk of bias. Twenty-two independent risk factors were reported, including eight reported both in multiple studies and low risk of bias studies. Those eight risk factors were being male, having diabetes, increased HbA1c, insulin management, chronic kidney disease, peripheral neuropathy, peripheral artery disease and no footcare within 12 months. CONCLUSIONS: This review suggests that the common risk factors for foot disease-related hospitalisations are being male, having diabetes, chronic kidney disease, peripheral neuropathy, peripheral artery disease and lack of footcare, particularly in diabetes populations. There were no studies investigating hospitalisations for other foot-related conditions and few in nondiabetes populations.
The Association Between Self-Perceptions of Ageing and Foot and Lower-Limb Health in Community-Dwelling Older Adults.
Molyneux P, Bloomfield E, Broderick M … +1 more , Stewart S
J Foot Ankle Res · 2026 Jun · PMID 42260286 · Full text
BACKGROUND: Self-perceptions of ageing have an important influence on the physical function in later life, yet little is known about how these perceptions relate to foot and lower limb health. Exploring how self-percepti...
BACKGROUND: Self-perceptions of ageing have an important influence on the physical function in later life, yet little is known about how these perceptions relate to foot and lower limb health. Exploring how self-perceptions of ageing interact with subjective reports of foot health as well as objective measures such as lower limb joint movement, muscle strength and functional mobility may provide important insights to support more person-centred and responsive models of care. This study aimed to determine the association between self-perceptions of ageing and subjective and objective measures of foot and lower limb health in older adults. METHODS: This cross-sectional study included 40 community-dwelling adults ≥ 65 years who completed the five subscales of the Brief Ageing Perceptions Questionnaire (B-APQ) alongside patient-reported outcomes (100 mm Visual Analogue Scale [VAS] for foot pain, Manchester Foot Pain and Disability Index [MFPDI] and Lower Limb Task Questionnaire [LLTQ]). Objective assessments of joint range of motion, foot and ankle muscle strength and functional mobility tasks (timed up and go [TUG] and Short Physical Performance Battery [SPPB]) were also conducted. B-APQ subscale scores were direction-aligned so that higher scores reflect more negative ageing perceptions. Relationships between B-APQ subscales and foot and lower limb outcomes were modelled using linear regression. All models were adjusted for key clinical and demographic confounders. Omnibus block tests evaluated the joint contribution of the five B-APQ subscales. RESULTS: The B-APQ dimension block showed no evidence of association with foot pain (VAS, MFPDI). The B-APQ block was associated with plantarflexion and inversion strength, with more adverse beliefs about consequences/low control (consequences-control negative) and lower perceived control (control-positive) associated with weaker strength. Consequences-control negative was also associated with slower TUG, whereas SPPB total and joint motion showed no evidence of association. CONCLUSION: Associations between self-perceptions of ageing and lower limb function and mobility appear dimension-specific with beliefs about adverse consequences and perceived control most consistently related to neuromuscular strength and mobility, rather than pain. Interventions combining progressive strengthening with strategies addressing specific ageing-belief dimensions, may support mobility in older adults.
Development and Validation of an Algorithm to Objectively Quantify Adherence to Offloading Interventions.
Yalla SV, Jhaveri SN, Negron-Fernandez NS … +2 more , Crews RT, Rosenblatt NJ
J Foot Ankle Res · 2026 Jun · PMID 42237058 · Full text
BACKGROUND: Diabetic foot ulcers require offloading for healing. However, adherence with removable offloading devices is often poor. Prior objective measures of adherence yielded important behavioral insights, despite su...
BACKGROUND: Diabetic foot ulcers require offloading for healing. However, adherence with removable offloading devices is often poor. Prior objective measures of adherence yielded important behavioral insights, despite substantial methodological limitations. This study sought to address these limitations by developing a method to track offloading adherence during walking and standing paired with tracking contralateral therapeutic footwear (shoe-lift) use. METHODS: Thirty healthy adults wore a removable cast walker (RCW) and contralateral shoe-lift. Accelerometers were placed on both and unilaterally on participants' thighs. Participants performed activities in the laboratory that were logged by investigators, after which monitoring continued for 24 h with participants logging footwear use in a diary. Walking and standing episodes were quantified via the thigh worn monitor. A custom algorithm was developed to classify RCW and shoe-lift adherence during walking and standing based on sample-to-sample variance thresholds. Algorithm accuracy was determined by comparing its adherence metrics with log entries. RESULTS: The final algorithm resulted in > 99% accuracy in detecting steps and standing while using the RCW and shoe-lift during in-lab testing. In 24-h, community monitoring, algorithm-derived adherence showed excellent agreement with diary-based adherence (ICC > 0.96, p < 0.01). Error rates (misclassifications) were < 3%. CONCLUSION: A method to objectively quantify RCW and contralateral shoe-lift adherence use was developed and validated. Strong agreement with lab observations and user diaries support its use for monitoring real-world offloading behavior. This method will allow for enhanced assessments of adherence in future trials and may eventually be incorporated into clinical practice for patient monitoring.
Australian Podiatry Research in Workforce and Education: A Bibliometric Analysis.
Ho M, Tehan P, Carroll MR … +1 more , Williams C
J Foot Ankle Res · 2026 Jun · PMID 42231061 · Full text
BACKGROUND: To conduct a bibliographic analysis of English language research pertaining to podiatry workforce and education by Australian authors. METHODS: The Scopus database search was conducted to identify all Austral...
BACKGROUND: To conduct a bibliographic analysis of English language research pertaining to podiatry workforce and education by Australian authors. METHODS: The Scopus database search was conducted to identify all Australian workforce and education-related articles published by podiatric authors in English from 1970 to 2024. Bibliometric analysis was performed using Biblioshiny, a web-based graphical interface for the bibliometric R package. Citations, journals, authors, institutions, and countries were described. Publications were manually categorised according to research type, level of evidence and funding source. RESULTS: The search strategy yielded 105 eligible articles, which received a total of 975 citations and were published by 338 authors in 33 journals. The most frequent journal was Journal of Foot and Ankle Research (34 articles; 32%), and the most frequently cited was the University of South Australia (affiliation of 85 authors). Most Australian workforce and education articles published by podiatrists focused on health and social care services research (n = 60; 57%) and only five articles (5%) provided level I evidence. Fifty-six articles (53%) reported no research funding. Research generally fell under four themes. CONCLUSION: Workforce and education research make up a small percentage of podiatry-related research. Most are published in low-impact journals with low citations. The articles are highly collaborative, with multiple authors nationally and internationally. Studies are driven by academics with a vested interest in workforce and education issues, with little or no funding. There is a lack of research in continuing professional development educational activities and workforce in the private sector. Being a small profession, podiatry data may be missed in large allied health workforce studies. Podiatry workforce and education research must be driven by the profession, thereby creating opportunities for sustainable podiatry career growth.
Prevalence and Severity of Self-Assessed Hallux Valgus in Community-Dwelling Older South African and Flemish Individuals.
Breet MC, Vanwanseele B, Menz HB … +2 more , Esterhuizen TM, Venter R
J Foot Ankle Res · 2026 Jun · PMID 42231049 · Full text
INTRODUCTION: Hallux valgus (HV) is a common foot deformity in older adults, frequently associated with pain and functional impairment. Global prevalence is estimated at 19%, although it varies by continent; consequently...
INTRODUCTION: Hallux valgus (HV) is a common foot deformity in older adults, frequently associated with pain and functional impairment. Global prevalence is estimated at 19%, although it varies by continent; consequently, there is a notable knowledge gap concerning its prevalence and severity in older populations of South Africa and Belgium. This study aimed to compare HV prevalence and severity, report on footwear habits within these cohorts, and examine associations with sex, age, and body mass index (BMI). METHODS: This observational cross-sectional study recruited 300 community-dwelling adults aged ≥ 60 years from Flanders, Belgium (n = 145) and the Western Cape, South Africa (n = 155). Demographic data, footwear habits, and HV self-assessment scores (using the Manchester scale) were collected via an online questionnaire. Associations between HV and other variables were examined using chi-square tests. RESULTS: HV prevalence was 27.6% in the Flemish cohort and 31.6% in the South African cohort. Although South Africans reported more frequent barefootedness, HV prevalence rates remained similar. HV prevalence was significantly higher in females (35.4%) compared to males (17.0%). Furthermore, prevalence and severity increased with age but were inversely associated with BMI. CONCLUSION: HV prevalence is similar in older South African and Flemish individuals, despite differing footwear habits, supporting the multifactorial nature of HV formation. These findings emphasize the need for region-specific data and clinical strategies to address HV in older populations.
Menopause and Plantar Heel Pain: Findings From a Series of Focus Groups Exploring Lived Experience.
Douglas-Harris M, Wilkins R, Ramaskandhan J … +2 more , Mankelow J, Branthwaite H
J Foot Ankle Res · 2026 Jun · PMID 42224090 · Full text
BACKGROUND: Plantar heel pain (PHP) is a debilitating problem disproportionately affecting women between the age of 40 and 60 at twice the rate of men, coinciding with perimenopause and menopause. Whether a causative rel...
BACKGROUND: Plantar heel pain (PHP) is a debilitating problem disproportionately affecting women between the age of 40 and 60 at twice the rate of men, coinciding with perimenopause and menopause. Whether a causative relationship exists is uncertain, but their concurrence presents challenges for both patients and healthcare providers. AIM: To conduct focus groups to understand people's perception of menopause and PHP. The primary objective was to identify whether people with experience of PHP and menopause or their healthcare providers, thought their PHP was related to menopausal status. The secondary objective was to find out if this population thought this was an important area of research and what the barriers may be for further investigation. METHODS: Following National Institute for Health and Care Research (NIHR) guidance on 'co-producing a research project', 17 participants were invited via VOICE GLOBAL public engagement UK platform to take part in focus groups with 5-6 participants in each session. Participants self-identified as having experienced PHP and were either perimenopausal or postmenopausal. Each group was asked if they felt that there was an association between PHP and menopausal status; if a link between menopause and PHP was made by their healthcare provider; if research in this area was important and what the barriers may be to further investigation in this area. RESULTS: Of the 17 participants, 76% did not initially perceive that there to be an association between menopause and PHP and reported that it was not mentioned in their healthcare consultations when they sought help. Some felt stigma remained around the menopause, particularly in ethnic minority communities, and that this may be a barrier to further research. Participants unanimously felt that this was an area that needed more investigation, with improved awareness on the part of healthcare providers being particularly important. CONCLUSIONS: Participants felt the relationship between menopause and PHP requires further investigation, with a focus on understanding the level of awareness of association among healthcare professionals and patients. The implementation of any findings needs to consider ethnic and cultural barriers, and those that may be present in a primary care setting.
Malignant Melanoma Misdiagnosis in the Diabetic Foot. What Can We Learn From the Published Literature?
Bristow IR, Reynolds ML, Young M
J Foot Ankle Res · 2026 Jun · PMID 42165691 · Full text
BACKGROUND: The foot is an independent risk factor for a poorer prognostic outcome in melanoma. Delayed diagnosis may arise because melanoma mimics other benign diagnoses, such as ulceration on the foot, including those...
BACKGROUND: The foot is an independent risk factor for a poorer prognostic outcome in melanoma. Delayed diagnosis may arise because melanoma mimics other benign diagnoses, such as ulceration on the foot, including those with associated with diabetes. Improving outcomes for patients includes raising awareness amongst professionals involved in diabetic foot care. Evaluation of published case studies may help identify common themes to inform practice and improve recognition and referral for lesions requiring biopsy. METHODS: The authors undertook a systematic literature search of PubMed (National Library of Health) (2010-2025) to identify published case studies reporting delayed diagnosis or misdiagnosis of melanoma arising on the skin of the foot or in the toenail in patients with diabetes. Data were collated and tabulated to give basic demographics and assist in identification of common themes. A structured content analysis was undertaken to inform key aspects regarding missed diagnosis. RESULTS: Following a systematic search of the literature, 1485 papers were identified. After removal of duplicates and irrelevant papers, a total of 86 case studies were identified. A total of 20 cases were reported in patients with diabetes (reported in 19 papers) from 10 countries, including 14 males and 7 females (average age 73 years), with a mean Breslow thickness of 3.58 mm. Melanoma lesions were located on the heels (n = 8), forefoot (n = 5), toes (n = 3), subungual regions (n = 2) and in the arch (n = 2). The most common misdiagnosis was a diabetic foot ulcer (n = 17). CONCLUSION: Based on the reviewed cases, distinguishing melanoma from diabetic foot ulceration (DFU) is difficult. Common themes from the content analysis suggest that clues such as ulceration despite lack of the corresponding risk factors, hypergranulation and lack of improvement to be key aspects to suggest an alternative diagnosis. The authors propose a simple acronym, 'U.L.C.E.R', as an aide-mémoire to assist healthcare professionals in the identification of potential melanoma masquerading as DFU.
The Sacred Connection of the Feet (Te Tuhono Tapu o ngā Waewae): The Cultural and Spiritual Impact of Diabetes-Related Lower Limb Amputation Among Māori.
Otene C, Ihaka B, Carroll MR
J Foot Ankle Res · 2026 Jun · PMID 42162943 · Full text
Diabetes prevalence in Aotearoa New Zealand is rising rapidly, disproportionately affecting Māori communities and contributing to significantly higher rates of diabetes-related lower limb amputations. These inequities re...
Diabetes prevalence in Aotearoa New Zealand is rising rapidly, disproportionately affecting Māori communities and contributing to significantly higher rates of diabetes-related lower limb amputations. These inequities reflect systemic issues such as colonisation, racism, and limited access to culturally safe care rather than clinical factors alone. Embedding tikanga (Māori customs) within podiatry foot screening offers a pathway to culturally responsive practice that honours Māori spiritual, physical, and cultural well-being. Integrating Rongoā Māori (traditional healing) and whānau-centred approaches alongside biomedical care can improve engagement and outcomes, whereas marae-based and community-led models enhance accessibility and trust. Workforce development in cultural safety is essential to uphold Te Tiriti o Waitangi obligations of equity, partnership, and protection. Culturally grounded podiatry services not only reduce the risk of amputation but also restore connections to tūrangawaewae (place of belonging) and whakapapa (genealogy), ensuring that care is meaningful and effective for Māori communities.
Do Commercially Available Insoles Meaningfully Change Reported Comfort and Biomechanics During One Day of Wear?
Lewin M, Jones R, Price C
J Foot Ankle Res · 2026 Jun · PMID 42135601 · Full text
INTRODUCTION: Identifying meaningful changes in comfort and any underpinning biomechanical changes is crucial to understanding differences in perceptions of footwear comfort. Research rarely considers changes in comfort,...
INTRODUCTION: Identifying meaningful changes in comfort and any underpinning biomechanical changes is crucial to understanding differences in perceptions of footwear comfort. Research rarely considers changes in comfort, and rarely reports how meaningful these are. This study aims to utilise a portable biomechanics measurement tool to establish whether commercially available insoles make meaningful changes in comfort and identify any concurrent changes in biomechanics compared with a control whilst worn during a users' normal day. MATERIALS AND METHODS: Thirty participants wore five insole conditions (participants' own shoe, and four commercially available insoles) for a typical day whilst the Runscribe inertial measurement unit (IMU) captured: Ground reaction force (GRF), GRF rate, pronation excursion, pronation velocity, impact shock, braking shock, and total shock. Comfort was measured using a 100 mm visual analogue scale. A pre-defined ± 8.28 mm minimal clinical important difference (MCID) for comfort was used as the threshold of meaningful change to group individuals into comfort classifications: 'more' (47 participants) and 'less' (36 participants). MCID was also defined for biomechanics variables from the RunScribe. Insole conditions were compared between classifications to identify significant and meaningful changes in biomechanics associated with meaningful changes in comfort from the control condition. Paired sample t-tests compared biomechanical parameters from the RunScribe between comfort classifications. RESULTS: Similar numbers of individuals reported 'more' and 'less' comfort across conditions. There were only significant reductions in braking shock when individuals reported meaningfully 'less comfort'. The primary result from meaningful change thresholds for biomechanics was meaningful increases in impact shock when comfort was both 'more' and 'less'. DISCUSSION: The measurement approach enabled identification of comfort changes, and underpinning biomechanical differences during one day of wear of insoles. Impact shock was the main contributor to comfort perception, consistent with previous literature. Highlighting impact shock as a potential variable for assessment of interventions in pathological study.
Impact of Bone Grafting and Graft Type on Fusion and Patient-Reported Outcomes Following Subtalar Arthrodesis: A Multicenter Retrospective Cohort Study.
Mazzella GG, Bove A, De Fazio A … +9 more , Gangemi NM, Peruzzi M, Forconi F, Krekosch P, Lausmann C, Citak M, Di Sanzo V, Maccauro G, Vitiello R
J Foot Ankle Res · 2026 Jun · PMID 42121338 · Full text
BACKGROUND: The role of bone grafting in subtalar joint arthrodesis (SJA) remains controversial. This study aimed to compare clinical and radiographic outcomes of SJA performed with and without bone graft and to evaluate...
BACKGROUND: The role of bone grafting in subtalar joint arthrodesis (SJA) remains controversial. This study aimed to compare clinical and radiographic outcomes of SJA performed with and without bone graft and to evaluate the influence of different graft types on fusion and functional results. METHODS: A multicenter retrospective observational study was conducted including 66 patients who underwent isolated SJA between 2023 and 2025. Patients were divided into graft (n = 51) and no graft (n = 15) groups. A subgroup analysis compared autologous, fresh frozen allogeneic, and commercial allogeneic grafts. Outcomes included osseous union, time to union, complications, and functional scores (AOFAS, FAAM-ADL, and FAAM-Sports). Multivariable regression and ROC analyses were performed to identify independent predictors of nonunion and delayed union. RESULTS: Overall, the union rate was 90.9%. Union was achieved in 92.2% of grafted patients and 86.7% of nongrafted patients (p = 0.612). Bone graft use was not independently associated with union, complications, or time to union in the adjusted exploratory analyses. Increasing age and BMI were independently associated with a prolonged time to union. ROC analysis identified age ≥ 60 years as a predictor of nonunion (AUC 0.782) and age ≥ 59 years and BMI ≥ 25.9 kg/m as predictors of delayed union. Both groups showed significant postoperative improvements in all functional scores (all p < 0.001). Autologous graft was associated with higher postoperative functional scores, although this finding should be interpreted cautiously given potential baseline differences and selection bias. CONCLUSIONS: In isolated SJA performed in a well-aligned hindfoot, high union rates and significant functional improvement were achieved regardless of bone graft use. However, due to the retrospective, nonrandomized design and limited number of nonunion events, no definitive conclusions can be drawn regarding the routine necessity or superiority of bone grafting. Though, bone graft use appeared to be associated with improved functional outcomes in selected higher risk patients, although these findings should be interpreted cautiously given the exploratory nature of the analysis. All subgroup and threshold analyses should be interpreted as exploratory.
Bibliometric Analysis of Charcot Arthropathy (1995-2025): Current Status and Emerging Trends.
Zhou JL, Peng H, Sun F
J Foot Ankle Res · 2026 Jun · PMID 42092303 · Full text
BACKGROUND: Charcot Arthropathy (CA) is a destructive joint condition tied to neurotrophic and neuropathic processes. The clinical course is often complicated-high amputation rates and a generally poor prognosis have lon...
BACKGROUND: Charcot Arthropathy (CA) is a destructive joint condition tied to neurotrophic and neuropathic processes. The clinical course is often complicated-high amputation rates and a generally poor prognosis have long made management difficult. Decades of research have brought progress in basic science and clinical care, yet a clear, data-driven picture of the global research landscape and how it has shifted over time remains, in many ways, incomplete. OBJECTIVE: This study set out to map the core components, current hotspots, and emerging frontiers in the CA literature. METHODS: We focused on English-language publications in the Web of Science (WoS) database from 1995 to 2025. Using tools such as CiteSpace, the R package bibliometrix, and GraphPad, we conducted a quantitative analysis of the countries or regions, institutions, authors, collaboration patterns, journals, cited references, and keywords associated with CA-related publications. RESULTS: We screened 349 papers. Annual output has generally trended upward-perhaps a sign of growing interest in the field. The United States ranked first in both total publications (n = 180) and citations (n = 3949), and sat at the center of international collaboration networks. Key authors (e.g., Dane K. Wukich) and institutions (e.g., the University of Texas System) emerged as major contributors; their dense collaborations appear to drive much of the field's progress. The Journal of Foot and Ankle Surgery published the most CA-related papers (n = 47). Current research hotspots appear to center on the foot and ankle, pathogenesis, and surgical treatment. Looking at keyword trends, the field seems to be moving toward biomechanics, advanced reconstruction, and three-dimensional imaging. CONCLUSION: This study is the first comprehensive mapping of CA literature over three decades. It highlights the United States' leading role and a shift toward technology in diagnosis and surgery. These findings may guide future research, collaboration, and clinical practice.
Taking the Next Step: How Can Implementation Science Advance Diabetes Foot Care for Rural and Remote Australians?
Byrnes A, Charles J, Cramb S … +11 more , Jensen S, Johnston T, Larkins S, McPhail S, Netten JJV, Parker CN, Tulleners R, Tyack Z, Golledge J, Lazzarini PA, QFeet Study Group
J Foot Ankle Res · 2026 Jun · PMID 42083119 · Full text
Diabetes-related foot disease (DFD) is a leading cause of disability worldwide. In Australia, DFD affects approximately half a million people and is the primary driver of diabetes-related hospitalisations, amputations an...
Diabetes-related foot disease (DFD) is a leading cause of disability worldwide. In Australia, DFD affects approximately half a million people and is the primary driver of diabetes-related hospitalisations, amputations and costs. Guideline-based multidisciplinary footcare can halve these rates and improve quality of life, yet access remains inequitable, particularly for rural and remote communities for whom DFD hospitalisation and amputation rates are persistently high. Geographic isolation, workforce shortages and fragmented service delivery are barriers to DFD care, with Aboriginal and Torres Strait Islander Peoples experiencing additional cultural and systemic challenges. Telehealth-enabled models of care offer a promising solution to reducing inequities in access without compromising effectiveness. Four 'Foot Hubs' have been established across Queensland (Australia) to deliver specialist multidisciplinary footcare via a hub-and-spoke model, combining telehealth, outreach, and local partnerships to improve access for people living with DFD in rural and remote areas. This commentary provides an introductory overview of these Foot Hub services and how implementation science (the scientific study of methods and strategies to promote the systematic and sustainable uptake of new practices) can support the uptake and sustainability of these new models of care.
Australian Podiatry Research in Gerontology: A Bibliometric Analysis.
Menz HB, Nor Azhar A, Bergin SM … +2 more , Tehan PE, Carroll MR
J Foot Ankle Res · 2026 Jun · PMID 42056849 · Full text
BACKGROUND: To conduct a bibliographic analysis of English language research pertaining to gerontology by Australian resea. METHODS: A Scopus database search was conducted to identify all Australian gerontology articles...
BACKGROUND: To conduct a bibliographic analysis of English language research pertaining to gerontology by Australian resea. METHODS: A Scopus database search was conducted to identify all Australian gerontology articles published by podiatric authors in English from 1970 to 2024. Bibliometric analysis was performed using an open-source tool based on the R language. Citations, journals, authors, institutions, and countries were described. Publications were manually categorised according to research type, level of evidence and funding source. RESULTS: The search strategy yielded 81 eligible articles, which received a total of 5024 citations and were published by 174 authors in 39 journals. The most frequent journal was Gait and Posture (12 articles; 15%), and the most published institution was La Trobe University (affiliation of 102 authors). Most of the Australian gerontology articles published by podiatrists focussed on aetiology (n = 48; 59%) and only six articles (7%) provided level I evidence. Thirty articles (37%) reported no research funding. CONCLUSION: Gerontology remains an underrepresented focus within Australian podiatry research. Despite attracting relatively high citation rates, this field suffers from chronic underfunding and limited research capacity. Investing in dedicated funding and expanding the gerontology research workforce within podiatry is essential to drive innovation, address the growing needs of an ageing population, and strengthen the evidence base for clinical care.
Effect of Long-Term Non-Weight Bearing on the Morphology and Function of the Heel Fat Pad.
Maemichi T, Matsumoto M, Tsutsui T … +1 more , Kumai T
J Foot Ankle Res · 2026 Jun · PMID 42056840 · Full text
BACKGROUND: We aimed to investigate the effects of long-term non-weight-bearing conditions, including prolonged bedridden states, on the morphology and function of the heel fat pad. METHODS: We recruited 13 elderly indiv...
BACKGROUND: We aimed to investigate the effects of long-term non-weight-bearing conditions, including prolonged bedridden states, on the morphology and function of the heel fat pad. METHODS: We recruited 13 elderly individuals bedridden for over 1 year (BR group) and 89 age-matched healthy controls (CON group) living independently. Using diagnostic ultrasound imaging, we measured the thickness of the microchamber, macrochamber, and whole layers of the heel fat pad under non-compressed and compressed conditions. RESULTS: Significant reductions in both non-compressed and compressed thicknesses were observed across all layers in the BR group. Furthermore, a significant negative correlation was observed between age and thickness change in the BR group, whereas no such correlation was observed in the CON group. CONCLUSION: Long-term non-weight-bearing was associated with morphological changes and functional deterioration in the heel fat pad. These findings suggest that prolonged unloading may influence heel fat pad morphology, which may be relevant when considering weight-bearing management.
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