Podiatry

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Pre-formed orthoses in Juvenile Idiopathic Arthritis [JIA] - a multi-centre single blinded randomised control trial
(2011-11-30) Coda, Andrea; Davidson, J.; Fowlie, P.; Walsh, J.; Carline, Tom; Santos, Derek
Pre-formed orthoses in Juvenile Idiopathic Arthritis [JIA]: preliminary results from an RCT
(2011-09) Coda, Andrea; Carline, Tom; Santos, Derek
Background: Currently there is limited evidence supporting podiatric treatment of children with JIA. This trial aimed to determine whether pre-formed cost-effective orthoses impacted on pain, quality of life (primary outcomes) and/or gait-parameters (secondary outcomes) in children affected by JIA. The RCT aims to strengthen and add new knowledge to the podiatric management of children affected by this paediatric condition. Methods: The study took place at the Gait Analysis laboratory at Queen Margaret University – Edinburgh and at the TORT Centre, Ninewells Hospital-Dundee. Children with JIA, as diagnosed by a consultant paediatric rheumatologist, were block randomised by a computer generator. Intervention was blinded to the patients. The trial group received Slimflex Plus insoles, with the addition of chair side corrections and the control insole supplied was made with leather board (1mm thick) without corrections. Both insoles had the same black EVA top cover. Primary outcome measures were recorded at each of the 3 data recording appointments over the 6 months period, using validated questionnaires such as VAS, CHAQ and PedsQL. Tekscan™ equipment (F-Scan™ and HR Walkway®) measured in-shoe pressure and force data with and without orthotic intervention, using same type of sensors of equal resolution. Multiple foot strikes and repetitive gait patterns were compared pre and post-treatment. In addition, the HR Walkway® captures multiple sequential footsteps during barefoot walking; allowing barefoot and in-shoe measurements to be compared. Results: Sixty children were recruited; 48.3% (n=29) control and 51.7% (n=31) active treatment group. Within the control group 20.7% (n=6) of patients were male. Within the active treatment group, 29% (n=9) subjects were male. Age ranged between 5 to 18 years, mean age for the control group was 11.17(SD3.51) and for the trial group were 10.64 (SD3.84). In order to attribute any effect solely on the FOs intervention, details of changes of medication and/or new joint injections were recorded during the trial. 65.5% (n=19) of the control group were on stable medications. 74.2% (n=23) of the children receiving active treatment were on stable medication. Overall, 99.4% (n=179/180) appointments were completed and contributed to this preliminary data analysis. Significant improvement was identified in the primary outcomes favouring active treatment with regards to pain and quality of life measures: VAS (p<0.05); PedsQL paediatric-generic (p<0.05) Peds paediatric rheumatology (p<0.05); PedsQL parent generic (p<0.05); PedsQL parent rheumatology (p<0.05). In all these quality of life tools, clinical significance was also obtained. Significant differences were also identified between the groups for gait time, stance time, total plantar surface, heel contact, midfoot, 5th metatarsal head and distal phalanx. Conclusion: The results show that pre-formed orthoses are effective in improving pain, quality of life and most gait parameters in JIA children. This research also provides new evidence to the role of podiatrists within the multidisciplinary team in paediatric rheumatology and hopes to raise the profile of podiatrists working within the paediatric hospitals and private practices.
Pre-Formed Orthoses in Juvenile Idiopathic Arthritis:results from an RCT
(Oxford University Press, 2012-05-02) Coda, Andrea; Davidson, J.; Fowlie, P.; Walsh, J.; Carline, Tom; Santos, Derek
Dutch is a West-Germanic language spoken by most inhabitants of the Netherlands(approximately 16 million speakers). It is the official language of the Netherlands,Belgium, Suriname, Aruba, and the Dutch Antilles. It is thought to be spoken by around 24 million people worldwide (http://en.wikipedia.org/wiki/Dutch_language).Dutch has many dialects which differ from Standard Dutch in their vocabulary, syntax,morphology and phonology. The Netherlands has a heterogeneous population withpeople from many different nationalities and as a consequence a wide variety of languages is spoken. The majority of the immigrant population is from Turkishdescent, followed by Surinam, and Moroccan descent (source: Statistics Netherlands,www.cbs.nl).
Repeatability and Reproducibility of the F-Scan System in Healthy Children
(ELYNS Publications Group, 2015-11-10) Coda, Andrea; Santos, Derek
This study investigated the repeatability and reproducibility of the F-scan system with regards to Peak Pressure Values (PP) and Pressure Time Integral (PTI) in healthy children, ranging between 5 to 18 years of age. Participants took part in two non-invasive clinical assessments, at baseline and one week later. Standardized footwear was supplied and each child was fitted with the equivalent F-scan insole size. A total of 3 trials of 7 meters distance each were conducted. Plantar pressure analysis was carried out using a novel approach of masking the recordings into 10 different areas; both peak pressure (PP) and pressure time integrals (PTI) values were investigated. The PP and PTI were investigated for the left, right and both feet analysed together. Interclass Correlation Coefficient (ICC) test was adopted for statistical analysis. Overall, 30 healthy children were recruited and 60 appointments were completed; 53.3% (n = 16) were female, mean age was 13.3 years (SD = 4.5). Results highlighted that overall the ICC for repeatability was > 0.75 for 95.8% (no = 115) and between 0.5 and 0.75 for 4.2% (no = 5); the ICC for reproducibility was > 0.75 for 85% (no = 51), and between 0.5 and 0.75 for 15% (no = 9). In conclusion, the F-Scan system can be utilised to record repeatable and reproducible data in paediatric gait analysis.
Repeatability and reproducibility of the Tekscan HR-Walkway system in healthy children
(Elsevier, 2014-06) Coda, Andrea; Carline, Tom; Santos, Derek
This study investigated the repeatability and reproducibility of the HR Walkway system with regards to peak pressure values (PP) and pressure time integral (PTI) in healthy children, ranging between 5 and 18 years of age. Subjects recruited took part in two non-invasive clinical assessments, at baseline and 1 week later. Gait analysis was carried out using the PP box approach, and plantar foot recording was divided into 10 anatomical areas. The PP and PTI was investigated for the left, right and both feet accounted together. Interclass Correlation Coefficient (ICC) test was adopted for statistical analysis. Overall, 30 healthy patients were recruited and 60 appointments were completed, 53.3% (n = 16) were female and 46.7% (n = 14) were male. Mean age was 13.3 years (SD = 4.5), with an age-range of 5-18.6 years old. Results indicated that for all variables tested the repeatability data were 'good' ICC for 73.8% (n = 121) and 'moderate' ICC for 26.2% (n = 43). For all variables tested, the reproducibility data showed that 'good' ICC for 70.7% (n = 58) and 'moderate' ICC for 29.3% (n = 24). In conclusion, the HR Walkway system is able to provide repeatable and reproducible data. 2014 Elsevier Ltd. All rights reserved.