Podiatry
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Item Early Weight-bearing Following Modified Lapidus Arthrodesis: A Retrospective Review of 104 Cases & Postoperative Protocol(Elsevier, 2025-09-27) Uddin, Akram; Bramall, John W.; Leong, Keng; Klos, Kajetan; Roth, Edgar; Santos, DerekBackground Lapidus arthrodesis is indicated for the treatment of first ray dysfunction or hypermobility, hallux valgus (HV) and functional hallux limitus (FHL). Postoperative weightbearing protocols vary amongst surgeons. Purpose To report radiographic osseous healing and patient-reported outcome measures (PROMS) following a single early weightbearing protocol. Study Design Retrospective review of 104 adults (≥18 years) (104 feet) who underwent open modified Lapidus arthrodesis (without bone graft) by single compression screw and medial locking plate by two surgeons at one centre (between January 2019 to May 2023). Methods Pre- and postoperative radiographs and electronic records were reviewed for evidence of osseous healing and return to full weightbearing. Secondary measures included deformity reduction and PROMS. Results At 6-weeks follow-up 98 patients (94%) were confirmed of osseous healing and returned to full weightbearing. Six patients (6%) had delayed osseous healing at 6-weeks but showed signs of osseous healing by 3-months follow-up. Postoperative HV and intermetatarsal angle (IMA) showed significant reduction (mean difference: -12 (SD=8) and -5 (SD=4) degrees respectively; p<0.001 for both). Ten patients (10%) had postoperative complications: hardware irritation 5 (5%), sesamoiditis 2 (2%), hypertrophic scar 2 (2%) and joint stiffness 1 (1%). Eight patients (8%) required further surgery (5 required fixation removal due to hardware irritation. Three underwent either; 1st MTPJ open-mobilization, excision of scar or distal metatarsal osteotomy with tibial sesamoid planning). Manchester-Oxford Foot Questionnaire (MOXFQ) showed significant improvement across all domains (mean difference (SD): -51 (SD=22); walking/standing -49 (SD=24); pain -52 (SD=22); and social interaction -51 (SD=28); (p<0.001 for all) with clinically significant effect size (Cohen’s d: 2.37; 2.01; 2.37; and 1.84 respectively). Patient satisfaction questionnaire (PSQ-10) score was high mean of 91 (SD=8). 5 patients (5%) were lost by 6-months follow-up. Conclusion Early weightbearing achieved consistent osseous healing and high PROMS. Larger controlled studies are required to validate these results. Level of evidence Retrospective study. Level III.Item No effect of custom foot orthoses and sex on mechanical asymmetries during treadmill running(Taylor & Francis, 2025-10-07) Van Alsenoy, Ken; Santos, Derek; van der Linden, Marietta; Ryu, Joong Hyun; Al Raisi, Lubna; Girard, OlivierWe investigated the influence of custom foot orthoses and sex on mechanical asymmetries during treadmill running. Eighteen injury-free trained individuals (9 females) ran on an instrumented treadmill for six minutes at a speed 10% below their first ventilatory threshold (average: 9.9±1.3 km/h) under four footwear conditions: original shoe liner (control), two custom orthotics (one EVA, one TPU), and a hybrid (EVA heel, TPU forefoot). Vertical and antero-posterior ground reaction forces were recorded after ~5 minutes of running, encompassing 40 steps. Mechanical asymmetry was assessed using the ‘symmetry angle’ (SA) score. There were no significant main effects for condition (all P≥0.302) or sex (P≥0.137), and no significant condition × sex interactions for any variables (P≥0.063). Mean SA scores were less than 2% for contact time (0.39±0.23%), flight time (1.90±1.35%), step frequency (0.34±0.26%), peak vertical force (1.44±1.15%), and mean vertical loading rate (1.79±1.17%). Vertical and leg stiffness had mean SA scores of 3.11±1.73% and 1.86±1.00%, respectively. For braking (1.56±0.78%) and push-off (1.54±0.81%) phases and peak braking (2.94±1.61%) and push-off (2.33±1.17%) forces, mean SA scores ranged from ~1.5% to 3.0%. Overall, both male and female runners showed relatively even strides, and custom foot orthoses did not significantly alter natural stride asymmetries.Item Beyond grades: integrating communication skills into the undergraduate curriculum for podiatry students(Springer International Publishing, 2025-03-12) Coda, A.; Hawke, F.; Santos, Derek; Stevenson, E.; Girones, X.; Ruiz, X.; Escalona, C.; Sanson-Fisher, R.; Fellas, A.This commentary paper emphasises the pivotal role of effective communication in the field of podiatry and advocates for its comprehensive integration into the educational curriculum. It argues that the combination of strong academic performance and well-developed communication skills equips podiatry students to improve diagnoses and successful future treatment outcomes. These skills should be comprehensively taught and carefully assessed as part of the patient-centered care approach for podiatry students. The paper explores the multifaceted role of communication in podiatry, highlighting its importance in various aspects of the profession. These include building rapport with patients, interpreting complex medical information, and fostering a therapeutic alliance that is conducive to successful treatment outcomes. It also underscores the significance of communication in collaborating with interdisciplinary teams and advocating for patient wellbeing. Proficiency in communicating with patients can contribute to the development of a wide range of career competencies in podiatric medicine, including clinical skills, research and innovation, cultural competence, and effective teamwork, both nationally and internationally. The paper also delves into various topics such as gathering patient history, explaining diagnoses and treatment options, providing patient education, and enhancing patient outcomes through interprofessional practice. This commentary paper explores the role of communication in research participation and the teaching and assessment of communication skills through innovative methods such as role-playing, simulations, and standardized patients. In conclusion, by reiterating that the essence of podiatry extends beyond technical proficiency to include meaningful interactions between the podiatrist and the patient, which are facilitated by strong communication skills. This paper may serve as a call to action for universities nationally and internationally to place greater emphasis in integrating and thoroughly assessing communication skills in their podiatric medicine programs.Item Effects of hybrid custom foot orthoses on running economy, running mechanics and comfort: a double-blinded randomized crossover study(Elsevier, 2025-02-01) Van Alsenoy, Ken K.; van der Linden, Marietta; Santos, Derek; Girard, OlivierObjective: This study examined the effects of orthotic materials on running economy, running mechanics, and footwear comfort. Design: A double-blinded randomized crossover study design was used. Method: Eighteen athletes ran on an instrumented treadmill for six minutes at speeds corresponding to 10% below their first ventilatory threshold (average: 9.9 ± 1.3 km/h) in four footwear conditions [control (CON), Ethyl vinyl acetate (EVA), Thermoplastic Polyurethane (TPU), and a combination of EVA and TPU (HYB)]. Results: No differences were found in running economy between conditions (p=0.099). All custom foot orthoses materials reduced peak heel impact force vs CON (p<0.001). TPU reduced hysteresis at heel impact vs CON (-47.8%, p=0.016). Shorter flight time (-3.8%, p=0.016; -3.1%, p=0.021) and lower mean vertical loading rate (-4.0%, p=0.003; -7.1%, p<0.001) occurred for HYB vs TPU and CON, respectively. Higher peak vertical loading rates (+7.4%, p=0.002) and earlier impact peaks (-5.7%, p<0.001) were found for HYB vs TPU. HYB exhibited longer propulsive phase duration (+2.0%, p=0.003) but lower peak propulsive force (-3.3%, p=0.009) vs CON. Reduced ‘overall comfort’ (-26.4%, p=0.004), ‘comfort of heel cushioning’ (-43.3%, p<0.001), and ‘comfort of forefoot cushioning’ (-18.3%, p=0.048) was found for HYB vs TPU, but ‘comfort of forefoot cushioning’ (+48.0%, p=0.032) showed an increase vs EVA. Conclusions: Combining materials could enhance comfort during running causing subtle changes in running mechanics. Overall, neither EVA, TPU nor their combination significantly improved running economy compared to CON.Item Paediatric Preparedness: Document Analysis of the Challenges Experienced Using Smartwatch Technologies to Support Children Living with a Chronic Health Condition(MDPI, 2025-01-21) Butler, Sonia; Sculley, Dean; Santos, Derek; Gironès, Xavier; Singh-Grewal, Davinder; Coda, AndreaSmartwatch technology is increasingly being used to support the management of chronic health conditions. Yet, many new digital health innovations fail because the correct foundations are not well established. This exploratory study aims to uncover the challenges experienced during the setup phase of a smartwatch intervention, to support the prototype development of a digital health intervention for children. Five children with a chronic health condition were asked to wear a smartwatch for 14 days that collects health data (pain levels, medication adherence, and physical activity performance). To explore the experiences of these children, their parents and the research team, all written records were analysed using READ’s four steps of document analysis and reported using the Standards for Reporting Qualitative Research checklist. The following three themes emerged: 1.) Infrastructure limitations: inexpensive smartphones prevented connection, and outpatient clinics’ internet black spots constrained setup and training; 2.) Personal phone restrictions: limited setup, training, and engagement; 3.) Elimination of the parent’s phone: provided children with digital support (a smartphone, pre-installed apps, cellular data) to allow active participation. Overall, we identified barriers hindering the use of smartwatch technology in clinical practice. More resources are needed to ensure paediatric preparedness for digital health support.Item The effect of weight reduction on the diabetes foot: A scoping review and clinical implications(Obesity Medicine Association, 2024-12-06) Roll Ahmed, Janine E.; Veto, John; Santos, DerekBackground: This scoping review aims to explore the literature available on rapid weight reduction (either via diet/exercise or bariatric surgery) on the diabetes foot. Methods: A search strategy was developed using Population, Intervention, Comparison, Outcome (PICO). A search using all identified keywords and index terms was performed on Cumulated Index in Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), PubMed, International Clinical Trials Registry Platform (ICTRP) and Web of Science (WoS) databases as well as Proquest, and Cochrane systematic reviews. A search of grey literature was also performed on Google Scholar and Internet explorer. No restrictions were placed on the date of publication. Results: There were few studies that explored the effects of weight reduction on the diabetes foot. Only 2 articles met the scoping review's inclusion criteria. These were a case study where the intervention was bariatric surgery and a case series study where the interventions were bariatric surgery or diet and exercise. Conclusion: This scoping review has highlighted the lack of research in this area, raising opportunities for further research that focus on the effects of rapid weight reduction (either following bariatric surgery or weight reduction and diet) on the diabetes foot. Patients with diabetes mellitus should receive individualised pre and post weight reduction care to their feet, either by a podiatrist or multidisciplinary care team.Item Effects of Hybrid Custom Foot Orthoses on Running Economy, Running Mechanics and Comfort: A Double-Blinded Randomized Crossover Study(Elsevier, 2024-10-23) Van Alsenoy, Ken K.; van der Linden, Marietta; Girard, Olivier; Ryu, Joong; Al Raisi, Lubna; Santos, DerekObjective: This study examined the effects of orthotic materials on running economy (RE), running mechanics, and footwear comfort. Design: A double-blinded randomized crossover study design was used. Method: Eighteen athletes ran on an instrumented treadmill for six minutes at speeds corresponding to 10% below their first ventilatory threshold (average: 9.9 ± 1.3 km/h) in four footwear conditions [control (CON), Ethyl vinyl acetate (EVA), Thermoplastic Polyurethane (TPU), and a combination of EVA and TPU (HYB)]. Results: No differences were found in RE between conditions (p=0.099). All CFO materials reduced peak heel impact force vs CON (p<0.001). TPU reduced hysteresis at heel impact vs CON (-47.8%, p=0.016). Shorter flight time (-3.8%, p=0.016; -3.1%, p=0.021) and lower mean vertical loading rate (-4.0%, p=0.003; -7.1%, p<0.001) occurred for HYB vs TPU and CON, respectively. Higher peak vertical loading rates (+7.4%, p=0.002) and earlier impact peaks (-5.7%, p<0.001) were found for HYB vs TPU. HYB exhibited longer propulsive phase duration (+2.0%, p=0.003) but lower peak propulsive force (-3.3%, p=0.009) vs CON. Reduced ‘overall comfort’ (-26.4%, p=0.004), ‘comfort of heel cushioning’ (-43.3%, p<0.001), and ‘comfort of forefoot cushioning’ (-18.3%, p=0.048) was found for HYB vs TPU, but ‘comfort of forefoot cushioning’ (+48.0%, p=0.032) showed an increase vs EVA. Conclusions: Combining materials could enhance comfort during running causing subtle changes in running mechanics. Overall, neither EVA, TPU nor their combination significantly improved RE compared to CON.Item Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review(MDPI, 2024-05-24) Uddin, Akram; Russell, David A; Game, Fran; Santos, Derek; Siddle, Heidi JBackground: Diabetic foot osteomyelitis (DFO) is a major complication and can lead to significant morbidity and mortality. Systemic antibiotic therapy is often initiated first line to achieve quiescence of infection. To perform a multi-centre case review of systemic antibiotic intervention to treat adults with DFO in England and Wales and compare with national guidelines ‘Diabetic foot problems: prevention and management’. Methods: Eight centres from England and Wales retrospectively collated data from a minimum of five adults (aged ≥ 18 years) from electronic case records. All patients were treated with systemic antibiotics following a new diagnosis of DFO (1 June 2021–31 December 2021). Results: 40 patients (35 males and 5 females) were included; the mean age was 62.3 years (standard deviation (SD) 13.0). Patients commenced systemic oral 14 (35%) or intravenous 26 (65%) antibiotic therapy following a new diagnosis of DFO. Twenty-seven (67.5%) patients were medically or surgically managed in the 12-week period with clinical quiescence of infection. Twenty-one patients (52.5%) had no recurrence of DFO infection within 12 weeks; seventeen (42.5%) of these patients had clinical quiescence of infection with systemic antibiotics alone without surgical intervention and nine (22.5%) of these cases had no recurrence of DFO. There were no cases of major amputation or death. All centres showed significant in-centre variability in systemic antibiotic management; variability was reported in the clinical and quantity indicators specifically to antibiotic selection, single versus dual therapy, mode of delivery and duration of treatment. Conclusions: This case review identifies there is existing variation when treating adults with systemic antibiotics for DFO. Further national guidance is required to standardise service delivery and care to improve patient outcomes.Item Development and Delivery of an Integrated Digital Healthcare Approach for children with Juvenile Idiopathic Arthritis: Usability Study(JMIR Publications, 2024-09-17) Butler, Sonia; Sculley, Dean; Santos, Derek; Girones, Xavier; Singh-Grewal, Davinder; Coda, AndreaBackground: Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disorder, with no cure. Most children are prescribed: several medications aimed to control disease activity, manage symptom, and reduce pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long term adherence, ongoing monitoring from a paediatric rheumatologist, and involvement from an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics, by children with JIA. Methods: As part of this pediatric cross-sectional usability study, twelve children were asked to wear a smart watch for two weeks, synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain levels. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a post-intervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data employed thematic analysis. Results: Twelve children, aged 10 to 18 years (mean 14.2, SD 3.1, female 66.7%, 8/12) and one parent for each child (n=12, 66.7%, 8/12, female) were enrolled in the study. Reviewing the highest and lowest agreement areas of the survey, most children and parents liked the smart watch and web-based platform, they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers were identified in the phone app and medication module that hindered uptake. Children required a more unique in-app experience, and their suggestive improvements included: more personalisation within the app, simplification by removing all non-relevant links, flexibility in response times, improved conferment through gamification, additional comment fields for the input of more data such as medication side effects or pain-related symptoms, more detailed graphical illustrations of the physical activity module, including a breakdown of metrics, and importantly, interconnections between modules, because medication adherence, pain levels and physical activity can each influence the other. Overall improving usefulness for children and parents. Conclusions: Usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a more unique in-app experience, through more personalisation, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care. Clinical Trial: Australian and New Zealand Clinical Trial Registry: ACTRN12616000665437.Item Paediatric Rheumatology Fails to Meet Current Benchmarks, a Call for Health Equity for Children Living with Juvenile Idiopathic Arthritis, Using Digital Health Technologies(Springer, 2024-03-11) Butler, Sonia; Sculley, Dean; Santos, Derek; Girones, Xavier; Singh-Grewal, Davinder; Coda, AndreaPurpose of Review This critical review begins by presenting the history of Juvenile Idiopathic Arthritis (JIA) management. To move the conversation forward in addressing the current shortcomings that exist in the clinical management of children living with JIA, we argue that to date, the advancement of successful treatments for JIA has been historically slow. Factors implicated in this situation include a lack of rigorous research, JIA being considered a rare disease, and JIA’s idiopathic and complex pathophysiology. Recent Findings Despite the well-intended legislative changes to increase paediatric research, and the major advancements seen in molecular medicine over the last 30 years, globally, paediatric rheumatology services are still failing to meet the current benchmarks of best practice. Provoking questions on how the longstanding health care disparities of poor access and delayed treatment for children living with JIA can be improved, to improve healthcare outcomes. Summary Globally, paediatric rheumatology services are failing to meet the current benchmarks of best practice. Raising awareness of the barriers hindering JIA management is the first step in reducing the current health inequalities experienced by children living with JIA. Action must be taken now, to train and well-equip the paediatric rheumatology interdisciplinary workforce. We propose, a resource-efficient way to improve the quality of care provided could be achieved by embedding digital health into clinical practice, to create an integrative care model between the children, general practice and the paediatric rheumatology team. To improve fragmented service delivery and the coordination of interdisciplinary care, across the healthcare system.