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Podiatry

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7

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Start date: 2010Has files: No

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    OP0207-HPR EFFECT OF FOOT ORTHOSES IN REDUCING PAIN IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A 12-MONTH RANDOMISED CLINICAL TRIAL
    (Elsevier, 2025-01-02) Fellas, A.; Chaitow, J.; Singh-Grewal, D.; Santos, Derek; Clapham, M.; Coda, A.
    Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents [1]. The manifestation of JIA may include joint swelling, tenderness, and painful limitation with joint movement. Only few studies have explored the effect of foot orthoses (FOs) alone in children with JIA [2,3]. These studies showed FOs can reduce pain in children with JIA, however, further research with larger sample sizes and longer follow-ups are needed [4]. Prescribing FOs on the same day of the initial assessment may promote early clinical and targeted intervention, which is the gold standard approach in paediatric rheumatology. Objectives This single blinded multicentre randomised clinical trial (RCT) aims to investigate the effect of customised prefabricated FOs in reducing pain amongst children and adolescents with JIA. Methods Overall, 66 children and adolescents with JIA presenting with foot symptoms were recruited from the Sydney Children's Hospitals Network (Westmead and Randwick) and John Hunter Children's Hospital (Newcastle). The primary outcome measure was pain with a minimal clinical significance of 8mm on the visual analogue scale (VAS). Participants were randomly allocated to receive either customised prefabricated or sham FOs. The trial intervention was a low-density Slimflex Simple device that was customised at chair-side. The control (sham) device was made of 2mm flat leather board with no corrective modifications. Standardised tests such as the Foot Posture Index, navicular drift and drop were used to identify biomechanical abnormalities. The FOs were worn for a total of 12 months, with data collected at baseline, 4 weeks, 3, 6 months and 12 months. Results Reduction in self-reported pain was statistically and clinically significant at 4-weeks (p=0.018, -14.92 [-27.30, -2.55]) and 3 months (p=<0.001, -28.93 [-40.90, -16.96]) post intervention in favour of the trial group. The 6- and 12-month follow-ups were not statistically or clinically significant. Parent reported pain was statistically and clinically significant at the 3-month (p=<0.001, -21.92 [-33.16, -10.67]) in the reduction of pain in favour of the trial group. However, parent reported pain was not statistically significant at the 4-week, 6- and 12- month follow-ups. These results are similar to child reported pain with a p-value of less than 0.001 and average coefficients twice that of the clinical significance cut-off for VAS pain in paediatric rheumatology. The trial intervention was safe and tolerated well by participants with high compliance and adherence rates. Conclusion Results of this clinical trial indicate customised preformed FOs can be effective in reducing pain and in children with JIA experiencing foot and ankle symptoms. Significant clinical effects appear to be within the first 3-months of intervention prescription and reduce beyond 6 months. Overall, this podiatric intervention was safe, inexpensive, well tolerated and it can be easily implemented as part of the multidisciplinary paediatric rheumatology care. References [1]Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767–78. [2]Powell M, Seid M, Szer IS. Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: a randomized trial. J Rheumatol 2005;32:943–50. [3]Coda A, Fowlie PW, Davidson JE et al. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Arch Dis Child 2014;99:649–51. [4]Fellas A, Coda A, Hawke F. Physical and mechanical therapies for lower-limb problems in juvenile idiopathic arthritis: a systematic review with meta-analysis. Journal of the American Podiatric Medical Association. 2017 Sep;107(5):399-412. Acknowledgements We would like to acknowledge all parents and children for their precious time. Disclosure of Interests None declared
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    POS0283 EFFECT OF CUSTOMISED FOOT ORTHOSES ON PEAK PRESSURE AND PRESSURE TIME INTEGRALS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A RANDOMISED CLINICAL TRIAL
    (Elsevier, 2025-01-02) Fellas, A.; Singh-Grewal, D.; Chaitow, J.; Santos, Derek; Clapham, M.; Coda, A.
    Background Children with juvenile idiopathic arthritis (JIA) often exhibit joint symptoms in the lower limb. Prolonged joint disease may cause further physical and functional impairment, which can lead to significant disturbances in gait such as abnormal pressure distributions and sub-optimal peak plantar pressures [1-3]. Recent studies have shown that children with JIA compared to an age and sex matched cohort displayed significantly higher peak pressures (PP) in most areas of the plantar foot [2]. Research also showed that children with JIA are displaying elevated pressure time integrals (PTI), meaning they are spending higher amounts of time in the stance phase of gait and less in the swing phase and thus a less propulsive gait [2]. To our knowledge only one previous clinical trial has explored the effect of a mechanical intervention such as foot orthoses (FOs) to improve the distribution of peak plantar pressures in children with JIA [4]. Objectives The aim of our randomised clinical trial is to further evaluate the effect of customised prefabricated FOs in improving PTI and PP in children with JIA. Methods A multicentre, parallel design, single-blinded randomised clinical trial was used to assess the impact of customised preformed FOs on plantar pressures in children with JIA. Children with a diagnosis of JIA, exhibiting lower limb symptoms and aged 5-18 were eligible. The trial group received a low-density full length, Slimflex Simple device which was customised chair side and the control group received a sham device. PP and PTI were used as the main gait outcomes and were measured using portable Tekscan gait analysis technology at baseline, 3 and 6 months. PP were measured using kilo pascals (kPa) and PTI measured kPa per seconds (kPa/s). Differences at each follow-up were assessed using the Wilcoxon rank sum test. Results A total of 66 participants were recruited. Customised prefabricated FOs were effective in altering plantar pressures in children with JIA versus a control device. Reductions of PP in the heel (baseline p=<0.001 (-104.33 kPa), 3-month p=0.004 (-126.16 kPa)), forefoot (baseline p=0.027 (-131.5 kPa)), 5th metatarsophalangeal joint (baseline p=0.007 (-37.17 kPa), 3-month p=0.001 (-69.5 kPa), 6-month p=0.016 (-50.91 kPa)) were statistically significant in favour of the trial group. These results were also positively correlated with PTI with the trial group spending less time and pressure on the heel, forefoot and rearfoot than the control. Finally, PP and PTI reductions were also associated with statistically significant increased midfoot contact with the trial device at baseline (29.84 kPa), 3 (24 kPa) and 6-month (43.75 kPa) data collections, showing that the trial intervention was successful in capturing the arch profile of participants and redistributing pressure. The trial intervention was safe and well accepted by participants, which is reflected in the high retention rate (92%). Conclusion Clinicians may prescribe customised prefabricated FOs in children with JIA to deflect pressure from painful joints and redistribute from high pressure areas such as the rearfoot and forefoot. References [1]Woolnough L, Pomputius A, Vincent HK. Juvenile idiopathic arthritis, gait characteristics and relation to function. Gait & Posture. 2021;85:38-54. [2]Merker J, Hartmann M, Haas J-P, Schwirtz A. Combined three-dimensional gait and plantar pressure analyses detecting significant functional deficits in children with juvenile idiopathic arthritis. Gait & Posture. 2018;66:247-54. [3]Hartmann M, Kreuzpointner F, Haefner R, Michels H, Schwirtz A, Haas J. Effects of juvenile idiopathic arthritis on kinematics and kinetics of the lower extremities call for consequences in physical activities recommendations. International journal of pediatrics. 2010;2010. [4]Coda A, Fowlie PW, Davidson JE, Walsh J, Carline T, Santos D. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Archives of Disease in Childhood. 2014;99(7):649-51. Acknowledgements: NIL. Disclosure of Interests None declared.
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    Effects of pH on the antibiotic resistance of bacteria recovered from diabetic foot ulcer fluid
    (American Podiatric Medical Association, 2018-01-01) McArdle, Carla; Lagan, Katie M.; McDowell, David A.
    Background: This study investigated the resistance of bacteria isolated from diabetic foot ulcers (DFUs) to antibiotics frequently used in the management of the diabetic foot infections, at a range of pH values (pH 6.5, 7.5, and 8.5) known to exist in DFU wound fluid. This study aimed to determine whether changes (or atypical stasis) in wound fluid pH modulate the antibiotic resistance of DFU isolates, with potential implications in relation to the suppression/eradication of bacterial infections in DFUs. Methods: Thirty bacterial isolates were recovered from DFU wound fluid, including Staphylococcus spp, Staphylococcus aureus, Escherichia coli, Streptococcus spp, Pseudomonas spp, and Pseudomonas aeruginosa. The resistances of these isolates to a panel of antibiotics currently used in the treatment of infected or potentially infected DFUs, ie, ciprofloxacin, amoxicillin-clavulanate, doxycycline, and piperacillin-tazobactam, at the previously mentioned pH values were determined by a modification of the Kirby-Bauer assay. Results: The resistance of DFU isolates to clinically relevant antibiotics was significantly affected by the pH levels in DFU wound fluid. Conclusions: These findings highlight the importance of a more comprehensive understanding of the conditions in DFUs to inform clinical decision making in the selection and application of antibiotics in treating these difficult-to-heal wounds. The scale of the differences in the efficacies of antibiotics at the different pH values examined is likely to be sufficient to suggest reconsideration of the antibiotics of choice in the treatment of DFU infection.
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    Prediction of stump healing in lower limb amputation: A narrative review
    (Mark Allen Group, 2019-12-11) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, Tom
    Both types of diabetes, as well as different forms of acquired diabetes, are associated with diabetic peripheral neuropathy. Diabetic foot ulcers (DFU) is the condition most commonly related to somatic peripheral neuropathy, often leading to gangrene and limb amputation. Independent from large-vessel disease, sensory loss may result in DFU development and even amputation. The crucial part of any lower limb amputation is the stump healing process, which represents the central goal of postoperative management. Despite the importance attributed to this process, a standard set of guidelines regarding efficient healing methods is yet to be formulated. Health professionals are faced with the challenge of assessing the different risk factors and deciding which has a greater influence on the stump healing rate. There is currently an insufficient number of studies regarding factors effecting lower limb amputation. The main purpose of this review is to discuss the markers that can be helpful in the prediction of stump healing in patients who have undergone lower limb amputation.
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    Alcohol injections for the treatment of intermetatarsal neuromas [Summary]
    (2019-08-15) Santos, Derek; Coda, Andrea
    Intermetatarsal neuromas, sometimes called Morton’s neuroma, cause nerve pain in the forefoot. It arises due to entrapment of the nerve(s) supplying the toes(s) due to compression of the forefoot. Although any foot can be affected it’s uncommon to affect both feet. Similarly, it’s unusual to find multiple neuromas affecting the same foot. The condition is 8-10 times more common in females than males with people aged 45-50 years more at risk. The part of the forefoot most commonly affected is the third inter-metatarsal space with the first and fourth space rarely affected.
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    The Role of APs and the Allied Health Professions - a Scottish Perspective
    (MA Healthcare Ltd, 2010-07) Dunlop, G.
    This article will review the development of the assistant practitioners' (AP's) role for the Allied Health Professions in Scotland since the outcome of an audit conducted in 2004. The study tracks progress made in developing the role through the review of published literature from journal articles and from government health department reports.
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    The nature of decision making within a specialist diabetes multidisciplinary team: a qualitative approach
    (Society of Chiropodists & Podiatrists, 2012-12) Thomson, S. J.; Ellis, Mairghread JH
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    Measurement of changes in the oxygenation of quadriceps muscles during the voluntary and involuntary fatigue test in normal healthy sedentary subjects
    (Universidad de Alicante, 2015) Rehma, Amir Ur; Siddiqui, Muhammad A.; Darain, Haider
    The Purpose of this study is to investigate the changes in muscle oxygen consumption in response to the different fatigue protocol cycle ergometry and electrical stimulation (voluntary and involuntary) in human quadriceps muscle using near infrared spectroscopy (NIRS). Fifteen healthy sedentary voluntary University students between ages 20-60 were invited to participate in the study. Three minutes stimulation was performed to fatigue the muscle. Changes in muscle oxygenation were measured by near infrared spectroscopy. The present resistance was calculated as the estimated maximal power output. The data were analysed using the Kolmogorov-Smirnov (K-S) test to determine the distribution. Descriptive statistics are used to characterize the shape, central tendency, and variability within a set of data. Differences were tested by utilizing the Friedman test the level of statistical significance was set at P<0.05. There was no significant difference (p>0.05) was found between right leg oxygenated (HbO2), deoxygenated (HHb), and total haemoglobin (CHb) as compared to left leg during cycle ergometry fatigue test. On the other hand, significant difference (p<0.05) was found in oxygenated haemoglobin of right leg when two (cycle ergometry and electrical stimulation) fatigue results were compared. However, no significant difference (p>0.05) was found in deoxygenated (HHb) and total haemoglobin (CHb) of right leg when two (cycle ergometry and electrical stimulation) fatigue results were compared. There was no significant difference (p>0.05) found in oxygenated, deoxygenated and total haemoglobin between right and left leg cycle ergometry fatigue indices. Similarly, no significant difference (p>0.05) was found in oxygenated, deoxygenated and total haemoglobin of right leg when two (cycle ergometry and electrical stimulation) fatigue indices were compared. The significant difference (p<0.001) were found between two (cycle ergometry and electrical stimulation) fatigue results. This study reveals that the oxygen consumption was more in the electrical stimulation as compared to the cycle ergometry during the fatigue test. Significant difference was observed between the oxygenated haemoglobin when comparing the electrical stimulation with cycle ergometry. Similarly, significant differences were found between the legs in cycle ergometry fatigue test. influences, together with exercise-induced-effects, should be considered as causes. Results show a functioning preparation-system within the DRV for better prepared-junior-athletes to commence the IPCP. Faculty of Education. University of Alicante.
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    The psychosocial impact of diabetes in adolescents: A review
    (2013-05) Ashraff, Suhel; Siddiqui, Muhammad A.; Carline, Tom
    Type 1 Diabetes mellitus is known to have a major psychological impact on adolescents. Different types of therapies have been developed to support the patient as well as their families to deal with this impact. These include Behavioral Family Systems Therapy and Cognitive Behavioral Therapy. However, studies conducted recently, though few in numbers have shown a direct relationship between general psychological functioning and metabolic control. Self-management of diabetes and its complication therefore, is an integral part of these program. This review looks into the various studies carried out that decide the best approach towards addressing the psychological aspect of type 1 Diabetes Mellitus. OMSB, 2013.
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    Girls with right thoracic adolescent idiopathic scoliosis (AIS): lower body mass index (BMI) and evidence suggesting an inverse relation between sympathoactivation and somatotropic (GH/1GF) secretions
    (IOS Press, 2010-07-10) Burwell, R. G.; Aujla, R. K.; Grevitt, M. P.; Randell, T. L.; Dangerfield, P. H.; Cole, A. A.; Kirby, Alanah; Polak, F. J.; Pratt, R. K.; Moulton, A.; Webb, J. K.; Aubin, Carl-Eric; Labelle, Hubert; Moreau, Alain; Stokes, Ian A. F.
    Introduction: Relatively lower but not higher BMI was associated with left-right skeletal asymmetries in 1)preoperative AIS girls, upper arm length asymmetry (UALA), 2) normal adolescent girls and boys, trunk asymmetry; and 3) normal juvenile girls, skeletal sizes for age associated withUALA. Objectives: In girls with right thoracic AIS to evaluate the effect of lower and higher BMI upon the relation of curve severity to UALA. Material and Methods: Data from girls with right thoracic AIS (n=110, preoperative n=77, screened n=33) including Cobb angle, apical vertebral rotation (AVR) and UALA (right minus left, mm), are evaluated by higher (n-57) and lower (n=53) BMI relative to median values (mean BMIs 21.8 and 17.3 respectively, p<0.001). Results: Mean Cobb angles and UALA are not significantly different between lower and higher BMI. Mean AVR in the lower BMI subset is significantly less than in the higher BMI subset. Cobbangle and AVR each correlate significantly with UALA in girls with lower but not higher BMI. Conclusion: In accordance with our double neuro-osseous theory for AIS pathogenesis in girls, we postulate that lower BMI girls with presumptively lower circulating leptin levels, have relatively more sympathoactivation causing the skeletal asymmetries and less somatotropic secretions. From previous findings of younger preoperative girls with higher BMI showing early skeletal overgrowth, such girls may have relatively more somatotropic secretions and less sympathoactivation. Significance: This putative inverse relation for AIS is in accordance with several medical conditions showingan inverse relationship between sympathoactivation and GH/1GF secretions.