共找到 20 条结果
We are delighted to announce our established partnership with the American Podiatric Medical Association (APMA) to publish the Journal of the American Podiatric Medical Association (JAPMA) on its behalf [...].
The purpose of this meta-analysis was to discern the changes in morphological characteristics of the intrinsic foot muscles, including changes in the cross-sectional area (CSA) and thickness of the abductor hallucis (AbH), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and abductor digiti minimi (AbDM) in individuals with flat foot (FF). We conducted our literature search in the PubMed, Web of Science, and Scopus electronic databases. We included English-language case–control and cross-sectional studies comparing the morphological features of the intrinsic foot muscles in adults with and without FF. The methodological quality of the five studies that met the inclusion criteria was assessed with an adapted version of the Newcastle-Ottawa Scale for cross-sectional studies. The mean difference (MD) with corresponding 95% confidence intervals (CIs) was used to quantify the effects between adults with and without FF. The study included five studies, one of which was classified as high quality, while the remaining studies were classified as moderate quality. The CSA of the FHB (MD = −0.41, 95% CI = −0.61, −0.22; p < 0.001, I2: 59%) and AbDM (MD = −0.21, 95% CI = −0.32, −0.11; p < 0.001; I2 = 1%) and the thickness of the AbDM (MD = −1.43, 95% CI = −1.81, −1.05; p < 0.001; I2 = 1%) were lower in individuals with FF than in the control group. However, the CSA of the AbH and FDB, and the thickness of the AbH, FHB, and FDB, exhibited no significant differences between the FF and control groups. The results of our study indicate that individuals with FF exhibited significant atrophy of the FHB and AbDM muscles. However, the morphology of the AbH and FDB muscles did not appear to influence foot posture, based on the five studies that were considered.
Background: Flatfoot is an alteration of the normal structure of the foot, characterized by a partial or total reduction of the medial longitudinal plantar arch, valgus deformity of the heel, and abduction of the forefoot. While treatments often include strengthening of the intrinsic foot muscles, evidence of its efficacy in adults with flatfoot remains limited. Objectives: The main objective of this review was to evaluate the effects of strengthening the plantar intrinsic muscles in adults with flatfoot. Methods: Searches were conducted in PubMed, Embase, Cochrane, PEDro, and Web of Science databases up to October 2023. The review protocol was developed and followed according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies included were those published on intrinsic muscle strengthening in adult populations. A qualitative synthesis of all included articles was performed, along with a quantitative sub-analysis of randomized controlled trials and a critical methodological assessment. Results: Eleven studies involving a total of 374 participants were selected. Most studies identified the "short foot exercise" as the optimal exercise for isolating and training the plantar intrinsic foot muscles. The most commonly analyzed variables were the Foot Posture Index and the Navicular Drop Test. Conclusions: Strengthening the plantar intrinsic muscles enhances the height of the medial longitudinal arch, improves hindfoot posture and balance, and increases hallux abductor muscle activity. This strengthening, whether achieved through short foot exercises alone or in combination with other techniques, is effective in treating adult flatfoot. Current literature suggests that a duration of 4-6 weeks may be sufficient to achieve beneficial outcomes.
The Therapeutic Shoe Benefit (TSB) allows Medicare insurance beneficiaries to reduce their diabetic foot ulcer risk by providing offloading shoes. Anecdotal evidence suggests that the process is cumbersome and that not all providers are aware of this benefit. This study evaluated TSB awareness across multiple healthcare disciplines and documented barriers to utilization. An online study surveyed healthcare providers practicing in the United States to determine familiarity with TSB and barriers to prescribing therapeutic shoes. The project was IRB-reviewed and received exempt status. The survey was sent to a wide variety of healthcare practitioners including: podiatrists, primary care providers, physical therapists, orthotist/prosthetists, specialty providers, and diabetes educators. This was done through targeted emails from professional organizations, word-of-mouth messaging through private practice groups, and marketing on LinkedIn. The survey was administered via Qualtrics with embedded branching logic used to gather data from the TSB's three classifications of healthcare specialists: certifying physicians, prescribing practitioners, and suppliers. A total of 580 valid completions of the survey were analyzed. Irrespective of the TSB, podiatric physicians and medical professionals providing direct patient care recommend supportive shoes for patients with diabetes 98.2% (336/342) of the time. When asked about knowledge of the TSB, 522 or 90% of respondents indicated awareness of this Medicare benefit. Knowledge by specialty was hard to differentiate due to low responses by some specialties; however, prescribing podiatrists and prosthetic providers both responded with a familiarity rate above 92%. Common obstacles to providers prescribing shoes were: complexity of documentation (67.8%), challenges communicating with other providers (55.0%), and financial reasons/labor-to-reimbursement ratio (38.4%). TSB has the potential to reduce amputations and wound care costs. However, therapeutic shoes are underutilized with less than 20% of potential beneficiaries accessing this benefit. This research strengthens the argument that streamlining the process may increase access to therapeutic shoes.
Background: Effective communication with patients is vital for improving health outcomes in chronic disease management. In this study, we investigated WoundScribeAI's Scribe AI, also known as Ambient Technology, and its patient education and engagement app, Pingoo.AI. It employed a multi-agent AI model that leveraged Large Language Models (LLMs) and NotebookLM to enhance patient communication in clinical settings. Methods: The system comprised specialized agents that transcribed healthcare provider-patient conversations through ambient dictation. This transcription generated medical notes that followed the Subjective, Objective, Assessment, and Plan (SOAP) format-a structured document used by healthcare providers to record and communicate information about patient encounters. Simultaneously, comprehensive visit summaries were also created. In the next step, these visit summaries were used to produce conversational and educational content by leveraging NotebookLM, an AI model introduced by Google that can generate podcast-style conversations from provided information. Integrating these agents allows clinicians to deliver engaging, empathetic, and actionable information to patients. Medical experts conducted a two-phase evaluation of the system's performance based on multiple criteria, with a particular focus on diabetes education and diabetic foot care. The first phase used pre-recorded training videos, while the second phase involved simulated consultations by clinicians using the system. To validate the AI-generated educational content, we used several established frameworks in health communication that closely align with our enhancement goals. Results: The results showed that the AI model generated accurate clinical documentation and met the criteria for accurate SOAP Notes, visit summaries, and engaging educational content for patients. Given that hallucination is a significant concern related to large language models, especially in critical fields like healthcare, we meticulously analyzed the generated outputs to identify any signs of hallucinated information. Three outcomes successfully passed the validation criteria, including accuracy, completeness, comprehensiveness, absence of potential harm, and no hallucination. Additionally, the Conversational Education content was confirmed against established patient education frameworks and met criteria such as the use of metaphors, empathetic tone, and appropriate language, providing additional detail to help manage the condition. Conclusions: By providing specific instructions and prompts to NotebookLM to transform visit summaries into educational conversations, we significantly enhanced the comprehensiveness and engagement of the content for patients. In contrast to a traditional summary of the clinical visit, the podcast-style conversation enriched the content with background information, encouraging language, an empathetic tone, and helpful metaphors. Our analysis confirmed that the system did not exhibit any hallucinations, highlighting the effectiveness of our approach in mitigating this risk. These findings support the use of multi-agent AI models, combined with ambient dictation and tools like NotebookLM, to improve patient communication that surpasses traditional paper-based brochures, which are often impersonal, minimal, and do not always adhere to recommended factors for health literacy.
Background: The etiology and diagnosis of heel pain are complex and multifactorial, and it has been reported that Baxter's entrapment is responsible for up to 20% of foot disorders. The most conservative treatment of Baxter's entrapment has been the use of custom insoles. Electromyography was considered an effective test to assess muscle activity. The aim of this study was to test the use of insoles of different hardness on muscle activity of the abductor hallucis muscle in subjects with entrapment of the lateral branch of the external plantar nerve. Methods: 18 subjects (7 women and 11 men) diagnosed with nerve entrapment of the first branch of the lateral plantar nerve were recruited. Muscle activity of the adductor hallucis muscle was analyzed with insoles of different hardness in static and dynamic situations using electromyographic evaluation. Results: The statistical analysis did not show statistically significant differences in the muscle activity of the abductor hallucis muscle in the static position, with and without plantar orthoses (p>0.05), in contrast, in dynamic situations statistically significant differences were found between groups (p<0.01). Conclusions: The use of a hard insole decreases the maximum peak muscular activity of the abductor hallucis muscle in subjects with Baxter's nerve entrapment in walking conditions.
Background: Changes in the rearfoot calcaneal position affect the foot "arch structure" during the stance phase of gait and hence influence reactions in the plantar fascia thickness and stiffness during weight bearing. However, previous research has focused on the non-weight-bearing assessment of plantar fascia thickness (PFT) and stiffness (PFS) and has not linked these measurements to rearfoot position. Methods: This study aims to investigate if a change in the weight-bearing rearfoot position influences the PFT and PFS. A linear actuator-driven 3D-printed platform was utilised to reliably move the rearfoot through a range of frontal (F (4,12) = 19,585.8, p = 0.00) and sagittal plane angles (F (2,6) = 11,751.32, p = 0.00) whilst weight bearing. An ultrasound probe capable of shear wave elastography was incorporated into the platform for the closed-chain weight-bearing assessment of the PF. The PFT and PFS were collected for 13 (26 feet) participants (11 male, two female; age 35.62 ± 15.04; BMI: 30.31± 6.22 Kg/m2) from a convenience sample who met the inclusion criteria. Results: The data were subject to appropriate statistical, collective and cluster analysis. Individual participant data analysis showed a strong nonlinear correlation between PFT and PFS in the relaxed calcaneal position. The rearfoot sagittal plane cluster demonstrated an auxetic property in 54.3% of the group, where both the PFT and PFS increased. The frontal plane cluster demonstrated an auxetic property in 76% of the group, where the PFT increased as the PFS increased. Conclusions: The results suggest that the PF does have a specific response to changes in the rearfoot position for individuals, which, in some, can show an auxetic property.
Background: We sought to compare the results of the Heifetz and Winograd methods, used in the surgical treatment of ingrown toenails, and their efficacy in different age groups. Methods: A total of 160 toes of 143 patients surgically treated with the diagnosis of toes growing into the skin between 1 June 2012, and 31 July 2019 were evaluated retrospectively. The age, sex, involved foot, involved toe, and relevant Heifetz stages of the patients were assessed. The patients underwent either the Winograd or Heifetz surgical treatment method. The groups were further divided by age (<18 years and ≥18 years) and were re-evaluated in terms of recurrence. Results: No statistically significant difference was detected between the groups in terms of age, sex, side, early infection, and recurrence rates. However, when the groups were divided according to age, a significantly lower recurrence rate was found in patients younger than 18 years who underwent the Heifetz method compared with patients 18 years and older who underwent the Winograd method. Conclusions: Aligned with the literature, these two surgical methods may be regarded as considerably successful, easily applied, and safe, with fewer complications in ingrown toenail cases. Although it is appropriate to select a surgical treatment method depending on the experience of the surgeon, we believe that the Heifetz method should be given priority due to better outcomes in terms of recurrence in patients younger than 18 years.
Background: Persons with intellectual disability have a significantly higher prevalence of diabetes than the general population. Special Olympics Fit Feet, a major screening process for evaluating foot health in persons with intellectual disability, has not included an assessment for the risk of diabetic foot ulcers thus far. A probable reason for this may be that clinicians in the past have felt that persons with intellectual disability were not capable of understanding how to complete the Semmes-Weinstein test for lack of protective sensation. A study was designed to assess whether the Special Olympics athletes could complete the Semmes-Weinstein test for lack of protective sensation. Methods: 31 Special Olympics athletes with intellectual disability participating in a Fit Feet foot screening underwent a Semmes-Weinstein test for lack of protective sensation (LOPS). An assessment was completed using predetermined criteria to establish whether the subject understood what was required and could satisfactorily complete the test. Likewise, it was also determined if the Special Olympics athletes believed they understood the test. Results: Study findings determined that approximately 67% of the athletes in the study were able to successfully complete the test and 90% of the Special Olympics athletes reported they completely understood the test. These results do not apply to the intellectual disability population at large. Conclusion: A significant percentage of the test population appeared able to successfully undergo the Semmes-Weinstein test for lack of protective sensation (LOPS). Therefore, it is recommended that any foot screening process for Special Olympics athletes should include an assessment for loss of protective sensation including use of monofilament testing.
Lateral column lengthening (LCL) calcaneal osteotomy is a well-established surgical procedure used in flexible flatfoot reconstructive surgery. The effects of LCL on subtalar joint (STJ) range of motion (ROM) have not been thoroughly explored in the literature. Our study aimed to objectively measure the average decrease in the total ROM of the STJ following LCL. A retrospective cohort study was conducted on 15 patients (20 feet) who underwent LCL for various indications. Data for STJ ROM was collected from both the preoperative and postoperative periods. Mean follow-up for the cohort was 12 weeks postoperatively. The mean total preoperative STJ ROM was 39.65 ± 2.52 degrees, while the mean total postoperative STJ ROM was 19.17 ± 2.62 degrees (p < 0.001). This represents a statistically significant reduction of 20.48 degrees (48% decrease) in STJ ROM from preoperative to postoperative measurements. This study provides the first objective measurement of the STJ ROM decrease following LCL calcaneal osteotomy on patients in vivo. The findings highlight the substantial impact of the procedure on the ROM in the STJ. These results have important implications for patient management and should be considered when evaluating the outcomes of LCL procedures. Further research is warranted to explore the functional consequences and long-term effects of the reduced STJ ROM and to develop strategies for optimizing foot function in patients undergoing this procedure.
Background: We present a retrospective radiographic analysis showcasing the ability to correct hallux valgus using the Lapidus arthrodesis without focused frontal plane rotation of the first metatarsal. Methods: A total of 33 feet in 30 patients who had undergone Lapidus arthrodesis for the treatment of hallux abducto valgus deformity from 1 August 2015 to 31 December 2020 were identified. The median age of the cohort was 55.4 years (range, 33-78 years), 23 were female (76.7%), three (10%) underwent bilateral Lapidus arthrodesis, and the median duration of follow-up was 15.9 months (range, 5-72 months). Results: The median (minimum, maximum) preoperative first intermetatarsal angle was 16° (13°, 28°), and at final follow-up it was 5° (0°, 6°) (p < 0.001). The median (minimum, maximum) preoperative hallux abductus angle was 37° (26°, 51°), and at final follow-up it was 8.5° (0°, 22.5°) (p < 0.001). The median (minimum, maximum) preoperative tibial sesamoid position was 6 (4, 7), and at final follow-up it was 3 (2, 5) (p = 0.001). Conclusions: We found the radiographic first metatarsal lateral round sign to be ambiguous. Qualitative comparison of the results of this investigation with prior studies describing outcomes following Lapidus arthrodesis with focused frontal plane rotation of the first metatarsal suggests that similar outcomes can be achieved without employment of a decisive frontal plane rotation of the first metatarsal. Our findings lead us to believe that correction of substantial hallux abducto valgus deformities can be accomplished using the Lapidus procedure combined with lateral release of the first metatarsophalangeal joint without focused derotation of the first metatarsal.
Background: Flatfoot is a condition brought on by trauma, persistent foot stress, obesity, and poor biomechanics. These factors result in the development of a flat foot, collapse of the foot arch, and malfunction of the posterior tibial tendon. This study aimed to assess the immediate effects of Kinesio Tape on static plantar foot pressure and force in young females with flexible flatfoot. Methods: A pilot study (pre-experimental study design) with a convenience sample of 20 female subjects from a university with flexible flatfoot (age = 20.1 ± 1.3 years, weight = 91.8 ± 14.4 kg, height = 162.2 ± 6.3 cm, BMI = 34.9 ± 5, foot posture index (FPI) = 8.8 ± 2.1) was selected. The TekScan MatScan® system was used to measure the static plantar forces and pressures, foot contact area, and the mediolateral displacement of COF over time while standing (Boston, MA, USA) before and immediately after the application of Kinesio Tape (KT). Results: While there were no statistically significant changes in the foot peak or total pressure, paired-sample t-tests showed a statistically significant reduction in foot contact area (p < 0.05) and a statistically significant increase in midfoot maximum force (p < 0.05) following the application of KT. Furthermore, after applying KT, there was a statistically significant decrease in the mediolateral COF velocity, indicating greater lateral displacement of COF (p < 0.05). Conclusions: The results of this study concluded that Kinesio Tape was a useful intervention method for immediately redistributing pressure and forces in young females with flexible flat feet.
Background: Caregivers often seek medical assistance when their child experiences podiatric medical ailments. Podiatric medical diseases such as ingrown toenails, callosities, warts, metatarsus varus, and hallux valgus frequently occur in children and adolescents. However, treatment, prevention, and rehabilitation are often based on empirical experiences; thus, as a first endeavor, clinical and epidemiologic mapping of podiatric medical diseases in children is warranted. We describe the prevalence of common foot conditions-callosities, ingrown toenails, hallux valgus, metatarsus varus, and warts-among Danish schoolchildren aged 6 to 16 years. Methods: In this cross-sectional study, we evaluated foot conditions in children in first (aged 6-8 years), fifth (aged 10-12 years), and ninth (aged 14-16 years) grades. The clinical status of the feet was examined by teams of two podiatric physicians each. Specifically, we evaluated deformities of the foot, foot pathologies, and their anatomical localization. Results: Of 501 children (1002 extremities) evaluated, 417 had one or more of the investigated foot deformities or pathologies. We found 266 various foot pathologies among Danish schoolchildren. Metatarsus varus (53%) and callosities (46%) were the most frequently occurring foot conditions. The prevalence of foot pathologies of ingrown toenails and warts was 14% and 12%, respectively. The prevalence of ingrown toenails, metatarsus varus, and hallux valgus increased with age. Conclusions: This study found that foot pathologies such as warts and ingrown toenails and conditions such as metatarsus varus and callosities are common in Danish primary school students. These findings of high prevalences of foot pathologies and conditions motivate future research projects to clarify how this affects general health and subsequently the relation to pain, health challenges, socioeconomics, and quality of life.
COVID-19, caused by the SARS-CoV-2 virus, has become a global public health crisis with diverse clinical manifestations affecting multiple organ systems, including the integumentary system. One notable cutaneous manifestation, referred to as "COVID toes," involves the development of pernio-like chilblains, characterized by red-to-violet macules, plaques, or nodules, primarily on toes and fingers. This characteristic clinical feature gained significant attention due to its apparent association with COVID-19, especially during the early stages of the pandemic when individuals with mild or asymptomatic cases exhibited these symptoms. Concurrently, digital platforms such as Google Trends have emerged as tools for tracking public interest in health-related topics, offering insights into real-time patterns of disease awareness. Previous research has demonstrated that Google Trends data may correlate with the incidence of infectious diseases, suggesting that search interest can be a proxy for disease outbreaks. In this study, we sought to explore the potential relationship between public interest in COVID toes, as reflected in Google Trends, and the incidence and mortality rates of COVID-19. Specifically, we examined whether peaks in search interest for "COVID toes" corresponded with surges in COVID-19 cases and deaths. By analyzing trends in search data, we aimed to assess the utility of digital platforms as an epidemiological tool for monitoring disease progression and public awareness. Our findings provide insights into the potential role of digital search data in forecasting outbreaks and highlight the interplay between public perception and the clinical burden of COVID-19, emphasizing the importance of real-time data in public health surveillance and response.
Background: Chronic insertional Achilles tendinopathy (CIAT) is a type of tendinopathy resistant to conventional conservative treatments. The efficacy of extracorporeal shock wave therapy (ESWT) remains controversial. This study aims to evaluate the effects of ESWT on pain management and functional improvement in CIAT patients and compare it with physical and medical treatments Methods: In this retrospective study, 372 patients diagnosed with CIAT between 2019 and 2023 were evaluated. The patients were divided into two groups: those who received only physical/medical therapy (Group 1) and those who underwent a combination of ESWT and physical/medical therapy (Group 2). Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale (VAS) scores. The severity of the disease was determined through magnetic resonance imaging (MRI). Group comparisons were conducted using the independent samples t-test and Fisher's exact test, while changes over time were assessed with repeated measures ANOVA. Correlation analyses were evaluated using Pearson and Spearman correlation coefficients. Results: Significant improvement in AOFAS and VAS scores was observed in both groups by the third month (p < 0.01). However, at 6 and 12 months, ESWT did not demonstrate superiority over physical/medical treatment. Correlation analysis showed a positive relationship between baseline AOFAS scores and functional improvement, while higher initial VAS scores correlated with greater post-treatment pain reduction. Cardiovascular risk factors negatively impacted both functional recovery and pain reduction (p < 0.05). Although patient satisfaction was higher in the ESWT group, the difference was not statistically significant. Conclusions: ESWT may provide short-term pain relief and functional improvement in CIAT but does not offer a long-term advantage over physical/medical treatment. The placebo effect may contribute to early positive outcomes. These findings do not support ESWT as a routine treatment for CIAT.
Evaluation of the static angle of the forefoot-to-rearfoot relationship in the sagittal plane is essential in determining the degree of pseudoequinus in the lower extremity. The concept of an increased sagittal plane forefoot-to-rearfoot relationship is generally referred to as anterior equinus, which may result in a pseudoequinus syndrome. As its name implies, pseudoequinus is not a true lack of ankle joint dorsiflexion but rather a condition wherein the ankle joint functions as if it were restricted. Currently, the literature lacks specifications on how to obtain this measurement. Qualitative methods exist to identify an increased sagittal plane forefoot-to-rearfoot relationship whereby the clinician observes whether the patient has an anterior equinus or pseudoequinus present. However, no method has been reported that is suitable for structured evaluation determining the degree of pseudoequinus present. Evaluation of this measurement is important in understanding the overall magnitude of equinus influence present and its concomitant effects on the superstructure. This article describes a new method for measuring the static angle for the sagittal plane forefoot-to-rearfoot relationship using an orthopedic evaluation device. The results of this study indicated that this measurement yielded high interrater and intrarater reliabilities. In effect, this is a simple-to-perform analytics assessment that, as part of comprehensive biomechanical examination, will provide the astute clinician with additional insights into the cause and effect of pathomechanical foot and limb function.
Background: There is a positive relationship between mitochondrial damage in the cell and uptake in technetium Tc 99m monomer methoxy isobutyl isonitrile (99mTc-MIBI) scintigraphy. Severe mitochondrial dysfunction with cell death occurs in patients with diabetic foot ulcers (DFUs). To decide on the level of amputation, 99mTc-MIBI scintigraphy should be considered. Methods: Prospectively, 24 patients with DFUs were included in the study. Based on treatment that started with the hospitalization, patients were divided into two groups: those whose DFUs healed and did not need surgical intervention (healed group) and those whose DFUs did not regress despite surgical and medical treatment and who required further surgical intervention (reoperation group). Before surgery, 99mTc-MIBI scintigraphy was performed. The 99mTc-MIBI uptake rates of the injured foot relative to the healthy foot were recorded. Deep-tissue culture was taken at surgery. Erythrocyte sedimentation rate, white blood cell count, and C-reactive protein (CRP) and albumin levels were measured. Results: The 99mTc-MIBI uptake rates of patients with poor prognosis were higher at all times than those of patients who did not require revision surgery. A significant difference was found between these values in the 10 and 30 s rates. The mean ± SD CRP level was 86.04 ± 21.87 mg/dL in the healed group and 144.43 ± 27.54 mg/dL in the reoperation group (p = 0.040). There was a positive correlation between ulcerated foot and healthy foot 99mTc-MIBI involvement rates at 10 and 30 s and CRP values, and a negative correlation between albumin values. Conclusions: There was a significant relationship between 99mTc-MIBI involvement rates and poor prognosis and reamputation. The correlation between CRP and albumin levels, which are among the predictive values, and 99mTc-MIBI uptake confirmed this relationship in DFUs, which are difficult to manage and treat.
Background: The aim of this study was to investigate the effect of dry needling (DN) applied to the abductor hallucis (ABH) muscle on pain function and angle in patients with hallux valgus (HV). Methods: The study included 31 HV patients. Patients were randomly divided into two groups. The first group received toe-spread-out (TSO) exercise. The second group received three sessions of DN for myofascial trigger points in the ABH muscle in addition to TSO exercise. Visual analog scale (VAS) (rest, activity) and foot function index (FFI) (pain, disability, activity) were used for clinical evaluation. Hallux valgus angle (HVA) and intermetatarsal angle (HVA) were measured. The evaluations were performed at baseline and at the first and fourth weeks following treatment. Results: VAS-rest baseline-fourth week and baseline-first week changes were significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.023, p = 0.039, respectively). FFI-disability baseline-fourth week change was significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.040). HVA and IMA baseline-fourth week changes were significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.001, p = 0.045, respectively). Conclusions: According to our findings, the combination of DN for the ABH muscle with TSO exercise may be recommended for the treatment of patients with mild-to-moderate HV.
Background: Prolonged standing can lead to musculoskeletal disorders, especially in the lower extremities, when appropriate footwear is not used. The aim of this study is to investigate the relationship between footwear styles, foot problems, and pain characteristics related to lower extremities in individuals with prolonged standing. Methods: A descriptive, cross-sectional study design was employed, using a random sample of individuals with prolonged standing (n = 159). Participants were asked questions about their footwear choices. They were asked to mark the lower extremity pain localization on the McGill Pain Map. In addition, foot deformities were evaluated by physical examination. Results: The findings revealed that most females (n = 88) and males (n = 71) preferred flat/sports footwear styles in both summer and winter. There was no significant difference between footwear styles and foot pain duration, intensity, and localization in both genders (p > 0.05). However, a statistically significant difference was observed among males between their summer footwear styles and pain related to lower extremities (low back pain and knee pain), and among females between their summer footwear styles and foot problems (bone deformities, skin pathologies and soft tissue issues) (p < 0.05). Conclusions: The results of this study show that the preferred footwear style was associated with lower extremity pain and foot problems, which emphasized the importance of footwear selection and footwear evaluation in the musculoskeletal evaluation of the lower extremities.
Background: Diabetic foot ulcers (DFUs) and lower-extremity amputations (LEAs) complicating diabetes mellitus are significant contributors to morbidity, mortality, and disease burden. There is insufficient evidence, however, linking podiatric care to mortality and healthcare resource use. There is, concurrently, inadequate access to podiatric care, particularly in Asia. This study evaluated the clinical and healthcare use outcomes of patients with DFUs who received podiatric care. Methods: A longitudinal study involving patients in Diabetic Foot in Primary and Tertiary (DEFINITE) Care followed over a period of 2 years reviewed the effectiveness of podiatric care with regard to 1-year outcomes using multiple logistic and zero-inflated negative binomial regressions, adjusting for covariates. Clinical outcomes were minor and major LEA, mortality, and LEA-free survival rates; healthcare use outcomes were the number of admissions, number of visits to clinics and emergency departments, and length of stay. Results: Eligible patients (n = 2798 [65.5%]) completed at least 12 months of follow-up. Comparisons were made with patients without access to podiatric care. The overall mean ± SD patient age was 65.7 ± 12.7 years. Most patients receiving podiatric follow-up were of Malay or Indian ethnicities and had poor diabetic control and chronic kidney disease. There were more admissions (p < 0.01) and visits to the emergency department (p < 0.01) and hospital outpatient clinics (p < 0.01), but a shorter length of stay (incidence rate ratio, 0.833; p < 0.01), without any reported differences regarding visits to public primary care clinics (p = 0.68). There were more minor LEAs (p < 0.01) but fewer deaths (p < 0.01) and greater LEA-free survival (odds ratio, 1.26; p = 0.02). Conclusions: Podiatric care improved clinical outcomes for patients with DFU, particularly in terms of LEA-free survival, with a positive impact on healthcare utilization. This is a crucial contribution to the limited evidence on podiatric care in diabetic limb salvage in Asian populations.