Underpinning ongoing colonisation of the lands now known as Australia, scientific racism in colonial research delivered flawed results by building Indigenous inferiority into methodology to produce dehumanising conclusions of First Nations Peoples. Scientific racism facilitated exclusion of First Nations Peoples from systems design and development; foregrounding ways exclusive and enforced colonial health systems cause First Nations health and wellbeing inequality. Inequities in foot health contribute to this inequality. This work describes and documents a process of First Nations-led authentic co-design for foot health research. This study represents ways and means to develop culturally responsive foot health research as judged by First Nations Peoples which will translate into improved and more responsive ways of delivering foot care. Non-Indigenous and First Nations Peoples sought authentic First Nations-led co-design process in foot health research methods, a governing First Nations Advisory Group, and broader First Nations governance and ethics approvals. Indigenous methodology, data sovereignty, and redistribution of power were imperative in ways of working. First Nations-led co-design developed culturally responsive semi-structured interviews to collect data. Talking with 10 registered health practitioners who work closely with lower limb and foot health represented the right mix of participants and enough data to convey a more complicated mosaic of multi-faceted stories. First Nations expertise informed analytic induction and the use of inductive reasoning and constant comparison to identify common and overarching themes, and to perform thematic analysis. Authentic First Nations-led ways of working in cross-sectional qualitative study design are documented. Results of data analysis following these ways of working will be published subsequently. This work provides insights into working right ways in research which will underpin good foot health services with and for First Nations Peoples. The paper highlights ways of working that empowers First Nations Peoples in authentic co-design. First Nations-led foot health research changes ways of working to counter inequities in foot health caused and maintained by ongoing colonisation and systemic racism. This study provides qualified voiced lived experience which foot health researchers must listen to and receive learning and direction from.
Podiatrists are the primary health professionals associated with assessment, diagnosis and management of lower limb problems. Research is critical in informing evidence-based practice. As part of a national research priorities project, this bibliometric review aimed to map all Australian podiatry-relevant research from 1970 to 2024 and explore volume over time, authors, institutions, level of evidence, funding sources and categories of research. Podiatry-relevant research was categorised into 10 streams: dermatology, diabetes-related foot disease, gerontology, musculoskeletal and sports, paediatrics, rheumatology, surgery, workforce and education, First Nations foot health and neurological and vascular disease. A systematic search of the literature was conducted in each stream up until December 2024. Meta-data from Scopus were analysed in Biblioshiny, where publications volume, authors, institutions, journals and collaborations were described. Each publication was also categorised for level of evidence using the National Health and Medical Research Council criteria, research type using the United Kingdom Clinical Research Collaboration Health Research Classification System and funding source using Higher Education Research Data Collection specifications. A total of 1641 publications were included across all research streams. Steady increases in publication volume occurred over the past 20 years, with diabetes-related foot disease yielding the highest volume (n = 335), followed by musculoskeletal (n = 308) and paediatrics (n = 280). Musculoskeletal and sports research demonstrated the highest proportion of level I evidence (22%), whereas most streams were dominated by level IV evidence. The majority of research across all streams received no funding support, ranging from 32% unfunded in First Nations foot health research to 87% in surgical research. Rheumatology achieved the highest proportion of competitive funding (47% Category 1). The most frequent research categories were aetiology, detection and screening and evaluation of treatments. The Journal of Foot and Ankle Research was the most frequent publication source, with 140 (8%) of total publications. Australian podiatry-relevant research has grown substantially, particularly over the past 2 decades. However, significant disparities exist in volume, evidence quality and funding across different streams, with most research conducted without external funding support, highlighting the need for strategic investment to enhance evidence generation in key areas of podiatry practice.
People experiencing homelessness face profound barriers in accessing healthcare, particularly preventive services such as foot care. Globally, rough sleepers are vulnerable to foot-related morbidity due to prolonged exposure, inadequate footwear and poor hygiene access. Despite this, foot health remains an under-researched aspect of homelessness. To explore the lived experiences of rough-sleeping adults in the United Kingdom in relation to foot health, self-care practices and access to podiatric services, and to understand how these experiences influence their overall health and well-being. This qualitative study employed interpretative phenomenological analysis (IPA) to investigate the narratives of seven adults (five men and two women, aged between 30 and 62, all identifying as White British) who were sleeping rough in an urban UK setting. Semistructured interviews were conducted at a community drop-in centre. The consequent transcripts were analyzed thematically, focusing on participants' interpretations of foot health, access to care and coping within the context of homelessness. Four themes were identified: foot care as survival, normalisation of foot health problems, barriers to foot care access and the charity sector as a lifeline. Participants reported widespread foot problems, including chronic pain, infections and poor nail health. Barriers to care included stigma, distrust of medical professionals, inflexible services and competing survival priorities. Lack of access to basic hygiene and footwear exacerbated foot health issues. In contrast, charitable services offering podiatry were described as vital sources of support and dignity. Foot health is integral to the mobility, independence and psychosocial well-being of people experiencing homelessness. Findings highlight the need for flexible, outreach-oriented and stigma-informed approaches to podiatric care. Charitable models offer transferable insights for statutory and community services seeking to improve equitable access to foot care for socially marginalised populations.
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. 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. 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. 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.
To conduct a bibliographic analysis of English language research pertaining to podiatry workforce and education by Australian authors. 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. 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. 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.
Diabetes-related foot disease is a leading cause of global disease burden, however the prevalence and incidence of diabetes-related foot disease in Ireland is poorly understood. Up-to-date population-level estimates of the incidence and prevalence are imperative to support appropriate health service planning. This study examined the prevalence and incidence of diabetes-related foot disease in the Irish population. We systematically searched Pubmed, EMBASE and Lenus the Irish Health Research repository, for peer-reviewed articles published until August 2025. Publications reporting on prevalence and incidence of peripheral neuropathy, peripheral artery disease, foot ulceration or amputation in people with diabetes in Ireland, were eligible for inclusion. The Joanna Briggs Institute Prevalence (JBI) Critical Appraisal Tool was used to assess included studies methodological quality and establish the degree to which bias was addressed in the study's design and analysis. Results were synthesised descriptively according to study characteristics and outcomes. Three studies met the inclusion criteria (n = 145,945), with varying outcome measurement methods. In community-based diabetes populations, peripheral neuropathy prevalence ranged from 15% to 39% (n = 1055) and peripheral artery disease prevalence ranged from 18% to 34% (n = 383). For the history of foot ulcers, prevalence was 3.7% (n = 563) and annual incidence was 2.6% (n = 383). One national population-based study (n = 144,710) reported incidence of amputation increased from 144.2 to 175.7 per 100,000 people with diabetes between 2005 and 2009. This review found there is a paucity of information on prevalence and incidence of diabetes-related foot disease in Ireland. However, these findings suggest that prevalence is similar to, if not lower than, global rates of peripheral neuropathy, peripheral artery disease outcomes and amputation incidence outcomes. High heterogeneity in populations and outcomes highlights the need for robust studies and consensus on diabetes-related foot outcome assessment. Establishing a national diabetes register could strengthen surveillance, identify high-risk groups and inform cost-effective public health planning. PROSPERO (CRD42023472904).
Understanding the structural anatomy and biomechanics of the foot arches is essential for podiatry students due to its clinical relevance in diagnosing conditions such as Pes Planus and Pes Cavus. The foot arches form a flexible base that supports body weight, absorbs shock and functions as a spring lever during activities such as walking and jumping. Therefore, understanding this anatomical knowledge is fundamental for podiatry students for maintaining foot health and supporting clinical assessment and treatment planning. Traditional pedagogical methods often face limitations due to cost, accessibility and emotional or cultural barriers. To address these challenges, the footprint practical activity (FPA) was introduced as a hands-on, cost-effective and inclusive pedagogical strategy. Students collected their footprints and analysed two-dimensional footprints to interpret three-dimensional foot arch structures using Staheli's and Chippaux-Smirak indices. Educational impact was assessed by comparing overall grades between pre- (2020) and post-implementation (2023) cohorts. Implementation of the FPA resulted in a 12% improvement in academic outcomes. Student feedback highlighted enhanced anatomical comprehension and appreciation of clinical relevance, supporting the effectiveness of the intervention. The diagnostic tools used in the activity, Staheli's index and the Chippaux-Smirak index, showed consistent classification outcomes. The finding supports the integration of footprint-based analysis into lower limb anatomy education as a clinically relevant student-centred approach. The FPA enhances student engagement, supports anatomical learning and facilitates the teaching of foot arch variation, offering a valuable alternative to traditional pedagogical methods in podiatry anatomy education.
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. This study set out to map the core components, current hotspots, and emerging frontiers in the CA literature. 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. 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. 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.
Currently, there is no patient-reported outcome measure (PROM) specifically for evaluating foot orthoses treatments. This led us to ask the following question: What is the quality of the validated foot and ankle PROMs used to evaluate foot orthosis interventions? To do so, we analyzed the psychometric properties of these PROMs and identified the most widely used and those with the best measurement properties. Two literature searches were conducted in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. The methodological quality of the articles was assessed using the updated COSMIN checklist. Psychometric evidence for the properties investigated in the articles was assessed using the updated COSMIN criteria for good psychometric properties. Ratings of methodological quality and psychometric evidence were synthesized using the method of Schellingerhout et al. (2012). A total of 205 articles were included, identifying 11 validated PROMs for foot and ankle used in the evaluation of foot orthoses. The Foot Function Index (FFI) and the Foot Health Status Questionnaire (FHSQ) were the most commonly used, whereas the Victorian Institute of Sport Assessment-Achilles tendon (VISA-A) questionnaire demonstrated the best measurement properties. The VISA-A, the Foot and Ankle Outcome Score (FAOS), and the Revised Foot Function Index (FFI-R) appear to be useful PROMs for evaluating foot orthoses treatments; however, more evidence is needed to make more robust and reliable statements.
The role of deltoid ligament (DL) repair in supination-external rotation (SER)-type trimalleolar equivalent ankle fractures (TEAFs) remains controversial. Additionally, it remains unclear whether posterior malleolar fixation alone can prevent postoperative syndesmotic widening. Therefore, this study aimed to determine the optimal combination of surgical treatments for SER-type TEAFs involving the lateral and posterior malleoli and the DL. We retrospectively evaluated 77 patients who underwent surgical treatment for SER-type TEAFs involving Weber type B lateral malleolar fractures with associated posterior malleolar fractures and DL injuries between 2010 and 2023. The patients were divided into DL repair (n = 32) and no repair (n = 45) groups. All the patients underwent open reduction and internal fixation of the lateral and posterior malleoli without syndesmotic fixation. Radiographic parameters, including the medial clear space (MCS), talar tilt (TT), tibiofibular clear space (TFCS), and tibiofibular overlap (TFO), were assessed on standing, gravity stress, and valgus stress radiographs. Clinical outcomes were evaluated using the Foot and Ankle Ability Measure (FAAM). At a minimum follow-up of 2 years, no significant differences were observed between the groups in any radiographic parameters on standing, gravity stress, or valgus stress views (P > 0.05). When compared with the contralateral side, both groups demonstrated significantly increased TFCS and decreased TFO on standing mortise views (P < 0.05), whereas MCS and TT remained comparable. The FAAM-Activities of Daily Living and FAAM-Sports scores improved significantly in both groups with no intergroup differences at the final follow-up. The DL repair group had a longer operative time and experienced DL repair-related local irritation in 11% of cases. In SER-type TEAFs, routine DL repair does not confer additional radiographic or clinical benefits when stable fixation of the lateral and posterior malleoli is achieved. Residual syndesmotic widening after posterior malleolar fixation did not result in medial instability, valgus TT, or post-traumatic valgus ankle arthritis. These findings suggest that accurate bone reduction alone may be sufficient for this injury pattern without routine DL repair. Retrospective comparative study.
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. 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. 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. 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. 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.
BackgroundTo date, most reference data on foot and ankle morphology are derived from Western cohorts, potentially overlooking significant ethnic variation in Asian population. This study utilized 3D weight-bearing computed tomography (WBCT) to establish population-specific reference values of 3D foot and ankle parameters for a Korean cohort and compare these values with published European data.MethodsThis retrospective, cross-sectional study analyzed the asymptomatic contralateral feet of 39 Korean adults (≥18 years old) using WBCT under natural weight-bearing conditions. Automated 3D measurements-including Meary, talonavicular, and Saltzman view angles-were calculated across sagittal, axial, and coronal planes. Results were compared to a published European cohort (n = 100) using Welch t test. For the subgroup analysis, an independent sample t test was used to compare the parameters between male and female participants within the Korean cohort. Pearson correlation analysis was performed to assess the relationship between age and the measured foot parameters.ResultsStatistically significant differences were observed in 18 of the measured parameters between the Korean and European cohorts. The Korean cohort showed a significantly lower sagittal Meary angle, higher talonavicular angle, and lower Saltzman view angle than European data. Analysis of the Korean cohort revealed no significant sex-based differences across most 3D WBCT parameters, except for the sagittal third tarsometatarsal angle. Age was positively correlated with axial Meary angle, Saltzman view angle, and hallux valgus angle.ConclusionThis study provides preliminary 3D WBCT reference values for the adult Korean foot and ankle. The distinct morphologic variations observed between Korean and European populations underscore the need for ethnic-specific reference values. These findings provide a foundational 3D metric for clinical diagnosis and surgical planning in East Asian populations.
In Australia, approximately 50,000 people suffer from diabetes-related foot ulcers (DFU) with another 300,000 people at risk each year. Evidence suggests that social determinants of health may impact DFU outcomes; however, systematic evaluation of studies is lacking. The aim of this systematic review was to evaluate studies investigating the impact of social determinants of health on DFU outcomes. MEDLINE, EMBASE, CINAHL and Scopus were searched from inception to December 2024. Original published studies conducted in Australia investigating the impact of social determinants of health on DFU outcomes, such as wound healing, hospital admission and amputation, were potentially eligible for inclusion. Social determinants of health had to meet the World Health Organisation definition. Authors independently screened studies for inclusion, extracted data and assessed risk of bias using the Quality in Prognostic Studies tool. Twelve studies which investigated socioeconomic status (n = 5), geographical remoteness (n = 5) and access to healthcare services (n = 7) and their impact on DFU outcomes were included. Socioeconomic disadvantage and geographic remoteness were associated with worse DFU outcomes including longer healing times and increased rates of amputation. Access to health services, which aligned with guideline recommendations, was associated with improved DFU healing outcomes. Social determinants of health impact DFU outcomes and are important for clinicians, policy makers and researchers to consider in the design and delivery of health care services. Further research is needed to explore the impact of social determinants of health on a broader range of DFU outcomes and across diverse geographical settings.
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. 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. 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/m2 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. 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.
Patients with rheumatoid arthritis (RA) may continue to experience foot-related disability despite clinical remission. Foot involvement is associated with self-reported disability and objective gait alterations. Foot involvement is heterogeneous; studying patients with localised forefoot pain may help clarify which structural and inflammatory factors are associated with functional impairment. To identify clinical, structural and imaging factors associated with disability and gait performance in patients with RA in clinical remission with metatarsal-region forefoot pain. Cross-sectional study of 81 patients with RA in remission with metatarsal-region forefoot pain. Outcomes were Foot Function Index disability and activity limitation (FFI-D and FFI-AL), gait velocity (GV) and double-support time (DS). Associations were examined using Spearman correlations, age- and BMI-adjusted individual linear regression, parsimonious multivariable linear regression and exploratory cluster analysis. Mean (SD) FFI-D and FFI-AL were 29.8 (29.4) and 29.1 (27.7); gait velocity (GV) was 0.90 (0.34) m/s and double-support time (DS) was 22.9 (8.2)% of the gait cycle. In bivariate and age/BMI-adjusted analyses, graded structural measures showed more consistent associations with disability and gait outcomes than dichotomous/count variables. In parsimonious models, disability (FFI-D/FFI-AL) was independently associated with pain intensity (VAS) and first metatarsophalangeal joint stiffness/limited dorsiflexion (1stMTP), whereas gait performance was mainly associated with age/BMI, greater graded forefoot structural severity and 1stMTP. Cluster analysis identified a higher grey-scale synovitis (GS)/lower structural-burden group and a lower GS/higher structural-burden group, with worse function and slower gait in the latter. In RA remission with metatarsal-region forefoot pain, perceived disability is mainly associated with pain and forefoot stiffness, whereas gait performance is more closely related to age/BMI and graded forefoot structural severity. These findings support severity-based region-specific structural assessment alongside pain evaluation in clinical follow-up, to avoid underestimating the independent contribution of structural damage to function and gait.
Ankle fractures are common and debilitating injuries usually treated with immobilisation using a foot-ankle brace (walker). Emerging evidence suggests that a less restrictive ankle stirrup may accelerate recovery without increasing complications, and patients tend to prefer ankle stirrups. However, evidence supporting their non-inferiority is inconclusive. The aim of this study is to assess whether ankle stirrups are non-inferior to walkers in improving function and pain measured by the Manchester-Oxford Foot Questionnaire three months after ankle fracture. The trial will be a two-phase, multicentre, pragmatic, non-inferiority randomised controlled trial. Patients ≥ 18 years with surgically or non-surgically treated ankle fractures will be included. A three-month pilot phase will assess trial feasibility, including recruitment rates. The full trial will randomise a maximum of 1,400 patients. The sample size is estimated to be sufficient to assess non-inferiority in the overall population and to explore non-inferiority in six subgroups stratified by sex and age (males 18-39 years, males 40-59 years and 60+ years) and treatment (surgical or non-surgical). The bracing after ankle fracture trial will determine whether ankle stirrups are non-inferior to walkers in terms of patient-reported function and pain. Secondarily, the study will assess whether the ankle stirrup facilitates faster recovery of function, earlier return to work, and reduced healthcare costs. Findings will support evidence-based decision-making with respect to patient preferences. Independent Research Fund Denmark, Grant no. 10.46540/4308-00191B. NCT07163091.
The purpose of this study was to undertake a bibliographic analysis of foot and lower leg research relating to paediatric podiatry by Australian or affiliated Australian authors. The Scopus database search was conducted to identify all foot and lower limb research articles involving an Australian cohort of participants, published by Australian authors, or those affiliated with Australian institutions, pertaining to paediatric podiatry, in English from 1970 to 2024. We used bibliometric analysis through an open-source tool based on the R language. We described citations, journals, authors and institutions; countries and publications were manually categorised according to research type, level of evidence and funding source. The search strategy yielded 280 eligible articles, which received a total of 8331 citations and were published by 793 authors in 104 journals. The most frequent journal was Gait & Posture (35 articles; 12%), and the most published institution was the University of Sydney (170 affiliations). Most of the Australian paediatric articles published focused on detection, screening and diagnosis (n = 70, 25%) and only 33 articles (12%) provided Level I evidence. Seventy-three paediatric articles (25%) received Category 1 funding; 154 articles (55%) reported no research funding. Paediatric podiatry research represents 17% of Australian foot and lower limb research. Despite the smaller population base, paediatric research attracts a high level of engagement, moderate citation rates and low funding rates when compared to adult population studies. Paediatric podiatry research is primarily produced via Level 3 evidence. This highlights the need for an increase in the robustness of research methodologies in paediatric podiatry research to strengthen the quality and applicability of evidence informing clinical care for children and adolescent populations.
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.
Melanoma of the foot and nail unit carries a worse prognosis than cutaneous melanoma elsewhere because lesions are frequently hidden, misdiagnosed, and therefore diagnosed at more advanced stages. Traditional ABCDE criteria are often insufficient for foot and nail presentations; the CUBED recognition tool was developed to improve detection of atypical plantar and subungual lesions. To evaluate four consecutive cases of foot melanoma seen in a single NHS community podiatry department, compare case characteristics against ABCDE and CUBED recognition tools, and describe service responses that aimed to improve early detection. A retrospective case series of four patients diagnosed with foot melanoma between 2019 and 2022 in one community podiatry service. Clinical features, referral timelines, diagnostic pathways, treatments, and outcomes were extracted and mapped against ABCDE and CUBED criteria. Shared-learning interventions developed by the department following these cases are described. All four cases were toe-based melanomas (one lentigo maligna, one nail-bed malignant melanoma, two acral melanomas). Presentations commonly included irregular colour, bleeding or ulceration, delayed healing, diagnostic uncertainty, and lesion enlargement. CUBED criteria more consistently identified concerning features across the series than ABCDE criteria, prompting urgent dermatology referral in each case. Outcomes varied: one patient remains disease-free after excision, one developed distant metastasis and died, two underwent toe amputation and received systemic treatment. Departmental responses included case-based teaching and a poster campaign promoting CUBED and ABCDE recognition across local clinical networks. Podiatrists are pivotal in early detection of foot melanoma. The CUBED tool demonstrated greater sensitivity for atypical foot and nail lesions in this series. Wider education and adoption of CUBED alongside ABCDE may reduce misdiagnosis, shorten diagnostic delay, and improve clinical outcomes.
The supination resistance test quantifies the force required to supinate the foot and ankle. Although it demonstrates good to excellent intra- and inter-rater reliability and shows potential for predicting foot and ankle biomechanics during walking, assessing the biomechanical effects of foot orthoses, and distinguishing between healthy and pathological conditions, the supination resistance test remains underutilised in both clinical and research settings due to the lack of normative reference values. Thus, the primary objective of this study was to establish international normative values for the supination resistance test based on age and sex. A secondary objective was to compare supination resistance across age groups and between sexes. In this international cross-sectional study, supination resistance was measured in 1198 healthy participants aged 18 years and older from North America, the Middle East, and Europe. Supination resistance was compared across age decades and between sexes using a two-way analysis of covariance, with body mass included as a covariate. Correlation coefficients and coefficients of determination were calculated to examine the relationships between supination resistance, body mass, and the Foot Posture Index. Supination resistance was greater in males than in females during the 3rd to 5th and 9th decades of life. In males, it increased from the 3rd to the 5th decade and then progressively declined. In females, it increased from the 3rd to the 6th decade, remained stable through the 7th decade, and then dropped sharply. Body mass accounted for 18.1% of the variance in supination resistance, whereas the Foot Posture Index accounted for only 0.3%. The international clinical reference values established for the supination resistance test, stratified by age and sex, carry important clinical implications and may support clinicians in screening, monitoring, and managing foot and ankle musculoskeletal conditions. Future research should investigate whether deviations from these normative values represent a risk factor for the development of musculoskeletal injuries and explore the relationship between restoring supination resistance to normative levels and the reduction of clinical symptoms.