Associations of Region-Specific Foot Pain and Foot Biomechanics: The Framingham Foot Study

PubMed Central

Hagedorn, Thomas J.; Dufour, Alyssa B.; Hannan, Marian T.

2015-01-01

Background. Specific regions of the foot are responsible for the gait tasks of weight acceptance, single-limb support, and forward propulsion. With region foot pain, gait abnormalities may arise and affect the plantar pressure and force pattern utilized. Therefore, this study’s purpose was to evaluate plantar pressure and force pattern differences between adults with and without region-specific foot pain. Methods. Plantar pressure and force data were collected on Framingham Foot Study members while walking barefoot at a self-selected pace. Foot pain was evaluated by self-report and grouped by foot region (toe, forefoot, midfoot, or rearfoot) or regions (two or three or more regions) of pain. Unadjusted and adjusted linear regression with generalized estimating equations was used to determine associations between feet with and without foot pain. Results. Individuals with distal foot (forefoot or toes) pain had similar maximum vertical forces under the pain region, while those with proximal foot (rearfoot or midfoot) pain had different maximum vertical forces compared to those without regional foot pain (referent). During walking, there were significant differences in plantar loading and propulsion ranging from 2% to 4% between those with and without regional foot pain. Significant differences in normalized maximum vertical force and plantar pressure ranged from 5.3% to 12.4% and 3.4% to 24.1%, respectively, between those with and without regional foot pain. Conclusions. Associations of regional foot pain with plantar pressure and force were different by regions of pain. Region-specific foot pain was not uniformly associated with an increase or decrease in loading and pressure patterns regions of pain. PMID:25995291

Contributions of foot muscles and plantar fascia morphology to foot posture.

PubMed

Angin, Salih; Mickle, Karen J; Nester, Christopher J

2018-03-01

The plantar foot muscles and plantar fascia differ between different foot postures. However, how each individual plantar structure contribute to foot posture has not been explored. The purpose of this study was to investigate the associations between static foot posture and morphology of plantar foot muscles and plantar fascia and thus the contributions of these structures to static foot posture. A total of 111 participants were recruited, 43 were classified as having pes planus and 68 as having normal foot posture using Foot Posture Index assessment tool. Images from the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles, and the calcaneal (PF1), middle (PF2) and metatarsal (PF3) regions of the plantar fascia were obtained using a Venue 40 ultrasound system with a 5-13 MHz transducer. In order of decreasing contribution, PF3 > FHB > FHL > PER > FDB were all associated with FPI and able to explain 69% of the change in FPI scores. PF3 was the highest contributor explaining 52% of increases in FPI score. Decreased thickness was associated with increased FPI score. Smaller cross sectional area (CSA) in FHB and PER muscles explained 20% and 8% of increase in FPI score. Larger CSA of FDB and FHL muscles explained 4% and 14% increase in FPI score respectively. The medial plantar structures and the plantar fascia appear to be the major contributors to static foot posture. Elucidating the individual contribution of multiple muscles of the foot could provide insight about their role in the foot posture. Copyright © 2018. Published by Elsevier B.V.

Relationship between static foot posture and foot mobility

PubMed Central

2011-01-01

Background It is not uncommon for a person's foot posture and/or mobility to be assessed during a clinical examination. The exact relationship, however, between static posture and mobility is not known. Objective The purpose of this study was to determine the degree of association between static foot posture and mobility. Method The static foot posture and foot mobility of 203 healthy individuals was assessed and then analyzed to determine if low arched or "pronated" feet are more mobile than high arched or "supinated" feet. Results The study demonstrated that those individuals with a lower standing dorsal arch height and/or a wider standing midfoot width had greater mobility in their foot. In addition, those individuals with higher Foot Posture Index (FPI) values demonstrated greater mobility and those with lower FPI values demonstrated less mobility. Finally, the amount of foot mobility that an individual has can be predicted reasonably well using either a 3 or 4 variable linear regression model. Conclusions Because of the relationship between static foot posture and mobility, it is recommended that both be assessed as part of a comprehensive evaluation of a individual with foot problems. PMID:21244705

Athlete's Foot

MedlinePlus

... this page. Please enable Javascript in your browser. Athlete's Foot Athlete's foot is a skin infection caused by fungus. A ... the body; on the foot, it is called athlete’s foot, or tinea pedis. Fungus commonly attacks the feet ...

Foot Pain and Pronated Foot Type are Associated with Self-Reported Mobility Limitations in Older Adults: the Framingham Foot Study

PubMed Central

Menz, Hylton B.; Dufour, Alyssa B.; Katz, Patricia; Hannan, Marian T.

2015-01-01

Background The foot plays an important role in supporting the body when undertaking weight bearing activities. Aging is associated with an increased prevalence of foot pain and a lowering of the arch of the foot, both of which may impair mobility. Objective To examine the associations of foot pain, foot posture and dynamic foot function with self-reported mobility limitations in community-dwelling older adults. Methods Foot examinations were conducted on 1,860 members of the Framingham Study in 2002–2005. Foot posture was categorized as normal, planus or cavus using static pressure measurements, and foot function was categorized as normal, pronated or supinated using dynamic pressure measurements. Participants were asked whether they had foot pain and any difficulty performing a list of nine weight bearing tasks. Multivariate logistic regression and linear regression models were used to examine the associations of foot pain, posture, function and ability to perform these activities. Results After adjusting for age, sex, height and weight, foot pain was significantly associated with difficulty performing all nine weight bearing activities. Compared to those with normal foot posture and function, participants with planus foot posture were more likely to report difficulty remaining balanced (odds ratio [OR] = 1.40, 95% confidence interval [CI] 1.06 to 1.85; p=0.018) and individuals with pronated foot function were more likely to report difficulty walking across a small room (OR = 2.07, 95% CI 1.02 to 4.22; p=0.045). Foot pain and planus foot posture were associated with an overall mobility limitation score combining performances on each measure. Conclusion Foot pain, planus foot posture and pronated foot function are associated with self-reported difficulty undertaking common weight bearing tasks. Interventions to reduce foot pain and improve foot posture and function may therefore have a role in improving mobility in older adults. PMID:26645379

Foot morphometric phenomena.

PubMed

Agić, Ante

2007-06-01

Knowledge of the foot morphometry is important for proper foot structure and function. Foot structure as a vital part of human body is important for many reasons. The foot anthropometric and morphology phenomena are analyzed together with hidden biomechanical descriptors in order to fully characterize foot functionality. For Croatian student population the scatter data of the individual foot variables were interpolated by multivariate statistics. Foot morphometric descriptors are influenced by many factors, such as life style, climate, and things of great importance in human society. Dominant descriptors related to fit and comfort are determined by the use 3D foot shape and advanced foot biomechanics. Some practical recommendations and conclusions for medical, sportswear and footwear practice are highlighted.

Foot shape modeling.

PubMed

Luximon, Ameersing; Goonetilleke, Ravindra S

2004-01-01

This study is an attempt to show how a "standard" foot can be parameterized using foot length, foot width, foot height, and a measure of foot curvature so that foot shape can be predicted using these simple anthropometric measures. The prediction model was generated using 40 Hong Kong Chinese men, and the model was validated using a different group of 25 Hong Kong Chinese men. The results show that each individual foot shape may be predicted to a mean accuracy of 2.1 mm for the left foot and 2.4 mm for the right foot. Application of this research includes the potential design and development of custom footwear without the necessity of expensive 3-D scanning of feet.

Associations of Foot Posture and Function to Lower Extremity Pain: The Framingham Foot Study

PubMed Central

Riskowski, JL; Dufour, AB; Hagedorn, TJ; Hillstrom, Howard; Casey, VA; Hannan, MT

2014-01-01

Objective Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults. Methods Participants were members of the Framingham Foot Study. lower extremity joint pain was determined by the response to the NHANES-type question, “On most days do you have pain, aching or stiffness in your [hips, knees, ankles, or feet]?” Modified Arch Index (MAI) classified participants as having planus, rectus (referent) or cavus foot posture. Center of Pressure Excursion Index (CPEI) classified participants as having over-pronated, normal (referent) or over-supinated foot function. Crude and adjusted (age, gender, BMI) logistic regression determined associations of foot posture and function to lower extremity pain. Results Participants with planus structure had higher odds of knee (1.57, 95% CI: 1.24– 1.99) or ankle (1.47, 95% CI: 1.05–2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (7.56, 95% CI: 1.99–28.8) and pain at one lower extremity site (1.37, 95% CI: 1.04–1.80). Associations between foot function and lower extremity joint pain were not statistically significant, except for a reduced risk of hip pain in those with an over-supinated foot function (0.69, 95% CI: 0.51–0.93). Conclusions These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies. PMID:24591410

Common foot problems in diabetic foot clinic.

PubMed

Tantisiriwat, Natthiya; Janchai, Siriporn

2008-07-01

To study common foot problems presented in diabetic foot clinic. A retrospectively review of out patient department records and diabetic foot evaluation forms of patients who visited the diabetic foot clinic at King Chulalongkorn Memorial Hospital between 2004 and 2006. Of all diabetic patients, 70 men and 80 women with the average age of 63.8 years were included in this study. About 32% of all reported cases had lower extremity amputation in which the toe was the most common level. Foot problems were evaluated and categorized in four aspects, dermatological, neurological, musculoskeletal, and vascular, which were 67.30%, 79.3%, 74.0%, and 39.3% respectively. More than half of the patients had skin dryness, nail problem and callus formation. Fifty six percent had the abnormal plantar pressure area, which was presented as callus. The great toe was the most common site of callus formation, which was correlated with gait cycle. The current ulcer was 18.8%, which was presented mostly at heel and great toe. Three-fourth of the patients (75.3%) had lost protective sensation, measured by the 5.07 monofilament testing. The most common problem found in musculoskeletal system was limited motion of the joint (44.0%). Claw toe or hammer toe were reported as 32.0% whereas the other deformities were bunnion (12.0%), charcot joint (6.0%) and flat feet (5.3%). The authors classified patients based on category risk to further lower extremity amputation into four groups. Forty-seven percent had highest risk for having further amputation because they had lost protective sensation from monofilament testing, previous current ulcer, or history of amputation. Only half of the patients had previous foot care education. Multidisciplinary diabetic foot care including patient education (proper foot care and footwear), early detection, effective management of foot problems, and scheduled follow-up must be emphasized to prevent diabetes-related lower extremities amputation.

Obese older adults suffer foot pain and foot-related functional limitation.

PubMed

Mickle, Karen J; Steele, Julie R

2015-10-01

There is evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis. However, no research has comprehensively examined the effects of overweight or obesity on the feet of individuals older than 60 years of age. Therefore we investigated whether foot pain, foot structure, and/or foot function is affected by obesity in older adults. Three hundred and twelve Australian men and women, aged over 60 years, completed validated questionnaires to establish the presence of foot pain and health related quality of life. Foot structure (anthropometrics and soft tissue thickness) and foot function (ankle dorsiflexion strength and flexibility, toe flexor strength, plantar pressures and spatiotemporal gait parameters) were also measured. Obese participants (BMI >30) were compared to those who were overweight (BMI=25-30) and not overweight (BMI <25). Obese participants were found to have a significantly higher prevalence of foot pain and scored significantly lower on the SF-36. Obesity was also associated with foot-related functional limitation whereby ankle dorsiflexion strength, hallux and lesser toe strength, stride/step length and walking speed were significantly reduced in obese participants compared to their leaner counterparts. Therefore, disabling foot pain and altered foot structure and foot function are consequences of obesity for older adults, and impact upon their quality of life. Interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of life for older obese individuals. Copyright © 2015 Elsevier B.V. All rights reserved.

Foot Type Biomechanics Part 1: Structure and Function of the Asymptomatic Foot

PubMed Central

Hillstrom, Howard J.; Song, Jinsup; Kraszewski, Andrew P.; Hafer, Jocelyn F.; Mootanah, Rajshree; Dufour, Alyssa B.; PT, Betty (Shingpui) Chow; Deland, Jonathan T.

2012-01-01

Background Differences in foot structure are thought to be associated with differences in foot function during movement. Many foot pathologies are of a biomechanical nature and often associated with foot type. Fundamental to the understanding of foot pathomechanics is the question: do different foot types have distinctly different structure and function? Aim To determine if objective measures of foot structure and function differ between planus, rectus and cavus foot types in asymptomatic individuals. Methods Sixty-one asymptomatic healthy adults between 18 and 77 years old, that had the same foot type bilaterally (44 planus feet, 54 rectus feet, and 24 cavus feet), were recruited. Structural and functional measurements were taken using custom equipment, an emed-x plantar pressure measuring device, a GaitMatII gait pattern measurement system, and a goniometer. Generalized Estimation Equation modeling was employed to determine if each dependent variable of foot structure and function was significantly different across foot type while accounting for potential dependencies between sides. Post hoc testing was performed to assess pairwise comparisons. Results Several measures of foot structure (malleolar valgus index and arch height index) were significantly different between foot types. Gait pattern parameters were invariant across foot types. Peak pressure, maximum force, pressure-time-integral, force-time-integral and contact area were significantly different in several medial forefoot and arch locations between foot types. Planus feet exhibited significantly different center of pressure excursion indices compared to rectus and cavus feet. Conclusions Planus, rectus and cavus feet exhibited significantly different measures of foot structure and function. PMID:23107625

Foot type biomechanics part 1: structure and function of the asymptomatic foot.

PubMed

Hillstrom, Howard J; Song, Jinsup; Kraszewski, Andrew P; Hafer, Jocelyn F; Mootanah, Rajshree; Dufour, Alyssa B; Chow, Betty Shingpui; Deland, Jonathan T

2013-03-01

Differences in foot structure are thought to be associated with differences in foot function during movement. Many foot pathologies are of a biomechanical nature and often associated with foot type. Fundamental to the understanding of foot pathomechanics is the question: do different foot types have distinctly different structure and function? To determine if objective measures of foot structure and function differ between planus, rectus and cavus foot types in asymptomatic individuals. Sixty-one asymptomatic healthy adults between 18 and 77 years old, that had the same foot type bilaterally (44 planus feet, 54 rectus feet, and 24 cavus feet), were recruited. Structural and functional measurements were taken using custom equipment, an emed-x plantar pressure measuring device, a GaitMat II gait pattern measurement system, and a goniometer. Generalized Estimation Equation modeling was employed to determine if each dependent variable of foot structure and function was significantly different across foot type while accounting for potential dependencies between sides. Post hoc testing was performed to assess pair wise comparisons. Several measures of foot structure (malleolar valgus index and arch height index) were significantly different between foot types. Gait pattern parameters were invariant across foot types. Peak pressure, maximum force, pressure-time-integral, force-time-integral and contact area were significantly different in several medial forefoot and arch locations between foot types. Planus feet exhibited significantly different center of pressure excursion indices compared to rectus and cavus feet. Planus, rectus and cavus feet exhibited significantly different measures of foot structure and function. Copyright © 2012 Elsevier B.V. All rights reserved.

Foot Health

MedlinePlus

... straight across and not too short Your foot health can be a clue to your overall health. For example, joint stiffness could mean arthritis. Tingling ... foot checks are an important part of your health care. If you have foot problems, be sure ...

Foot Placement Modulation Diminishes for Perturbations Near Foot Contact.

PubMed

Vlutters, Mark; Van Asseldonk, Edwin H F; van der Kooij, Herman

2018-01-01

Whenever a perturbation occurs during walking we have to maintain our balance using the recovery strategies that are available to us. Foot placement adjustment is often considered an important recovery strategy. However, because this strategy takes time it is likely a poor option if the foot is close to contact at the instant a perturbation occurs. The main goal of this study is to gain a better understanding of how humans deal with balance perturbations during walking if foot placement adjustments are constrained by time. Ten healthy subjects walked on an instrumented treadmill and received mediolateral and anteroposterior pelvis perturbations at various instances during the single support phase. The results show that foot placement modulation in the first recovery step following anteroposterior perturbations is fairly invariant of the perturbation magnitude and direction, regardless of the onset instance. For mediolateral perturbations, foot placement adjustments strongly modulate with the perturbation magnitude and direction, but these effects diminish when the perturbation onset is closer to the instant of foot contact. For most perturbations the first recovery step was consistent across subjects for all onset instances. However, in the second step various strategies arose that were not consistent across subjects, nor within subjects, especially for perturbations applied close to foot contact. Despite these different strategies, the COP location following foot contact strongly related to the COM velocity throughout these strategies. The results show that humans have various ways to compensate for limited availability of a foot placement strategy, with strategy selection highly dependent on the instant during the gait phase at which the perturbation is applied.

SKITTER foot design

NASA Technical Reports Server (NTRS)

Choi, Gene; Jones, David L.; Morris, James; Parham, Martin; Stephens, Jim; Yancey, Gregg

1987-01-01

A mechanical design team was formed to design a foot for the lunar utility vehicle SKITTER. The primary design was constrained to be a ski pole design compatible with the existing femur-tibia design legs. The lunar environment had several important effects on the foot design. Three materials were investigated for the SKITTER foot: aluminum alloys, cold worked stainless steel alloys, and titanium alloys. Thin film coatings were investigated as a method of wear reduction for the foot. The performance of the foot is dependent on the action of the legs. The range of motion for the legs was determined to be vertical to 15 degrees above horizontal. An impact analysis was performed for the foot movement, but the results were determined to be inconclusive due to unknown soil parameters. The initial foot design configuration consisted of an annulus attached to the pointed pole. The annulus was designed to prevent excess sinkage. Later designs call for a conical shaped foot with a disk at the point of the tibia attachment. The conical design was analyzed for strength and deflection by two different approaches. A deformable body analysis was performed for the foot under crane load in crane position, and also under actuator load in the vertical position. In both cases, the deflection of the foot was insignificant and the stresses well below the strength of the titanium alloy.

Comparison of Foot Bathing and Foot Massage in Chemotherapy-Induced Peripheral Neuropathy.

PubMed

Park, Ranhee; Park, Chaisoon

2015-01-01

In a clinical setting, patients have been observed to complain of discomfort and to discontinue treatment because of chemotherapy-induced peripheral neuropathy (CIPN), but few data exist regarding the quality of life in these patients in Korea. The purpose of this quasi-experimental study was to analyze the effects of foot bathing and massage in patients with CIPN. Subjects included 48 patients with CIPN, who were hospitalized in C University Hospital. The subjects were alternately assigned to 1 of 2 groups according to their registration order. The interventions consisted of 8 treatments of foot bathing or massage over a period of 2 weeks, at 30 minutes per session, every other day. The foot skin temperature increased significantly in the foot bathing group, whereas it decreased significantly in the massage group. Quality of life was significantly increased in the foot bathing group, whereas it was significantly decreased in the massage group. Although foot bathing and foot massage are both supportive care techniques for CIPN patients, foot bathing was more effective than foot massage on skin temperature, grade of neurotoxicity, and quality of life. Additional well-designed studies are recommended, so that the effectiveness of foot bathing and foot massage is confirmed. Foot bathing is more useful as supportive care with respect to nonpharmacologic interventions for alleviating CIPN and promoting the quality of life in cancer patients.

Starting off on the right foot: strong right-footers respond faster with the right foot to positive words and with the left foot to negative words

PubMed Central

de la Vega, Irmgard; Graebe, Julia; Härtner, Leonie; Dudschig, Carolin; Kaup, Barbara

2015-01-01

Recent studies have provided evidence for an association between valence and left/right modulated by handedness, which is predicted by the body-specificity hypothesis (Casasanto, 2009) and also reflected in response times. We investigated whether such a response facilitation can also be observed with foot responses. Right-footed participants classified positive and negative words according to their valence by pressing a key with their left or right foot. A significant interaction between valence and foot only emerged in the by-items analysis. However, when dividing participants into two groups depending on the strength of their footedness, an interaction between valence and left/right was observed for strong right-footers, who responded faster with the right foot to positive words, and with the left foot to negative words. No interaction emerged for weak right-footers. The results strongly support the assumption that fluency lies at the core of the association between valence and left/right. PMID:25852609

Magnitude and Spatial Distribution of Impact Intensity Under the Foot Relates to Initial Foot Contact Pattern.

PubMed

Breine, Bastiaan; Malcolm, Philippe; Segers, Veerle; Gerlo, Joeri; Derie, Rud; Pataky, Todd; Frederick, Edward C; De Clercq, Dirk

2017-12-01

In running, foot contact patterns (rear-, mid-, or forefoot contact) influence impact intensity and initial ankle and foot kinematics. The aim of the study was to compare impact intensity and its spatial distribution under the foot between different foot contact patterns. Forty-nine subjects ran at 3.2 m·s -1 over a level runway while ground reaction forces (GRF) and shoe-surface pressures were recorded and foot contact pattern was determined. A 4-zone footmask (forefoot, midfoot, medial and lateral rearfoot) assessed the spatial distribution of the vertical GRF under the foot. We calculated peak vertical instantaneous loading rate of the GRF (VILR) per foot zone as the impact intensity measure. Midfoot contact patterns were shown to have the lowest, and atypical rearfoot contact patterns the highest impact intensities, respectively. The greatest local impact intensity was mainly situated under the rear- and midfoot for the typical rearfoot contact patterns, under the midfoot for the atypical rearfoot contact patterns, and under the mid- and forefoot for the midfoot contact patterns. These findings indicate that different foot contact patterns could benefit from cushioning in different shoe zones.

Foot roll-over evaluation based on 3D dynamic foot scan.

PubMed

Samson, William; Van Hamme, Angèle; Sanchez, Stéphane; Chèze, Laurence; Van Sint Jan, Serge; Feipel, Véronique

2014-01-01

Foot roll-over is commonly analyzed to evaluate gait pathologies. The current study utilized a dynamic foot scanner (DFS) to analyze foot roll-over. The right feet of ten healthy subjects were assessed during gait trials with a DFS system integrated into a walkway. A foot sole picture was computed by vertically projecting points from the 3D foot shape which were lower than a threshold height of 15 mm. A 'height' value of these projected points was determined; corresponding to the initial vertical coordinates prior to projection. Similar to pedobarographic analysis, the foot sole picture was segmented into anatomical regions of interest (ROIs) to process mean height (average of height data by ROI) and projected surface (area of the projected foot sole by ROI). Results showed that these variables evolved differently to plantar pressure data previously reported in the literature, mainly due to the specificity of each physical quantity (millimeters vs Pascals). Compared to plantar pressure data arising from surface contact by the foot, the current method takes into account the whole plantar aspect of the foot, including the parts that do not make contact with the support surface. The current approach using height data could contribute to a better understanding of specific aspects of foot motion during walking, such as plantar arch height and the windlass mechanism. Results of this study show the underlying method is reliable. Further investigation is required to validate the DFS measurements within a clinical context, prior to implementation into clinical practice. Copyright © 2013 Elsevier B.V. All rights reserved.

Effect of foot shape on the three-dimensional position of foot bones.

PubMed

Ledoux, William R; Rohr, Eric S; Ching, Randal P; Sangeorzan, Bruce J

2006-12-01

To eliminate some of the ambiguity in describing foot shape, we developed three-dimensional (3D), objective measures of foot type based on computerized tomography (CT) scans. Feet were classified via clinical examination as pes cavus (high arch), neutrally aligned (normal arch), asymptomatic pes planus (flat arch with no pain), or symptomatic pes planus (flat arch with pain). We enrolled 10 subjects of each foot type; if both feet were of the same foot type, then each foot was scanned (n=65 total). Partial weightbearing (20% body weight) CT scans were performed. We generated embedded coordinate systems for each foot bone by assuming uniform density and calculating the inertial matrix. Cardan angles were used to describe five bone-to-bone relationships, resulting in 15 angular measurements. Significant differences were found among foot types for 12 of the angles. The angles were also used to develop a classification tree analysis, which determined the correct foot type for 64 of the 65 feet. Our measure provides insight into how foot bone architecture differs between foot types. The classification tree analysis demonstrated that objective measures can be used to discriminate between feet with high, normal, and low arches. Copyright (c) 2006 Orthopaedic Research Society.

The foot core system: a new paradigm for understanding intrinsic foot muscle function.

PubMed

McKeon, Patrick O; Hertel, Jay; Bramble, Dennis; Davis, Irene

2015-03-01

The foot is a complex structure with many articulations and multiple degrees of freedom that play an important role in static posture and dynamic activities. The evolutionary development of the arch of the foot was coincident with the greater demands placed on the foot as humans began to run. The movement and stability of the arch is controlled by intrinsic and extrinsic muscles. However, the intrinsic muscles are largely ignored by clinicians and researchers. As such, these muscles are seldom addressed in rehabilitation programmes. Interventions for foot-related problems are more often directed at externally supporting the foot rather than training these muscles to function as they are designed. In this paper, we propose a novel paradigm for understanding the function of the foot. We begin with an overview of the evolution of the human foot with a focus on the development of the arch. This is followed by a description of the foot intrinsic muscles and their relationship to the extrinsic muscles. We draw the parallels between the small muscles of the trunk region that make up the lumbopelvic core and the intrinsic foot muscles, introducing the concept of the foot core. We then integrate the concept of the foot core into the assessment and treatment of the foot. Finally, we call for an increased awareness of the importance of the foot core stability to normal foot and lower extremity function. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The experience of foot problems and decisions to access foot care in patients with rheumatoid arthritis: a qualitative study.

PubMed

Wilson, Oonagh; Kirwan, John; Dures, Emma; Quest, Enid; Hewlett, Sarah

2017-01-01

Although foot problems are common in rheumatoid arthritis (RA), the consequences of foot problems from the patient perspective have not been fully explored. The aims of this study were to explore the experience of foot problems and decisions to access foot care services or not in patients with RA. Semi structured, one-to-one interviews with patients recruited from 2 UK rheumatology units, purposively sampled for self-reported foot problems and a range of personal/disease characteristics. Inductive thematic analysis was used, with rigour provided by multiple independent analysers. Emerging themes were discussed and agreed by all authors. Twelve patients participated: 7 female; mean age 56 years (29-72); mean disease duration 12 years (2-27), 5 had accessed foot care services. The 'Impact' of foot problems was substantial and formed the underpinning theme, comprising three organising themes: 'Foot symptoms'; 'Consequences'; and 'Cost'. Foot symptoms such as pain and numbness required self-management, and affected daily life (walking, working) leading to social and emotional costs. The global theme, 'Decision to access foot care or not', also comprised three organising themes: 'Access perceived unnecessary' (no problem, can cope); 'Access hindered by patients' perception'; and 'Access supported by patient and clinician'. Decisions to access foot care or not were complex and influenced by patient beliefs regarding possible treatments and how to access these, and hindered by patient perceptions that their feet were ignored by rheumatology clinicians. Positive experience of foot care encouraged continued utilisation but negative experiences contributed to patients' decisions to discontinue foot care services. Foot problems are important issues for patients and impact on many aspects of their physical, social and emotional lives. Patients who had accessed foot care services prioritised their foot problems as an important health care need. However, for others who would

[Foot growth and foot types in children and adolescents: a narrative review].

PubMed

Xu, Miaomiao; Wang, Lin

2017-08-01

Foot shape and size are important for footwear design and production. Information about important foot characteristics helps not only to improve shoe comfort but to maintain the proper physiological development of the feet. What's more, plenty of studies have suggested that the shape of the shoe must closely resemble the shape of the foot to create a properly fitted shoe. This means that the differences between various populations should be considered and that footwear should be designed according to the measurements of users. Childhood and adolescent are important periods of human growth. During these periods, foot shape changes with human growth and can be influenced by extrinsic factors. Therefore, the foot shape characteristics of children and adolescents should be investigated. The results from these investigations can contribute to developing appropriate shoe for children and adolescents, improving perceived comfort of children shoes and preventing pedopathy among children and adolescents. This review aims to discuss measuring methods of foot shape, types of foot shape, and factors influencing foot shape. The results of the review can provide recommendations for investigating growth development of foot shape and useful information for consumers and shoe manufacturers.

Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

PubMed Central

Amin, Noha; Doupis, John

2016-01-01

The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities. PMID:27076876

Associations of foot posture and function to lower extremity pain: results from a population-based foot study.

PubMed

Riskowski, Jody L; Dufour, Alyssa B; Hagedorn, Thomas J; Hillstrom, Howard J; Casey, Virginia A; Hannan, Marian T

2013-11-01

Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults. Participants were members of the Framingham Foot Study. Lower extremity joint pain was determined by the response to the National Health and Nutrition Examination Survey-type question, "On most days do you have pain, aching or stiffness in your (hips, knees, ankles, or feet)?" The Modified Arch Index classified participants as having planus, rectus (referent), or cavus foot posture. The Center of Pressure Excursion Index classified participants as having overpronated, normal (referent), or oversupinated foot function. Crude and adjusted (age, sex, and body mass index) logistic regression determined associations of foot posture and function to lower extremity pain. Participants with planus structure had higher odds of knee (odds ratio [OR] 1.57, 95% confidence interval [95% CI] 1.24-1.99) or ankle (OR 1.47, 95% CI 1.05-2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (OR 7.56, 95% CI 1.99-28.8) and pain at 1 lower extremity site (OR 1.37, 95% CI 1.04-1.80). Associations between foot function and lower extremity joint pain were not statistically significant except for a reduced risk of hip pain in those with an oversupinated foot function (OR 0.69, 95% CI 0.51-0.93). These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies. Copyright © 2013 by the American College of Rheumatology.

Effects of ankle-foot orthoses on mediolateral foot-placement ability during post-stroke gait.

PubMed

Zissimopoulos, Angelika; Fatone, Stefania; Gard, Steven

2015-10-01

Accurate and precise mediolateral foot placement is important for balance during gait, but is impaired post stroke. Mediolateral foot placement may be improved with ankle-foot orthosis use. The purpose of this study was to determine whether an ankle-foot orthosis improves mediolateral foot-placement ability during post-stroke ambulation. Crossover trial with randomized order of conditions tested. The accuracy and precision of mediolateral foot placement was quantified while subjects targeted four different randomized step widths. Subjects were tested with and without their regular non-rigid ankle-foot orthosis in two separate visits (order randomized). While ankle-foot orthosis use corrected foot and ankle alignment (i.e. significantly decreased mid-swing plantar flexion, p = 0.000), effects of ankle-foot orthosis use on hip hiking (p = 0.545), circumduction (p = 0.179), coronal plane hip range of motion (p = 0.06), and mediolateral foot-placement ability (p = 0.537) were not significant. While ankle-foot orthosis-mediated equinovarus correction of the affected foot and ankle was not associated with improved biomechanics of walking (i.e. proximal ipsilateral hip kinematics or mediolateral foot-placement ability), it may affect other aspects of balance that were not tested in this study (e.g. proprioception, cerebellar, vestibular, and cognitive mechanisms). Studies that investigate the effect of ankle-foot orthosis on gait can help advance stroke rehabilitation by documenting the specific gait benefits of ankle-foot orthosis use. In this study, we investigated the effect of ankle-foot orthosis use on mediolateral foot-placement ability, an aspect of gait important for maintaining balance. © The International Society for Prosthetics and Orthotics 2014.

Shoes alter the spring-like function of the human foot during running.

PubMed

Kelly, Luke A; Lichtwark, Glen A; Farris, Dominic J; Cresswell, Andrew

2016-06-01

The capacity to store and return energy in legs and feet that behave like springs is crucial to human running economy. Recent comparisons of shod and barefoot running have led to suggestions that modern running shoes may actually impede leg and foot-spring function by reducing the contributions from the leg and foot musculature. Here we examined the effect of running shoes on foot longitudinal arch (LA) motion and activation of the intrinsic foot muscles. Participants ran on a force-instrumented treadmill with and without running shoes. We recorded foot kinematics and muscle activation of the intrinsic foot muscles using intramuscular electromyography. In contrast to previous assertions, we observed an increase in both the peak (flexor digitorum brevis +60%) and total stance muscle activation (flexor digitorum brevis +70% and abductor hallucis +53%) of the intrinsic foot muscles when running with shoes. Increased intrinsic muscle activation corresponded with a reduction in LA compression (-25%). We confirm that running shoes do indeed influence the mechanical function of the foot. However, our findings suggest that these mechanical adjustments are likely to have occurred as a result of increased neuromuscular output, rather than impaired control as previously speculated. We propose a theoretical model for foot-shoe interaction to explain these novel findings. © 2016 The Author(s).

Is the foot elevation the optimal position for wound healing of a diabetic foot?

PubMed

Park, D J; Han, S K; Kim, W K

2010-03-01

In managing diabetic foot ulcers, foot elevation has generally been recommended to reduce oedema and prevent other sequential problems. However, foot elevation may decrease tissue oxygenation of the foot more than the dependent position since the dependent position is known to increase blood flow within the arterial system. In addition, diabetic foot ulcers, which have peripheral vascular insufficiency, generally have less oedema than other wounds. Therefore, we argue that foot elevation may not be helpful for healing of vascularly compromised diabetic foot ulcers since adequate tissue oxygenation is an essential factor in diabetic wound healing. The purpose of this study was to evaluate the influence of foot height on tissue oxygenation and to determine the optimal foot position to accelerate wound healing of diabetic foot ulcers. This study included 122 cases (73 males and 47 females; two males had bilateral disease) of diabetic foot ulcer patients aged 40-93 years. Trans-cutaneous partial oxygen tension (TcpO(2)) values of diabetic feet were measured before and after foot elevation (n=21). Elevation was achieved by placing a foot over four cushions. We also measured foot TcpO(2) values before and after lowering the feet (n=122). Feet were lowered to the patient's tibial height, approximately 30-35 cm, beside a bed handrail. Due to the large number of lowering measurements, we divided them into five sub-groups according to initial TcpO(2.) Tissue oxygenation values were compared. Foot-elevation-lowered TcpO(2) values before and after elevation were 32.5+/-22.2 and 23.8+/-23.1 mmHg (p<0.01), respectively. Foot-lowering-augmented TcpO(2) values before and after lowering were 44.6+/-23.8 and 58.0+/-25.9 mmHg (p<0.01), respectively. The lower the initial TcpO(2) level, the more the TcpO(2) level increased. The foot lowering, rather than elevation, significantly augments TcpO(2) and may stimulate healing of diabetic foot ulcers. (c) 2008 British Association of Plastic

Parametric study of orthopedic insole of valgus foot on partial foot amputation.

PubMed

Guo, Jun-Chao; Wang, Li-Zhen; Chen, Wei; Du, Cheng-Fei; Mo, Zhong-Jun; Fan, Yu-Bo

2016-01-01

Orthopedic insole was important for partial foot amputation (PFA) to achieve foot balance and avoid foot deformity. The inapposite insole orthosis was thought to be one of the risk factors of reamputation for foot valgus patient, but biomechanical effects of internal tissues on valgus foot had not been clearly addressed. In this study, plantar pressure on heel and metatarsal regions of PFA was measured using F-Scan. The three-dimensional finite element (FE) model of partial foot evaluated different medial wedge angles (MWAs) (0.0°-10.0°) of orthopedic insole on valgus foot. The effect of orthopedic insole on the internal bone stress, the medial ligament tension of ankle, plantar fascia tension, and plantar pressure was investigated. Plantar pressure on medial heel region was about 2.5 times higher than that of lateral region based on the F-Scan measurements. FE-predicted results showed that the tension of medial ankle ligaments was the lowest, and the plantar pressure was redistributed around the heel, the first metatarsal, and the lateral longitudinal arch regions when MWA of orthopedic insole ranged from 7.5° to 8.0°. The plantar fascias maintained about 3.5% of the total load bearing on foot. However, the internal stresses from foot bones increased. The simulation in this study would provide the suggestion of guiding optimal design of orthopedic insole and therapeutic planning to pedorthist.

Anisotropic bioelectrical impedance determination of subcutaneous fat thickness

NASA Astrophysics Data System (ADS)

Hernández-Becerra, P. A. I.; Delgadillo-Holtfort, I.; Balleza-Ordaz, M.; Huerta-Franco, M. R.; Vargas-Luna, M.

2014-11-01

Preliminary results have shown that bioelectrical impedance measurements performed on different parts of the human body strongly depend upon the subcutaneous fat of the considered region. In this work, a method for the determination of subcutaneous fat thickness is explored. Within this method the measurement of the bioelectrical impedance response of the fat-muscle system, both along the direction defined by the muscle fibers and along the corresponding perpendicular direction, are performed. Measurements have been carried out on human female and male subjects of ages around 25 years old at the region of the biceps. Correlation has been performed with skinfold caliper measurements.

Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: a systematic review.

PubMed

Ahmad Sharoni, Siti Khuzaimah; Minhat, Halimatus Sakdiah; Mohd Zulkefli, Nor Afiah; Baharom, Anisah

2016-09-01

To assess the effectiveness of health education programmes to improve foot self-care practices and foot problems among older people with diabetes. The complications of diabetes among older people are a major health concern. Foot problems such as neuropathy, ulcer and ultimately amputation are a great burden on older people with diabetes. Diabetes foot education programmes can influence the behaviour of older people in practising foot self-care and controlling the foot problems. However, the educational approaches used by the educators are different. Therefore, it is important to assess the education programmes from various evidence-based practices. Six databases, EBSCOhost medical collections (MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection), SAGE, Wiley Online Library, ScienceDirect, SpringerLink and Web of Science, were used to search for articles published from January 2000 to March 2015. The search was based on the inclusion criteria and keywords including 'foot', 'care' and 'diabetes'. Fourteen studies were assessed and reviewed in the final stage. Health education programmes varied according to their design, setting, approach, outcome measured and results. Foot assessment, verbal and written instructions and discussion were proved to improve the foot self-care and foot problems. Subsequent follow-ups and evaluations had a significant effect. An improvement was observed in foot self-care scores and foot problems (such as neuropathy, foot disability, lesion, ulcer, tinea pedis and callus grade) after implementation of the health education programme. The findings of this study support the claim that a health education programme increases the foot self-care scores and reduces the foot problems. However, there were certain methodological concerns in the reviewed articles, indicating the need for further evaluation. In future, researchers and practitioners must implement a vigorous education programme focusing on diabetes foot self-care among the

Bioelectrical Impedance Methods for Noninvasive Health Monitoring: A Review

PubMed Central

Bera, Tushar Kanti

2014-01-01

Under the alternating electrical excitation, biological tissues produce a complex electrical impedance which depends on tissue composition, structures, health status, and applied signal frequency, and hence the bioelectrical impedance methods can be utilized for noninvasive tissue characterization. As the impedance responses of these tissue parameters vary with frequencies of the applied signal, the impedance analysis conducted over a wide frequency band provides more information about the tissue interiors which help us to better understand the biological tissues anatomy, physiology, and pathology. Over past few decades, a number of impedance based noninvasive tissue characterization techniques such as bioelectrical impedance analysis (BIA), electrical impedance spectroscopy (EIS), electrical impedance plethysmography (IPG), impedance cardiography (ICG), and electrical impedance tomography (EIT) have been proposed and a lot of research works have been conducted on these methods for noninvasive tissue characterization and disease diagnosis. In this paper BIA, EIS, IPG, ICG, and EIT techniques and their applications in different fields have been reviewed and technical perspective of these impedance methods has been presented. The working principles, applications, merits, and demerits of these methods has been discussed in detail along with their other technical issues followed by present status and future trends. PMID:27006932

Shoes alter the spring-like function of the human foot during running

PubMed Central

Kelly, Luke A.; Lichtwark, Glen A.; Farris, Dominic J.; Cresswell, Andrew

2016-01-01

The capacity to store and return energy in legs and feet that behave like springs is crucial to human running economy. Recent comparisons of shod and barefoot running have led to suggestions that modern running shoes may actually impede leg and foot-spring function by reducing the contributions from the leg and foot musculature. Here we examined the effect of running shoes on foot longitudinal arch (LA) motion and activation of the intrinsic foot muscles. Participants ran on a force-instrumented treadmill with and without running shoes. We recorded foot kinematics and muscle activation of the intrinsic foot muscles using intramuscular electromyography. In contrast to previous assertions, we observed an increase in both the peak (flexor digitorum brevis +60%) and total stance muscle activation (flexor digitorum brevis +70% and abductor hallucis +53%) of the intrinsic foot muscles when running with shoes. Increased intrinsic muscle activation corresponded with a reduction in LA compression (−25%). We confirm that running shoes do indeed influence the mechanical function of the foot. However, our findings suggest that these mechanical adjustments are likely to have occurred as a result of increased neuromuscular output, rather than impaired control as previously speculated. We propose a theoretical model for foot–shoe interaction to explain these novel findings. PMID:27307512

Combined Ankle-Foot Energetics are Conserved When Distal Foot Energy Absorption is Minimized.

PubMed

Arch, Elisa S; Fylstra, Bretta L

2016-12-01

The large, late-stance energy generated by the ankle is believed to be critical during gait. However, the distal foot absorbs/dissipates a considerable amount of energy during the same phase. Thus, the energy generated by the combined ankle-foot system is more modest, which raises questions regarding the necessity of such a large ankle power and the interplay between foot and ankle energetics. This study aimed to evaluate our conservation of energy hypothesis, which predicted if distal foot energy absorption/dissipation was reduced, then less energy would be generated at the ankle and thus the same combined ankle-foot energetics would be achieved. Motion analysis data were collected as healthy subjects walked under 2 conditions (Shoes, Footplate). In the Footplate condition, the shoe was replaced with a customized, rigid footplate with a rocker profile. In support of the hypothesis, there was significantly less positive ankle and less negative distal foot work with footplate use, resulting in very similar combined ankle-foot work between conditions. These findings suggest that there is an interplay between the energy generated by the ankle and absorbed by the foot. This interplay should be considered when designing orthotic and prosthetic ankle-foot systems and rehabilitation programs for individuals with weakened ankle muscles.

Athlete's Foot

MedlinePlus

... Athlete's Foot? Athlete's foot, or tinea pedis (say: TIN-ee-uh PEH-dus), is a common skin ... doctor. © 1995- The Nemours Foundation. All rights reserved. Images provided by The Nemours Foundation, iStock, Getty Images, ...

Bioelectrical impedance analysis to define an excess of body fat: evaluation in patients with psoriasis.

PubMed

Galluzzo, M; Talamonti, M; Perino, F; Servoli, S; Giordano, D; Chimenti, S; De Simone, C; Peris, K

2017-06-01

There is strong evidence that obesity is closely associated with psoriasis. However, data on body composition are lacking in psoriasis. The purpose of this study were to investigate the body composition in psoriasis patients using bioelectrical impedance analysis and to correlate the bioelectrical impedance data with disease severity and laboratory parameters. Anthropometric measurements and bioelectrical impedance analyses were performed on patients with psoriasis, naïve to any systemic treatment, who attended the outpatient clinics of two University centers. Data of 164 adult patients were analyzed. Compared to men, women had several significantly higher bioelectrical impedance parameters including reactance, fat mass% and adipose tissue%. The values of adipose tissue were positively correlated only with patients age (p = .021) and age at disease onset (p = .0006), but not with disease severity. In addition, we observed that the use of BMI cutoffs allowed to categorize 36.7% of women and 19.2% of men as obese, while fat mass% showed that 53.3% of women and 48.1% of men were obese. In our study, psoriasis is been associated with a high fat mass%. We suggest that screening for body fat distribution in psoriatic patients might be useful to identify early obesity-related disease.

Bioelectrical Impedance and Body Composition Assessment

ERIC Educational Resources Information Center

Martino, Mike

2006-01-01

This article discusses field tests that can be used in physical education programs. The most common field tests are anthropometric measurements, which include body mass index (BMI), girth measurements, and skinfold testing. Another field test that is gaining popularity is bioelectrical impedance analysis (BIA). Each method has particular strengths…

Prevention of foot blisters.

PubMed

Knapik, Joseph J

2014-01-01

Foot blisters are the most common medical problem faced by Soldiers during foot march operations and, if untreated, they can lead to infection. Foot blisters are caused by boots rubbing on the foot (frictional forces), which separates skin layers and allows fluid to seep in. Blisters can be prevented by wearing properly sized boots, conditioning feet through regular road marching, wearing socks that reduce reduce friction and moisture, and possibly applying antiperspirants to the feet. 2014.

Diabetic neuropathy and foot complications.

PubMed

Boulton, Andrew J M

2014-01-01

Foot ulceration and Charcot neuroarthropathy (CN) are well recognized and documented late sequelae of diabetic peripheral, somatic, and sympathetic autonomic neuropathy. The neuropathic foot, however, does not ulcerate spontaneously: it is a combination of loss of sensation due to neuropathy together with other factors such as foot deformity and external trauma that results in ulceration and indeed CN. The commonest trauma leading to foot ulcers in the neuropathic foot in Western countries is from inappropriate footwear. Much of the management of the insensate foot in diabetes has been learned from leprosy which similarly gives rise to insensitive foot ulceration. No expensive equipment is required to identify the high risk foot and recently developed tests such as the Ipswich Touch Test and the Vibratip have been shown to be useful in identifying the high risk foot. A comprehensive screening program, together with education of high risk patients, should help to reduce the all too high incidence of ulceration in diabetes. More recently another very high risk group has been identified, namely patients on dialysis, who are at extremely high risk of developing foot ulceration; this should be preventable. The most important feature in management of neuropathic foot ulceration is offloading as patients can easily walk on active foot ulcers due to the loss of pain sensation. Infection should be treated aggressively and if there is any evidence of peripheral vascular disease, arteriography and appropriate surgical management is also indicated. CN often presents with a unilateral hot, swollen foot and any patient presenting with these features known to have neuropathy should be treated as a Charcot until this is proven otherwise. Most important in the management of acute CN is offloading, often in a total contact cast.

The role of foot morphology on foot function in diabetic subjects with or without neuropathy.

PubMed

Guiotto, Annamaria; Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Avogaro, Angelo; Cobelli, Claudio

2013-04-01

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P<0.05), decreased contact surface on the hindfoot (P<0.03). While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions. Copyright © 2012 Elsevier B.V. All rights reserved.

Body weight and the medial longitudinal foot arch: high-arched foot, a hidden problem?

PubMed

Woźniacka, R; Bac, A; Matusik, S; Szczygieł, E; Ciszek, E

2013-05-01

This study had two objectives. First, to determine the prevalence of hollow (high-arched) and flat foot among primary school children in Cracow (Poland). Second, to evaluate the relationship between the type of medial longitudinal arch (MLA; determined by the Clarke's angle) and degree of fatness. The prevalence of underweight, overweight, and obesity was determined by means of IOTF cut-offs with respect to age and gender. A sample of 1,115 children (564 boys and 551 girls) aged between 3 and 13 years was analyzed. In all age groups, regardless of gender, high-arched foot was diagnosed in the majority of children. A distinct increase in the number of children with high-arched foot was observed between 7- and 8-year olds. Regardless of the gender, high-arched foot was more common among underweight children. In the group of obese children, the biggest differences were attributed to gender. High-arched foot was the most frequently observed among boys. In all gender and obesity level groups, the flat foot was more common among boys than among girls. High-arched foot is the most common foot defect among children 3-13 years old regardless of gender. Flat foot is least frequently observed in children 3-13 years old. A statistic correlation between MLA and adiposity is observed. Stronger correlation is observed among girls.

Implementation of foot thermometry plus mHealth to prevent diabetic foot ulcers: study protocol for a randomized controlled trial.

PubMed

Lazo-Porras, Maria; Bernabe-Ortiz, Antonio; Sacksteder, Katherine A; Gilman, Robert H; Malaga, German; Armstrong, David G; Miranda, J Jaime

2016-04-19

Diabetic foot neuropathy (DFN) is one of the most important complications of diabetes mellitus; its early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is concerning. Delivering messages to remind patients to perform thermometry and foot care might be helpful to guarantee regular foot monitoring. This trial was designed to compare the incidence of diabetic foot ulcers (DFUs) between participants who receive thermometry alone and those who receive thermometry as well as mHealth (SMS and voice messaging) over a year-long study period. This is an evaluator-blinded, randomized, 12-month trial. Individuals with a diagnosis of type 2 diabetes mellitus, aged between 18-80 years, having a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Foot), have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent will be eligible to participate in the study. Recruitment will be performed in diabetes outpatient clinics at two Ministry of Health tertiary hospitals in Lima, Peru. participants in both groups will receive education about foot care at the beginning of the study and they will be provided with a thermometry device (TempStat™). TempStat™ is a tool that captures a thermal image of the feet, which, depending on the temperature of the feet, shows different colors. In this study, if a participant notes a single yellow image or variance between one foot and the contralateral foot, they will be prompted to notify a nurse to evaluate their activity within the previous 2 weeks and make appropriate recommendations. In addition to thermometry, participants in the intervention arm

Smart Multi-Frequency Bioelectrical Impedance Spectrometer for BIA and BIVA Applications.

PubMed

Harder, Rene; Diedrich, Andre; Whitfield, Jonathan S; Buchowski, Macie S; Pietsch, John B; Baudenbacher, Franz J

2016-08-01

Bioelectrical impedance analysis (BIA) is a noninvasive and commonly used method for the assessment of body composition including body water. We designed a small, portable and wireless multi-frequency impedance spectrometer based on the 12 bit impedance network analyzer AD5933 and a precision wide-band constant current source for tetrapolar whole body impedance measurements. The impedance spectrometer communicates via Bluetooth with mobile devices (smart phone or tablet computer) that provide user interface for patient management and data visualization. The export of patient measurement results into a clinical research database facilitates the aggregation of bioelectrical impedance analysis and biolectrical impedance vector analysis (BIVA) data across multiple subjects and/or studies. The performance of the spectrometer was evaluated using a passive tissue equivalent circuit model as well as a comparison of body composition changes assessed with bioelectrical impedance and dual-energy X-ray absorptiometry (DXA) in healthy volunteers. Our results show an absolute error of 1% for resistance and 5% for reactance measurements in the frequency range of 3 kHz to 150 kHz. A linear regression of BIA and DXA fat mass estimations showed a strong correlation (r(2)=0.985) between measures with a maximum absolute error of 6.5%. The simplicity of BIA measurements, a cost effective design and the simple visual representation of impedance data enables patients to compare and determine body composition during the time course of a specific treatment plan in a clinical or home environment.

Foot ulcer risk and location in relation to prospective clinical assessment of foot shape and mobility among persons with diabetes.

PubMed

Cowley, Matthew S; Boyko, Edward J; Shofer, Jane B; Ahroni, Jessie H; Ledoux, William R

2008-11-01

We assessed baseline clinical foot shape for 2939 feet of diabetic subjects who were monitored prospectively for foot ulceration. Assessments included hammer/claw toes, hallux valgus, hallux limitus, prominent metatarsal heads, bony prominences, Charcot deformity, plantar callus, foot type, muscle atrophy, ankle and hallux mobility, and neuropathy. Risk factors were linked to ulcer occurrence and location via a Cox proportional hazards model. Hammer/claw toes (hazard ratio [HR] (95% confidence interval [CI])=1.43 (1.06, 1.94) p=0.02), marked hammer/claw toes (HR=1.77 (1.18, 2.66) p=0.006), bony prominences (HR=1.38 (1.02, 1.88), p=0.04), and foot type (Charcot or drop foot vs. neutrally aligned) (HR=2.34 (1.33, 4.10), p=0.003) were significant risk factors for ulceration adjusting for age, body mass index, insulin medication, ulcer history and amputation history. With adjustment for neuropathy only hammer/claw toes (HR=1.40 (1.03, 1.90), p=0.03) and foot type (HR=1.76 (1.04, 3.04), p=0.05) were significantly related to ulceration. However, there was no relationship between ulcer location and foot deformity. Certain foot deformities were predictive of ulceration, although there was no relationship between clinical foot deformity and ulcer location.

Repeatability of the Oxford Foot Model in children with foot deformity.

PubMed

McCahill, Jennifer; Stebbins, Julie; Koning, Bart; Harlaar, Jaap; Theologis, Tim

2018-03-01

The Oxford Foot Model (OFM) is a multi-segment, kinematic model developed to assess foot motion. It has previously been assessed for repeatability in healthy populations. To determine the OFM's reliability for detecting foot deformity, it is important to know repeatability in pathological conditions. The aim of the study was to assess the repeatability of the OFM in children with foot deformity. Intra-tester repeatability was assessed for 45 children (15 typically developing, 15 hemiplegic, 15 clubfoot). Inter-tester repeatability was assessed in the clubfoot population. The mean absolute differences between testers (clubfoot) and sessions (clubfoot and hemiplegic) were calculated for each of 15 clinically relevant, kinematic variables and compared to typically developing children. Children with clubfoot showed a mean difference between visits of 2.9° and a mean difference between raters of 3.6° Mean absolute differences were within one degree for the intra and inter-rater reliability in 12/15 variables. Hindfoot rotation, forefoot/tibia abduction and forefoot supination were the most variable between testers. Overall the clubfoot data were less variable than the typically developing population. Children with hemiplegia demonstrated slightly higher differences between sessions (mean 4.1°), with the most reliable data in the sagittal plane, and largest differences in the transverse plane. The OFM was designed to measure different types of foot deformity. The results of this study show that it provides repeatable results in children with foot deformity. To be distinguished from measurement artifact, changes in foot kinematics as a result of intervention or natural progression over time must be greater than the repeatability reported here. Copyright © 2018 Elsevier B.V. All rights reserved.

Analysis of foot kinematics wearing high heels using the Oxford foot model.

PubMed

Wang, Meizi; Gu, Yaodong; Baker, Julien Steven

2018-04-29

Wearing high heels is thought to lead to various foot disorders and injuries such as metatarsal pain, Achilles tendon tension, plantar fasciitis and Haglund malformation. However, there is little available information explaining the specific mechanisms and reasons why wearing high heels causes foot deformity. Therefore, the purpose of this study was to investigate the foot kinematics of high heel wearers and compare any differences with barefoot individuals using the Oxford Foot Model (OFM). Fifteen healthy women aged 20-25 years were measured while walking barefoot and when wearing high heels. The peak value of angular motion for the hallux with respect to the forefoot, the forefoot with respect to the hind foot, and the hind foot with respect to the tibia were all analyzed. Compared to the barefoot, participants wearing high heels demonstrated larger hallux dorsiflexion (22.55∘± 1.62∘ VS 26.6∘± 2.33∘ for the barefoot; P= 0.001), and less hallux plantarflexion during the initial stance phase (-4.86∘± 2.32∘ VS -8.68∘± 1.13∘; P< 0.001). There were also greater forefoot adduction (16.15∘± 1.37∘ VS 13.18∘± 0.79∘; P< 0.001), but no significant differences were found in forefoot abduction between the two conditions. The hind foot demonstrated a larger dorsiflexion in the horizontal plane (16.59∘± 1.69∘ VS 12.08∘± 0.9∘; P< 0.001), greater internal rotation (16.72∘± 0.48∘ VS 7.97∘± 0.55∘; P< 0.001), and decreased peak hind foot extension rotation (-5.49∘± 0.69∘ VS -10.73∘± 0.42∘; P= 0.001). These findings complement existing kinematic evidence that wearing high heels can lead to foot deformities and injuries.

Custom-Molded Foot-Orthosis Intervention and Multisegment Medial Foot Kinematics During Walking

PubMed Central

Cobb, Stephen C.; Tis, Laurie L.; Johnson, Jeffrey T.; Wang, Yong “Tai”; Geil, Mark D.

2011-01-01

Context: Foot-orthosis (FO) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinically. However, the results of quantitative gait analyses have been equivocal. The foot models used, participants receiving intervention, and orthoses used might contribute to the variability. Objective: To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture. Design: Crossover study. Setting: University biomechanics and ergonomics laboratory. Patients or Other Participants: Sixteen participants with low-mobile foot posture (7 men, 9 women) were assigned randomly to 1 of 2 FO groups. Interventions : After a 2-week period to break in the FOs, individuals participated in a gait analysis that consisted of 5 successful walking trials (1.3 to 1.4 m/s) during no-FO and FO conditions. Main Outcome Measure(s): Three-dimensional displacements during 4 subphases of stance (loading response, mid-stance, terminal stance, preswing) were computed for each multisegment foot model articulation. Results: Repeated-measures analyses of variance (ANOVAs) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition (F1,14 = 5.24, P = .04, partial η2 = 0.27). Terminal stance repeated-measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal joint complex (F1,14 = 7.87, P = .01, partial η2 = 0.36). However, additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional orthosis (F1,14 = 4.32, P = .08, partial η2 = 0.38) or full-contact orthosis (F1,14 = 4.10, P = .08, partial η2 = 0.37). Conclusions: Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures. Furthermore, FO intervention might

A methodological framework for detecting ulcers' risk in diabetic foot subjects by combining gait analysis, a new musculoskeletal foot model and a foot finite element model.

PubMed

Scarton, Alessandra; Guiotto, Annamaria; Malaquias, Tiago; Spolaor, Fabiola; Sinigaglia, Giacomo; Cobelli, Claudio; Jonkers, Ilse; Sawacha, Zimi

2018-02-01

Diabetic foot is one of the most debilitating complications of diabetes and may lead to plantar ulcers. In the last decade, gait analysis, musculoskeletal modelling (MSM) and finite element modelling (FEM) have shown their ability to contribute to diabetic foot prevention and suggested that the origin of the plantar ulcers is in deeper tissue layers rather than on the plantar surface. Hence the aim of the current work is to develop a methodology that improves FEM-derived foot internal stresses prediction, for diabetic foot prevention applications. A 3D foot FEM was combined with MSM derived force to predict the sites of excessive internal stresses on the foot. In vivo gait analysis data, and an MRI scan of a foot from a healthy subject were acquired and used to develop a six degrees of freedom (6 DOF) foot MSM and a 3D subject-specific foot FEM. Ankle kinematics were applied as boundary conditions to the FEM together with: 1. only Ground Reaction Forces (GRFs); 2. OpenSim derived extrinsic muscles forces estimated with a standard OpenSim MSM; 3. extrinsic muscle forces derived through the (6 DOF) foot MSM; 4. intrinsic and extrinsic muscles forces derived through the 6 DOF foot MSM. For model validation purposes, simulated peak pressures were extracted and compared with those measured experimentally. The importance of foot muscles in controlling plantar pressure distribution and internal stresses is confirmed by the improved accuracy in the estimation of the peak pressures obtained with the inclusion of intrinsic and extrinsic muscle forces. Copyright © 2017 Elsevier B.V. All rights reserved.

Gender differences of foot characteristics in older Japanese adults using a 3D foot scanner.

PubMed

Saghazadeh, Mahshid; Kitano, Naruki; Okura, Tomohiro

2015-01-01

Knowledge of gender differences in foot shape assists shoe manufactures with designing appropriate shoes for men and women. Although gender differences in foot shapes are relatively known among young men and women, less is known about how the older men and women's feet differ in shape. A recent development in foot shape assessment is the use of 3D foot scanners. To our knowledge this technology has yet to be used to examine gender differences in foot shape of Japanese older adults. This cross-sectional study included 151 older men (74.5 ± 5.6 years) and 140 older women (73.9 ± 5.1 years) recruited in Kasama City, Japan. Foot variables were measured in sitting and standing positions using Dream GP Incorporated's 3D foot scanner, Footstep PRO (Osaka, Japan). Scores were analyzed as both raw and normalized to truncated foot length using independent samples t-test and analysis of covariance, respectively. In men, the measurement values for navicular height, first and fifth toe and instep heights, ball and heel width, ball girth, arch height index (just standing), arch rigidity index and instep girth were significantly greater than the women's, whereas the first toe angle, in both sitting and standing positions was significantly smaller. However, after normalizing, the differences in ball width, heel width, height of first and fifth toes in both sitting and standing and ball girth in sitting position were nonsignificant. According to Cohen's d, among all the foot variables, the following had large effect sizes in both sitting and standing positions: truncated foot length, instep, navicular height, foot length, ball girth, ball width, heel width and instep girth. This study provides evidence of anthropometric foot variations between older men and women. These differences need to be considered when manufacturing shoes for older adults.

Welcome to Journal of Foot and Ankle Research: a new open access journal for foot health professionals

PubMed Central

Menz, Hylton B; Potter, Mike J; Borthwick, Alan M; Landorf, Karl B

2008-01-01

Journal of Foot and Ankle Research (JFAR) is a new, open access, peer-reviewed online journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. JFAR will cover a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care. The journal encourages submission from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care. All manuscripts will undergo open peer review, and all accepted manuscripts will be freely available on-line using the open access platform of BioMed Central. PMID:18822156

X-Ray Exam: Foot

MedlinePlus

... Staying Safe Videos for Educators Search English Español X-Ray Exam: Foot KidsHealth / For Parents / X-Ray Exam: Foot What's in this article? What ... Have Questions Print What It Is A foot X-ray is a safe and painless test that ...

The neuropathic foot.

PubMed

Jernberger, A

1993-12-01

The neuropathic foot is described with relation to cause, presentation, dysfunction and identification. The various mechanisms of neuropathic foot lesions are outlined--overload, diabetic gangrene, continuous pressure, direct injury and cutting and temperature effects. The orthotic treatment of the foot is discussed and in particular the importance of proper shoe provision and patient education and indoctrination emphasised. The use of plaster casts and fenestrations to control pressure distribution is described. Finally results of an intensive treatment programme are presented to identify the effect on outcome, as measured by delay in amputation.

Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet

PubMed Central

Lee, Hong-Jae; Lim, Kil-Byung; Yoo, JeeHyun; Yun, Hyun-Ju; Jeong, Tae-Ho

2015-01-01

Objective To evaluate the effect of custom-molded foot orthoses on foot pain and balance in children with symptomatic flexible flat foot 1 month and 3 months after fitting foot orthosis. Method A total of 24 children over 6 years old with flexible flat feet and foot pain for at least 6 months were recruited for this study. Their resting calcaneal stance position and calcaneal pitch angle were measured. Individual custom-molded rigid foot orthoses were prescribed using inverted orthotic technique to control foot overpronation. Pain questionnaire was used to obtain pain sites, degree, and frequency. Balancing ability was determined using computerized posturography. These evaluations were performed prior to custom-molded foot orthoses, 1 month, and 3 months after fitting foot orthoses. Result Of 24 children with symptomatic flexible flat feet recruited for this study, 20 completed the study. Significant (p<0.001) improvements in pain degree and frequency were noted after 1 and 3 months of custom-molded foot orthoses. In addition, significant (p<0.05) improvement in balancing ability was found after 3 months of custom-molded foot orthoses. Conclusion Short-term use of custom-molded foot orthoses significantly improved foot pain and balancing ability in children with symptomatic flexible flat foot. PMID:26798604

Foot anthropometry and morphology phenomena.

PubMed

Agić, Ante; Nikolić, Vasilije; Mijović, Budimir

2006-12-01

Foot structure description is important for many reasons. The foot anthropometric morphology phenomena are analyzed together with hidden biomechanical functionality in order to fully characterize foot structure and function. For younger Croatian population the scatter data of the individual foot variables were interpolated by multivariate statistics. Foot structure descriptors are influenced by many factors, as a style of life, race, climate, and things of the great importance in human society. Dominant descriptors are determined by principal component analysis. Some practical recommendation and conclusion for medical, sportswear and footwear practice are highlighted.

Heart rate detection from single-foot plantar bioimpedance measurements in a weighing scale.

PubMed

Diaz, Delia H; Casas, Oscar; Pallas-Areny, Ramon

2010-01-01

Electronic bathroom scales are an easy-to-use, affordable mean to measure physiological parameters in addition to body weight. They have been proposed to obtain the ballistocardiogram (BCG) and derive from it the heart rate, cardiac output and systolic blood pressure. Therefore, weighing scales may suit intermittent monitoring in e-health and patient screening. Scales intended for bioelectrical impedance analysis (BIA) have also been proposed to estimate the heart rate by amplifying the pulsatile impedance component superimposed on the basal impedance. However, electronic weighing scales cannot easily obtain the BCG from people that have a single leg neither are bioimpedance measurements between both feet recommended for people wearing a pacemaker or other electronic implants, neither for pregnant women. We propose a method to detect the heart rate (HR) from bioimpedance measured in a single foot while standing on an bathroom weighting scale intended for BIA. The electrodes built in the weighing scale are used to apply a 50 kHz voltage between the outer electrode pair and to measure the drop in voltage across the inner electrode pair. The agreement with the HR simultaneously obtained from the ECG is excellent. We have also compared the drop in voltage across the waist and the thorax with that obtained when measuring bioimpedance between both feet to compare the possible risk of the proposed method to that of existing BIA scales.

Correlations between ankle-foot impairments and dropped foot gait deviations among stroke survivors.

PubMed

Chisholm, Amanda E; Perry, Stephen D; McIlroy, William E

2013-01-01

The purpose of this paper is to 1) evaluate the relationship between ankle kinematics during gait and standardized measures of ankle impairments among sub-acute stroke survivors, and 2) compare the degree of stroke-related ankle impairment between individuals with and without dropped foot gait deviations. Fifty-five independently ambulating stroke survivors participated in this study. Dropped foot was defined as decreased peak dorsiflexion during the swing phase and reduced ankle joint motion in stance. Standardized outcome measures included the Chedoke-McMaster Stroke Assessment (motor impairment), Modified Ashworth Scale (spasticity), Medical Research Council (muscle strength), passive and active range of motion, and isometric muscle force. Foot impairment was not related to peak dorsiflexion during swing (r=-0.17, P=0.247) and joint motion during stance (r=0.05, P=0.735). Active (r=0.45, P<0.001) and passive (r=0.48, P<0.001) range of motion was associated with stance phase joint motion. Peak dorsiflexion during swing was related to isometric dorsiflexor muscle force (r=-0.32, P=0.039). Individuals with dropped foot demonstrated greater motor impairment, plantarflexor spasticity and ankle muscle weakness compared to those without dropped foot. Our investigation suggests that ankle-foot impairments are related to ankle deviations during gait, as indicated by greater impairment among individuals with dropped foot. These findings contribute to a better understanding of gait-specific ankle deviations, and may lead to the development of a more effective clinical assessment of dropped foot impairment. © 2013.

Beyond the Bottom of the Foot: Topographic Organization of the Foot Dorsum in Walking.

PubMed

Klarner, Taryn; Pearcey, Gregory E P; Sun, Yao; Barss, Trevor S; Kaupp, Chelsea; Munro, Bridget; Frank, Nick; Zehr, E Paul

2017-12-01

Sensory feedback from the foot dorsum during walking has only been studied globally by whole nerve stimulation. Stimulating the main nerve innervating the dorsal surface produces a functional stumble corrective response that is phase-dependently modulated. We speculated that effects evoked by activation of discrete skin regions on the foot dorsum would be topographically organized, as with the foot sole. Nonnoxious electrical stimulation was delivered to five discrete locations on the dorsal surface of the foot during treadmill walking. Muscle activity from muscles acting at the ankle, knee, hip, and shoulder were recorded along with ankle, knee, and hip kinematics and kinetic information from forces under the foot. All data were sorted on the basis of stimulus occurrence in 12 step cycle phases, before being averaged together within a phase for subsequent analysis. Results reveal dynamic changes in reflex amplitudes and kinematics that are site specific and phase dependent. Most responses from discrete sites on the foot dorsum were seen in the swing phase suggesting function to conform foot trajectory to maintain stability of the moving limb. In general, responses from lateral stimulation differed from medial stimulation, and effects were largest from stimulation at the distal end of the foot at the metatarsals; that is, in anatomical locations where actual impact with an object in the environment is most likely during swing. Responses to stimulation extend to include muscles at the hip and shoulder. We reveal that afferent feedback from specific cutaneous locations on the foot dorsum influences stance and swing phase corrective responses. This emphasizes the critical importance of feedback from the entire foot surface in locomotor control and has application for rehabilitation after neurological injury and in footwear development.

Robust Foot Clearance Estimation Based on the Integration of Foot-Mounted IMU Acceleration Data

PubMed Central

Benoussaad, Mourad; Sijobert, Benoît; Mombaur, Katja; Azevedo Coste, Christine

2015-01-01

This paper introduces a method for the robust estimation of foot clearance during walking, using a single inertial measurement unit (IMU) placed on the subject’s foot. The proposed solution is based on double integration and drift cancellation of foot acceleration signals. The method is insensitive to misalignment of IMU axes with respect to foot axes. Details are provided regarding calibration and signal processing procedures. Experimental validation was performed on 10 healthy subjects under three walking conditions: normal, fast and with obstacles. Foot clearance estimation results were compared to measurements from an optical motion capture system. The mean error between them is significantly less than 15% under the various walking conditions. PMID:26703622

Bipedal vs. unipedal: a comparison between one-foot and two-foot driving in a driving simulator.

PubMed

Wang, Dong-Yuan Debbie; Richard, F Dan; Cino, Cullen R; Blount, Trevin; Schmuller, Joseph

2017-04-01

Is it better to drive with one foot or with two feet? Although two-foot driving has fostered interminable debate in the media, no scientific and systematic research has assessed this issue and federal and local state governments have provided no answers. The current study compared traditional unipedal (one-foot driving, using the right foot to control the accelerator and the brake pedal) with bipedal (two-foot driving, using the right foot to control the accelerator and the left foot to control the brake pedal) responses to a visual stimulus in a driving simulator study. Each of 30 undergraduate participants drove in a simulated driving scenario. They responded to a STOP sign displayed on the centre of the screen by bringing their vehicle to a complete stop. Brake RT was shorter under the bipedal condition, while throttle RT showed advantage under the unipedal condition. Stopping time and distance showed a bipedal advantage, however. We discuss further limitations of the current study and implications in a driving task. Before drawing any conclusions from the simulator study, further on-road driving tests are necessary to confirm these obtained bipedal advantages. Practitioner Summary: Traditional unipedal (using the right foot to control the accelerator and the brake pedal) with bipedal (using the right foot to control the accelerator and the left foot to control the brake pedal) responses to a visual stimulus in a driving simulator were compared. Our results showed a bipedal advantage. Promotion: Although two-foot driving has fostered interminable debate in the media, no scientific and systematic research has assessed this issue and federal and local state governments have provided no answers. Traditional (one-foot driving, using the right foot to control the accelerator and the brake pedal) with bipedal (using the right foot to control the accelerator and the left foot to control the brake pedal) responses to a visual stimulus in a simulated driving study were

Footwear and foot care knowledge as risk factors for foot problems in Indian diabetics

PubMed Central

Chandalia, H. B.; Singh, D.; Kapoor, V.; Chandalia, S. H.; Lamba, P. S.

2008-01-01

We assessed 300 diabetic and 100 age- and sex-matched controls for correlating foot wear practices and foot care knowledge and the presence of foot complications. A structured questionnaire evaluated the knowledge about foot care, type of footwear used, education level, association of tobacco abuse, and any associated symptoms of foot disease. Clinical evaluation was done by inspection of feet for presence of any external deformities, assessment of sensory function (vibration perception threshold, VPT), vascular status (foot pulses and ankle brachial ratio) and presence of any infection. In the diabetes category, 44.7% patients had not received previous foot care education. 0.6% walked barefoot outdoors and 45% walked barefoot indoors. Fourteen (4.7%) patients gave history of foot ulceration in the past and comprised the high risk group; only 2 out of 14 had received foot care education, 6 gave history of tobacco abuse, 8 had symptoms of claudication, 9 had paresthesias, 2 walked barefoot indoors. Average duration of diabetes in the high-risk and low-risk diabetes group was 10.85 ± 6.53 and 9.83 ± 7.99 years, respectively. In the high- and low-risk diabetic groups, VPT was 19.57 ± 11.26 and 15.20 ± 10.21V (P < 0.02), ankle brachial ratio was 1.05 ± 0.19 and 1.14 ± 0.18 (P < 0.05), and the questionnaire scores was 40.8% and 57%, respectively. In the diabetic and the control group, VPT was 15.62 ± 10.39 and 8.36 ± 3.61 V (P < 0.01), ankle brachial ratio was 1.14 ± 0.18 and 1.15 ± 0.12, and the questionnaire scores were 57% and 40.3%, respectively. In conclusion, poor knowledge of foot care and poor footwear practices were important risk factors for foot problems in diabetes. PMID:20165597

The influence of foot orthoses on foot mobility magnitude and arch height index in adults with flexible flat feet.

PubMed

Sheykhi-Dolagh, Roghaye; Saeedi, Hassan; Farahmand, Behshid; Kamyab, Mojtaba; Kamali, Mohammad; Gholizadeh, Hossein; Derayatifar, Amir A; Curran, Sarah

2015-06-01

Flexible flat foot is described as a reduction in the height of the medial longitudinal arch and may occur from abnormal foot pronation. A foot orthosis is thought to modify and control excessive pronation and improve arch height. To compare the immediate effect of three types of orthoses on foot mobility and the arch height index in subjects with flexible flat feet. A quasi-experimental study. The dorsal arch height, midfoot width, foot mobility and arch height index were assessed in 20 participants with flexible flat feet (mean age = 23.2 ± 3 years) for three different foot orthosis conditions: soft, semi-rigid and rigid University of California Biomechanics Laboratory (UCBL). Maximum midfoot width at 90% with arch mobility in the coronal plane was shown in the semi-rigid orthosis condition. The semi-rigid orthosis resulted in the highest mean foot mobility in 90% of weight bearing, and the rigid orthosis (UCBL) had the lowest mean foot mobility. The soft orthosis resulted in foot mobility between that of the rigid and the semi-rigid orthosis. UCBL orthosis showed the highest arch height index, and the semi-rigid orthosis showed the lowest mean arch height index. Due to its rigid structure and long medial-lateral walls, the UCBL orthosis appears to limit foot mobility. Therefore, it is necessary to make an orthosis that facilitates foot mobility in the normal range of the foot arch. Future studies should address the dynamic mobility of the foot with using various types of foot orthoses. Although there are many studies focussed on flat foot and the use of foot orthoses, the mechanism of action is still unclear. This study explored foot mobility and the influence of foot orthoses and showed that a more rigid foot orthosis should be selected based on foot mobility. © The International Society for Prosthetics and Orthotics 2014.

The Glasgow-Maastricht foot model, evaluation of a 26 segment kinematic model of the foot.

PubMed

Oosterwaal, Michiel; Carbes, Sylvain; Telfer, Scott; Woodburn, James; Tørholm, Søren; Al-Munajjed, Amir A; van Rhijn, Lodewijk; Meijer, Kenneth

2016-01-01

Accurately measuring of intrinsic foot kinematics using skin mounted markers is difficult, limited in part by the physical dimensions of the foot. Existing kinematic foot models solve this problem by combining multiple bones into idealized rigid segments. This study presents a novel foot model that allows the motion of the 26 bones to be individually estimated via a combination of partial joint constraints and coupling the motion of separate joints using kinematic rhythms. Segmented CT data from one healthy subject was used to create a template Glasgow-Maastricht foot model (GM-model). Following this, the template was scaled to produce subject-specific models for five additional healthy participants using a surface scan of the foot and ankle. Forty-three skin mounted markers, mainly positioned around the foot and ankle, were used to capture the stance phase of the right foot of the six healthy participants during walking. The GM-model was then applied to calculate the intrinsic foot kinematics. Distinct motion patterns where found for all joints. The variability in outcome depended on the location of the joint, with reasonable results for sagittal plane motions and poor results for transverse plane motions. The results of the GM-model were comparable with existing literature, including bone pin studies, with respect to the range of motion, motion pattern and timing of the motion in the studied joints. This novel model is the most complete kinematic model to date. Further evaluation of the model is warranted.

Heat removal using microclimate foot cooling: a thermal foot manikin study.

PubMed

Castellani, John W; Demes, Robert; Endrusick, Thomas L; Cheuvront, Samuel N; Montain, Scott J

2014-04-01

It has been proposed that microclimate cooling systems exploit the peripheral extremities because of more efficient heat transfer. The purpose of this study was to quantify, using a patented microclimate cooling technique, the heat transfer from the plantar surface of the foot for comparison to other commonly cooled body regions. A military boot was fitted with an insole embedded with a coiled, 1.27 m length of hollow tubing terminating in inlet and outlet valves. A thermal foot manikin with a surface temperature of 34 degrees C was placed in the boot and the valves were connected to a system that circulated water through the insole at a temperature of 20 degrees C and flow rate of 120 ml x min(-1). The manikin foot served as a constant heat source to determine heat transfer provided by the insole. Testing was done with the foot model dry and sweating at a rate of 500 ml x h(- 1) x m(-2). Climatic chamber conditions were 30 degrees C with 30% RH. Heat loss was approximately 4.1 +/- 0.1 and approximately 7.7 +/- 0.3 W from the dry and sweating foot models, respectively. On a relative scale, the heat loss was 3.0 W and 5.5 W per 1% (unit) body surface area, respectively, for the dry and sweating conditions. The relative heat loss afforded by plantar foot cooling was similar compared to other body regions, but the absolute amount of heat removal is unlikely to make an impact on whole body heat balance.

From the diabetic foot ulcer and beyond: how do foot infections spread in patients with diabetes?

PubMed Central

Aragón-Sánchez, Javier; Lázaro-Martínez, Jose Luis; Pulido-Duque, Juan; Maynar, Manuel

2012-01-01

A diabetic foot infection is usually the result of a pre-existing foot ulceration and is the leading cause of lower extremity amputation in patients with diabetes. It is widely accepted that diabetic foot infections may be challenging to treat for several reasons. The devastating effects of hyperglycemia on host defense, ischemia, multi-drug resistant bacteria and spreading of infection through the foot may complicate the course of diabetic foot infections. Understanding the ways in which infections spread through the diabetic foot is a pivotal factor in order to decide the best approach for the patient's treatment. The ways in which infections spread can be explained by the anatomical division of the foot into compartments, the tendons included in the compartments, the initial location of the point of entry of the infection and the type of infection that the patient has. The aim of this paper is to further comment on the existed and proposed anatomical principles of the spread of infection through the foot in patients with diabetes. PMID:23050067

The foot of Homo naledi.

PubMed

Harcourt-Smith, W E H; Throckmorton, Z; Congdon, K A; Zipfel, B; Deane, A S; Drapeau, M S M; Churchill, S E; Berger, L R; DeSilva, J M

2015-10-06

Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo.

The foot of Homo naledi

PubMed Central

Harcourt-Smith, W. E. H.; Throckmorton, Z.; Congdon, K. A.; Zipfel, B.; Deane, A. S.; Drapeau, M. S. M.; Churchill, S. E.; Berger, L. R.; DeSilva, J. M.

2015-01-01

Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo. PMID:26439101

Challenging the foundations of the clinical model of foot function: further evidence that the root model assessments fail to appropriately classify foot function.

PubMed

Jarvis, Hannah L; Nester, Christopher J; Bowden, Peter D; Jones, Richard K

2017-01-01

The Root model of normal and abnormal foot function remains the basis for clinical foot orthotic practice globally. Our aim was to investigate the relationship between foot deformities and kinematic compensations that are the foundations of the model. A convenience sample of 140 were screened and 100 symptom free participants aged 18-45 years were invited to participate. The static biomechanical assessment described by the Root model was used to identify five foot deformities. A 6 segment foot model was used to measure foot kinematics during gait. Statistical tests compared foot kinematics between feet with and without foot deformities and correlated the degree of deformity with any compensatory motions. None of the deformities proposed by the Root model were associated with distinct differences in foot kinematics during gait when compared to those without deformities or each other. Static and dynamic parameters were not correlated. Taken as part of a wider body of evidence, the results of this study have profound implications for clinical foot health practice. We believe that the assessment protocol advocated by the Root model is no longer a suitable basis for professional practice. We recommend that clinicians stop using sub-talar neutral position during clinical assessments and stop assessing the non-weight bearing range of ankle dorsiflexion, first ray position and forefoot alignments and movement as a means of defining the associated foot deformities. The results question the relevance of the Root assessments in the prescription of foot orthoses.

Diabetes - foot ulcers

MedlinePlus

... produce chemicals that help the ulcer heal. Taking Pressure off Your Foot Ulcer Foot ulcers are partly caused by too much ... ulcer has healed. These devices will take the pressure off of the ulcer area. This will help speed healing. Be sure ...

Flip-flop footwear with a moulded foot-bed for the treatment of foot pain: a randomised controlled trial.

PubMed

Chuter, Vivienne Helaine; Searle, Angela; Spink, Martin J

2016-11-11

Foot pain is a common problem affecting up to 1 in 5 adults and is known to adversely affect activities of daily living and health related quality of life. Orthopaedic footwear interventions are used as a conservative treatment for foot pain, although adherence is known to be low, in part due to the perception of poor comfort and unattractiveness of the footwear. The objective of this trial was to assess the efficacy of flip-flop style footwear (Foot Bio-Tec©) with a moulded foot-bed in reducing foot pain compared to participant's usual footwear. Two-arm parallel randomised controlled trial using computer generated random allocation schedule at an Australian university podiatry clinic. 108 volunteers with disabling foot pain were enrolled after responding to an advertisement and eligibility screening. Participants were randomly allocated to receive footwear education and moulded flip-flop footwear to wear as much as they were comfortable with for the next 12 weeks (n = 54) or footwear education and instructions to wear their normal footwear for the next 12 weeks (n = 54). Primary outcome was the pain domain of the Foot Health Status Questionnaire (FHSQ). Secondary outcomes were the foot function and general foot health domains of the FHSQ, a visual analogue scale (VAS) for foot pain and perceived comfort of the intervention footwear. Compared to the control group, the moulded flip-flop group showed a significant improvement in the primary outcome measure of the FHSQ pain domain (adjusted mean difference 8.36 points, 95 % CI 5.58 to 13.27, p < 0.01). Statistical and clinically significant differences were observed for the secondary measure of foot pain assessed by a VAS and the FSHQ domains of foot function and general foot health. None of the participants reported any pain or discomfort from the intervention footwear and six (footwear group = 4) were lost to follow up. Our results demonstrate that flip-flop footwear with a moulded foot-bed can

A database of virtual healthy subjects to assess the accuracy of foot-to-foot pulse wave velocities for estimation of aortic stiffness.

PubMed

Willemet, Marie; Chowienczyk, Phil; Alastruey, Jordi

2015-08-15

While central (carotid-femoral) foot-to-foot pulse wave velocity (PWV) is considered to be the gold standard for the estimation of aortic arterial stiffness, peripheral foot-to-foot PWV (brachial-ankle, femoral-ankle, and carotid-radial) are being studied as substitutes of this central measurement. We present a novel methodology to assess theoretically these computed indexes and the hemodynamics mechanisms relating them. We created a database of 3,325 virtual healthy adult subjects using a validated one-dimensional model of the arterial hemodynamics, with cardiac and arterial parameters varied within physiological healthy ranges. For each virtual subject, foot-to-foot PWV was computed from numerical pressure waveforms at the same locations where clinical measurements are commonly taken. Our numerical results confirm clinical observations: 1) carotid-femoral PWV is a good indicator of aortic stiffness and correlates well with aortic PWV; 2) brachial-ankle PWV overestimates aortic PWV and is related to the stiffness and geometry of both elastic and muscular arteries; and 3) muscular PWV (carotid-radial, femoral-ankle) does not capture the stiffening of the aorta and should therefore not be used as a surrogate for aortic stiffness. In addition, our analysis highlights that the foot-to-foot PWV algorithm is sensitive to the presence of reflected waves in late diastole, which introduce errors in the PWV estimates. In this study, we have created a database of virtual healthy subjects, which can be used to assess theoretically the efficiency of physiological indexes based on pulse wave analysis. Copyright © 2015 the American Physiological Society.

A database of virtual healthy subjects to assess the accuracy of foot-to-foot pulse wave velocities for estimation of aortic stiffness

PubMed Central

Chowienczyk, Phil; Alastruey, Jordi

2015-01-01

While central (carotid-femoral) foot-to-foot pulse wave velocity (PWV) is considered to be the gold standard for the estimation of aortic arterial stiffness, peripheral foot-to-foot PWV (brachial-ankle, femoral-ankle, and carotid-radial) are being studied as substitutes of this central measurement. We present a novel methodology to assess theoretically these computed indexes and the hemodynamics mechanisms relating them. We created a database of 3,325 virtual healthy adult subjects using a validated one-dimensional model of the arterial hemodynamics, with cardiac and arterial parameters varied within physiological healthy ranges. For each virtual subject, foot-to-foot PWV was computed from numerical pressure waveforms at the same locations where clinical measurements are commonly taken. Our numerical results confirm clinical observations: 1) carotid-femoral PWV is a good indicator of aortic stiffness and correlates well with aortic PWV; 2) brachial-ankle PWV overestimates aortic PWV and is related to the stiffness and geometry of both elastic and muscular arteries; and 3) muscular PWV (carotid-radial, femoral-ankle) does not capture the stiffening of the aorta and should therefore not be used as a surrogate for aortic stiffness. In addition, our analysis highlights that the foot-to-foot PWV algorithm is sensitive to the presence of reflected waves in late diastole, which introduce errors in the PWV estimates. In this study, we have created a database of virtual healthy subjects, which can be used to assess theoretically the efficiency of physiological indexes based on pulse wave analysis. PMID:26055792

A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable.

PubMed

Bus, Sicco A; van Netten, Jaap J

2016-01-01

Diabetic foot ulceration poses a heavy burden on the patient and the healthcare system, but prevention thereof receives little attention. For every euro spent on ulcer prevention, ten are spent on ulcer healing, and for every randomized controlled trial conducted on prevention, ten are conducted on healing. In this article, we argue that a shift in priorities is needed. For the prevention of a first foot ulcer, we need more insight into the effect of interventions and practices already applied globally in many settings. This requires systematic recording of interventions and outcomes, and well-designed randomized controlled trials that include analysis of cost-effectiveness. After healing of a foot ulcer, the risk of recurrence is high. For the prevention of a recurrent foot ulcer, home monitoring of foot temperature, pressure-relieving therapeutic footwear, and certain surgical interventions prove to be effective. The median effect size found in a total of 23 studies on these interventions is large, over 60%, and further increases when patients are adherent to treatment. These interventions should be investigated for efficacy as a state-of-the-art integrated foot care approach, where attempts are made to assure treatment adherence. Effect sizes of 75-80% may be expected. If such state-of-the-art integrated foot care is implemented, the majority of problems with foot ulcer recurrence in diabetes can be resolved. It is therefore time to act and to set a new target in diabetic foot care. This target is to reduce foot ulcer incidence with at least 75%. Copyright © 2016 John Wiley & Sons, Ltd.

Inter-segment foot motion in girls using a three-dimensional multi-segment foot model.

PubMed

Jang, Woo Young; Lee, Dong Yeon; Jung, Hae Woon; Lee, Doo Jae; Yoo, Won Joon; Choi, In Ho

2018-05-06

Several multi-segment foot models (MFMs) have been introduced for in vivo analyses of dynamic foot kinematics. However, the normal gait patterns of healthy children and adolescents remain uncharacterized. We sought to determine normal foot kinematics according to age in clinically normal female children and adolescents using a Foot 3D model. Fifty-eight girls (age 7-17 years) with normal function and without radiographic abnormalities were tested. Three representative strides from five separate trials were analyzed. Kinematic data of foot segment motion were tracked and evaluated using an MFM with a 15-marker set (Foot 3D model). As controls, 50 symptom-free female adults (20-35 years old) were analyzed. In the hindfoot kinematic analysis, plantar flexion motion in the pre-swing phase was significantly greater in girls aged 11 years or older than in girls aged <11 years, thereby resulting in a larger sagittal range of motion. Coronal plane hindfoot motion exhibited pronation, whereas transverse plane hindfoot motion exhibited increased internal rotation in girls aged <11 years. Hallux valgus angles increased significantly in girls aged 11 years or older. The foot progression angle showed mildly increased internal rotation in the loading response phase and the swing phase in girls aged <11 years old. The patterns of inter-segment foot motion in girls aged 11 years or older showed low-arch kinematic characteristics, whereas those in girls aged 11 years or older were more similar to the patterns in young adult women. Copyright © 2018 Elsevier B.V. All rights reserved.

FOOT experiment (Foot/Ground Reaction Forces during Space Flight)

NASA Image and Video Library

2005-06-29

ISS011-E-09831 (29 June 2005) --- Astronaut John L. Phillips, Expedition 11 NASA Space Station science officer and flight engineer, works at the Canadarm2 controls while participating in the Foot/Ground Reaction Forces During Spaceflight (FOOT) experiment in the Destiny laboratory of the International Space Station. Phillips wore the specially instrumented Lower Extremity Monitoring Suit (LEMS), cycling tights outfitted with sensors, during the experiment.

FOOT experiment (Foot/Ground Reaction Forces during Space Flight)

NASA Image and Video Library

2005-06-29

ISS011-E-09825 (29 June 2005) --- Astronaut John L. Phillips, Expedition 11 NASA Space Station science officer and flight engineer, enters data into a computer while participating in the Foot/Ground Reaction Forces During Spaceflight (FOOT) experiment in the Destiny laboratory of the International Space Station. Phillips wore the specially instrumented Lower Extremity Monitoring Suit (LEMS), cycling tights outfitted with sensors, during the experiment.

Alterations in body fluid content can be detected by bioelectrical impedance analysis.

PubMed

Scheltinga, M R; Jacobs, D O; Kimbrough, T D; Wilmore, D W

1991-05-01

The electrical resistance across the whole body and its segments to the conduction of a weak alternating current was determined in human subjects under three different conditions: (1) during bed rest, (2) during infusion of 1 liter of saline, and (3) during donation of 1 unit of blood. During bed rest, extracellular and total body water were measured by dilution of bromide and heavy water, respectively. Electrical resistance obtained from electrodes placed on proximal portions of extremities ("proximal resistance") accounted for less than 50% of that determined by electrodes positioned on routinely used portions of a hand and foot ("whole body resistance"). Following saline infusion, resistance determined from the whole body and all its segments fell (P less than 0.001); the magnitude of the drop in both proximal and whole body resistance was inversely related to the volume of total body water (TBW) (r = -0.82, P less than 0.002, and r = -0.73, P less than 0.01, respectively). In contrast, blood donation was associated with significantly increased resistance at both measurement sites. TBW predicted from anthropometrics was inversely related to both proximal (r = -0.90, P less than 0.001) and whole body resistance (r = -0.75, P less than 0.001). Bioelectrical impedance analysis is a simple technique which may be useful in monitoring minimal alterations in TBW. Furthermore, altered fluid status may be predicted more accurately by changes in proximal resistance compared to changes in traditionally used whole body resistance.

The Diabetic Foot Attack: "'Tis Too Late to Retreat!"

PubMed

Vas, Prashanth R J; Edmonds, Michael; Kavarthapu, Venu; Rashid, Hisham; Ahluwalia, Raju; Pankhurst, Christian; Papanas, Nikolaos

2018-03-01

The "diabetic foot attack" is one of the most devastating presentations of diabetic foot disease, typically presenting as an acutely inflamed foot with rapidly progressive skin and tissue necrosis, at times associated with significant systemic symptoms. Without intervention, it may escalate over hours to limb-threatening proportions and poses a high amputation risk. There are only best practice approaches but no international protocols to guide management. Immediate recognition of a typical infected diabetic foot attack, predominated by severe infection, with prompt surgical intervention to debride all infected tissue alongside broad-spectrum antibiotic therapy is vital to ensure both limb and patient survival. Postoperative access to multidisciplinary and advanced wound care therapies is also necessary. More subtle forms exist: these include the ischemic diabetic foot attack and, possibly, in a contemporary categorization, acute Charcot neuroarthropathy. To emphasize the importance of timely action especially in the infected and ischemic diabetic foot attack, we revisit the concept of "time is tissue" and draw parallels with advances in acute myocardial infarction and stroke care. At the moment, international protocols to guide management of severe diabetic foot presentations do not specifically use the term. However, we believe that it may help increase awareness of the urgent actions required in some situations.

Foot posture is associated with kinematics of the foot during gait: A comparison of normal, planus and cavus feet.

PubMed

Buldt, Andrew K; Levinger, Pazit; Murley, George S; Menz, Hylton B; Nester, Christopher J; Landorf, Karl B

2015-06-01

Variations in foot posture are associated with the development of some lower limb injuries. However, the mechanisms underlying this relationship are unclear. The objective of this study was to compare foot kinematics between normal, pes cavus and pes planus foot posture groups using a multi-segment foot model. Ninety-seven healthy adults, aged 18-47 were classified as either normal (n=37), pes cavus (n=30) or pes planus (n=30) based on normative data for the Foot Posture Index, Arch Index and normalised navicular height. A five segment foot model was used to measure tri-planar motion of the rearfoot, midfoot, medial forefoot, lateral forefoot and hallux during barefoot walking at a self-selected speed. Angle at heel contact, peak angle, time to peak angle and range of motion was measured for each segment. One way ANOVAs with post-hoc analyses of mean differences were used to compare foot posture groups. The pes cavus group demonstrated a distinctive pattern of motion compared to the normal and pes planus foot posture groups. Effect sizes of significant mean differences were large and comparable to similar studies. Three key differences in overall foot function were observed between the groups: (i) altered frontal and transverse plane angles of the rearfoot in the pes cavus foot; (ii) Less midfoot motion in the pes cavus foot during initial contact and midstance; and (iii) reduced midfoot frontal plane ROM in the pes planus foot during pre-swing. These findings indicate that foot posture does influence motion of the foot. Copyright © 2015 Elsevier B.V. All rights reserved.

FOOT experiment (Foot/Ground Reaction Forces during Space Flight)

NASA Image and Video Library

2005-06-29

ISS011-E-09822 (29 June 2005) --- Astronaut John L. Phillips, Expedition 11 NASA Space Station science officer and flight engineer, uses the Cycle Ergometer with Vibration Isolation System (CEVIS) while participating in the Foot/Ground Reaction Forces During Spaceflight (FOOT) experiment in the Destiny laboratory of the International Space Station. Phillips wore the specially instrumented Lower Extremity Monitoring Suit (LEMS), cycling tights outfitted with sensors, during the experiment.

Investigations of Potential Phenotypes of Foot Osteoarthritis: Cross‐Sectional Analysis From the Clinical Assessment Study of the Foot

PubMed Central

Marshall, Michelle; Thomas, Martin J.; Menz, Hylton B.; Myers, Helen L.; Thomas, Elaine; Downes, Thomas; Peat, George; Roddy, Edward

2016-01-01

Objective To investigate the existence of distinct foot osteoarthritis (OA) phenotypes based on pattern of joint involvement and comparative symptom and risk profiles. Methods Participants ages ≥50 years reporting foot pain in the previous year were drawn from a population‐based cohort. Radiographs were scored for OA in the first metatarsophalangeal (MTP) joint, first and second cuneometatarsal, navicular first cuneiform, and talonavicular joints according to a published atlas. Chi‐square tests established clustering, and odds ratios (ORs) examined symmetry and pairwise associations of radiographic OA in the feet. Distinct underlying classes of foot OA were investigated by latent class analysis (LCA) and their association with symptoms and risk factors was assessed. Results In 533 participants (mean age 64.9 years, 55.9% female) radiographic OA clustered across both feet (P < 0.001) and was highly symmetrical (adjusted OR 3.0, 95% confidence interval 2.1, 4.2). LCA identified 3 distinct classes of foot OA: no or minimal foot OA (64%), isolated first MTP joint OA (22%), and polyarticular foot OA (15%). After adjustment for age and sex, polyarticular foot OA was associated with nodal OA, increased body mass index, and more pain and functional limitation compared to the other classes. Conclusion Patterning of radiographic foot OA has provided insight into the existence of 2 forms of foot OA: isolated first MTP joint OA and polyarticular foot OA. The symptom and risk factor profiles in individuals with polyarticular foot OA indicate a possible distinctive phenotype of foot OA, but further research is needed to explore the characteristics of isolated first MTP joint and polyarticular foot OA. PMID:26238801

Validity of bioelectrical impedance measurement in predicting fat-free mass of Chinese children and adolescents.

PubMed

Wang, Lin; Hui, Stanley Sai-chuen; Wong, Stephen Heung-sang

2014-11-15

The current study aimed to examine the validity of various published bioelectrical impedance analysis (BIA) equations in estimating FFM among Chinese children and adolescents and to develop BIA equations for the estimation of fat-free mass (FFM) appropriate for Chinese children and adolescents. A total of 255 healthy Chinese children and adolescents aged 9 to 19 years old (127 males and 128 females) from Tianjin, China, participated in the BIA measurement at 50 kHz between the hand and the foot. The criterion measure of FFM was also employed using dual-energy X-ray absorptiometry (DEXA). FFM estimated from 24 published BIA equations was cross-validated against the criterion measure from DEXA. Multiple linear regression was conducted to examine alternative BIA equation for the studied population. FFM estimated from the 24 published BIA equations yielded high correlations with the directly measured FFM from DEXA. However, none of the 24 equations was statistically equivalent with the DEXA-measured FFM. Using multiple linear regression and cross-validation against DEXA measurement, an alternative prediction equation was determined as follows: FFM (kg)=1.613+0.742×height (cm)2/impedance (Ω)+0.151×body weight (kg); R2=0.95; SEE=2.45 kg; CV=6.5, 93.7% of the residuals of all the participants fell within the 95% limits of agreement. BIA was highly correlated with FFM in Chinese children and adolescents. When the new developed BIA equations are applied, BIA can provide a practical and valid measurement of body composition in Chinese children and adolescents.

Validity of Bioelectrical Impedance Measurement in Predicting Fat-Free Mass of Chinese Children and Adolescents

PubMed Central

Wang, Lin; Hui, Stanley Sai-chuen; Wong, Stephen Heung-sang

2014-01-01

Background The current study aimed to examine the validity of various published bioelectrical impedance analysis (BIA) equations in estimating FFM among Chinese children and adolescents and to develop BIA equations for the estimation of fat-free mass (FFM) appropriate for Chinese children and adolescents. Material/Methods A total of 255 healthy Chinese children and adolescents aged 9 to 19 years old (127 males and 128 females) from Tianjin, China, participated in the BIA measurement at 50 kHz between the hand and the foot. The criterion measure of FFM was also employed using dual-energy X-ray absorptiometry (DEXA). FFM estimated from 24 published BIA equations was cross-validated against the criterion measure from DEXA. Multiple linear regression was conducted to examine alternative BIA equation for the studied population. Results FFM estimated from the 24 published BIA equations yielded high correlations with the directly measured FFM from DEXA. However, none of the 24 equations was statistically equivalent with the DEXA-measured FFM. Using multiple linear regression and cross-validation against DEXA measurement, an alternative prediction equation was determined as follows: FFM (kg)=1.613+0.742×height (cm)2/impedance (Ω)+0.151×body weight (kg); R2=0.95; SEE=2.45kg; CV=6.5, 93.7% of the residuals of all the participants fell within the 95% limits of agreement. Conclusions BIA was highly correlated with FFM in Chinese children and adolescents. When the new developed BIA equations are applied, BIA can provide a practical and valid measurement of body composition in Chinese children and adolescents. PMID:25398209

Drop foot corrective device

NASA Technical Reports Server (NTRS)

Deis, B. C. (Inventor)

1986-01-01

A light weight, economical device to alleviate a plurality of difficulties encountered in walking by a victim suffering from a drop foot condition is discussed. A legband girdles the leg below the knee and above the calf providing an anchor point for the upper end of a ligament having its lower end attached to a toe of a shoe or a toe on the foot. The ligament is of such length that the foot is supported thereby and retained in a normal position during walking.

Sex-related differences in foot shape.

PubMed

Krauss, I; Grau, S; Mauch, M; Maiwald, C; Horstmann, T

2008-11-01

The purpose of the study was to investigate sex-related differences in foot morphology. In total, 847 subjects were scanned using a 3-D-footscanner. Three different analysis methods were used: (1) comparisons were made for absolute foot measures within 250-270 mm foot length (FL); (2) and for averaged measures (% FL) across all sizes; (3) the feet were then classified using a cluster analysis. Within 250-270 mm FL, male feet were wider and higher (mean differences (MD) 1.3-5.9 mm). No relevant sex-related differences could be found in the comparison of averaged measures (MD 0.3-0.6% FL). Foot types were categorised into voluminous, flat-pointed and slender. Shorter feet were more often voluminous, longer feet were more likely to be narrow and flat. However, the definition of 'short' and 'long' was sex-related; thus, allometry of foot measures was different. For shoe design, measures should be derived for each size and sex separately. Different foot types should be considered to account for the variety in foot shape. Improper footwear can cause foot pain and deformity. Therefore, knowledge of sex-related differences in foot measures is important to assist proper shoe fit in both men and women. The present study supplements the field of knowledge within this context with recommendations for the manufacturing of shoes.

The role of foot self-care behavior on developing foot ulcers in diabetic patients with peripheral neuropathy: a prospective study.

PubMed

Chin, Yen-Fan; Liang, Jersey; Wang, Woan-Shyuan; Hsu, Brend Ray-Sea; Huang, Tzu-Ting

2014-12-01

Although foot self-care behavior is viewed as beneficial for the prevention of diabetic foot ulceration, the effect of foot self-care behavior on the development of diabetic foot ulcer has received little empirical investigation. To explore the relationship between foot self-care practice and the development of diabetic foot ulcers among diabetic neuropathy patients in northern Taiwan. A longitudinal study was conducted at one medical center and one teaching hospital in northern Taiwan. A total of 295 diabetic patients who lacked sensitivity to a monofilament were recruited. Five subjects did not provide follow-up data; thus, only the data of 290 subjects were analyzed. The mean age was 67.0 years, and 72.1% had six or fewer years of education. Data were collected by a modified version of the physical assessment portion of the Michigan Neuropathy Screening Instrument and the Diabetes Foot Self-Care Behavior Scale. Cox regression was used to analyze the predictive power of foot self-care behaviors. A total of 29.3% (n=85) of diabetic neuropathy patients developed a diabetic foot ulcer by the one-year follow-up. The total score on the Diabetes Foot Self-Care Behavior Scale was significantly associated with the risk of developing foot ulcers (HR=1.04, 95% CI=1.01-1.07, p=0.004). After controlling for the demographic variables and the number of diabetic foot ulcer hospitalizations, however, the effect was non-significant (HR=1.03, 95% CI=1.00-1.06, p=0.061). Among the foot self-care behaviors, lotion-applying behavior was the only variable that significantly predicted the occurrence of diabetic foot ulcer, even after controlling for demographic variables and diabetic foot ulcer predictors (neuropathy severity, number of diabetic foot ulcer hospitalizations, insulin treatment, and peripheral vascular disease; HR=1.19, 95% CI=1.04-1.36, p=0.012). Among patients with diabetic neuropathy, foot self-care practice may be insufficient to prevent the occurrence of diabetic

The influence of transient change of total body water on relative body fats based on three bioelectrical impedance analyses methods. Comparison between before and after exercise with sweat loss, and after drinking.

PubMed

Demura, S; Yamaji, S; Goshi, F; Nagasawa, Y

2002-03-01

The purpose of this study was to clarify the influence of change of total body water caused by exercise and drinking, on relative body fat (%BF) based on three bioelectrical impedance analyses (BIA) methods, between hand and foot (H-F), between hand and hand (H-H), and between foot and foot (F-F). The subjects were 30 Japanese healthy young adults aged 18 to 23 years (15 males, 15 females). Measurements were made three times for each BIA method; before and after exercise with sweat, and after drinking, and also twice according to the under water weighing (UW) method, before exercise and after drinking. A pedaling exercise, with a bicycle ergometer, was used for 60 minutes as the exercise. The relationship of %BF between the UW method and each BIA method was mid-range or more (r=0.765-0.839). However, %BF based on the H-F and F-F BIA methods were higher than that based on the UW method. After drinking, %BF of all the BIA methods were higher than the UW method. %BF of the BIA methods after exercise indicated values lower than those before exercise. %BF of the H-F and H-H BIA methods after drinking were a little higher than those before exercise, indicating that those measurements reflect a slight change of body water. It was demonstrated that %BF of any BIA method reflect the change of body water caused by exercise, sweating, and drinking.

Diabetic Foot - Multiple Languages

MedlinePlus

... Are Here: Home → Multiple Languages → All Health Topics → Diabetic Foot URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Diabetic Foot - Multiple Languages To use the sharing features on ...

A new approach to children's footwear based on foot type classification.

PubMed

Mauch, M; Grau, S; Krauss, I; Maiwald, C; Horstmann, T

2009-08-01

Current shoe designs do not allow for the comprehensive 3-D foot shape, which means they are unable to reproduce the wide variability in foot morphology. Therefore, the purpose of this study was to capture these variations of children's feet by classifying them into groups (types) and thereby provide a basis for their implementation in the design of children's shoes. The feet of 2867 German children were measured using a 3-D foot scanner. Cluster analysis was then applied to classify the feet into three different foot types. The characteristics of these foot types differ regarding their volume and forefoot shape both within and between shoe sizes. This new approach is in clear contrast to previous systems, since it captures the variability of foot morphology in a more comprehensive way by using a foot typing system and therefore paves the way for the unimpaired development of children's feet. Previous shoe systems do not allow for the wide variations in foot morphology. A new approach was developed regarding different morphological foot types based on 3-D measurements relevant in shoe construction. This can be directly applied to create specific designs for children's shoes.

Effect of Intravenous Infusion Solutions on Bioelectrical Impedance Spectroscopy.

PubMed

Yap, Jason; Rafii, Mahroukh; Azcue, Maria; Pencharz, Paul

2017-05-01

Bioelectrical impedance (BIA) is often used to measure body fluid spaces and thereby body composition. However, in acute animal studies, we found that impedance was driven by the saline content of intravenous (IV) fluids and not by the volume. The aim of the study was to investigate the effect of 3 different fluids acutely administered on the change in impedance, specifically resistance (R). Nine healthy adults participated in 3 treatment (0.9% saline, 5% dextrose, and a mixture of 0.3% saline + 3.3% dextrose) experiments on nonconsecutive days. They all received 1 L of one of the treatments intravenously over a 1-hour period. Repeated BIA measurements were performed prior to IV infusion and then every 5 minutes for the 1-hour infusion period, plus 3 more measurements up to 15 minutes after the completion of the infusion. The change in R in the 0.9% saline infusion experiment was significantly lower than that of the glucose and mixture treatment ( P < .001). Bioelectrical impedance spectroscopy and BIA measure salt rather than the volume changes over the infusion period. Hence, in patients receiving IV fluids, BIA of any kind (single frequency or multifrequency) cannot be used to measure body fluid spaces or body composition.

Foot Conditions among Homeless Persons: A Systematic Review

PubMed Central

To, Matthew J.; Brothers, Thomas D.; Van Zoost, Colin

2016-01-01

Introduction Foot problems are common among homeless persons, but are often overlooked. The objectives of this systematic review are to summarize what is known about foot conditions and associated interventions among homeless persons. Methods A literature search was conducted on MEDLINE (1966–2016), EMBASE (1947–2016), and CINAHL (1982–2016) and complemented by manual searches of reference lists. Articles that described foot conditions in homeless persons or associated interventions were included. Data were independently extracted on: general study characteristics; participants; foot assessment methods; foot conditions and associated interventions; study findings; quality score assessed using the Downs and Black checklist. Results Of 333 articles screened, 17 articles met criteria and were included in the study. Prevalence of any foot problem ranged from 9% to 65% across study populations. Common foot-related concerns were corns and calluses, nail pathologies, and infections. Foot pathologies related to chronic diseases such as diabetes were identified. Compared to housed individuals across studies, homeless individuals were more likely to have foot problems including tinea pedis, foot pain, functional limitations with walking, and improperly-fitting shoes. Discussion Foot conditions were highly prevalent among homeless individuals with up to two thirds reporting a foot health concern, approximately one quarter of individuals visiting a health professional, and one fifth of individuals requiring further follow-up due to the severity of their condition. Homeless individuals often had inadequate foot hygiene practices and improperly-fitting shoes. These findings have service provision and public health implications, highlighting the need for evidence-based interventions to improve foot health in this population. An effective interventional approach could include optimization of foot hygiene and footwear, provision of comprehensive medical treatment, and

Ertapenem for diabetic foot infections.

PubMed

Rogers, Lee C; Bevilacqua, Nicholas J; Armstrong, David G

2006-11-01

Foot infections are a common cause of hospitalization in people with diabetes. Diabetic foot infections are associated with increased risk of amputation and death. This monograph reviews the diagnosis and treatment of diabetic foot infections with particular attention to a new carbapenem antibiotic, ertapenem, which has the potential to reduce inpatient length of stay and hospital-associated costs. (c) 2006 Prous Science. All rights reserved.

Athlete's foot.

PubMed

Crawford, Fay

2006-11-01

Around 15-25% of people are likely to have athlete's foot at any one time. The infection can spread to other parts of the body and to other people. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical treatments for athlete's foot? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 11 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: improved foot hygiene, including socks, and hosiery; topical allylamines (naftifine, terbinafine); topical azoles; and topical ciclopirox olamine.

Computer-aided design of customized foot orthoses: reproducibility and effect of method used to obtain foot shape.

PubMed

Telfer, Scott; Gibson, Kellie S; Hennessy, Kym; Steultjens, Martijn P; Woodburn, Jim

2012-05-01

To determine, for a number of techniques used to obtain foot shape based around plaster casting, foam box impressions, and 3-dimensional scanning, (1) the effect the technique has on the overall reproducibility of custom foot orthoses (FOs) in terms of inter- and intracaster reliability and (2) the reproducibility of FO design by using computer-aided design (CAD) software in terms of inter- and intra-CAD operator reliability for all these techniques. Cross-sectional study. University laboratory. Convenience sample of individuals (N=22) with noncavus foot types. Not applicable. Parameters of the FO design (length, width at forefoot, width at rearfoot, and peak medial arch height), the forefoot to rearfoot angle of the foot shape, and overall volume match between device designs. For intra- and intercaster reliability of the different methods of obtaining the foot shape, all methods fell below the reproducibility quality threshold for the medial arch height of the device, and volume matching was <80% for all methods. The more experienced CAD operator was able to achieve excellent reliability (intraclass correlation coefficients >0.75) for all variables with the exception of forefoot to rearfoot angle, with overall volume matches of >87% of the devices. None of the techniques for obtaining foot shape met all the criteria for excellent reproducibility, with the peak arch height being particularly variable. Additional variability is added at the CAD stage of the FO design process, although with adequate operator experience good to excellent reproducibility may be achieved at this stage. Taking only basic linear or angular measurement parameters from the device may fail to fully capture the variability in FO design. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Biomechanics of the Ankle-Foot System during Stair Ambulation: Implications for Design of Advanced Ankle-Foot Prostheses

DTIC Science & Technology

2011-12-15

Biomechanics of the ankle–foot system during stair ambulation: Implications for design of advanced ankle–foot prostheses$ Emily H. Sinitski a, Andrew...Wilken). Please cite this article as: Sinitski, E.H., et al., Biomechanics of the ankle–foot system during stair ambulation: Implications for design of...REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Biomechanics Of The Ankle-Foot System During Stair Ambulation

Foot Complications in a Representative Australian Inpatient Population

PubMed Central

Hurn, Sheree E.; Kamp, Maarten C.; Ng, Vanessa; Thomas, Courtney; Jen, Scott; Wills, Jude; Kinnear, Ewan M.; d'Emden, Michael C.; Reed, Lloyd F.

2017-01-01

We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p < 0.01). Previous amputation (4.1%) was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p < 0.01). Previous foot ulceration (9.8%) was associated with PN, PAD, past podiatry, and past nurse treatment (p < 0.02). PAD (21.0%) was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p < 0.02). PN (22.0%) was associated with older age, diabetes, mobility impairment, and PAD (p < 0.05). Foot deformity (22.4%) was associated with older age, mobility impairment, past podiatry treatment, and PN (p < 0.01). Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment. PMID:29164152

What Is a Foot and Ankle Surgeon?

MedlinePlus

... Foot & Ankle Surgeon? A A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle ... of conditions that affect people of every age. What education has a foot and ankle surgeon received? ...

Assessment of foot perfusion in patients with a diabetic foot ulcer.

PubMed

Forsythe, Rachael O; Hinchliffe, Robert J

2016-01-01

Assessment of foot perfusion is a vital step in the management of patients with diabetic foot ulceration, in order to understand the risk of amputation and likelihood of wound healing. Underlying peripheral artery disease is a common finding in patients with foot ulceration and is associated with poor outcomes. Assessment of foot perfusion should therefore focus on identifying the presence of peripheral artery disease and to subsequently estimate the effect this may have on wound healing. Assessment of perfusion can be difficult because of the often complex, diffuse and distal nature of peripheral artery disease in patients with diabetes, as well as poor collateralisation and heavy vascular calcification. Conventional methods of assessing tissue perfusion in the peripheral circulation may be unreliable in patients with diabetes, and it may therefore be difficult to determine the extent to which poor perfusion contributes to foot ulceration. Anatomical data obtained on cross-sectional imaging is important but must be combined with measurements of tissue perfusion (such as transcutaneous oxygen tension) in order to understand the global and regional perfusion deficit present in a patient with diabetic foot ulceration. Ankle-brachial pressure index is routinely used to screen for peripheral artery disease, but its use in patients with diabetes is limited in the presence of neuropathy and medial arterial calcification. Toe pressure index may be more useful because of the relative sparing of pedal arteries from medial calcification but may not always be possible in patients with ulceration. Fluorescence angiography is a non-invasive technique that can provide rapid quantitative information about regional tissue perfusion; capillaroscopy, iontophoresis and hyperspectral imaging may also be useful in assessing physiological perfusion but are not widely available. There may be a future role for specialized perfusion imaging of these patients, including magnetic resonance

Bioelectrical Impedance and The Frequency Dependent Current Conduction Through Biological Tissues: A Short Review

NASA Astrophysics Data System (ADS)

Kanti Bera, Tushar

2018-03-01

Biological tissues are developed with biological cells which exhibit complex electrical impedance called electrical bioimpedance. Under an alternating electrical excitation the bioimpedance varies with the tissue anatomy, composition and the signal frequency. The current penetration and conduction paths vary with frequency of the applied signal. Bioimpedance spectroscopy is used to study the frequency response of the electrical impedance of biological materials noninvasively. In bioimpedance spectroscopy, a low amplitude electrical signal is injected to the tissue sample or body parts to characterization the sample in terms of its bioimpedance. The electrical current conduction phenomena, which is highly influenced by the tissue impedance and the signal frequency, is an important phenomena which should be studied to understand the bioimpedance techniques like bioelectrical impedance analysis (BIA), EIS, or else. In this paper the origin of bioelectrical impedance and current conduction phenomena has been reviewed to present a brief summary of bioelectrical impedance and the frequency dependent current conduction through biological tissues. Simulation studies are conducted with alternation current injection through a two dimensional model of biological tissues containing finite number of biological cells suspended in extracellular fluid. The paper demonstrates the simulation of alternating current conduction through biological tissues conducted by COMSOL Multiphysics. Simulation studies also show the frequency response of the tissue impedance for different tissue compositions.

Mechanism and Design Analysis of Articulated Ankle Foot Orthoses for Drop-Foot

PubMed Central

Choudhury, Imtiaz Ahmed; Mamat, Azuddin Bin

2014-01-01

Robotic technologies are being employed increasingly in the treatment of lower limb disabilities. Individuals suffering from stroke and other neurological disorders often experience inadequate dorsiflexion during swing phase of the gait cycle due to dorsiflexor muscle weakness. This type of pathological gait, mostly known as drop-foot gait, has two major complications, foot-slap during loading response and toe-drag during swing. Ankle foot orthotic (AFO) devices are mostly prescribed to resolve these complications. Existing AFOs are designed with or without articulated joint with various motion control elements like springs, dampers, four-bar mechanism, series elastic actuator, and so forth. This paper examines various AFO designs for drop-foot, discusses the mechanism, and identifies limitations and remaining design challenges. Along with two commercially available AFOs some designs possess promising prospective to be used as daily-wear device. However, the design and mechanism of AFO must ensure compactness, light weight, low noise, and high efficiency. These entailments present significant engineering challenges to develop a new design with wide consumer adoption. PMID:24892102

Nurses' foot care activities in home health care.

PubMed

Stolt, Minna; Suhonen, Riitta; Puukka, Pauli; Viitanen, Matti; Voutilainen, Päivi; Leino-Kilpi, Helena

2013-01-01

This study described the basic foot care activities performed by nurses and factors associated with these in the home care of older people. Data were collected from nurses (n=322) working in nine public home care agencies in Finland using the Nurses' Foot Care Activities Questionnaire (NFAQ). Data were analyzed statistically using descriptive statistics and multivariate liner models. Although some of the basic foot care activities of nurses reported using were outdated, the majority of foot care activities were consistent with recommendations in foot care literature. Longer working experience, referring patients with foot problems to a podiatrist and physiotherapist, and patient education in wart and nail care were associated with a high score for adequate foot care activities. Continuing education should focus on updating basic foot care activities and increasing the use of evidence-based foot care methods. Also, geriatric nursing research should focus in intervention research to improve the use of evidence-based basic foot care activities. Copyright © 2013 Mosby, Inc. All rights reserved.

The Influence of Segmental Impedance Analysis in Predicting Validity of Consumer Grade Bioelectrical Impedance Analysis Devices

NASA Astrophysics Data System (ADS)

Sharp, Andy; Heath, Jennifer; Peterson, Janet

2008-05-01

Consumer grade bioelectric impedance analysis (BIA) instruments measure the body's impedance at 50 kHz, and yield a quick estimate of percent body fat. The frequency dependence of the impedance gives more information about the current pathway and the response of different tissues. This study explores the impedance response of human tissue at a range of frequencies from 0.2 - 102 kHz using a four probe method and probe locations standard for segmental BIA research of the arm. The data at 50 kHz, for a 21 year old healthy Caucasian male (resistance of 180φ±10 and reactance of 33φ±2) is in agreement with previously reported values [1]. The frequency dependence is not consistent with simple circuit models commonly used in evaluating BIA data, and repeatability of measurements is problematic. This research will contribute to a better understanding of the inherent difficulties in estimating body fat using consumer grade BIA devices. [1] Chumlea, William C., Richard N. Baumgartner, and Alex F. Roche. ``Specific resistivity used to estimate fat-free mass from segmental body measures of bioelectrical impedance.'' Am J Clin Nutr 48 (1998): 7-15.

Evaluation of a new geriatric foot versus the Solid Ankle Cushion Heel foot for low-activity amputees.

PubMed

Bonnet, Xavier; Adde, Jean N; Blanchard, François; Gedouin-Toquet, Annick; Eveno, Dominique

2015-04-01

It is always a challenge to rehabilitate geriatric amputees to perform self-care skills at home with limited ambulation. A new geriatric foot (with a lower effective foot length) has been specifically designed to reduce residual limb stress and to ease the step completion. The aim of this study is to evaluate the benefit of a new geriatric foot versus a Solid Ankle Cushion Heel foot for low-activity persons with transtibial amputation. Crossover study. A total of 12 patients were included in this study. 2-min walking test, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 questionnaire and pressure socket measurements. The geriatric foot allows for greater patient satisfaction. The maximal pressure was significantly lower in the proximal anterior stump area. No statistical differences were obtained from the 2-min walking test. A geriatric foot designed with a low effective foot length improves the satisfaction and reduces proximal anterior socket pressures for poor-performing persons with transtibial amputation. The development and evaluation of feet specifically designed for geriatric persons with transtibial amputation could improve their specific requirements and satisfaction. © The International Society for Prosthetics and Orthotics 2014.

Foot index: is it a tool for sex determination?

PubMed

Moudgil, Rohan; Kaur, Ramneet; Menezes, Ritesh G; Kanchan, Tanuj; Garg, Rakesh K

2008-05-01

Identification of an individual is of paramount importance in forensic investigations. The dimensions of the foot can be used for the determination of sex and stature of an individual in forensic investigations. No systematic studies are available on the determination of sex from foot measurements of North Indians. Therefore, foot index is derived to determine the sex of an individual in a single community of North India. The foot index for both genders is derived by dividing the foot breadth by foot length and multiplying it by hundred. In the present investigation, the foot index is found to be slightly higher in females in the right foot and males in the left foot. The study suggests that although foot length and foot breadth show significant sex differences, sex determination cannot be made conclusively from the foot index.

Prevention and treatment of diabetic foot ulcers.

PubMed

Lim, Jonathan Zhang Ming; Ng, Natasha Su Lynn; Thomas, Cecil

2017-03-01

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

The Athletic Foot and Its Import to Performance during Running.

ERIC Educational Resources Information Center

Bogdan, Richard

In this paper, problems and conditions of the foot, including flat feet, achilles tendon problems, heel spur syndrome, digital problems, shin splints, and leg stress fractures, are examined. Ways to examine the athlete's foot and leg are described, including the one-foot test and the off weight-bearing examination. (CJ)

Athlete's foot

PubMed Central

2009-01-01

Introduction Around 15% to 25% of people are likely to have athlete's foot at any one time. The infection can spread to other parts of the body and to other people. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical treatments for athlete's foot? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: improved foot hygiene, including socks and hosiery; topical allylamines (naftifine and terbinafine); topical azoles (bifonazole, clotrimazole, econazole nitrate, miconazole nitrate, sulconazole nitrate, and tioconazole); and topical ciclopirox olamine. PMID:21696646

Athlete's foot.

PubMed

Crawford, Fay

2009-07-20

Around 15% to 25% of people are likely to have athlete's foot at any one time. The infection can spread to other parts of the body and to other people. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical treatments for athlete's foot? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: improved foot hygiene, including socks and hosiery; topical allylamines (naftifine and terbinafine); topical azoles (bifonazole, clotrimazole, econazole nitrate, miconazole nitrate, sulconazole nitrate, and tioconazole); and topical ciclopirox olamine.

Comparison of foot muscle morphology and foot kinematics between recreational runners with normal feet and with asymptomatic over-pronated feet.

PubMed

Zhang, Xianyi; Aeles, Jeroen; Vanwanseele, Benedicte

2017-05-01

Over-pronated feet are common in adults and are associated with lower limb injuries. Studying the foot muscle morphology and foot kinematic patterns is important for understanding the mechanism of over-pronation related injuries. The aim of this study is to compare the foot muscle morphology and foot inter-segmental kinematics between recreational runners with normal feet and those with asymptomatic over-pronated feet. A total of 26 recreational runners (17 had normal feet and 9 had over-pronated feet) participated in this study and their foot type was assessed using the 6-item Foot Posture Index. Selected foot muscles were scanned using an ultrasound device and the scanned images were processed to measure the thickness and cross-sectional area of the muscles. Muscles of interest include abductor hallucis, abductor digiti minimi, flexor digitorum brevis and longus, tibialis anterior and peroneus muscles. Foot kinematic data during walking was collected using a 3D motion capture system incorporating the Oxford Foot Model. The results show that individuals with over-pronated feet have larger size of abductor hallucis, flexor digitorum brevis and longus and smaller abductor digiti minimi than controls. Higher rearfoot peak eversion and forefoot peak supination during walking were observed in individuals with over-pronated feet. However, during gait the forefoot peak abduction was comparable. These findings indicate that in active asymptomatic individuals with over-pronated feet, the foot muscle morphology is adapted to increase control of the foot motion. The morphological characteristics of the foot muscles in asymptomatic individuals with over-pronated feet may affect their foot kinematics and benefit prevention from injuries. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of static foot posture on the dynamic stiffness of foot joints during walking.

PubMed

Sanchis-Sales, E; Sancho-Bru, J L; Roda-Sales, A; Pascual-Huerta, J

2018-05-01

The static foot posture has been related to the development of lower limb injuries. This study aimed to investigate the dynamic stiffness of foot joints during gait in the sagittal plane to understand the role of the static foot posture in the development of injuries. Seventy healthy adult male subjects with different static postures, assessed by the Foot Posture Index (FPI) (30 normal, 20 highly pronated and 20 highly supinated), were recruited. Kinematic and kinetic data were recorded using an optical motion capture system and a pressure platform, and dynamic stiffness at the different stages of the stance was calculated from the slopes of the linear regression on the flexion moment-angle curves. The effect of foot type on dynamic stiffness and on ranges of motion and moments was analysed using ANOVAs and post-hoc tests, and linear correlation between dynamic stiffness and FPI was also tested. Highly pronated feet showed a significantly smaller range of motion at the ankle and metatarsophalangeal joints and also a larger range of moments at the metatarsophalangeal joint than highly supinated feet. Dynamic stiffness during propulsion was significantly greater at all foot joints for highly pronated feet, with positive significant correlations with the squared FPI. Highly supinated feet showed greater dynamic stiffness than normal feet, although to a lesser extent. Highly pronated feet during normal gait experienced the greatest decrease in the dorsiflexor moments during propulsion, normal feet being the most balanced regarding work generated and absorbed. Extreme static foot postures show greater dynamic stiffness during propulsion and greater absorbed work, which increases the risk of developing injuries. The data presented may be used when designing orthotics or prostheses, and also when planning surgery that modifies joint stiffness. Copyright © 2018 Elsevier B.V. All rights reserved.

Comparing 3D foot scanning with conventional measurement methods.

PubMed

Lee, Yu-Chi; Lin, Gloria; Wang, Mao-Jiun J

2014-01-01

Foot dimension information on different user groups is important for footwear design and clinical applications. Foot dimension data collected using different measurement methods presents accuracy problems. This study compared the precision and accuracy of the 3D foot scanning method with conventional foot dimension measurement methods including the digital caliper, ink footprint and digital footprint. Six commonly used foot dimensions, i.e. foot length, ball of foot length, outside ball of foot length, foot breadth diagonal, foot breadth horizontal and heel breadth were measured from 130 males and females using four foot measurement methods. Two-way ANOVA was performed to evaluate the sex and method effect on the measured foot dimensions. In addition, the mean absolute difference values and intra-class correlation coefficients (ICCs) were used for precision and accuracy evaluation. The results were also compared with the ISO 20685 criteria. The participant's sex and the measurement method were found (p < 0.05) to exert significant effects on the measured six foot dimensions. The precision of the 3D scanning measurement method with mean absolute difference values between 0.73 to 1.50 mm showed the best performance among the four measurement methods. The 3D scanning measurements showed better measurement accuracy performance than the other methods (mean absolute difference was 0.6 to 4.3 mm), except for measuring outside ball of foot length and foot breadth horizontal. The ICCs for all six foot dimension measurements among the four measurement methods were within the 0.61 to 0.98 range. Overall, the 3D foot scanner is recommended for collecting foot anthropometric data because it has relatively higher precision, accuracy and robustness. This finding suggests that when comparing foot anthropometric data among different references, it is important to consider the differences caused by the different measurement methods.

Kinematic foot types in youth with equinovarus secondary to hemiplegia.

PubMed

Krzak, Joseph J; Corcos, Daniel M; Damiano, Diane L; Graf, Adam; Hedeker, Donald; Smith, Peter A; Harris, Gerald F

2015-02-01

Elevated kinematic variability of the foot and ankle segments exists during gait among individuals with equinovarus secondary to hemiplegic cerebral palsy (CP). Clinicians have previously addressed such variability by developing classification schemes to identify subgroups of individuals based on their kinematics. To identify kinematic subgroups among youth with equinovarus secondary to CP using 3-dimensional multi-segment foot and ankle kinematics during locomotion as inputs for principal component analysis (PCA), and K-means cluster analysis. In a single assessment session, multi-segment foot and ankle kinematics using the Milwaukee Foot Model (MFM) were collected in 24 children/adolescents with equinovarus and 20 typically developing children/adolescents. PCA was used as a data reduction technique on 40 variables. K-means cluster analysis was performed on the first six principal components (PCs) which accounted for 92% of the variance of the dataset. The PCs described the location and plane of involvement in the foot and ankle. Five distinct kinematic subgroups were identified using K-means clustering. Participants with equinovarus presented with variable involvement ranging from primary hindfoot or forefoot deviations to deformtiy that included both segments in multiple planes. This study provides further evidence of the variability in foot characteristics associated with equinovarus secondary to hemiplegic CP. These findings would not have been detected using a single segment foot model. The identification of multiple kinematic subgroups with unique foot and ankle characteristics has the potential to improve treatment since similar patients within a subgroup are likely to benefit from the same intervention(s). Copyright © 2014 Elsevier B.V. All rights reserved.

Kinematic foot types in youth with equinovarus secondary to hemiplegia

PubMed Central

Krzak, Joseph J.; Corcos, Daniel M.; Damiano, Diane L.; Graf, Adam; Hedeker, Donald; Smith, Peter A.; Harris, Gerald F.

2015-01-01

Background Elevated kinematic variability of the foot and ankle segments exists during gait among individuals with equinovarus secondary to hemiplegic cerebral palsy (CP). Clinicians have previously addressed such variability by developing classification schemes to identify subgroups of individuals based on their kinematics. Objective To identify kinematic subgroups among youth with equinovarus secondary to CP using 3-dimensional multi-segment foot and ankle kinematics during locomotion as inputs for principal component analysis (PCA), and K-means cluster analysis. Methods In a single assessment session, multi-segment foot and ankle kinematics using the Milwaukee Foot Model (MFM) were collected in 24 children/adolescents with equinovarus and 20 typically developing children/adolescents. Results PCA was used as a data reduction technique on 40 variables. K-means cluster analysis was performed on the first six principal components (PCs) which accounted for 92% of the variance of the dataset. The PCs described the location and plane of involvement in the foot and ankle. Five distinct kinematic subgroups were identified using K-means clustering. Participants with equinovarus presented with variable involvement ranging from primary hindfoot or forefoot deviations to deformtiy that included both segments in multiple planes. Conclusion This study provides further evidence of the variability in foot characteristics associated with equinovarus secondary to hemiplegic CP. These findings would not have been detected using a single segment foot model. The identification of multiple kinematic subgroups with unique foot and ankle characteristics has the potential to improve treatment since similar patients within a subgroup are likely to benefit from the same intervention(s). PMID:25467429

Foot Type Biomechanics Part 2: are structure and anthropometrics related to function?

PubMed

Mootanah, Rajshree; Song, Jinsup; Lenhoff, Mark W; Hafer, Jocelyn F; Backus, Sherry I; Gagnon, David; Deland, Jonathan T; Hillstrom, Howard J

2013-03-01

Many foot pathologies are associated with specific foot types. If foot structure and function are related, measurement of either could assist with differential diagnosis of pedal pathologies. Biomechanical measures of foot structure and function are related in asymptomatic healthy individuals. Sixty-one healthy subjects' left feet were stratified into cavus (n=12), rectus (n=27) and planus (n=22) foot types. Foot structure was assessed by malleolar valgus index, arch height index, and arch height flexibility. Anthropometrics (height and weight), age, and walking speed were measured. Foot function was assessed by center of pressure excursion index, peak plantar pressure, maximum force, and gait pattern parameters. Foot structure and anthropometric variables were entered into stepwise linear regression models to identify predictors of function. Measures of foot structure and anthropometrics explained 10-37% of the model variance (adjusted R(2)) for gait pattern parameters. When walking speed was included, the adjusted R(2) increased to 45-77% but foot structure was no longer a factor. Foot structure and anthropometrics predicted 7-47% of the model variance for plantar pressure and 16-64% for maximum force parameters. All multivariate models were significant (p<0.05), supporting acceptance of the hypothesis. Foot structure and function are related in asymptomatic healthy individuals. The structural parameters employed are basic measurements that do not require ionizing radiation and could be used in a clinical setting. Further research is needed to identify additional predictive parameters (plantar soft tissue characteristics, skeletal alignment, and neuromuscular control) and to include individuals with pathology. Copyright © 2012. Published by Elsevier B.V.

Foot Plantar Pressure Measurement System: A Review

PubMed Central

Razak, Abdul Hadi Abdul; Zayegh, Aladin; Begg, Rezaul K.; Wahab, Yufridin

2012-01-01

Foot plantar pressure is the pressure field that acts between the foot and the support surface during everyday locomotor activities. Information derived from such pressure measures is important in gait and posture research for diagnosing lower limb problems, footwear design, sport biomechanics, injury prevention and other applications. This paper reviews foot plantar sensors characteristics as reported in the literature in addition to foot plantar pressure measurement systems applied to a variety of research problems. Strengths and limitations of current systems are discussed and a wireless foot plantar pressure system is proposed suitable for measuring high pressure distributions under the foot with high accuracy and reliability. The novel system is based on highly linear pressure sensors with no hysteresis. PMID:23012576

Illiteracy and diabetic foot complications.

PubMed

Al-Kaabi, Juma M; Al Maskari, Fatma; Cragg, Paul; Afandi, Bachar; Souid, Abdul-Kader

2015-12-01

Diabetes is especially common in the United Arab Emirates. Its complications in patients residing in the region have yet to be fully explored. This study reports on foot problems in our diabetic patients, with emphasis on the impact of illiteracy on foot care and complications due to diabetes. Adults were randomly recruited from the Diabetes Center at Tawam-John Hopkins affiliated hospital. A questionnaire addressing foot care and problems was completed for all patients. In addition, an examination was performed by a trained nurse, an endocrinologist, and a podiatrist. Four hundred twenty-two adults with type 2 (93%) or type 1 (7%) diabetes were enrolled; 67% were females. Patients' mean age was 52 ± 13 years and duration of diabetes ≥ 1 year. Illiterate patients were 51% and were less likely to practice foot care (p=0.002), recognize foot risk factors (p=0.004), use proper footwear (p=0.010), and being physically active (p<0.001). In addition, they were more likely to have diabetic complications, such as neuropathy (p=0.027), eye disease (p=0.032), hypertension (p<0.001), obesity (p=0.003), increased body fat percentage (p<0.001), reduced capillary refill time (p=0.002), reduced monofilament (p=0.003), and reduced vibration (p<0.001). Logistic regression analysis revealed literates [OR=2.4, CI=1.1-5.4, p=0.031], female gender [OR=2.7, CI=1.1-6.2, p=0.023], and history of foot ulcer [OR=6.0, CI=2.1-17.2, p=0.001] were predictors of practicing foot care. Illiteracy invoked significant challenges to diabetic attentiveness and imposed increased foot complications. Physicians should realize that illiterate patients are vulnerable and require effective strategies to improve their education about the disease and reduce their diabetic complications. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Research on the Effect of the Foot Bath and Foot Massage on Residual Schizophrenia Patients.

PubMed

Kito, Kazuko; Suzuki, Keiko

2016-06-01

Researchers performed foot baths and massages for residual schizophrenia patients to gauge the effects on psychiatric symptoms. Subjects were six residual schizophrenia patients hospitalized in a psychiatric hospital. Three times a week for 4weeks, they received an 8-minute effleurage massage to their legs after a 10-minute foot bath. The effect of physiological relaxation was identified by a significant decline in heart rate in all cases. The results of the Positive and Negative Symptom Scale are as follows: a mean score of 29.0 was measured before treatment, which lowered to 21.5 after treatment, indicating that foot care improved their negative symptoms (p<0.05).The results of the Quality of Life Scale before the foot care intervention, were 10.5 and increased to 34.0 after the intervention, indicating improvement in their quality of life (p<0.05). The results of the two measurements indicate that foot baths and massages were effective in improving psychiatric symptoms. Copyright © 2016 Elsevier Inc. All rights reserved.

[Minor foot amputations in diabetic foot syndrome].

PubMed

Biehl, C; Eckhard, M; Szalay, G; Heiss, C

2016-10-01

The treatment strategy for diabetic foot syndrome must take into account protective sensibility of the foot, open wounds, infection status, and the rules of septic bone surgery. Interventions are classified as elective, prophylactic, curative, or emergency. Amputations in the forefoot and midfoot region are performed as ray amputations (including metatarsal), which can often be carried out as "inner" amputations. Gentle tissue treatment mandatory because of greater risk of revision with re-amputation compared to classical amputation. Good demarcation of infection, acute osteomyelitis, osteolytic lesions, neurotropic ulcer, arterial and venous blood flow to the other toes, gangrene of other toes with metatarsal affection. Arterial occlusive disease, infection of neighboring areas, avoidable amputations, poorly healing ulcers on the lower leg. Primary dorsal approach; minimal incisional distance (5 cm) to minimize skin necrosis risk. Atraumatic preparation, minimize hemostasis to not compromise the borderline perfusion situation. In amputations, plantar skin preparation and longer seams placed as dorsal as possible, either disarticulated and maintain cartilage, or round the cortical metatarsal bone after resection. Diabetes control. Braun splint, mobilization in a shoe with forefoot decompression and hindfoot support, physiotherapy. Antibiotics based on resistance testing. If no complications, dressing change on postoperative day 1. Optimal wound drainage by lowering foot several times a day; drainage removal after 12-24 h. Insoles and footwear optimization. Amputations require continued attention and if necessary treatment to avoid sequelae. Insufficient treatment associated with recurrent ulceration and altered anatomy.

The Influence of Beliefs About Health and Illness on Foot Care in Ugandan Persons with Diabetic Foot Ulcers

PubMed Central

Hjelm, Katarina; Beebwa, Esther

2013-01-01

Diabetes mellitus is becoming pandemic, particularly affecting Sub-Saharan Africa, and the prevalence of complications is increasing. Diabetic foot disorders are a major source of morbidity and disability. Delay in the health care process due to patients’ beliefs may have deleterious consequences for limb and life in persons with diabetic foot ulcers. No previous studies of beliefs about health and illness in persons with diabetic foot ulcers living in Africa have been found. The aim of the study was to explore beliefs about health and illness among Ugandans with diabetic foot ulcers that might affect self-care and care seeking behaviour. In an explorative study with consecutive sample semi-structured interviews were held with 14 Ugandan men and women, aged 40-79, with diabetic foot ulcer. Knowledge was limited about causes, management and prevention of diabetic foot ulcers. Foot ulcers were often detected as painful sores, perceived to heal or improve, and led to stress and social isolation due to smell and reduced mobility. Most lacked awareness of the importance of complete daily foot care and seldom practised self-care. Health was described as absence of disease and pain. Many feared future health and related it to contact with nurses in the professional sector from whom they sought information, blood tests and wound dressings and desired better organised diabetes clinics offering health education and more opening hours. Many have an underutilised potential for self-care and need education urgently, delivered in well-organised diabetes clinics working to raise awareness of the threat and prevent foot ulcers. PMID:24039644

The Relationship with Balance, Foot Posture, and Foot Size in School of Physical Education and Sports Students

ERIC Educational Resources Information Center

Irez, Gonul Babayigit

2014-01-01

The aim of this study is to investigate the relationship of foot posture and foot size with balance. A hundred and thirteen healthy volunteers were recruited from undergraduate students (Male = 74, Female = 37, age range 18-22). The Foot Posture Index (FPI-6), anthropometric measurements, dynamic balance and static balance measurements were done…

Foot Type Biomechanics Part 2: Are structure and anthropometrics related to function?

PubMed Central

Mootanah, Rajshree; Song, Jinsup; Lenhoff, Mark W.; Hafer, Jocelyn F.; Backus, Sherry I.; Gagnon, David; Deland, Jonathan T.; Hillstrom, Howard J.

2013-01-01

Background Many foot pathologies are associated with specific foot types. If foot structure and function are related, measurement of either could assist with differential diagnosis of pedal pathologies. Hypothesis Biomechanical measures of foot structure and function are related in asymptomatic healthy individuals. Methods Sixty-one healthy subjects' left feet were stratified into cavus (n = 12), rectus (n = 27) and planus (n = 22) foot types. Foot structure was assessed by malleolar valgus index, arch height index, and arch height flexibility. Anthropometrics (height and weight), age, and walking speed were measured. Foot function was assessed by center of pressure excursion index, peak plantar pressure, maximum force, and gait pattern parameters. Foot structure and anthropometric variables were entered into stepwise linear regression models to identify predictors of function. Results Measures of foot structure and anthropometrics explained 10–37% of the model variance (adjusted R2) for gait pattern parameters. When walking speed was included, the adjusted R2 increased to 45–77% but foot structure was no longer a factor. Foot structure and anthropometrics predicted 7–47% of the model variance for plantar pressure and 16–64% for maximum force parameters. All multivariate models were significant (p < 0.05), supporting acceptance of the hypothesis. Discussion and conclusion Foot structure and function are related in asymptomatic healthy individuals. The structural parameters employed are basic measurements that do not require ionizing radiation and could be used in a clinical setting. Further research is needed to identify additional predictive parameters (plantar soft tissue characteristics, skeletal alignment, and neuromuscular control) and to include individuals with pathology. PMID:23107624

3D foot shape generation from 2D information.

PubMed

Luximon, Ameersing; Goonetilleke, Ravindra S; Zhang, Ming

2005-05-15

Two methods to generate an individual 3D foot shape from 2D information are proposed. A standard foot shape was first generated and then scaled based on known 2D information. In the first method, the foot outline and the foot height were used, and in the second, the foot outline and the foot profile were used. The models were developed using 40 participants and then validated using a different set of 40 participants. Results show that each individual foot shape can be predicted within a mean absolute error of 1.36 mm for the left foot and 1.37 mm for the right foot using the first method, and within a mean absolute error of 1.02 mm for the left foot and 1.02 mm for the right foot using the second method. The second method shows somewhat improved accuracy even though it requires two images. Both the methods are relatively cheaper than using a scanner to determine the 3D foot shape for custom footwear design.

Room for improvement: patient, parent, and practitioners' perceptions of foot problems and foot care in juvenile idiopathic arthritis.

PubMed

Hendry, Gordon J; Turner, Debbie E; Lorgelly, Paula K; Woodburn, James

2012-11-01

To explore the perceived impact of disease-related foot problems and foot care in juvenile idiopathic arthritis (JIA) from the perspectives of patients, parents, pediatric rheumatologists, and health professionals. A qualitative study using an interpretative phenomenological approach. Outpatients department, public health service children's hospital. Patients (N=15; 4 adult patients, 2 parents of children with JIA, 3 pediatric rheumatologists, and 6 health professionals) from 2 National Health Service rheumatology centers (1 pediatric and 1 adult). Not applicable. Qualitative outcomes were participants' perceptions elicited using semistructured interviews (telephone or face-to-face) and focus groups using an interpretative phenomenological approach. A data-driven inductive approach to coding and theme development was adopted for transcript analysis. Participants volunteered to take part in a total of 7 interviews and 2 focus groups. The analysis revealed 6 key themes related to the impact of foot problems and perceptions of foot care from respective groups. These were the following: (1) pain, (2) mobility impairment, (3) reduced ability to perform activities of daily living, (4) footwear difficulties, (5) poor referral pathways/delayed access to care, and (6) lack of evidence in support of conservative foot care. Several areas for development of foot care services were identified including a need for improved referral pathways, shorter waiting times for initial consultations, greater attention to patient compliance, and a need for better evidence in support of customized foot orthoses. Several key foot health-related outcomes were identified, which may be of importance for measuring therapeutic response to foot-related interventions. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Pathophysiology diabetic foot ulcer

NASA Astrophysics Data System (ADS)

Syafril, S.

2018-03-01

Diabetes Mellitus (DM) is known to have many complications. Diabetes and its complications are rapidly becoming the world’s most significant cause of morbidity and mortality, and one of the most distressing is Diabetic Foot Ulcer (DFU). Chronic wound complications are a growing concern worldwide, and the effect is a warning to public health and the economy. The etiology of a DFU is multifaceted, and several components cause added together create a sufficient impact on ulceration: neuropathy, vasculopathy, immunopathy, mechanical stress, and neuroarthropathy. There are many classifications of the diabetic foot. About 50% of patients with foot ulcers due to DM present clinical signs of infection. It is essential to manage multifactorial etiology of DFU to get a good outcome.

The 'ABC' of examining foot radiographs.

PubMed

Pearse, Eyiyemi O; Klass, Benjamin; Bendall, Stephen P

2005-11-01

We report a simple systematic method of assessing foot radiographs that improves diagnostic accuracy and can reduce the incidence of inappropriate management of serious forefoot and midfoot injuries, particularly the Lisfranc-type injury. Five recently appointed senior house officers (SHOs), with no casualty or Orthopaedic experience prior to their appointment, were shown a set of 10 foot radiographs and told the history and examination findings recorded in the casualty notes of each patient within 6 weeks of taking up their posts. They were informed that the radiographs might or might not demonstrate an abnormality. They were asked to make a diagnosis and decide on a management plan. The test was repeated after they were taught the 'ABC' method of evaluating foot radiographs. Diagnostic accuracy improved after SHOs were taught a systematic method of assessing foot radiographs. The proportion of correct diagnoses increased from 0.64 to 0.78 and the probability of recognising Lisfranc injuries increased from 0 to 0.6. The use of this simple method of assessing foot radiographs can reduce the incidence of inappropriate management of serious foot injuries by casualty SHOs, in particular the Lisfranc type injury.

Age determination enhanced by embryonic foot bud and foot plate measurements in relation to Carnegie stages, and the influence of maternal cigarette smoking.

PubMed

Lutterodt, M C; Rosendahl, M; Yding Andersen, C; Skouby, S O; Byskov, A G

2009-08-01

Reliable age determination of first-trimester human embryos and fetuses is an important parameter for clinical use and basic science. Age determination by ultrasound or morphometric parameters of embryos 4-6 weeks post conception (p.c.) have been questioned, and more accurate methods are required. Data on whether and how maternal smoking and alcohol consumption influence embryonic and fetal foot growth is also lacking. Embryonic tissue from 102 first-trimester legal abortions (aged 35-69 days p.c.) were collected. All women answered a questionnaire concerning smoking and drinking habits, and delivered a urine sample for cotinine analysis. Embryonic age was evaluated by vaginal ultrasound measurements and by post-termination foot length and compared with the Carnegie stages. Foot bud and foot plate were defined and measured as foot length in embryos aged 35-47 days p.c. (range 0.8-2.1 mm). In embryos and fetuses aged 41-69 days p.c., heel-toe length was measured (range 2.5-7.5 mm). We found a significant linear correlation between foot length and age. Morphology of the feet was compared visually with the Carnegie collection, and we found that the mean ages of the two collections correlated well. Foot length was independent of gender, Environmental Tobacco Smoke, maternal smoking and alcohol consumption. Foot length correlated linearly to embryonic and foetal age, and was unaffected by gender, ETS, maternal smoking and alcohol consumption.

BIOELECTRICAL IMPEDANCE VECTOR ANALYSIS IDENTIFIES SARCOPENIA IN NURSING HOME RESIDENTS

USDA-ARS?s Scientific Manuscript database

Loss of muscle mass and water shifts between body compartments are contributing factors to frailty in the elderly. The body composition changes are especially pronounced in institutionalized elderly. We investigated the ability of single-frequency bioelectrical impedance analysis (BIA) to identify b...

29 CFR 1917.94 - Foot protection.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 7 2011-07-01 2011-07-01 false Foot protection. 1917.94 Section 1917.94 Labor Regulations...) MARINE TERMINALS Personal Protection § 1917.94 Foot protection. (a) The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot injuries...

Optimal foot shape for a passive dynamic biped.

PubMed

Kwan, Maxine; Hubbard, Mont

2007-09-21

Passive walking dynamics describe the motion of a biped that is able to "walk" down a shallow slope without any actuation or control. Instead, the walker relies on gravitational and inertial effects to propel itself forward, exhibiting a gait quite similar to that of humans. These purely passive models depend on potential energy to overcome the energy lost when the foot impacts the ground. Previous research has demonstrated that energy loss at heel-strike can vary widely for a given speed, depending on the nature of the collision. The point of foot contact with the ground (relative to the hip) can have a significant effect: semi-circular (round) feet soften the impact, resulting in much smaller losses than point-foot walkers. Collisional losses are also lower if a single impulse is broken up into a series of smaller impulses that gradually redirect the velocity of the center of mass rather than a single abrupt impulse. Using this principle, a model was created where foot-strike occurs over two impulses, "heel-strike" and "toe-strike," representative of the initial impact of the heel and the following impact as the ball of the foot strikes the ground. Having two collisions with the flat-foot model did improve efficiency over the point-foot model. Representation of the flat-foot walker as a rimless wheel helped to explain the optimal flat-foot shape, driven by symmetry of the virtual spoke angles. The optimal long period foot shape of the simple passive walking model was not very representative of the human foot shape, although a reasonably anthropometric foot shape was predicted by the short period solution.

Foot preferences during resting in wildfowl and waders.

PubMed

Randler, Christoph

2007-03-01

Footedness in birds has been reported, e.g., in parrots and chickens, but the direction of footedness remained unclear. Is a bird left-footed because it uses its left foot for holding and handling food, or is it right-footed because it uses the right foot for stabilisation and balancing while perching? In 2004 and 2006 I examined footedness in wildfowl and waders while the birds were performing a single task: roosting on the ground on one foot. Avocet (Recurvirostra avosetta), northern shoveller (Anas clypeata), oystercatcher (Haematopus ostralegus), and Eurasian curlew (Numenius arquata) were right-footed. Another 21 species did not show any significant foot preferences. This study provides some evidence that asymmetries in preferential foot use in birds may be triggered by a preference during postural control.

The clinical assessment study of the foot (CASF): study protocol for a prospective observational study of foot pain and foot osteoarthritis in the general population

PubMed Central

2011-01-01

Background Symptomatic osteoarthritis (OA) affects approximately 10% of adults aged over 60 years. The foot joint complex is commonly affected by OA, yet there is relatively little research into OA of the foot, compared with other frequently affected sites such as the knee and hand. Existing epidemiological studies of foot OA have focussed predominantly on the first metatarsophalangeal joint at the expense of other joints. This three-year prospective population-based observational cohort study will describe the prevalence of symptomatic radiographic foot OA, relate its occurrence to symptoms, examination findings and life-style-factors, describe the natural history of foot OA, and examine how it presents to, and is diagnosed and managed in primary care. Methods All adults aged 50 years and over registered with four general practices in North Staffordshire, UK, will be invited to participate in a postal Health Survey questionnaire. Respondents to the questionnaire who indicate that they have experienced foot pain in the preceding twelve months will be invited to attend a research clinic for a detailed clinical assessment. This assessment will consist of: clinical interview; physical examination; digital photography of both feet and ankles; plain x-rays of both feet, ankles and hands; ultrasound examination of the plantar fascia; anthropometric measurement; and a further self-complete questionnaire. Follow-up will be undertaken in consenting participants by postal questionnaire at 18 months (clinic attenders only) and three years (clinic attenders and survey participants), and also by review of medical records. Discussion This three-year prospective epidemiological study will combine survey data, comprehensive clinical, x-ray and ultrasound assessment, and review of primary care records to identify radiographic phenotypes of foot OA in a population of community-dwelling older adults, and describe their impact on symptoms, function and clinical examination findings

Age-related differences in women's foot shape.

PubMed

Ansuategui Echeita, Jone; Hijmans, Juha M; Smits, Sharon; Van der Woude, Lucas H V; Postema, Klaas

2016-12-01

Describe age-related differences in women's foot shape using a wide range of measurements and ages. Cross-sectional, observational study. Six foot-shape measurements of each foot: foot lengths, ball widths, ball circumferences, low instep circumferences, high instep circumferences, and heel instep circumference. 168 women from 20 to over 80 years of age, divided into seven age categories, were included. Older women had significantly greater foot-shape measurements, even after adjusting for Body Mass Index. Ball widths increased 3.1-4.0mm per decade, ball circumferences 5.6-7.4mm per decade, high instep circumferences 0.4-4.8mm per decade, and heel instep circumferences 1.8-1.9mm per decade. Ball widths, ball circumferences, and left high instep circumference plateaued in the 70-75 years-of-age category, and decreased in the oldest age category. For low instep circumference, age did not prevail significantly over Body Mass Index. Foot length was not associated with age. This study described women's progressive foot-shape changes with age. The findings provide a better understanding of foot-shape changes, mainly found in the forefoot. It demonstrates that for a good fit, shoe design for older adults and for younger adults should differ. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Chinese cross-cultural adaptation and validation of the Foot Function Index as tool to measure patients with foot and ankle functional limitations.

PubMed

González-Sánchez, Manuel; Ruiz-Muñoz, Maria; Li, Guang Zhi; Cuesta-Vargas, Antonio I

2018-08-01

To perform a cross-cultural adaptation and validation of the Foot Function Index (FFI) questionnaire to develop the Chinese version. Three hundred and six patients with foot and ankle neuromusculoskeletal diseases participated in this observational study. Construct validity, internal consistency and criterion validity were calculated for the FFI Chinese version after the translation and transcultural adaptation process. Internal consistency ranged from 0.996 to 0.998. Test-retest analysis ranged from 0.985 to 0.994; minimal detectable change 90: 2.270; standard error of measurement: 0.973. Load distribution of the three factors had an eigenvalue greater than 1. Chi-square value was 9738.14 (p < 0.001). Correlations with the three factors were significant between Factor 1 and the other two: r = -0.634 (Factor 2) and r = -0.191 (Factor 1). Foot Function Index (Taiwan Version), Short-Form 12 (Version 2) and EuroQol-5D were used for criterion validity. Factors 1 and 2 showed significant correlation with 15/16 and 14/16 scales and subscales, respectively. Foot Function Index Chinese version psychometric characteristics were good to excellent. Chinese researchers and clinicians may use this tool for foot and ankle assessment and monitoring. Implications for rehabilitation A cross-cultural adaptation of the FFI has been done from original version to Chinese. Consistent results and satisfactory psychometric properties of the Foot Function Index Chinese version have been reported. For Chinese speaking researcher and clinician FFI-Ch could be used as a tool to assess patients with foot disease.

Taiwanese adult foot shape classification using 3D scanning data.

PubMed

Lee, Yu-Chi; Wang, Mao-Jiun

2015-01-01

This study classifies the foot shapes of Taiwanese using 3D foot scanning data from 2000 males and 1000 females. Nine foot dimensions relative to foot length and absolute measures in the common foot length categories were applied to compare the gender differences. Using foot breadth in % foot length (% FL), ball of foot length in % FL and arch height in % FL as feature parameters, three foot shape types for males and females can be classified. Significant gender differences were found in seven of the nine foot dimensions. Females had greater ball of foot length than males (0.2% FL). When comparing feet of the same foot length, males had greater breadth, girth and height dimensions than females, except for toe height. In addition, ethnic differences in foot shape were also observed. The findings can provide very useful information for building gender-specific shoe lasts and designing footwear insoles. 3D foot scanning data of 2000 males and 1000 females were classified into three different footshapes for males and females, respectively. Gender and ethnic differences on foot shape were also compared. The finding scan provide very useful information for gender-specific shoe last design and footwear production.

Foot osteoarthritis: latest evidence and developments

PubMed Central

Roddy, Edward; Menz, Hylton B.

2018-01-01

Foot osteoarthritis (OA) is a common problem in older adults yet is under-researched compared to knee or hand OA. Most existing studies focus on the first metatarsophalangeal joint, with evidence relating to midfoot OA being particularly sparse. Symptomatic radiographic foot OA affects 17% of adults aged 50 years and over. The first metatarsophalangeal joint is most commonly affected, followed by the second cuneometatarsal and talonavicular joints. Epidemiological studies suggest the existence of distinct first metatarsophalangeal joint and polyarticular phenotypes, which have differing clinical and risk factor profiles. There are few randomized controlled trials in foot OA. Existing trials provide some evidence of the effectiveness for pain relief of physical therapy, rocker-sole shoes, foot orthoses and surgical interventions in first metatarsophalangeal joint OA and prefabricated orthoses in midfoot OA. Prospective epidemiological studies and randomized trials are needed to establish the incidence, progression and prognosis of foot OA and determine the effectiveness of both commonly used and more novel interventions. PMID:29619094

Shear-reducing insoles to prevent foot ulceration in high-risk diabetic patients.

PubMed

Lavery, Lawrence A; LaFontaine, Javier; Higgins, Kevin R; Lanctot, Dan R; Constantinides, George

2012-11-01

To enhance the learner's competence with knowledge of the effectiveness of shear-reducing insoles for prevention of foot ulceration in patients with high-risk diabetes. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of foot ulceration risk, risk factors, incidence, and prevention.2. Apply knowledge gained from reviewing this study and a literature review about the use of shear-reducing insoles to patient scenarios. The objective of this study was to evaluate the effectiveness of a shear-reducing insole compared with a standard insole design to prevent foot ulceration in high-risk patients with diabetes. A total of 299 patients with diabetic neuropathy and loss of protective sensation, foot deformity, or history of foot ulceration were randomized into a standard therapy group (n = 150) or a shear-reducing insole group (n = 149). Patients were evaluated for 18 months. Standard therapy group consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. The shear-reducing insole group included a novel insole designed to reduce both pressure and shear on the sole of the foot. Insoles were replaced every 4 months in both groups. The primary clinical outcome was foot ulceration. The authors used Cox proportional hazards regression to evaluate time to ulceration. There were 2 significant factors from the Cox regression model: insole treatment and history of a foot complication. The standard therapy group was about 3.5 times more likely to develop an ulcer compared with shear-reducing insole group (hazard ratio, 3.47; 95% confidence interval, 0.96-12.67). These results suggest that a shear-reducing insole is more effective than traditional insoles to prevent foot ulcers in high-risk persons with diabetes.

Physical management of the Charcot foot.

PubMed

Crews, Ryan T; Wrobel, James S

2008-01-01

Charcot arthropathy places individuals at risk of developing diabetic foot ulcers and potentially subsequent limb amputation by means of altering the anatomy of the foot and ankle. Physical trauma is an important component to the etiology of the condition. The physical management of the Charcot foot is concerned with minimizing the stress applied to the affected foot and ankle skeletal structure. The most appropriate device is temporally dependent on the progression of the disease. At the initiation of Charcot arthropathy, care by total contact cast is recommended. As the affected bones begin to heal, use of a removable cast walker may be implemented. When the bones reach a fixed state, appropriate footwear is dictated by the degree of deformity.

Narrative review: Diabetic foot and infrared thermography

NASA Astrophysics Data System (ADS)

Hernandez-Contreras, D.; Peregrina-Barreto, H.; Rangel-Magdaleno, J.; Gonzalez-Bernal, J.

2016-09-01

Diabetic foot is one of the major complications experienced by diabetic patients. An early identification and appropriate treatment of diabetic foot problems can prevent devastating consequences such as limb amputation. Several studies have demonstrated that temperature variations in the plantar region can be related to diabetic foot problems. Infrared thermography has been successfully used to detect complication related to diabetic foot, mainly because it is presented as a rapid, non-contact and non-invasive technique to visualize the temperature distribution of the feet. In this review, an overview of studies that relate foot temperature with diabetic foot problems through infrared thermography is presented. Through this research, it can be appreciated the potential of infrared thermography and the benefits that this technique present in this application. This paper also presents the different methods for thermogram analysis and the advantages and disadvantages of each one, being the asymmetric analysis the method most used so far.

Trends in lumber processing in the western United States. Part I: board foot Scribner volume per cubic foot of timber

Treesearch

Charles E. Keegan; Todd A. Morgan; Keith A. Blatner; Jean M. Daniels

2010-01-01

This article describes trends in board foot Scribner volume per cubic foot of timber for logs processed by sawmills in the western United States. Board foot to cubic foot (BF/CF) ratios for the period from 2000 through 2006 ranged from 3.70 in Montana to 5.71 in the Four Corners Region (Arizona, Colorado, New Mexico, and Utah). Sawmills in the Four Corners Region,...

Foot burns: epidemiology and management.

PubMed

Hemington-Gorse, S; Pellard, S; Wilson-Jones, N; Potokar, T

2007-12-01

This is a retrospective study of the epidemiology and management of isolated foot burns presenting to the Welsh Centre for Burns from January 1998 to December 2002. A total of 289 were treated of which 233 were included in this study. Approximately 40% were in the paediatric age group and the gender distribution varied dramatically for adults and children. In the adult group the male:female ratio was 3.5:1, however in the paediatric group the male:female ratio was more equal (1.6:1). Scald burns (65%) formed the largest group in children and scald (35%) and chemical burns (32%) in adults. Foot burns have a complication rate of 18% and prolonged hospital stay. Complications include hypertrophic scarring, graft loss/delayed healing and wound infection. Although isolated foot burns represent a small body surface area, over half require treatment as in patients to allow for initial aggressive conservative management of elevation and regular wound cleansing to avoid complications. This study suggests a protocol for the initial acute management of foot burns. This protocol states immediate referral of all foot burns to a burn centre, admission of these burns for 24-48 h for elevation, regular wound cleansing with change of dressings and prophylactic antibiotics.

[Foot reflexology massage: a clinical study].

PubMed

Kesselring, A

1999-02-01

The aim of the study was to investigate the possible usefulness of foot reflexology on the recovery after a surgical intervention. 130 patients participated in the study. They underwent abdominal surgery under full anesthesia for different, but exclusively gynecological reasons. Foot reflexology investigated in this study was applied only for a few days for each patient. The following parameters were recorded: the subjective, self-assessed, general condition, pain intensity, movement of the bowels, micturition and sleep, beginning on the day before operation until day 10. Two other treatments served as controls, a simple massage of the foot or a personal conversation. The simple massage turned out to be a relaxing, positive experience, whereas foot reflexology had various effects, some of them were even negative. The conclusion was that foot reflexology is not recommended for acute, abdominal postsurgical situations in gynecology because it can occasionally trigger abdominal pain. This project is one of the few studies planned, conducted and performed by the nursing staff.

Prediction of anthropometric foot characteristics in children.

PubMed

Morrison, Stewart C; Durward, Brian R; Watt, Gordon F; Donaldson, Malcolm D C

2009-01-01

The establishment of growth reference values is needed in pediatric practice where pathologic conditions can have a detrimental effect on the growth and development of the pediatric foot. This study aims to use multiple regression to evaluate the effects of multiple predictor variables (height, age, body mass, and gender) on anthropometric characteristics of the peripubescent foot. Two hundred children aged 9 to 12 years were recruited, and three anthropometric measurements of the pediatric foot were recorded (foot length, forefoot width, and navicular height). Multiple regression analysis was conducted, and coefficients for gender, height, and body mass all had significant relationships for the prediction of forefoot width and foot length (P < or = .05, r > or = 0.7). The coefficients for gender and body mass were not significant for the prediction of navicular height (P > or = .05), whereas height was (P < or = .05). Normative growth reference values and prognostic regression equations are presented for the peripubescent foot.

Mechanics of the foot Part 2: A coupled solid-fluid model to investigate blood transport in the pathologic foot.

PubMed

Mithraratne, K; Ho, H; Hunter, P J; Fernandez, J W

2012-10-01

A coupled computational model of the foot consisting of a three-dimensional soft tissue continuum and a one-dimensional (1D) transient blood flow network is presented in this article. The primary aim of the model is to investigate the blood flow in major arteries of the pathologic foot where the soft tissue stiffening occurs. It has been reported in the literature that there could be up to about five-fold increase in the mechanical stiffness of the plantar soft tissues in pathologic (e.g. diabetic) feet compared with healthy ones. The increased stiffness results in higher tissue hydrostatic pressure within the plantar area of the foot when loaded. The hydrostatic pressure acts on the external surface of blood vessels and tend to reduce the flow cross-section area and hence the blood supply. The soft tissue continuum model of the foot was modelled as a tricubic Hermite finite element mesh representing all the muscles, skin and fat of the foot and treated as incompressible with transversely isotropic properties. The details of the mechanical model of soft tissue are presented in the companion paper, Part 1. The deformed state of the soft tissue continuum because of the applied ground reaction force at three foot positions (heel-strike, midstance and toe-off) was obtained by solving the Cauchy equations based on the theory of finite elasticity using the Galerkin finite element method. The geometry of the main arterial network in the foot was represented using a 1D Hermite cubic finite element mesh. The flow model consists of 1D Navier-Stokes equations and a nonlinear constitutive equation to describe vessel radius-transmural pressure relation. The latter was defined as the difference between the fluid and soft tissue hydrostatic pressure. Transient flow governing equations were numerically solved using the two-step Lax-Wendroff finite difference method. The geometry of both the soft tissue continuum and arterial network is anatomically-based and was developed using

Foot abnormalities of wild birds

USGS Publications Warehouse

Herman, C.M.; Locke, L.N.; Clark, G.M.

1962-01-01

The various foot abnormalities that occur in birds, including pox, scaly-leg, bumble-foot, ergotism and freezing are reviewed. In addition, our findings at the Patuxent Wildlife Research Center include pox from dove, mockingbird, cowbird, grackle and several species of sparrows. Scaly-leg has been particularly prevalent on icterids. Bumble foot has been observed in a whistling swan and in a group of captive woodcock. Ergotism is reported from a series of captive Canada geese from North Dakota. Several drug treatments recommended by others are presented.

[Effects of foot reflexology on essential hypertension patients].

PubMed

Park, Hyoung-Sook; Cho, Gyoo-Yeong

2004-08-01

This study was to evaluate the effects of foot reflexology on blood pressure, serum lipids level and life satisfaction in essential hypertension patients. The research design used was a nonequivalent control group pretest-posttest design. Foot Reflexology was used as the experimental treatment from June 23rd, 2003 until August 31st, 2003. Thirty-four subjects were assigned to an experimental group(18) and control group(16). Foot Reflexology was administered twice a week for 6 weeks and self foot Reflexology was administered twice a week for 4 weeks on the experimental group. There was a significant decrease in systolic blood pressure but no significant decrease in diastolic pressure in the experimental group compared to the control group. The total cholesterol level in the experimental group compared to the control group was not significantly decreased after foot reflexology. However, the triglyceride level in the experimental group compared to the control group was significantly decreased after foot reflexology. On the other hand, high density lipoprotein and low density lipoprotein levels in the experimental group compared to the control group was not significantly decreased after foot reflexology. Life satisfaction in the experimental group compared to the control group was significantly improved after foot reflexology. The results proved that foot reflexology was an effective nursing intervention to decrease systolic pressure, and triglyceride but not for the blood cholesterol and to improve life satisfaction. Therefore, blood cholesterol should be further evaluated in a larger group of subjects and for a longer period. Further research is regarded as necessary to evaluate and to compare effects of self-foot reflexology and foot reflexology.

Delving into foot mechanics and related problems.

PubMed

Zanni, Guido R; Wick, Jeannette Y

2011-12-01

Foot problems are common in elders, stemming from age-related podiatric mechanical problems or disease-induced pathology. Common mechanical problems include hammertoe, arthritis, bunions, and metatarsalgia. Disease-induced conditions include onychomycosis, athlete's foot, plantar warts, gout, and diabetes. Treatment is case-specific and often involves multiple interventions, including lifestyle changes. Prevention and treatment strategies are presented. Patient education on proper foot care is effective.When patients are unable to reach or see their feet, staff assumes responsibility for foot care.

Diagnostic considerations of lateral column foot pain in athletes.

PubMed

Traister, Eric; Simons, Stephen

2014-01-01

Foot maladies are often classified descriptively by general foot locations, i.e., forefoot, midfoot, and rearfoot. However, common vernacular verbiage, implicating a common biomechanical purpose, also applies pathology to the medial or lateral foot column. Although imprecisely defined, lateral column injuries to the foot encompass conditions that affect any of the lateral side of the foot from the calcaneus to the toes. The lateral column of the foot includes the calcaneus, the cuboid, the fourth and fifth metatarsals as well as the calcaneocuboid, cuboido-metatarsal, and intermetatarsal joints. It may be helpful to think in a "lateral column" fashion when evaluating and treating certain lateral foot injuries, load patterns, and biomechanical or anatomical faults. Misdiagnosed injuries in this area of the foot can be a source of great morbidity to the athlete. It is important for the clinician to be aware of common conditions presenting as pain to the lateral side of the foot.

Board-Foot and cubic-foot volume tables for Alaska-cedar in southeast Alaska.

Treesearch

Donald J. DeMars

1996-01-01

Four tables give cubic-foot and board-foot volume estimates for Alaska-cedar given breast-height diameter outside bark (DBHOB) and either total tree height or number of logs to a 6-inch top. The values for DBHOB and total tree height (or number of logs in the tree) that are in the tables have been limited to the ranges these variables had in the sample data.

Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study.

PubMed

Otter, S J; Lucas, K; Springett, K; Moore, A; Davies, K; Young, A; Walker-Bone, K

2011-11-01

Epidemiological studies report foot pain affects more than 90% of people with rheumatoid arthritis (RA). Most data about foot involvement in RA were collected prior to the availability of novel treatments such as biologics. The objective of this study is to compare the prevalence of foot symptoms, frequency of foot examination, and access to foot care services among RA patients currently treated with anti-TNFα to those not receiving biologics. This study is a cross-sectional epidemiological study: a 28-item self-administered questionnaire was posted to 1,040 people with RA throughout the UK. Overall, 585 (55%) useable replies were received, and 120 (20.5%) respondents were currently taking anti-TNFα medication. Prevalence of current foot pain was 99% among the biologics group compared with 76% not treated with biologics. Stiffness, swelling, and numbness in the feet were all significantly more common in the anti-TNFα group (P < 0.05). Most respondents (90%) taking biologics discussed their foot pain with their rheumatologist, but only 70% were receiving podiatry (compared to 78% not taking anti-TNFα). Subjects reported that their feet were examined significantly less frequently (P < 0.001) than their hands. Foot complaints are common in this group, and allied health professions could enhance rheumatological care by undertaking foot assessment.

Outcome of orthoses intervention in the rheumatoid foot.

PubMed

Kavlak, Yasemin; Uygur, Fatma; Korkmaz, Cengiz; Bek, Nilgün

2003-06-01

This study was carried out to determine the effect of foot orthoses on pain, gait, and energy expenditure in patients with rheumatoid arthritis. Eighteen patients were evaluated for these parameters. Each patient was given a foot insert or shoe modification suitable for his or her foot deformity. Following 3 months of orthosis use, a significant difference was found in regards to pain (p < .05), step length and stride length (p < .05), and physiological cost index (p < .05). The results suggest that foot orthoses are an important feature in the rehabilitation of the rheumatoid foot.

Biomechanics of ramp descent in unilateral trans-tibial amputees: Comparison of a microprocessor controlled foot with conventional ankle-foot mechanisms.

PubMed

Struchkov, Vasily; Buckley, John G

2016-02-01

Walking down slopes and/or over uneven terrain is problematic for unilateral trans-tibial amputees. Accordingly, 'ankle' devices have been added to some dynamic-response feet. This study determined whether use of a microprocessor controlled passive-articulating hydraulic ankle-foot device improved the gait biomechanics of ramp descent in comparison to conventional ankle-foot mechanisms. Nine active unilateral trans-tibial amputees repeatedly walked down a 5° ramp, using a hydraulic ankle-foot with microprocessor active or inactive or using a comparable foot with rubber ball-joint (elastic) 'ankle' device. When inactive the hydraulic unit's resistances were those deemed to be optimum for level-ground walking, and when active, the plantar- and dorsi-flexion resistances switched to a ramp-descent mode. Residual limb kinematics, joints moments/powers and prosthetic foot power absorption/return were compared across ankle types using ANOVA. Foot-flat was attained fastest with the elastic foot and second fastest with the active hydraulic foot (P<0.001). Prosthetic shank single-support mean rotation velocity (p =0.006), and the flexion (P<0.001) and negative work done at the residual knee (P=0.08) were reduced, and negative work done by the ankle-foot increased (P<0.001) when using the active hydraulic compared to the other two ankle types. The greater negative 'ankle' work done when using the active hydraulic compared to other two ankle types, explains why there was a corresponding reduction in flexion and negative work at the residual knee. These findings suggest that use of a microprocessor controlled hydraulic foot will reduce the biomechanical compensations used to walk down slopes. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Foot speed, foot-strike and footwear: linking gait mechanics and running ground reaction forces.

PubMed

Clark, Kenneth P; Ryan, Laurence J; Weyand, Peter G

2014-06-15

Running performance, energy requirements and musculoskeletal stresses are directly related to the action-reaction forces between the limb and the ground. For human runners, the force-time patterns from individual footfalls can vary considerably across speed, foot-strike and footwear conditions. Here, we used four human footfalls with distinctly different vertical force-time waveform patterns to evaluate whether a basic mechanical model might explain all of them. Our model partitions the body's total mass (1.0 Mb) into two invariant mass fractions (lower limb=0.08, remaining body mass=0.92) and allows the instantaneous collisional velocities of the former to vary. The best fits achieved (R(2) range=0.95-0.98, mean=0.97 ± 0.01) indicate that the model is capable of accounting for nearly all of the variability observed in the four waveform types tested: barefoot jog, rear-foot strike run, fore-foot strike run and fore-foot strike sprint. We conclude that different running ground reaction force-time patterns may have the same mechanical basis. © 2014. Published by The Company of Biologists Ltd.

Diabetic foot ulcers. Pathophysiology, assessment, and therapy.

PubMed Central

Bowering, C. K.

2001-01-01

OBJECTIVE: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. QUALITY OF EVIDENCE: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. MAIN MESSAGE: Foot ulcers in diabetic patients are common and frequently lead to lower limb amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Factors that affect development and healing of diabetic patients' foot ulcers include the degree of metabolic control, the presence of ischemia or infection, and continuing trauma to feet from excessive plantar pressure or poorly fitting shoes. Appropriate wound care for diabetic patients addresses these issues and provides optimal local ulcer therapy with débridement of necrotic tissue and provision of a moist wound-healing environment. Therapies that have no known therapeutic value, such as foot soaking and topical antiseptics, can actually be harmful and should be avoided. CONCLUSION: Family physicians are often primary medical contacts for patients with diabetes. Patients should be screened regularly for diabetic foot complications, and preventive measures should be initiated for those at risk of ulceration. PMID:11398715

Diabetic foot ulcers. Pathophysiology, assessment, and therapy.

PubMed

Bowering, C K

2001-05-01

To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. Foot ulcers in diabetic patients are common and frequently lead to lower limb amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Factors that affect development and healing of diabetic patients' foot ulcers include the degree of metabolic control, the presence of ischemia or infection, and continuing trauma to feet from excessive plantar pressure or poorly fitting shoes. Appropriate wound care for diabetic patients addresses these issues and provides optimal local ulcer therapy with débridement of necrotic tissue and provision of a moist wound-healing environment. Therapies that have no known therapeutic value, such as foot soaking and topical antiseptics, can actually be harmful and should be avoided. Family physicians are often primary medical contacts for patients with diabetes. Patients should be screened regularly for diabetic foot complications, and preventive measures should be initiated for those at risk of ulceration.

Clinical workflow for personalized foot pressure ulcer prevention.

PubMed

Bucki, M; Luboz, V; Perrier, A; Champion, E; Diot, B; Vuillerme, N; Payan, Y

2016-09-01

Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and "cluster volumes" (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer. Copyright © 2016. Published by Elsevier Ltd.

Evaluation of the effect of nurse education on patient-reported foot checks and foot care behaviour of people with diabetes receiving haemodialysis.

PubMed

Brand, S L; Musgrove, A; Jeffcoate, W J; Lincoln, N B

2016-02-01

To assess whether a programme of nurse education increased the frequency with which nurses conducted foot checks on people with diabetes undergoing haemodialysis and to evaluate whether this influenced self-reported foot care behaviour. A non-randomized stepped-wedge design was used to evaluate a nurse education programme implemented in four UK National Health Service dialysis units. People with diabetes undergoing haemodialysis were invited to complete a questionnaire on the frequency of foot examination by health professionals, on the presence of foot problems and on their own foot care behaviour, using the Nottingham Assessment of Functional Foot-care (NAFF). An education session for nurses, including procedures for foot examination, was conducted sequentially in each of four haemodialysis units. The questionnaire was repeated at 2-monthly intervals. The education session resulted in a significant increase in the reported number of foot examinations by nurses (P = 0.007). There was also a significant improvement in reported foot care behaviour (P < 0.001), but this occurred between the first and second 2-monthly assessments and was unrelated to the timing of the intervention. A single education session can improve the routine checking of the feet of people with diabetes undergoing haemodialysis. The administration of the Nottingham Assessment of Functional Foot-care questionnaire was associated with improved self-reported foot care behaviour, reflecting greater awareness of risk in this population. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

Foot and ankle problems in Muay Thai kickboxers.

PubMed

Vaseenon, Tanawat; Intharasompan, Piyapong; Wattanarojanapom, Thongaek; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit

2015-01-01

Muay Thai kickboxing is a common sport that uses the foot and ankle in fighting. Muay Thai kickboxing trainees usually receive training in Thailand Foot and ankle problems in this group ofpeople who usually train barefoot remain unexplored To evaluate the prevalence of common foot and ankle problems in Muay Thai kick boxers. The present study is a cross-sectional survey of Muay Thai kick boxers practicing in northern Thailand. Interviews were conducted and foot and ankle examinations were evaluated Foot morphology was examined using a Harris mat footprint. One hundred and twenty-three Muay Thai kickbox ersinnine training gyms were included in this study. Common foot and ankle problems found in the Muay Thai kick boxers were callosity (59%), gastrocnemius contracture (57%), toe deformities (49.3%), wounds (10%) and heel pain (9%). Callosity was most commonly found on the forefoot (77.5%), on the plantar first metatarsal (55.3%) and on the big toe (33.3%). An association was found between a tight heel cord and a history of foot injury with prolonged periods of weekly training. Toe deformities such as hallux rigidus (37.6%) were also associated with prolonged periods of training (p = 0.001). No correlation was found between type of foot arch and foot and ankle problems. Plantar forefoot callosities and wounds as well as toe deformities including tight heel cords are some of the foot and ankle problems commonly found in Muay Thai kick boxers. They are associated with prolonged periods of barefoot training. The unique pattern of training and of the kicks in Muay Thai might be a path mechanism, leading to the development of foot and ankle problems.

Athlete's foot and fungally infected toenails

PubMed Central

Crawford, Fay; Hart, Rachel; Bell-Syer, Sally E M; Torgerson, David J; Young, Philip; Russell, Ian

2001-01-01

Definition Athlete's foot is a cutaneous fungal infection that causes the skin to itch, flake, and fissure. Nail involvement is characterised by ungual thickening and discoloration. Incidence/prevalence In the United Kingdom, athlete's foot is present in about 15% of the general population,1 and 1.2 million people have fungally infected toenails.2 Aetiology/risk factors Swimming pool users and industrial workers may have increased risk of fungal foot infection. However, one survey found fungal foot infection in only 8.5% of swimmers, with the highest incidence (20%) in men aged 16 years and over.1 Prognosis Fungal infections of the foot are not life threatening in people with normal immunity, but in some people they cause persistent symptoms. Other people seem to be oblivious of persistent infection. The infection can spread to other parts of the body and to other people. Aims To control symptoms and prevent recurrence, with minimal adverse effects. Outcomes Rates of fungal eradication, shown by negative microscopy and culture, and resolution of clinical signs and symptoms at follow up. PMID:11157535

The Impact of Three-month Training Programme on Foot Care and Self-efficacy of Patients with Diabetic Foot Ulcers.

PubMed

Bahador, Raziyeh Sadat; Afrazandeh, Seyedeh Sara; Ghanbarzehi, Nezar; Ebrahimi, Maryam

2017-07-01

Patient's self-efficacy in disease management and foot care is considered as an important indicator in controlling the complications of diabetes. This study was aimed to determine the effect of three-month training programme on foot care and self-efficacy of patients with diabetic foot ulcers. A quasi-experimental study was conducted on 60 patients with diabetic foot ulcers in Jiroft Imam Khomeini hospital from January 2016 to May 2016. These patients were randomly divided into intervention and control groups (30 patients in each group). The research instrument was a questionnaire on demographic data, self-efficacy questions for patients with diabetes and a researcher made questionnaire of diabetic foot care. Training programmes for foot ulcers care and prevention of new ulcers formation and other aspects of the disease were implemented during three months in the test group. Data were analysed using descriptive and analytic statistical tests (Mann-Whitney U, paired t-test and Pearson correlation coefficient) by SPSS version 18.0 software. The results showed statistically significant difference (p<0.001) in the score of self-efficacy between intervention group (182.25) and control group (93.56), and the foot care score was 47.43 in the intervention group and 30.18 in control group after the intervention. The average scores of self-efficacy and foot ulcers care significantly increased in the intervention group after training programme (p<0.001). The results showed that the implementation of training programme has been able to increase the self-efficacy of patients and the rate of their foot ulcers care and the prevention of new ulcers and effectively reduce the complications in diabetic patients.

Bioelectrical impedance analysis for bovine milk: Preliminary results

NASA Astrophysics Data System (ADS)

Bertemes-Filho, P.; Valicheski, R.; Pereira, R. M.; Paterno, A. S.

2010-04-01

This work reports the investigation and analysis of bovine milk quality by using biological impedance measurements using electrical impedance spectroscopy (EIS). The samples were distinguished by a first chemical analysis using Fourier transform midinfrared spectroscopy (FTIR) and flow citometry. A set of milk samples (100ml each) obtained from 17 different cows in lactation with and without mastitis were analyzed with the proposed technique using EIS. The samples were adulterated by adding distilled water and hydrogen peroxide in a controlled manner. FTIR spectroscopy and flow cytometry were performed, and impedance measurements were made in a frequency range from 500Hz up to 1MHz with an implemented EIS system. The system's phase shift was compensated by measuring saline solutions. It was possible to show that the results obtained with the Bioelectrical Impedance Analysis (BIA) technique may detect changes in the milk caused by mastitis and the presence of water and hydrogen peroxide in the bovine milk.

Migratory routes and at-sea threats to Pink-footed Shearwaters

USGS Publications Warehouse

Adams, Josh; Felis, Jonathan J.; Hodum, Peter; Colodro, Valentina; Carle, Ryan; López, Verónica

2016-01-01

The Pink-footed Shearwater (Ardenna creatopus) is a seabird with a breeding range restricted to three islands in Chile and an estimated world population of approximately 56,000 breeding individuals (Muñoz 2011, Oikonos unpublished data). Due to multiple threats on breeding colonies and at-sea, Pink-footed Shearwaters are listed as Endangered by the government of Chile (Reglamento de Clasificación de Especies, 2011), Threatened by the government of Canada (Environment Canada 2008), and are listed under Appendix 1 of the Agreement on the Conservation of Albatrosses and Petrels (ACAP 2013). A principal conservation concern for the species is mortality from fisheries bycatch during the breeding and non-breeding seasons; thus, identification of areas of overlap between at-sea use by Pink-footed Shearwaters and fisheries is a high priority conservation objective (Hinojosa Sáez and Hodum 1997, Mangel et al. 2013, ACAP 2013). During the non-breeding period, Pink-footed Shearwaters range as far north as Canada, although little was known until recently about migration routes and important wintering areas where fisheries bycatch could be a risk. Additionally, Pink-footed Shearwaters face at-sea threats during the non-breeding season off the west coast of North America. Recently, areas used by wintering Pink-footed Shearwaters have been identified as areas of interest for developing alternative energy offshore in North America (e.g., floating wind generators; Trident Winds 2016). The goal of our study was to track Pink-footed Shearwater post-breeding movements with satellite tags to identify timing and routes of migration, locate important non-breeding foraging habitats, and determine population distribution among different wintering regions.

Diabetic Foot Complications Despite Successful Pancreas Transplantation.

PubMed

Seo, Dong-Kyo; Lee, Ho Seong; Park, Jungu; Ryu, Chang Hyun; Han, Duck Jong; Seo, Sang Gyo

2017-06-01

It is known that successful pancreas transplantation enables patients with diabetes to maintain a normal glucose level without insulin and reduces diabetes-related complications. However, we have little information about the foot-specific morbidity in patients who have undergone successful pancreas transplantation. The purpose of this study was to investigate the prevalence and predisposing factors for foot complications after successful pancreas transplantation. This retrospective study included 218 patients (91 males, 127 females) who had undergone pancreas transplantation for diabetes. The mean age was 40.7 (range, 15-76) years. Diabetes type, transplantation type, body mass index, and diabetes duration before transplantation were confirmed. After pancreas transplantation, the occurrence and duration of foot and ankle complications were assessed. Twenty-two patients (10.1%) had diabetic foot complications. Fifteen patients (6.9%) had diabetic foot ulcer and 7 patients (3.2%) had Charcot arthropathy. Three patients had both diabetic foot ulcer and Charcot arthropathy. Three insufficiency fractures (1.4%) were included. Mean time of complications after transplantation was 18.5 (range, 2-77) months. Creatinine level 1 year after surgery was higher in the complication group rather than the noncomplication group ( P = .02). Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes. Level III, comparative study.

Effects of kinesiotaping on foot posture in participants with pronated foot: a quasi-randomised, double-blind study.

PubMed

Luque-Suarez, Alejandro; Gijon-Nogueron, Gabriel; Baron-Lopez, Francisco Javier; Labajos-Manzanares, Maria Teresa; Hush, Julia; Hancock, Mark Jonathan

2014-03-01

To investigate whether kinesiotaping improves excessive foot pronation compared with sham kinesiotaping. Quasi-randomised, double-blind study. One primary care centre. One hundred and thirty participants were screened for inclusion. Sixty-eight participants with pronated feet [Foot Posture Index (FPI)≥ 6] were enrolled, and the follow-up rate was 100%. Participants were allocated into one of two groups: an experimental kinesiotaping group (KT1) and a sham taping group (KT2). Measures were collected by a blinded assessor at baseline, and 1 minute, 10 minutes, 60 minutes and 24 hours after taping. The primary outcome was total FPI score, and the secondary outcome was rear-foot FPI score. There were no significant differences in total FPI score between kinesiotaping and sham taping at any time point. Similarly, there were no significant differences in rear-foot FPI score, apart from at 60-minute follow-up when the difference between groups was significant (P=0.04) but the effect size was very small (0.85 points on the rear-foot FPI score between -6 and +6). Kinesiotaping does not correct foot pronation compared with sham kinesiotaping in people with pronated feet. Copyright © 2013 Chartered Society of Physiotherapy. All rights reserved.

24 CFR 3285.312 - Footings.

Code of Federal Regulations, 2014 CFR

2014-04-01

... section. Footings must be placed on undisturbed soil or fill compacted to 90 percent of maximum relative... (psi). Site-specific soil conditions or design load requirements may also require the use of... footings must consist of a minimum of two layers of nominal 2-inch thick pressure-treated wood, a single...

24 CFR 3285.312 - Footings.

Code of Federal Regulations, 2012 CFR

2012-04-01

... section. Footings must be placed on undisturbed soil or fill compacted to 90 percent of maximum relative... (psi). Site-specific soil conditions or design load requirements may also require the use of... footings must consist of a minimum of two layers of nominal 2-inch thick pressure-treated wood, a single...

24 CFR 3285.312 - Footings.

Code of Federal Regulations, 2011 CFR

2011-04-01

... section. Footings must be placed on undisturbed soil or fill compacted to 90 percent of maximum relative... (psi). Site-specific soil conditions or design load requirements may also require the use of... footings must consist of a minimum of two layers of nominal 2-inch thick pressure-treated wood, a single...

24 CFR 3285.312 - Footings.

Code of Federal Regulations, 2010 CFR

2010-04-01

... section. Footings must be placed on undisturbed soil or fill compacted to 90 percent of maximum relative... (psi). Site-specific soil conditions or design load requirements may also require the use of... footings must consist of a minimum of two layers of nominal 2-inch thick pressure-treated wood, a single...

24 CFR 3285.312 - Footings.

Code of Federal Regulations, 2013 CFR

2013-04-01

... section. Footings must be placed on undisturbed soil or fill compacted to 90 percent of maximum relative... (psi). Site-specific soil conditions or design load requirements may also require the use of... footings must consist of a minimum of two layers of nominal 2-inch thick pressure-treated wood, a single...

Foot and ankle function after tibial overlengthening.

PubMed

Emara, Khaled M; Diab, Ramy Ahmed; El Ghazali, Sherif; Farouk, Amr; El Kersh, Mohamed Ahmed

2014-01-01

Lengthening the tibia more than 25% of its original length can be indicated for proximal femoral deficiency, poliomyelitis, or femoral infected nonunion. Such lengthening of the tibia can adversely affect the ankle or foot shape and function. The present study aimed to assess the effect of tibial lengthening of more than 25% of its original length on the foot and ankle shape and function compared with the preoperative condition. This was a retrospective study of 13 children with severe proximal focal femoral deficiency, Aitken classification type D, who had undergone limb lengthening from June 2000 to June 2008 using Ilizarov external fixators. The techniques used in tibial lengthening included lengthening without intramedullary rodding and lengthening over a nail. The foot assessment was done preoperatively, at fixator removal, and then annually for 3 years, documenting the range of motion and deformity of the ankle and subtalar joints and big toe and the navicular height, calcaneal pitch angle, and talo-first metatarsal angle. At fixator removal, all cases showed equinocavovarus deformity, with decreased ankle, subtalar, and big toe motion. The mean American Orthopedic Foot and Ankle Society score was significantly reduced. During follow-up, the range of motion, foot deformity, and American Orthopedic Foot and Ankle Society score improved, reaching nearly to the preoperative condition by 2 years of follow-up. The results of our study have shown that tibial overlengthening has an adverse effect on foot and ankle function. This effect was reversible in the patients included in the present study. Lengthening of more than 25% can be safely done after careful discussion with the patients and their families about the probable effects of lengthening on foot and ankle function. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Body fat measurement by bioelectrical impedance and air displacement plethysmography: a cross-validation study to design bioelectrical impedance equations in Mexican adults

PubMed Central

Macias, Nayeli; Alemán-Mateo, Heliodoro; Esparza-Romero, Julián; Valencia, Mauro E

2007-01-01

Background The study of body composition in specific populations by techniques such as bio-impedance analysis (BIA) requires validation based on standard reference methods. The aim of this study was to develop and cross-validate a predictive equation for bioelectrical impedance using air displacement plethysmography (ADP) as standard method to measure body composition in Mexican adult men and women. Methods This study included 155 male and female subjects from northern Mexico, 20–50 years of age, from low, middle, and upper income levels. Body composition was measured by ADP. Body weight (BW, kg) and height (Ht, cm) were obtained by standard anthropometric techniques. Resistance, R (ohms) and reactance, Xc (ohms) were also measured. A random-split method was used to obtain two samples: one was used to derive the equation by the "all possible regressions" procedure and was cross-validated in the other sample to test predicted versus measured values of fat-free mass (FFM). Results and Discussion The final model was: FFM (kg) = 0.7374 * (Ht2 /R) + 0.1763 * (BW) - 0.1773 * (Age) + 0.1198 * (Xc) - 2.4658. R2 was 0.97; the square root of the mean square error (SRMSE) was 1.99 kg, and the pure error (PE) was 2.96. There was no difference between FFM predicted by the new equation (48.57 ± 10.9 kg) and that measured by ADP (48.43 ± 11.3 kg). The new equation did not differ from the line of identity, had a high R2 and a low SRMSE, and showed no significant bias (0.87 ± 2.84 kg). Conclusion The new bioelectrical impedance equation based on the two-compartment model (2C) was accurate, precise, and free of bias. This equation can be used to assess body composition and nutritional status in populations similar in anthropometric and physical characteristics to this sample. PMID:17697388

Subjective and quantitative scintigraphic assessment of the equine foot and its relationship with foot pain.

PubMed

Dyson, S J

2002-03-01

It was hypothesised that in solar bone images of the front feet of clinically normal horses, or horses with lameness unrelated to the front feet, there would be less than a 10% difference in the ratio of uptake of radiopharmaceutical in either the region of the navicular bone, or the region of insertion of the deep digital flexor tendon (DDFT), compared to the peripheral regions of the distal phalanx. Nuclear scintigraphic examination of the front feet of 15 Grand Prix show jumping horses, all of which were free from detectable lameness, was performed using dorsal, lateral and solar images. The results were compared with the examinations of 53 horses with primary foot pain, 21 with foot pain accompanying another more severe cause of lameness and 49 with lameness or poor performance unrelated to foot pain. None of the horses with foot pain had radiological changes compatible with navicular disease. All the images were evaluated subjectively. The solar views were assessed quantitatively using regions of interest around the navicular bone, the region of insertion of the deep digital flexor tendon and the toe, medial and lateral aspects of the distal phalanx. In 97% of the feet of normal showjumpers, there was <10% variance of uptake of the radiopharmaceutical in the navicular bone, the region of insertion of the DDFT and the peripheral regions of the distal phalanx. There was a significant difference in uptake of radiopharmaceutical in the region of the navicular bone in horses with foot pain compared to normal horses. There was a large incidence of false positive results related to the region of insertion of the DDFT. Lateral pool phase images appeared more sensitive in identifying potentially important DDFT lesions. There was a good correlation between a positive response to intra-articular analgesia of the distal interphalangeal joint and intrathecal analgesia of the navicular bursa and increased uptake of radiopharmaceutical in the region of the navicular bone in

Foot structure is significantly associated to subtalar joint kinetics and mechanical energetics.

PubMed

Maharaj, Jayishni N; Cresswell, Andrew G; Lichtwark, Glen A

2017-10-01

Foot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking. A total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures. Although no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility. The models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence. Copyright © 2017. Published by Elsevier B.V.

Ultrasound evaluation of foot deformities in infants.

PubMed

Miron, Marie-Claude; Grimard, Guy

2016-02-01

Foot deformity in infants is the most common congenital musculoskeletal condition. A precise diagnosis can sometimes be impossible to establish clinically. Radiologic imaging plays a major role in the evaluation of musculoskeletal abnormalities. However conventional imaging techniques, such as plain radiographs of the foot, are of very little help in this age group because of the lack of ossification of the tarsal bones. US presents a significant advantage because it permits the visualization of cartilaginous structures. This leads to the detailed assessment of foot deformities in infants. Furthermore, US can also be used as a dynamic imaging modality. Different scanning views are beneficial to evaluate the complete anatomy of the foot; depending on the suspected clinical diagnosis, some planes are more informative to display the pathological features of a specific deformity. We describe the US findings of five of the most common foot deformities referred to our pediatric orthopedic clinic (clubfoot, simple metatarsus adductus, skewfoot, and oblique and vertical talus). For each deformity we propose a specific imaging protocol based on US to provide an accurate diagnosis. US is a complementary tool to the clinical examination for determining the diagnosis and the severity of the deformity and also for monitoring the efficacy of treatment. Radiologists investigating foot deformities in infants should consider using US for the detailed assessment of the foot in this age group.

29 CFR 1915.156 - Foot protection.

Code of Federal Regulations, 2010 CFR

2010-07-01

... protective footwear when working in areas where there is a danger of foot injuries due to falling or rolling... Foot Protection,” and ASTM F-2413-2005, “Standard Specification for Performance Requirements for...

Adding Stiffness to the Foot Modulates Soleus Force-Velocity Behaviour during Human Walking

PubMed Central

Takahashi, Kota Z.; Gross, Michael T.; van Werkhoven, Herman; Piazza, Stephen J.; Sawicki, Gregory S.

2016-01-01

Previous studies of human locomotion indicate that foot and ankle structures can interact in complex ways. The structure of the foot defines the input and output lever arms that influences the force-generating capacity of the ankle plantar flexors during push-off. At the same time, deformation of the foot may dissipate some of the mechanical energy generated by the plantar flexors during push-off. We investigated this foot-ankle interplay during walking by adding stiffness to the foot through shoes and insoles, and characterized the resulting changes in in vivo soleus muscle-tendon mechanics using ultrasonography. Added stiffness decreased energy dissipation at the foot (p < 0.001) and increased the gear ratio (i.e., ratio of ground reaction force and plantar flexor muscle lever arms) (p < 0.001). Added foot stiffness also altered soleus muscle behaviour, leading to greater peak force (p < 0.001) and reduced fascicle shortening speed (p < 0.001). Despite this shift in force-velocity behaviour, the whole-body metabolic cost during walking increased with added foot stiffness (p < 0.001). This increased metabolic cost is likely due to the added force demand on the plantar flexors, as walking on a more rigid foot/shoe surface compromises the plantar flexors’ mechanical advantage. PMID:27417976

Adding Stiffness to the Foot Modulates Soleus Force-Velocity Behaviour during Human Walking

NASA Astrophysics Data System (ADS)

Takahashi, Kota Z.; Gross, Michael T.; van Werkhoven, Herman; Piazza, Stephen J.; Sawicki, Gregory S.

2016-07-01

Previous studies of human locomotion indicate that foot and ankle structures can interact in complex ways. The structure of the foot defines the input and output lever arms that influences the force-generating capacity of the ankle plantar flexors during push-off. At the same time, deformation of the foot may dissipate some of the mechanical energy generated by the plantar flexors during push-off. We investigated this foot-ankle interplay during walking by adding stiffness to the foot through shoes and insoles, and characterized the resulting changes in in vivo soleus muscle-tendon mechanics using ultrasonography. Added stiffness decreased energy dissipation at the foot (p < 0.001) and increased the gear ratio (i.e., ratio of ground reaction force and plantar flexor muscle lever arms) (p < 0.001). Added foot stiffness also altered soleus muscle behaviour, leading to greater peak force (p < 0.001) and reduced fascicle shortening speed (p < 0.001). Despite this shift in force-velocity behaviour, the whole-body metabolic cost during walking increased with added foot stiffness (p < 0.001). This increased metabolic cost is likely due to the added force demand on the plantar flexors, as walking on a more rigid foot/shoe surface compromises the plantar flexors’ mechanical advantage.

Adding Stiffness to the Foot Modulates Soleus Force-Velocity Behaviour during Human Walking.

PubMed

Takahashi, Kota Z; Gross, Michael T; van Werkhoven, Herman; Piazza, Stephen J; Sawicki, Gregory S

2016-07-15

Previous studies of human locomotion indicate that foot and ankle structures can interact in complex ways. The structure of the foot defines the input and output lever arms that influences the force-generating capacity of the ankle plantar flexors during push-off. At the same time, deformation of the foot may dissipate some of the mechanical energy generated by the plantar flexors during push-off. We investigated this foot-ankle interplay during walking by adding stiffness to the foot through shoes and insoles, and characterized the resulting changes in in vivo soleus muscle-tendon mechanics using ultrasonography. Added stiffness decreased energy dissipation at the foot (p < 0.001) and increased the gear ratio (i.e., ratio of ground reaction force and plantar flexor muscle lever arms) (p < 0.001). Added foot stiffness also altered soleus muscle behaviour, leading to greater peak force (p < 0.001) and reduced fascicle shortening speed (p < 0.001). Despite this shift in force-velocity behaviour, the whole-body metabolic cost during walking increased with added foot stiffness (p < 0.001). This increased metabolic cost is likely due to the added force demand on the plantar flexors, as walking on a more rigid foot/shoe surface compromises the plantar flexors' mechanical advantage.

Role of neuropathy and high foot pressures in diabetic foot ulceration.

PubMed

Frykberg, R G; Lavery, L A; Pham, H; Harvey, C; Harkless, L; Veves, A

1998-10-01

High plantar foot pressures in association with peripheral neuropathy have been ascertained to be important risk factors for ulceration in the diabetic foot. Most studies investigating these parameters have been limited by their size and the homogeneity of study subjects. The objective of this study was therefore to ascertain the risk of ulceration associated with high foot pressures and peripheral neuropathy in a large and diverse diabetic population. We studied a cross-sectional group of 251 diabetic patients of Caucasian (group C) (n=121), black (group B) (n=36), and Hispanic (group H) (n=94) racial origins with an overall age of 58.5+/-12.5 years (range 20-83). There was an equal distribution of men and women across the entire study population. All patients underwent a complete medical history and lower extremity evaluation for neuropathy and foot pressures. Neuropathic parameters were dichotomized (0/1) into two high-risk variables: patients with a vibration perception threshold (VPT) > or =25 V were categorized as HiVPT (n=132) and those with Semmes-Weinstein monofilament tests > or =5.07 were classified as HiSWF (n=190). The mean dynamic foot pressures of three footsteps were measured using the F-scan mat system with patients walking without shoes. Maximum plantar pressures were dichotomized into a high-pressure variable (Pmax6) indicating those subjects with pressures > or =6 kg/cm2 (n=96). A total of 99 patients had a current or prior history of ulceration at baseline. Joint mobility was significantly greater in the Hispanic cohort compared with the other groups at the first metatarsal-phalangeal joint (C 67+/-23 degrees, B 69+/-23 degrees, H 82+/-23 degrees, P=0.000), while the subtalar joint mobility was reduced in the Caucasian group (C 21+/-8 degrees, B 26+/-7 degrees, H 27+/-11 degrees, P=0.000). Maximum plantar foot pressures were significantly higher in the Caucasian group (C 6.7+/-2.9 kg/cm2, B 5.7+/-2.8 kg/cm2, H 4.4+/-1.9 kg/cm2, P=0

Foot-strike pattern and performance in a marathon

PubMed Central

Kasmer, Mark E.; Liu, Xue-cheng; Roberts, Kyle G.; Valadao, Jason M.

2016-01-01

Purpose To: 1) determine prevalence of heel-strike in a mid-size city marathon, 2) determine if there is an association between foot-strike classification and race performance, and 3) determine if there is an association between foot-strike classification and gender. Methods Foot-strike classification (fore-foot strike, mid-foot strike, heel strike, or split-strike), gender, and rank (position in race) were recorded at the 8.1 kilometer (km) mark for 2,112 runners at the 2011 Milwaukee Lakefront Marathon. Results 1,991 runners were classified by foot-strike pattern, revealing a heel-strike prevalence of 93.67% (n=1,865). A significant difference between foot-strike classification and performance was found using a Kruskal-Wallis test (p < 0.0001), with more elite performers being less likely to heel-strike. No significant difference between foot-strike classification and gender was found using a Fisher’s exact test. Additionally, subgroup analysis of the 126 non-heel strikers found no significant difference between shoe wear and performance using a Kruskal-Wallis test. Conclusions The high prevalence of heel-striking observed in this study reflects the foot-strike pattern of the majority of mid- to long-distance runners and more importantly, may predict their injury profile based on the biomechanics of a heel strike running pattern. This knowledge can aid the clinician in the appropriate diagnosis, management, and training modifications of the injured runner. PMID:23006790

Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations.

PubMed

Lavery, Lawrence A; Wunderlich, Robert P; Tredwell, Jeffrey L

2005-10-01

To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05). A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.

Find an Orthopaedic Foot and Ankle MD/DO

MedlinePlus

... All Site Content AOFAS / FootCareMD / Find a Surgeon Find a Foot & Ankle Orthopaedic Surgeon Page Content Who ... your prescribed treatment (surgical and/or non-surgical) ​ Find a Surgeon ​ Click here to find a foot ...

A comparison of foot kinematics in people with normal- and flat-arched feet using the Oxford Foot Model.

PubMed

Levinger, Pazit; Murley, George S; Barton, Christian J; Cotchett, Matthew P; McSweeney, Simone R; Menz, Hylton B

2010-10-01

Foot posture is thought to influence predisposition to overuse injuries of the lower limb. Although the mechanisms underlying this proposed relationship are unclear, it is thought that altered foot kinematics may play a role. Therefore, this study was designed to investigate differences in foot motion between people with normal- and flat-arched feet using the Oxford Foot Model (OFM). Foot posture in 19 participants was documented as normal-arched (n=10) or flat-arched (n=9) using a foot screening protocol incorporating measurements from weightbearing antero-posterior and lateral foot radiographs. Differences between the groups in triplanar motion of the tibia, rearfoot and forefoot during walking were evaluated using a three-dimensional motion analysis system incorporating a multi-segment foot model (OFM). Participants with flat-arched feet demonstrated greater peak forefoot plantar-flexion (-13.7° ± 5.6° vs -6.5° ± 3.7°; p=0.004), forefoot abduction (-12.9° ± 6.9° vs -1.8° ± 6.3°; p=0.002), and rearfoot internal rotation (10.6° ± 7.5° vs -0.2°± 9.9°; p=0.018) compared to those with normal-arched feet. Additionally, participants with flat-arched feet demonstrated decreased peak forefoot adduction (-7.0° ± 9.2° vs 5.6° ± 7.3°; p=0.004) and a trend towards increased rearfoot eversion (-5.8° ± 4.4° vs -2.5° ± 2.6°; p=0.06). These findings support the notion that flat-arched feet have altered motion associated with greater pronation during gait; factors that may increase the risk of overuse injury. Copyright © 2010 Elsevier B.V. All rights reserved.

Comparison of two bioelectrical impedance analysis devices with dual energy X-ray absorptiometry and magnetic resonance imaging in the estimation of body composition.

PubMed

Wang, Ji-Guang; Zhang, Yi; Chen, Han-E; Li, Yan; Cheng, Xiao-Guang; Xu, Li; Guo, Zhe; Zhao, Xing-Shan; Sato, Tetsuya; Cao, Qi-Yun; Chen, Ke-Min; Li, Biao

2013-01-01

We compared a 4-limb bioelectrical impedance analysis (BIA) system, HBF 359 (Omron), and a 2-limb foot-to-foot device, BC 532 (Tanita), with the standard dual energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI) methods for the measurement of body fat percentage (BF), skeletal muscle mass percentage (SMM, or fat-free mass [FFM] for BC 532), and visceral fat level (VF). Body composition was measured in 200 healthy volunteers (100 men and 100 women, mean age 48 years) by HBF 359 and BC 532 and by DXA and MRI. The agreement was assessed by correlation analysis and paired t-test. The correlation coefficients between BIA and DXA or MRI ranged from 0.71 to 0.89 for BF, SMM, and VF by HBF 359 and from 0.77 to 0.90 for BF, FFM, and VF by BC 532 in all subjects and in men and women separately (p < 0.001 for all). Compared with DXA, HBF 359 significantly (p < 0.001) underestimated BF by -5.8% in men and -9.6% in women. Compared with MRI, the corresponding underestimatons (negative) or overestimations (positive) by HBF 359 in men and women were, respectively, +1.9% (p = 0.02) and +1.7% (p = 0.10) for SMM, and +13.3% (p < 0.001) and -8.5% (p = 0.006), for VF. The corresponding values by BC 532 in men and women were -10.7 and -6.2% for BF, -1.4 and -2.5% for FFM, and +20.4 and -18.0% for VF. The BIA devices are accurate in the estimation of body composition, especially skeletal muscle mass or FFM.

Factors associated with combined hand and foot eczema.

PubMed

Agner, T; Aalto-Korte, K; Andersen, K E; Foti, C; Gimenéz-Arnau, A; Goncalo, M; Goossens, A; Le Coz, C; Diepgen, T L

2017-05-01

As for hand eczema, the aetiology of foot eczema is multifactorial and not very well understood. The aim of the present study was to identify factors associated with foot eczema in a cohort of hand eczema patients being classified into different subgroups. Associations between foot and hand eczema were studied in a cross-sectional design in a cohort of hand eczema patients. Consecutive patients were recruited from nine different European Centres during the period October 2011-September 2012. Data on demographic factors, presence of foot eczema, hand eczema duration and severity, and whether the hand eczema was work-related or not were available, as well as patch-test results. Of a total of 427 hand eczema patients identified, information on foot eczema was available in 419 patients who were included in the present study. A total of 125 patients (29.8%) had concomitant foot and hand eczema. It was found more often in association with hyperkeratotic hand eczema (P = 0.007) and was less often associated with irritant hand eczema (P < 0.001). However, foot eczema was nevertheless found in 18% of patient with irritant hand eczema and in 25% of patients with occupational hand eczema. Combined foot and hand eczema was associated with more severe and long-standing hand eczema (P < 0.001 and P = 0.004, respectively). Contact allergy was found in 51.8% with no difference between patients with combined foot and hand eczema and patients with hand eczema only. Occurrence of combined foot and hand eczema is a common finding and not restricted to endogenous hand eczema. © 2016 European Academy of Dermatology and Venereology.

Board-foot and cubic-foot volume tables for western red cedar in southeast Alaska.

Treesearch

Donald J. DeMars

1996-01-01

Four tables give cubic-foot and board-foot volume estimates for western redcedar given breast height diameter outside bark (DBHOB) and either total tree height or number of logs to a 6-inch top. The values for DBHOB and total tree height (or number of logs in the tree) that are in the tables have been limited to the ranges these variables had in the sample data.

Athlete's Foot.

PubMed

Brodin, M B

1979-03-01

The term athlete's foot doesn't accurately describe all maladies that afflict athletes' feet. Recognizing clinical characteristics and laboratory work will help physicians correctly diagnose and treat tineapedis, contact dermatitis, and eczema.

Repeatability of a 3D multi-segment foot model protocol in presence of foot deformities.

PubMed

Deschamps, Kevin; Staes, Filip; Bruyninckx, Herman; Busschots, Ellen; Matricali, Giovanni A; Spaepen, Pieter; Meyer, Christophe; Desloovere, Kaat

2012-07-01

Repeatability studies on 3D multi-segment foot models (3DMFMs) have mainly considered healthy participants which contrasts with the widespread application of these models to evaluate foot pathologies. The current study aimed at establishing the repeatability of the 3DMFM described by Leardini et al. in presence of foot deformities. Foot kinematics of eight adult participants were analyzed using a repeated-measures design including two therapists with different levels of experience. The inter-trial variability was higher compared to the kinematics of healthy subjects. Consideration of relative angles resulted in the lowest inter-session variability. The absolute 3D rotations between the Sha-Cal and Cal-Met seem to have the lowest variability in both therapists. A general trend towards higher σ(sess)/σ(trial) ratios was observed when the midfoot was involved. The current study indicates that not only relative 3D rotations and planar angles can be measured consistently in patients, also a number of absolute parameters can be consistently measured serving as basis for the decision making process. Copyright © 2012 Elsevier B.V. All rights reserved.

Measurement system for 3-D foot coordinates and parameters

NASA Astrophysics Data System (ADS)

Liu, Guozhong; Li, Yunhui; Wang, Boxiong; Shi, Hui; Luo, Xiuzhi

2008-12-01

The 3-D foot-shape measurement system based on laser-line-scanning principle and the model of the measurement system were presented. Errors caused by nonlinearity of CCD cameras and caused by installation can be eliminated by using the global calibration method for CCD cameras, which based on nonlinear coordinate mapping function and the optimized method. A local foot coordinate system is defined with the Pternion and the Acropodion extracted from the boundaries of foot projections. The characteristic points can thus be located and foot parameters be extracted automatically by the local foot coordinate system and the related sections. Foot measurements for about 200 participants were conducted and the measurement results for male and female participants were presented. 3-D foot coordinates and parameters measurement makes it possible to realize custom-made shoe-making and shows great prosperity in shoe design, foot orthopaedic treatment, shoe size standardization, and establishment of a feet database for consumers.

Foot Problems

MedlinePlus

... Falls Prevention Pain Management Join our e-newsletter! Aging & Health A to Z Foot Problems Basic Facts & ... April 2017 Posted: March 2012 © 2018 Health in Aging. All rights reserved. Feedback • Site Map • Privacy Policy • ...

Standardizing Foot-Type Classification Using Arch Index Values

PubMed Central

Weil, Rich; de Boer, Emily

2012-01-01

ABSTRACT Purpose: The lack of a reliable classification standard for foot type makes drawing conclusions from existing research and clinical decisions difficult, since different foot types may move and respond to treatment differently. The purpose of this study was to determine interrater agreement for foot-type classification based on photo-box-derived arch index values. Method: For this correlational study with two raters, a sample of 11 healthy volunteers with normal to obese body mass indices was recruited from both a community weight-loss programme and a programme in physical therapy. Arch index was calculated using AutoCAD software from footprint photographs obtained via mirrored photo-box. Classification as high-arched, normal, or low-arched foot type was based on arch index values. Reliability of the arch index was determined with intra-class correlations; agreement on foot-type classification was determined using quadratic weighted kappa (κw). Results: Average arch index was 0.215 for one tester and 0.219 for the second tester, with an overall range of 0.017 to 0.370. Both testers classified 6 feet as low-arched, 9 feet as normal, and 7 feet as high-arched. Interrater reliability for the arch index was ICC=0.90; interrater agreement for foot-type classification was κw=0.923. Conclusions: Classification of foot type based on arch index values derived from plantar footprint photographs obtained via mirrored photo-box showed excellent reliability in people with varying BMI. Foot-type classification may help clinicians and researchers subdivide sample populations to better differentiate mobility, gait, or treatment effects among foot types. PMID:23729964

Phillips during FOOT experiment

NASA Image and Video Library

2005-09-16

ISS011-E-13101 (16 Sept. 2005) --- Astronaut John L. Phillips, Expedition 11 NASA space station science officer and flight engineer, balances on the footplate of a special track attached to the Human Research Facility (HRF) rack in the Destiny laboratory on the International Space Station to perform Foot/Ground Reaction Forces During Spaceflight (FOOT) / Electromyography (EMG) calibration operations. Phillips is wearing the Lower Extremity Monitoring Suit (LEMS), the cycling tights outfitted with 20 sensors, which measures forces on joints and muscle activity.

Athlete's Foot: Clinical Update.

PubMed

Ramsey, M L

1989-10-01

In brief: Athletes are particularly prone to athlete's foot because they are generally more exposed than others to conditions that encourage fungal growth, eg, communal showers and locker rooms. Diagnosis of athlete's foot rests on clinical suspicion and laboratory testing. Treatment may consist of topical antifungal agents and, for more resistant cases, oral griseofulvin. Preventive measures include keeping the feet dry, wearing nonocclusive leather shoes or sandals and absorbent cotton socks, and applying talcum or antifungal powder at least twice daily.

Type 2 diabetes–related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature

PubMed Central

Bonner, Timethia; Foster, Margaret; Spears-Lanoix, Erica

2016-01-01

Introduction The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. Methods Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted. Results Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. Conclusion Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations. PMID:26899439

Type 2 diabetes-related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature.

PubMed

Bonner, Timethia; Foster, Margaret; Spears-Lanoix, Erica

2016-01-01

The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted. Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations.

The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot.

PubMed

Kelly, Luke A; Farris, Dominic J; Lichtwark, Glen A; Cresswell, Andrew G

2018-01-01

The aim of this study was to investigate the influence of foot-strike technique on longitudinal arch mechanics and intrinsic foot muscle function during running. Thirteen healthy participants ran barefoot on a force-instrumented treadmill at 2.8 ms with a forefoot (FFS) and rearfoot (RFS; habitual) running technique, whereas kinetic, kinematic, and electromyographic data from the intrinsic foot muscles were collected simultaneously. The longitudinal arch was modeled as a single "midfoot" joint representing motion of the rearfoot (calcaneus) relative to the forefoot (metatarsals). An inverse dynamic analysis was performed to estimate joint moments generated about the midfoot, as well as mechanical work and power. The midfoot was more plantar flexed (higher arch) at foot contact when running with a forefoot running technique (RFS 0.2 ± 1.8 vs FFS 6.9 ± 3.0°, effect size (ES) = 2.7); however, there was no difference in peak midfoot dorsiflexion in stance (RFS -11.6 ± 3.0 vs FFS -11.4 ± 3.4°, ES = 0.63). When running with a forefoot technique, participants generated greater moments about the midfoot (27% increase, ES = 1.1) and performed more negative work (240% increase, ES = 2.2) and positive work (42% increase, ES = 1.1) about the midfoot. Average stance-phase muscle activation was greater for flexor digitorum brevis (20% increase, ES = 0.56) and abductor hallucis (17% increase, ES = 0.63) when running with a forefoot technique. Forefoot running increases loading about the longitudinal arch and also increases the mechanical work performed by the intrinsic foot muscles. These findings have substantial implications in terms of injury prevention and management for runners who transition from a rearfoot to a forefoot running technique.

Foot deformation during walking: differences between static and dynamic 3D foot morphology in developing feet.

PubMed

Barisch-Fritz, Bettina; Schmeltzpfenning, Timo; Plank, Clemens; Grau, Stefan

2014-01-01

The complex functions of feet require a specific composition, which is progressively achieved by developmental processes. This development should take place without being affected by footwear. The aim of this study is to evaluate differences between static and dynamic foot morphology in developing feet. Feet of 2554 participants (6-16 years) were recorded using a new scanner system (DynaScan4D). Each foot was recorded in static half and full weight-bearing and during walking. Several foot measures corresponding to those used in last construction were calculated. The differences were identified by one-way ANOVA and paired Student's t-test. Static and dynamic values of each foot measure must be considered to improve the fit of footwear. In particular, footwear must account for the increase of forefoot width and the decrease of midfoot girth. Furthermore, the toe box should have a more rounded shape. The findings are important for the construction of footwear for developing feet.

Infrared thermal imaging for automated detection of diabetic foot complications.

PubMed

van Netten, Jaap J; van Baal, Jeff G; Liu, Chanjuan; van der Heijden, Ferdi; Bus, Sicco A

2013-09-01

Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of diabetic foot disease. The plantar foot surfaces of 15 diabetes patients were imaged with an infrared camera (resolution, 1.2 mm/pixel): 5 patients had no visible signs of foot complications, 5 patients had local complications (e.g., abundant callus or neuropathic ulcer), and 5 patients had diffuse complications (e.g., Charcot foot, infected ulcer, or critical ischemia). Foot temperature was calculated as mean temperature across pixels for the whole foot and for specified regions of interest (ROIs). No differences in mean temperature >1.5 °C between the ipsilateral and the contralateral foot were found in patients without complications. In patients with local complications, mean temperatures of the ipsilateral and the contralateral foot were similar, but temperature at the ROI was >2 °C higher compared with the corresponding region in the contralateral foot and to the mean of the whole ipsilateral foot. In patients with diffuse complications, mean temperature differences of >3 °C between ipsilateral and contralateral foot were found. With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of diabetic foot disease and to discriminate between no, local, or diffuse diabetic foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of diabetic foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings. © 2013 Diabetes Technology Society.

Infrared Thermal Imaging for Automated Detection of Diabetic Foot Complications

PubMed Central

van Netten, Jaap J.; van Baal, Jeff G.; Liu, Chanjuan; van der Heijden, Ferdi; Bus, Sicco A.

2013-01-01

Background Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of diabetic foot disease. Methods The plantar foot surfaces of 15 diabetes patients were imaged with an infrared camera (resolution, 1.2 mm/pixel): 5 patients had no visible signs of foot complications, 5 patients had local complications (e.g., abundant callus or neuropathic ulcer), and 5 patients had diffuse complications (e.g., Charcot foot, infected ulcer, or critical ischemia). Foot temperature was calculated as mean temperature across pixels for the whole foot and for specified regions of interest (ROIs). Results No differences in mean temperature >1.5 °C between the ipsilateral and the contralateral foot were found in patients without complications. In patients with local complications, mean temperatures of the ipsilateral and the contralateral foot were similar, but temperature at the ROI was >2 °C higher compared with the corresponding region in the contralateral foot and to the mean of the whole ipsilateral foot. In patients with diffuse complications, mean temperature differences of >3 °C between ipsilateral and contralateral foot were found. Conclusions With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of diabetic foot disease and to discriminate between no, local, or diffuse diabetic foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of diabetic foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings. PMID:24124937

Biomechanical response to ankle-foot orthosis stiffness during running.

PubMed

Russell Esposito, Elizabeth; Choi, Harmony S; Owens, Johnny G; Blanck, Ryan V; Wilken, Jason M

2015-12-01

The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is an ankle-foot orthosis developed to address the high rates of delayed amputation in the military. Its use has enabled many wounded Service Members to run again. During running, stiffness is thought to influence an orthosis' energy storage and return mechanical properties. This study examined the effect of orthosis stiffness on running biomechanics in patients with lower limb impairments who had undergone unilateral limb salvage. Ten patients with lower limb impairments underwent gait analysis at a self-selected running velocity. 1. Nominal (clinically-prescribed), 2. Stiff (20% stiffer than nominal), and 3. Compliant (20% less stiff than nominal) ankle-foot orthosis stiffnesses were tested. Ankle joint stiffness was greatest in the stiffest strut and lowest in the compliant strut, however ankle mechanical work remained unchanged. Speed, stride length, cycle time, joint angles, moments, powers, and ground reaction forces were not significantly different among stiffness conditions. Ankle joint kinematics and ankle, knee and hip kinetics were different between limbs. Ankle power, in particular, was lower in the injured limb. Ankle-foot orthosis stiffness affected ankle joint stiffness but did not influence other biomechanical parameters of running in individuals with unilateral limb salvage. Foot strike asymmetries may have influenced the kinetics of running. Therefore, a range of stiffness may be clinically appropriate when prescribing ankle-foot orthoses for active individuals with limb salvage. Published by Elsevier Ltd.

Athlete's foot

MedlinePlus

... you: Wear closed shoes, especially if they are plastic-lined Keep your feet wet for long periods ... can completely dry between wearings. Do not wear plastic-lined shoes. If athlete's foot does not get ...

The effect of foot arch on plantar pressure distribution during standing.

PubMed

Periyasamy, R; Anand, Sneh

2013-07-01

The aim of this study was to explore how foot type affects plantar pressure distribution during standing. In this study, 32 healthy subjects voluntarily participated and the subject feet were classified as: normal feet (n = 23), flat feet (n = 14) and high arch feet (n = 27) according to arch index (AI) values obtained from foot pressure intensity image analysis. Foot pressure intensity images were acquired by a pedopowergraph system to obtain a foot pressure distribution parameter-power ratio (PR) during standing in eight different regions of the foot. Contact area and mean PR were analysed in hind foot, mid-foot and fore foot regions. One-way analysis of variance was used to determine statistical differences between groups. The contact area and mean PR value beneath the mid-foot was significantly increased in the low arch foot when compared to the normal arch foot and high arch foot (p < 0.001) in both feet. However, subjects with low-arch feet had significantly higher body mass index (BMI) compared to subjects with high-arch feet (p < 0.05) and subjects with normal arch feet (p < 0.05) in both feet. In addition, subjects with low-arch feet had significant differences in arch index (AI) value as compared to subjects with high-arch feet (p < 0.001) and subjects with normal arch feet (p < 0.05) in both feet. Mean mid-foot PR value were positively (r = 0.54) correlated with increased arch index (AI) value. A significant (p < 0.05) change was obtained in PR value beneath the mid-foot of low arch feet when compared with other groups in both feet. The findings suggest that there is an increased mid-foot PR value in the low arch foot as compared to the normal arch foot and high arch foot during standing. Therefore, individuals with low arch feet could be at high risk for mid-foot collapse and Charcot foot problems, indicating that foot type should be assessed when determining an individual's risk for foot injury.

29 CFR 1917.94 - Foot protection.

Code of Federal Regulations, 2010 CFR

2010-07-01

... affected employee wears protective footwear when working in areas where there is a danger of foot injuries... Test Methods for Foot Protection,” and ASTM F-2413-2005, “Standard Specification for Performance...

A simple field method to identify foot strike pattern during running.

PubMed

Giandolini, Marlène; Poupard, Thibaut; Gimenez, Philippe; Horvais, Nicolas; Millet, Guillaume Y; Morin, Jean-Benoît; Samozino, Pierre

2014-05-07

Identifying foot strike patterns in running is an important issue for sport clinicians, coaches and footwear industrials. Current methods allow the monitoring of either many steps in laboratory conditions or only a few steps in the field. Because measuring running biomechanics during actual practice is critical, our purpose is to validate a method aiming at identifying foot strike patterns during continuous field measurements. Based on heel and metatarsal accelerations, this method requires two uniaxial accelerometers. The time between heel and metatarsal acceleration peaks (THM) was compared to the foot strike angle in the sagittal plane (αfoot) obtained by 2D video analysis for various conditions of speed, slope, footwear, foot strike and state of fatigue. Acceleration and kinematic measurements were performed at 1000Hz and 120Hz, respectively, during 2-min treadmill running bouts. Significant correlations were observed between THM and αfoot for 14 out of 15 conditions. The overall correlation coefficient was r=0.916 (P<0.0001, n=288). The THM method is thus highly reliable for a wide range of speeds and slopes, and for all types of foot strike except for extreme forefoot strike during which the heel rarely or never strikes the ground, and for different footwears and states of fatigue. We proposed a classification based on THM: FFS<-5.49msto ensure appropriate use of this method, it is reliable for distinguishing rearfoot and non-rearfoot strikers in situ. Copyright © 2014 Elsevier Ltd. All rights reserved.

Minimally important change was estimated for the Manchester-Oxford Foot Questionnaire after foot/ankle surgery.

PubMed

Dawson, Jill; Boller, Irene; Doll, Helen; Lavis, Grahame; Sharp, Robert; Cooke, Paul; Jenkinson, Crispin

2014-06-01

To ascertain the smallest amounts of change for the three Manchester-Oxford Foot Questionnaire (MOXFQ) domains that are likely to be clinically meaningful and beyond measurement error for conditions affecting the foot/ankle. Estimates were compared with those from the Short-Form 36 (SF-36). A prospective observational study of 671 consecutive patients undergoing foot or ankle surgery at an orthopedic hospital. Before and 9 months after surgery, patients completed the MOXFQ and SF-36; transition items (anchor) asked about perceived changes in foot/ankle pain or problems since the surgery. Four hundred ninety-one patients completed pre- and postoperative questionnaires. Anchor-based minimal clinically important change (MCIC) values were ~13 points for each of the MOXFQ Walking/standing (W/S), Pain, and Social Interaction (S-I) domains [and greater than the standard error of measurement (SEM)]. MCIC values for all SF-36 domains fell within the SEM. Between-group MCIDs for the MOXFQ were W/S, 16.2; Pain, 9.9; S-I, 9.3. Distribution-based minimal detectable change (MDC90) values for the MOXFQ were ~11, ~12, and ~16 score points for the W/S, Pain, and S-I scales, respectively. This article provides information for aiding the interpretability of MOXFQ outcomes data and for planning future studies. The SF-36 is not recommended as a primary outcome for foot/ankle surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Fusion in posttraumatic foot and ankle reconstruction.

PubMed

Thordarson, David B

2004-01-01

Despite appropriate acute treatment, many foot and ankle injuries result in posttraumatic arthritis. Arthrodesis remains the mainstay of treatment of end-stage arthritis of the foot and ankle. An understanding of the biomechanics of the foot and ankle, particularly which joints are most responsible for optimal function of the foot, can help guide reconstructive efforts. A careful history and physical examination, appropriate radiographs, and, when necessary, differential selective anesthetic blocks help limit fusion to only those joints that are causing pain. Compression fixation, when possible, remains the treatment of choice. When bone defects are present, however, neutralization fixation may be necessary to prevent a secondary deformity that could result from impaction into a bone defect.

Hyperspectral Imaging in Diabetic Foot Wound Care

PubMed Central

Yudovsky, Dmitry; Nouvong, Aksone; Pilon, Laurent

2010-01-01

Diabetic foot ulceration is a major complication of diabetes and afflicts as many as 15 to 25% of type 1 and 2 diabetes patients during their lifetime. If untreated, diabetic foot ulcers may become infected and require total or partial amputation of the affected limb. Early identification of tissue at risk of ulcerating could enable proper preventive care, thereby reducing the incidence of foot ulceration. Furthermore, noninvasive assessment of tissue viability around already formed ulcers could inform the diabetes caregiver about the severity of the wound and help assess the need for amputation. This article reviews how hyperspectral imaging between 450 and 700 nm can be used to assess the risk of diabetic foot ulcer development and to predict the likelihood of healing noninvasively. Two methods are described to analyze the in vivo hyperspectral measurements. The first method is based on the modified Beer-Lambert law and produces a map of oxyhemoglobin and deoxyhemoglobin concentrations in the dermis of the foot. The second is based on a two-layer optical model of skin and can retrieve not only oxyhemoglobin and deoxyhemoglobin concentrations but also epidermal thickness and melanin concentration along with skin scattering properties. It can detect changes in the diabetic foot and help predict and understand ulceration mechanisms. PMID:20920429

Treatment options for diabetic foot osteomyelitis.

PubMed

Senneville, Eric; Robineau, Olivier

2017-06-01

Diabetic foot osteomyelitis therapeutical options are based on antibiotic therapy and surgical resection of the infected bone(s). Surgical and medical approaches of patients suffering from a diabetic foot osteomyelitis do not oppose but are complementary and need to be discussed as a tailored manner. Areas covered: The aim of the present article is to discuss data issued from the most recent guidelines of the Infectious Diseases Society of America and the International Working Group on the Diabetic Foot on the management of the diabetic foot infection and from a search in the current literature using the terms diabetic foot osteomyelitis and treatment/therapy/therapeutical in both PubMed and Medline, restricted to the last five years. Expert opinion: Surgical removal of the entire infected bone(s) has been considered in the past as the standard treatment but medical approach of these patients has now proven efficacy in selected situations. The current emergence of bacteria, especially among Gram negative rods, resistant to almost all the available antibiotics gradually augments the complexity of the management of these patients and is likely to decrease the place of the medical approach and to worsen the outcome of these infections in the next future.

Foot care behaviors among adults with type 2 diabetes.

PubMed

D'Souza, Melba Sheila; Ruppert, Susan D; Parahoo, Kader; Karkada, Subrahmanya Nairy; Amirtharaj, Anandhi; Jacob, Devakirubai; Balachandran, Shreedevi; Al Salmi, Nasser Majid Dhabi

2016-12-01

The aim of the study was to determine factors influencing foot care behaviors among adults with type 2 diabetes. A correlational descriptive study was conducted with a random sample of 160 adults with type 2 diabetes from the public hospital between April and July 2014. Just over 15% of the sample had a history of foot ulcers and almost 42% had numbness/tingling and pain in their feet. Positive foot care behaviors were correlated with higher income, higher educational attainment, lower body weight, positive attitude and higher awareness of diabetes and its management. Targeting type 2 diabetes people with low level of education, low income and overweight may help to enhance their foot care and reduce foot complications in similar populations, Implications. Those most at risk of foot problems should be targeted for education to increase their awareness of ways to prevent and to manage foot problems. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

When and how to audit a diabetic foot service.

PubMed

Leese, Graham P; Stang, Duncan

2016-01-01

Quality improvement depends on data collection and audit of clinical services to inform clinical improvements. Various steps in the care of the diabetic foot can be used to audit a service but need defined audit standards. A diabetes foot service should have risk stratification system in place that should compare to the population-based figures of 76% having low-risk feet, 17% moderate risk and 7% being at high risk of ulceration. Resources can then be directed towards those with high-risk feet. Prevalence of foot ulceration needs to be audited. Community-based studies give an audit standard of around 2%, with 2 to 9% having had an ulcer at some stage in the past. Amputation rates should be easier to measure, and the best results are reported to be around 1.5-3 per 1000 people with diabetes. This is a useful benchmark figure, and the rate has been shown to decrease by approximately a third over the last 15 years in some centres. Ulceration rates and ulcer healing rates are the ultimate outcome audit measure as they are always undesirable, whilst occasionally for defined individuals, an amputation can be a good outcome. In addition to clinical outcomes, processes of care can be audited such as provision of clinical services, time from new ulcer to be seen by health care professional, inpatient foot care or use of antibiotics. Measurement of clinical services can be a challenge in the diabetic foot, but it is essential if clinical services and patient outcomes are to be improved. Copyright © 2016 John Wiley & Sons, Ltd.

The Metrical Foot in Diyari.

ERIC Educational Resources Information Center

Poser, William

1989-01-01

Considers the metrical foot in Diyari, a South Australian Language, and concludes that, on the basis of stress alone, an argument can be made for the constituency of the metrical stress foot under certain theoretical assumptions. This conclusion is reinforced by the occupance in Diyari of other less theory-dependant phenomena. (46 references) (JL)

Getting rid of athlete's foot.

PubMed

2002-07-01

At any one time, around 17% of adults in the UK have athlete's foot. While such fungal infection is not usually dangerous, it can cause discomfort, may be resistant to treatment, and may spread to other parts of the body or to other people. Affected feet can also become secondarily infected by bacteria. Here, we review the topical and systemic treatment of athlete's foot.

Hybrid imaging in foot and ankle disorders.

PubMed

García Jiménez, R; García-Gómez, F J; Noriega Álvarez, E; Calvo Morón, C; Martín-Marcuartu, J J

Disorders of the foot and ankle are some of the most frequent ones affecting the musculoskeletal system and have a great impact on patients' quality of life. Accurate diagnosis is an important clinical challenge because of the complex anatomy and function of the foot, that make it difficult to locate the source of the pain by routine clinical examination. In the study of foot pathology, anatomical imaging (radiography, magnetic resonance imaging [MRI], ultrasound and computed tomography [CT]) and functional imaging (bone scan, positron emission tomography [PET] and MRI) techniques have been used. Hybrid imaging combines the advantages of morphological and functional studies in a synergistic way, helping the clinician manage complex problems. In this article we delve into the anatomy and biomechanics of the foot and ankle and describe the potential indications for the current hybrid techniques available for the study of foot and ankle disease. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

The reliability and validity of a three-camera foot image system for obtaining foot anthropometrics.

PubMed

O'Meara, Damien; Vanwanseele, Benedicte; Hunt, Adrienne; Smith, Richard

2010-08-01

The purpose was to develop a foot image capture and measurement system with web cameras (the 3-FIS) to provide reliable and valid foot anthropometric measures with efficiency comparable to that of the conventional method of using a handheld anthropometer. Eleven foot measures were obtained from 10 subjects using both methods. Reliability of each method was determined over 3 consecutive days using the intraclass correlation coefficient and root mean square error (RMSE). Reliability was excellent for both the 3-FIS and the handheld anthropometer for the same 10 variables, and good for the fifth metatarsophalangeal joint height. The RMSE values over 3 days ranged from 0.9 to 2.2 mm for the handheld anthropometer, and from 0.8 to 3.6 mm for the 3-FIS. The RMSE values between the 3-FIS and the handheld anthropometer were between 2.3 and 7.4 mm. The 3-FIS required less time to collect and obtain the final variables than the handheld anthropometer. The 3-FIS provided accurate and reproducible results for each of the foot variables and in less time than the conventional approach of a handheld anthropometer.

Gait ground reaction force characteristics of low back pain patients with pronated foot and able-bodied individuals with and without foot pronation.

PubMed

Farahpour, Nader; Jafarnezhad, AmirAli; Damavandi, Mohsen; Bakhtiari, Abbas; Allard, Paul

2016-06-14

The link between gait parameters and foot abnormalities in association with low back pain is not well understood. The objective of this study was to investigate the effects of excessive foot pronation as well as the association of LBP with excessive foot pronation on the GRF components during shod walking. Forty-five subjects were equally divided into a control group, a group of subjects with pronated feet only, and another group with pronated feet and LBP. Ground reaction forces were analyzed during shod walking. Foot pronation without low back pain was associated with increased lateral-medial ground reaction force, impulse, and time to peak of all reaction forces in heel contact phase (p<0.03). In low back pain patients with pronated foot, greater vertical reaction forces (p=0.001) and loading rate, and time to peak on propulsion force were observed compared to pronated foot without low back pain group. Impulse in posterior-anterior reaction force was smaller in the able-bodied group with normal foot than in the other groups (p<0.05). Positive peak of free moments of the LBP group was significantly greater than that in other groups (p<0.05). In conclusion, foot pronation alone was not associated with elevated vertical ground reaction forces. While, low back pain patients with foot pronation displayed higher vertical ground reaction force as well as higher loading rate. Present results reveal that gait ground reaction force components in low back pain patients with pronated foot may have clinical values on the prognosis and rehabilitation of mechanical LBP patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Northeastern forest survey revised cubic-foot volume equations

Treesearch

Charles T. Scott

1981-01-01

Cubic-foot volume equations are presented for the 17 species groups used in the forest survey of the 14 northeastern states. The previous cubic- foot volume equations were simple linear in form; the revised cubic-foot volume equations are nonlinear.

Athlete's foot and onychomycosis caused by Hendersonula toruloidea.

PubMed

Abramson, C

1990-08-01

Fungi other than the dermatophytes can cause infections of the foot, toes and toenails that simulate classic "athlete's foot." Unless diagnosed culturally and morphologically by the clinical laboratory, treatment failures may occur. The saprophyte Hendersonula toruloidea as well as other fungi and yeasts reported to cause such infections have been shown to be clinically indistinguishable from classic dermatophytic "athlete's foot." The clinical and laboratory diagnosis of these types of foot infections caused by Hendersonula toruloidea are described. Specific transport media required for laboratory diagnosis and therapeutic alternatives are reviewed.

Fleet of Foot: Adolescent Foot and Ankle Mobility

ERIC Educational Resources Information Center

Legacy, Kelly Bromley

2018-01-01

In today's world of advanced technologies, accessible transportation, and fingertip talking, adolescents are spending too many hours each day sedentary. The purpose of this article is to underscore the importance of foot and ankle mobility in an adolescent population that spends very little time on their feet. Physical educators and athletic…

Foot anatomy specialization for postural sensation and control

PubMed Central

Ivanenko, Y. P.; Gurfinkel, V. S.

2012-01-01

Anthropological and biomechanical research suggests that the human foot evolved a unique design for propulsion and support. In theory, the arch and toes must play an important role, however, many postural studies tend to focus on the simple hinge action of the ankle joint. To investigate further the role of foot anatomy and sensorimotor control of posture, we quantified the deformation of the foot arch and studied the effects of local perturbations applied to the toes (TOE) or 1st/2nd metatarsals (MT) while standing. In sitting position, loading and lifting a 10-kg weight on the knee respectively lowered and raised the foot arch between 1 and 1.5 mm. Less than 50% of this change could be accounted for by plantar surface skin compression. During quiet standing, the foot arch probe and shin sway revealed a significant correlation, which shows that as the tibia tilts forward, the foot arch flattens and vice versa. During TOE and MT perturbations (a 2- to 6-mm upward shift of an appropriate part of the foot at 2.5 mm/s), electromyogram (EMG) measures of the tibialis anterior and gastrocnemius revealed notable changes, and the root-mean-square (RMS) variability of shin sway increased significantly, these increments being greater in the MT condition. The slow return of RMS to baseline level (>30 s) suggested that a very small perturbation changes the surface reference frame, which then takes time to reestablish. These findings show that rather than serving as a rigid base of support, the foot is compliant, in an active state, and sensitive to minute deformations. In conclusion, the architecture and physiology of the foot appear to contribute to the task of bipedal postural control with great sensitivity. PMID:22157121

The effects of prolonged running on foot posture: a repeated measures study of half marathon runners using the foot posture index and navicular height

PubMed Central

2013-01-01

Background Different foot postures are associated with alterations in foot function, kinetics and the subsequent occurrence of injury. Little is known about changes in foot posture following prolonged weightbearing exercise. This study aimed to identify changes in foot posture after running a half marathon. Methods Foot posture was measured using the Foot Posture Index (FPI-6) and navicular height in thirty volunteer participants before and after running a half marathon. FPI-6 scores were converted to Rasch logit values and means compared for these and navicular height using an ANOVA. Results There was a 5 mm drop in navicular height in both feet when measured after the half marathon (P < 0.05). The FPI-6 showed a side x time interaction with an increase in score indicating a more ‘pronated’ position in the left foot of + 2 [Rasch value + 1.7] but no change in the right foot (+ 0.4 [+ 0.76]) following the half marathon. Conclusion The apparent differences between the FPI-6 and navicular height on the right foot may be because the FPI-6 takes soft tissue contour changes into consideration whilst the navicular height focuses on skeletal changes. The changes in foot posture towards a more pronated position may have implications for foot function, and therefore risk of injury; shoe fit and comfort and also the effect of therapeutic orthoses worn during prolonged running. PMID:23705863

The shod foot and its implications for American women.

PubMed

Rudicel, S A

1994-01-01

Throughout history, members of human societies have gone barefoot, and those societies seemingly had a low incidence of foot deformities and pain. Only one study has addressed the problem of infection through injury to the bare foot; otherwise, the unshod foot seems to have had minimal problems. Initially shoes were made in the shape of the foot and were sandals. Over time, shoes became decorative items and symbols of status and vanity. As the shape of shoes changed, they became deforming forces on the foot and the source of pain. Recent studies by the Council on Women's Footwear of the American Orthopaedic Foot and Ankle Society have tried to document the problems caused by shoes on the feet of American women. Attempts should continue to educate women on appropriate shoes and proper fit.

Foot-strike pattern and performance in a marathon.

PubMed

Kasmer, Mark E; Liu, Xue-Cheng; Roberts, Kyle G; Valadao, Jason M

2013-05-01

To determine prevalence of heel strike in a midsize city marathon, if there is an association between foot-strike classification and race performance, and if there is an association between foot-strike classification and gender. Foot-strike classification (forefoot, midfoot, heel, or split strike), gender, and rank (position in race) were recorded at the 8.1-km mark for 2112 runners at the 2011 Milwaukee Lakefront Marathon. 1991 runners were classified by foot-strike pattern, revealing a heel-strike prevalence of 93.67% (n = 1865). A significant difference between foot-strike classification and performance was found using a Kruskal-Wallis test (P < .0001), with more elite performers being less likely to heel strike. No significant difference between foot-strike classification and gender was found using a Fisher exact test. In addition, subgroup analysis of the 126 non-heel strikers found no significant difference between shoe wear and performance using a Kruskal-Wallis test. The high prevalence of heel striking observed in this study reflects the foot-strike pattern of most mid-distance to long-distance runners and, more important, may predict their injury profile based on the biomechanics of a heel-strike running pattern. This knowledge can help clinicians appropriately diagnose, manage, and train modifications of injured runners.

Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.

PubMed

Boffeli, Troy J; Collier, Rachel C

2014-01-01

Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

29 CFR 1910.136 - Foot protection.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 5 2012-07-01 2012-07-01 false Foot protection. 1910.136 Section 1910.136 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Personal Protective Equipment § 1910.136 Foot protection. (a) General...

A foot-care program to facilitate self-care by the elderly: a non-randomized intervention study.

PubMed

Omote, Shizuko; Watanabe, Arisu; Hiramatsu, Tomoko; Saito, Emiko; Yokogawa, Masami; Okamoto, Rie; Sakakibara, Chiaki; Ichimori, Akie; Kyota, Kaoru; Tsukasaki, Keiko

2017-11-09

We aimed to evaluate a foot-care awareness program designed to improve foot morphology, physical functioning, and fall prevention among the community-dwelling elderly. Eleven independent community-dwelling elderly women (aged 61-83 years) were provided with foot-care advice and shown effective foot-care techniques to perform regularly for 6 months, and compared with a control group of 10 elderly women who did not receive any intervention. Measurements of foot form, functional capacity, subjective foot movement, and physical function were taken at baseline and 6-month follow-up. At follow-up, improvements were seen in the intervention group in foot morphology, subjective foot movement, foot pressure, and balance. In the intervention group, 90% of women had maintained or improved foot form and none of them had fallen during the post-intervention period, compared to the control group where 30% improved foot form (p = 0.0075) and four (40%) of them had fallen. Therefore, a foot-care program may have the potential to prevent falls and improve mobility among the elderly. Trial Registration UMIN-CTR No. UMIN000029632. Date of Registration: October 19, 2017.

Diabetic Foot and Risk: How to Prevent Losing Your Leg

MedlinePlus

... in blood flow to the foot. Darkening or loss of hair may indicate that the blood or nerve supply has decreased. Less blood to the foot can ... differences between hot/warm and cold water. Shower water can be first tested ... identify any loss of temperature sensation. Testing for any change in ...

Gross Motor Skills in Children With Idiopathic Clubfoot and the Association Between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion.

PubMed

Lööf, Elin; Andriesse, Hanneke; André, Marie; Böhm, Stephanie; Iversen, Maura D; Broström, Eva W

2017-02-24

Little is known regarding gross motor skills (GMS) in children with idiopathic clubfoot (IC). This study describes GMS, specifically foot involvement and asymmetries, and analyses the association between GMS, gait, and foot status in children with IC. Gross motor tasks and gait were analyzed in children with IC and typically developed (TD) children. GMS were assessed using videotapes and the Clubfoot Assessment Protocol (CAP). The Gait Deviation Index (GDI) and GDI-Kinetic were calculated from gait analyses. Children were divided into bilateral, unilateral clubfoot, or TD groups. To analyze asymmetries, feet within each group were further classified into superior or inferior foot, depending on their CAP scores. Correlations identified associations between CAP and GDI, GDI-Kinetic, passive foot motion, and Dimeglio Classification Scores at birth in the clubfeet. In total, 75 children (mean age, 5 years) were enrolled (bilateral n=22, unilateral clubfoot n=25, TD=28). Children with clubfeet demonstrated significantly lower GMS, gait, and foot motion compared with TD children. One leg standing and hopping deviated in 84% and 91%, respectively, in at least one foot in children with clubfoot. Gross motor asymmetries were evident in both children with bilateral and unilateral involvement. In children with unilateral clubfoot, contralateral feet showed few deviations in GMS compared with TD; however, differences existed in gait and foot motion. The association between GMS and gait, foot motion, and initial foot status varied between poor and moderate. Gross motor deficits and asymmetries are present in children with both bilateral and unilateral IC. Development of GMS of the contralateral foot mirrors that of TD children, but modifies to the clubfoot in gait and foot motion. The weak association with gait, foot motion, and initial clubfoot severity indicates that gross motor measurements represent a different outcome entity in clubfoot treatment. We therefore, recommend

The prevalence of diabetic foot disease in the Waikato region.

PubMed

O'Shea, C; McClintock, J; Lawrenson, R

2017-07-01

The aim of this study was to establish the prevalence of diabetic foot disease by utilising the retinal eye screening register in the Waikato region of New Zealand. Understanding both the prevalence and the degree of foot disease across the general diabetes population will help to determine what podiatry services are required for people with diabetes. 2192 people aged 15years and over, who attended the Waikato Regional Diabetes Service mobile retinal photo screening service for the six-month period between May and November 2014, consented to a foot screen including testing for sensation and pedal pulses. A digital image was taken of the dorsal and plantar aspect of each foot for review by a registered Podiatrist. Thirteen percent of the study sample was identified as having a high-risk foot including active foot complications. 65% were categorised as low risk and a further 22% at moderate risk of diabetic foot disease. Factors identified as significant included age, type of diabetes, duration of diabetes, and smoking. These factors placed people at greater risk of diabetic foot disease. A significant number of people with diabetes are at risk of diabetic foot disease. This study has highlighted the need for targeted podiatry services to address diabetic foot disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparative analysis and quantitative evaluation of ankle-foot orthoses for foot drop in chronic hemiparetic patients.

PubMed

Zollo, L; Zaccheddu, N; Ciancio, A L; Morrone, M; Bravi, M; Santacaterina, F; Laineri Milazzo, M; Guglielmelli, E; Sterzi, S

2015-04-01

Ankle-foot-orthoses (AFOs) are frequently prescribed for hemiparetic patients to compensate for the foot drop syndrome. However, there is not a systematic study either on the effectiveness of AFOs in the gait recovery process or pointing out the therapeutic differences among the various types of AFOs available on the market. To perform a comparative evaluation of solid and dynamic Ankle-Foot-Orthoses (AFOs) on hemiparetic patients affected by foot drop syndrome by means of spatio-temporal, kinematic and electromyographic indicators. Crossover design with randomization for the interventions. A rehabilitation center for adults with neurologic disorders. Ten chronic hemiparetic patients with foot drop syndrome met inclusion criteria and volunteered to participate. Biomechanical gait analysis was carried out on hemiparetic subjects with foot drop syndrome under 3 conditions with randomized sequences: 1) without AFO; 2) wearing a solid AFO; 3) wearing a dynamic AFO. Significant changes in spatio-temporal, kinematic and electromyographic features of gait were investigated. Gait analysis outcomes showed that there were no significant differences among the solid and the dynamic AFO on the spatio-temporal parameters. Both AFOs led to a reduction of the range of motion of the ankle dorsi-plantar-flexion during stance with respect to the ambulation without AFO. They also had the effect of reducing the asymmetry between the paretic and the contralateral limb in terms of ankle angle at initial contact and hip flexion. The solid AFO generally led to an increase of the co-contraction of the couples of muscles involved in the gait. The proposed set of indicators showed that the AFOs were capable of limiting the effect of the foot-drop in hemiparetic patients and balancing the two limbs. Main differences between the two orthoses were related to muscular activity, being the level of co-contraction of the two couples of analysed muscles typically lower when the dynamic AFO was worn

Cosmetic Foot Surgery: Fashion's Pandora's Box

MedlinePlus

... Fashion’s Pandora’s Box? A A A | Print | Share Cosmetic Foot Surgery: Fashion’s Pandora’s Box? Foot and ankle surgeons warn ... extreme and imprudent as it may sound, the cosmetic surgery craze is not just for faces anymore—it ...

[The gold standard in diabetic foot treatment: total contact cast].

PubMed

Lozano-Platonoff, Adriana; Florida Mejía-Mendoza, Melissa Desireé; Ibáñez-Doria, Mónica; Contreras-Ruiz, José

2014-01-01

In patients with diabetes, foot complications remain one of the main health issues, with ulcers representing one of the most common. These ulcerations originate from repetitive trauma on a foot with neuropathy. Inadequate care of the diabetic foot may lead to one of the gravest complications of the diabetic foot: amputation. The key to the treatment of the diabetic foot is the control of comorbidities (glucose levels and vascular disease), debridement, exudate control with the available modern dressings, treatment of infection, and offloading the affected foot. A common error in this basic treatment is the method used for offloading, leading to delayed healing as a result, and maybe even amputation. For this purpose we propose the total contact cast considered the "gold standard" in diabetic foot offloading. The objective of the present review is to present the existing evidence in the medical literature on the effectiveness of its use for healing diabetic foot ulcers and hence preventing amputations.

Foot Problems

MedlinePlus

... Over-the-counter anti-inflammatory medication or ice massages may help relieve the pain. Start OverDiagnosisYou may have an infection called CELLULITIS. If you have diabetes, an infection of your foot may be more common and more dangerous. Self ...

Gender differences in foot shape: a study of Chinese young adults.

PubMed

Hong, Youlian; Wang, Lin; Xu, Dong Qing; Li, Jing Xian

2011-06-01

One important extrinsic factor that causes foot deformity and pain in women is footwear. Women's sports shoes are designed as smaller versions of men's shoes. Based on this, the current study aims to identify foot shape in 1,236 Chinese young adult men and 1,085 Chinese young adult women. Three-dimensional foot shape data were collected through video filming. Nineteen foot shape variables were measured, including girth (4 variables), length (4 variables), width (3 variables), height (7 variables), and angle (1 variable). A comparison of foot measures within the range of the common foot length (FL) categories indicates that women showed significantly smaller values of foot measures in width, height, and girth than men. Three foot types were classified, and distributions of different foot shapes within the same FL were found between women and men. Foot width, medial ball length, ball angle, and instep height showed significant differences among foot types in the same FL for both genders. There were differences in the foot shape between Chinese young women and men, which should be considered in the design of Chinese young adults' sports shoes.

A survey of foot problems in juvenile idiopathic arthritis.

PubMed

Hendry, G; Gardner-Medwin, J; Watt, G F; Woodburn, J

2008-12-01

Evidence suggests that foot problems are common in juvenile idiopathic arthritis (JIA), with prevalence estimates over 90%. The aim of this survey was to describe foot-related impairment and disability associated with JIA and foot-care provision in patients managed under modern treatment paradigms, including disease-modifying anti-rheumatic drugs (DMARDs) and biologic therapies. The Juvenile Arthritis Foot Disability Index (JAFI), Child Health Assessment Questionnaire (CHAQ), and pain visual analogue scale (VAS) were recorded in 30 consecutive established JIA patients attending routine outpatient clinics. Foot deformity score, active/limited joint counts, walking speed, double-support time (s) (DS) and step length symmetry index % (SI) were also measured. Foot-care provision in the preceding 12 months was determined from medical records. Sixty-three per cent of children reported some foot impairment, with a median (range) JAFI subscale score of 1 (0-3); 53% reported foot-related activity limitation, with a JAFI subscale score of 1 (0-4); and 60% reported participation restriction, with a JAFI subscale score of 1 (0-3). Other reported variables were CHAQ 0.38 (0-2), VAS pain 22 (0-79), foot deformity 6 (0-20), active joints 0 (0-7), limited joints 0 (0-31), walking speed 1.09 m/s (0.84-1.38 m/s), DS 0.22 s (0.08-0.26 s) and SI +/-4.0% (+/-0.2-+/-31.0%). A total of 23/30 medical records were reviewed and 15/23 children had received DMARDS, 8/23 biologic agents and 20/23 multiple intra-articular corticosteroid injections. Ten children received specialist podiatry care comprising footwear advice, orthotic therapy and silicone digital splints together with intrinsic muscle strengthening exercises. Despite frequent use of DMARD/biologic therapy and specialist podiatry-led foot care, foot-related impairment and disability persists in some children with JIA.

Estimating body fat by using bioelectrical-impedance measurements: a preliminary assessment.

Treesearch

M.G. Raphael; H.J. Harlow; S.W. Buskirk

1991-01-01

We evaluated a technique for measuring body fat content of marten (Martes americana) by using a noninvasive bioelectrical-impedance device with four electrodes to introduce a current into the body. Instantaneous readings of resistance were significantly correlated with fat-free mass (determined from solvent extraction) of carcasses of 17 skinned (r...

Foot health and self-care activities of older people in home care.

PubMed

Stolt, Minna; Suhonen, Riitta; Puukka, Pauli; Viitanen, Matti; Voutilainen, Päivi; Leino-Kilpi, Helena

2012-11-01

To assess the foot health of older people and their self-care activities in home care. The ultimate goal is to prevent foot problems in older people and to develop the assessment skills of nurses working in home care. Foot health problems are one reason why older people seek home care services. These problems are prevalent in older people, and they can impair performance of daily activities and threaten functional ability. However, studies in this field have concentrated on foot problems related to specific diseases. Non-disease-related research on foot health from the preventative perspective is lacking. A descriptive explorative design was used. The foot health of older people was assessed by visiting home nurses with the Foot Health Assessment Instrument, and older people's foot self-care activities were evaluated with the Foot Self-Care Activities Structured Interview in 2010. The data were analysed statistically. Older people in home care have multiple foot health problems. The most prevalent problems were oedema, dry skin, thickened and discoloured toenails and hallux valgus. Caring for one's feet was a problem for many older people. Older people's foot health needs to be assessed regularly to recognise foot health and self-care problems. Health care professionals have a vital role in preventing, recognising and caring for foot health in older people. The foot health of older people needs to be improved by supporting older people in foot self-care and developing preventive nursing interventions. Regular foot health assessments and their documentation are crucial in preventing serious foot problems in older people. Moreover, multiprofessional collaboration is important to promote foot health in older people. © 2012 Blackwell Publishing Ltd.

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers.

PubMed

Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan(®). An exploratory analysis of the association of risk factors with PP was performed. Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

PubMed Central

Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Objective Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux

Movement coordination patterns between the foot joints during walking.

PubMed

Arnold, John B; Caravaggi, Paolo; Fraysse, François; Thewlis, Dominic; Leardini, Alberto

2017-01-01

In 3D gait analysis, kinematics of the foot joints are usually reported via isolated time histories of joint rotations and no information is provided on the relationship between rotations at different joints. The aim of this study was to identify movement coordination patterns in the foot during walking by expanding an existing vector coding technique according to an established multi-segment foot and ankle model. A graphical representation is also described to summarise the coordination patterns of joint rotations across multiple patients. Three-dimensional multi-segment foot kinematics were recorded in 13 adults during walking. A modified vector coding technique was used to identify coordination patterns between foot joints involving calcaneus, midfoot, metatarsus and hallux segments. According to the type and direction of joints rotations, these were classified as in-phase (same direction), anti-phase (opposite directions), proximal or distal joint dominant. In early stance, 51 to 75% of walking trials showed proximal-phase coordination between foot joints comprising the calcaneus, midfoot and metatarsus. In-phase coordination was more prominent in late stance, reflecting synergy in the simultaneous inversion occurring at multiple foot joints. Conversely, a distal-phase coordination pattern was identified for sagittal plane motion of the ankle relative to the midtarsal joint, highlighting the critical role of arch shortening to locomotor function in push-off. This study has identified coordination patterns between movement of the calcaneus, midfoot, metatarsus and hallux by expanding an existing vector cording technique for assessing and classifying coordination patterns of foot joints rotations during walking. This approach provides a different perspective in the analysis of multi-segment foot kinematics, and may be used for the objective quantification of the alterations in foot joint coordination patterns due to lower limb pathologies or following injuries.

Footwear interventions for foot pain, function, impairment and disability for people with foot and ankle arthritis: A literature review.

PubMed

Frecklington, Mike; Dalbeth, Nicola; McNair, Peter; Gow, Peter; Williams, Anita; Carroll, Matthew; Rome, Keith

2017-11-03

To conduct a literature review on the effectiveness of footwear on foot pain, function, impairment and disability for people with foot and ankle arthritis. A search of the electronic databases Scopus, Medline, CINAHL, SportDiscus and the Cochrane Library was undertaken in September 2017. The key inclusion criteria were studies reporting on findings of footwear interventions for people with arthritis with foot pain, function, impairment and/or disability. The Quality Index Tool was used to assess the methodological quality of studies included in the qualitative synthesis. The methodological variation of the included studies was assessed to determine the suitability of meta-analysis and the grading of recommendations, assessment, development and evaluation (GRADE) system. Between and within group effect sizes were calculated using Cohen's d. 1440 studies were identified for screening with 11 studies included in the review. Mean (range) quality scores were 67% (39-96%). The majority of studies investigated rheumatoid arthritis (n = 7), but also included gout (n = 2), and 1st metatarsophalangeal joint osteoarthritis (n = 2). Meta-analysis and GRADE assessment were not deemed appropriated based on methodological variation. Footwear interventions included off-the-shelf footwear, therapeutic footwear and therapeutic footwear with foot orthoses. Key footwear characteristics included cushioning and a wide toe box for rheumatoid arthritis; cushioning, midsole stability and a rocker-sole for gout; and a rocker-sole for 1st metatarsophalangeal joint osteoarthritis. Between group effect sizes for outcomes ranged from 0.01 to 1.26. Footwear interventions were associated with reductions in foot pain, impairment and disability for people with rheumatoid arthritis. Between group differences were more likely to be observed in studies with shorter follow-up periods in people with rheumatoid arthritis (12 weeks). Footwear interventions improved foot pain, function and disability in

Analysis of joint force and torque for the human and non-human ape foot during bipedal walking with implications for the evolution of the foot.

PubMed

Wang, Weijie; Abboud, Rami J; Günther, Michael M; Crompton, Robin H

2014-08-01

The feet of apes have a different morphology from those of humans. Until now, it has merely been assumed that the morphology seen in humans must be adaptive for habitual bipedal walking, as the habitual use of bipedal walking is generally regarded as one of the most clear-cut differences between humans and apes. This study asks simply whether human skeletal proportions do actually enhance foot performance during human-like bipedalism, by examining the influence of foot proportions on force, torque and work in the foot joints during simulated bipedal walking. Skeletons of the common chimpanzee, orangutan, gorilla and human were represented by multi-rigid-body models, where the components of the foot make external contact via finite element surfaces. The models were driven by identical joint motion functions collected from experiments on human walking. Simulated contact forces between the ground and the foot were found to be reasonably comparable with measurements made during human walking using pressure- and force-platforms. Joint force, torque and work in the foot were then predicted. Within the limitations of our model, the results show that during simulated human-like bipedal walking, (1) the human and non-human ape (NHA) feet carry similar joint forces, although the distributions of the forces differ; (2) the NHA foot incurs larger joint torques than does the human foot, although the human foot has higher values in the first tarso-metatarsal and metatarso-phalangeal joints, whereas the NHA foot incurs higher values in the lateral digits; and (3) total work in the metatarso-phalangeal joints is lower in the human foot than in the NHA foot. The results indicate that human foot proportions are indeed well suited to performance in normal human walking. © 2014 Anatomical Society.

Analysis of joint force and torque for the human and non-human ape foot during bipedal walking with implications for the evolution of the foot

PubMed Central

Wang, Weijie; Abboud, Rami J; Günther, Michael M; Crompton, Robin H

2014-01-01

The feet of apes have a different morphology from those of humans. Until now, it has merely been assumed that the morphology seen in humans must be adaptive for habitual bipedal walking, as the habitual use of bipedal walking is generally regarded as one of the most clear-cut differences between humans and apes. This study asks simply whether human skeletal proportions do actually enhance foot performance during human-like bipedalism, by examining the influence of foot proportions on force, torque and work in the foot joints during simulated bipedal walking. Skeletons of the common chimpanzee, orangutan, gorilla and human were represented by multi-rigid-body models, where the components of the foot make external contact via finite element surfaces. The models were driven by identical joint motion functions collected from experiments on human walking. Simulated contact forces between the ground and the foot were found to be reasonably comparable with measurements made during human walking using pressure- and force-platforms. Joint force, torque and work in the foot were then predicted. Within the limitations of our model, the results show that during simulated human-like bipedal walking, (1) the human and non-human ape (NHA) feet carry similar joint forces, although the distributions of the forces differ; (2) the NHA foot incurs larger joint torques than does the human foot, although the human foot has higher values in the first tarso-metatarsal and metatarso-phalangeal joints, whereas the NHA foot incurs higher values in the lateral digits; and (3) total work in the metatarso-phalangeal joints is lower in the human foot than in the NHA foot. The results indicate that human foot proportions are indeed well suited to performance in normal human walking. PMID:24925580

Changes in foot and shank coupling due to alterations in foot strike pattern during running.

PubMed

Pohl, Michael B; Buckley, John G

2008-03-01

Determining if and how the kinematic relationship between adjacent body segments changes when an individual's gait pattern is experimentally manipulated can yield insight into the robustness of the kinematic coupling across the associated joint(s). The aim of this study was to assess the effects on the kinematic coupling between the forefoot, rearfoot and shank during ground contact of running with alteration in foot strike pattern. Twelve subjects ran over-ground using three different foot strike patterns (heel strike, forefoot strike, toe running). Kinematic data were collected of the forefoot, rearfoot and shank, which were modelled as rigid segments. Coupling at the ankle-complex and midfoot joints was assessed using cross-correlation and vector coding techniques. In general good coupling was found between rearfoot frontal plane motion and transverse plane shank rotation regardless of foot strike pattern. Forefoot motion was also strongly coupled with rearfoot frontal plane motion. Subtle differences were noted in the amount of rearfoot eversion transferred into shank internal rotation in the first 10-15% of stance during heel strike running compared to forefoot and toe running, and this was accompanied by small alterations in forefoot kinematics. These findings indicate that during ground contact in running there is strong coupling between the rearfoot and shank via the action of the joints in the ankle-complex. In addition, there was good coupling of both sagittal and transverse plane forefoot with rearfoot frontal plane motion via the action of the midfoot joints.

Thyrotoxicosis Presenting as Unilateral Drop Foot

PubMed Central

Hara, Kenju; Miyata, Hajime; Motegi, Takahide; Shibano, Ken; Ishiguro, Hideaki

2017-01-01

Neuromuscular disorders associated with hyperthyroidism have several variations in their clinical phenotype, such as ophthalmopathy, periodic paralysis, and thyrotoxic myopathy. We herein report an unusual case of thyrotoxic myopathy presenting as unilateral drop foot. Histopathological examinations of the left tibialis anterior muscle showed marked variation in the fiber size, mild inflammatory cell infiltration, and necrotic and regenerated muscle fibers with predominantly type 1 fiber atrophy. Medical treatment with propylthiouracil resulted in complete improvement of the left drop foot. This case expands the phenotype of thyrotoxicosis and suggests that thyrotoxicosis be considered as a possible cause of unilateral drop foot. PMID:28768980

Thyrotoxicosis Presenting as Unilateral Drop Foot.

PubMed

Hara, Kenju; Miyata, Hajime; Motegi, Takahide; Shibano, Ken; Ishiguro, Hideaki

2017-01-01

Neuromuscular disorders associated with hyperthyroidism have several variations in their clinical phenotype, such as ophthalmopathy, periodic paralysis, and thyrotoxic myopathy. We herein report an unusual case of thyrotoxic myopathy presenting as unilateral drop foot. Histopathological examinations of the left tibialis anterior muscle showed marked variation in the fiber size, mild inflammatory cell infiltration, and necrotic and regenerated muscle fibers with predominantly type 1 fiber atrophy. Medical treatment with propylthiouracil resulted in complete improvement of the left drop foot. This case expands the phenotype of thyrotoxicosis and suggests that thyrotoxicosis be considered as a possible cause of unilateral drop foot.

Twelve Foot Subsatellite

NASA Image and Video Library

1958-04-25

Engineer and 12 foot Beacon showing NACA emblem on inflated satelloon . For related information see, Spaceflight Revolution, NASA from Sputnik to Apollo, by James R. Hansen. NASA SP-4308, 1995. p. 173.

Reliability, validity and responsiveness of the Spanish Manchester-Oxford Foot Questionnaire (MOXFQ) in patients with foot or ankle surgery.

PubMed

Garcés, Juan B Gerstner; Winson, Ian; Goldhahn, Sabine; Castro, Michael D; Swords, Michael P; Grujic, Leslie; Rammelt, Stefan; Sands, Andrew K

2016-03-01

The Manchester-Oxford Foot Questionnaire (MOXFQ) has been validated in Spanish for use in patients undergoing foot and ankle surgery. 120 patients completed the MOXFQ and the SF-36 before surgery and 6 and 12 months postoperative. Surgeons completed the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System. Psychometric properties were assessed for all three MOXFQ dimensions, and for the MOXFQ Index. The Spanish MOXFQ demonstrated consistency with Cronbach's alpha values between 0.65 and 0.90, and reliability ([ICCs] >0.95). It shows a moderate to strong correlation between the Walking/standing dimension and the related domains of the SF-36 (|r|>0.6), the AOFAS Ankle-Hindfoot Scale (|r|>0.47) and Hallux-MTP-IP Scale (|r|>0.64). Responsiveness was excellent, (effect sizes >2.1). The respective minimal detectable change (MDC90) was 14.18 for the MOXFQ Index. The Spanish version of the MOXFQ showed good psychometric properties in patients with foot and ankle disorders. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Foot Morphological Difference between Habitually Shod and Unshod Runners.

PubMed

Shu, Yang; Mei, Qichang; Fernandez, Justin; Li, Zhiyong; Feng, Neng; Gu, Yaodong

2015-01-01

Foot morphology and function has received increasing attention from both biomechanics researchers and footwear manufacturers. In this study, 168 habitually unshod runners (90 males whose age, weight & height were 23±2.4 years, 66±7.1 kg & 1.68±0.13 m and 78 females whose age, weight & height were 22±1.8 years, 55±4.7 kg & 1.6±0.11 m) (Indians) and 196 shod runners (130 males whose age, weight & height were 24±2.6 years, 66±8.2 kg & 1.72±0.18 m and 66 females whose age, weight & height were 23±1.5 years, 54±5.6 kg & 1.62±0.15 m) (Chinese) participated in a foot scanning test using the easy-foot-scan (a three-dimensional foot scanning system) to obtain 3D foot surface data and 2D footprint imaging. Foot length, foot width, hallux angle and minimal distance from hallux to second toe were calculated to analyze foot morphological differences. This study found that significant differences exist between groups (shod Chinese and unshod Indians) for foot length (female p = 0.001), width (female p = 0.001), hallux angle (male and female p = 0.001) and the minimal distance (male and female p = 0.001) from hallux to second toe. This study suggests that significant differences in morphology between different ethnicities could be considered for future investigation of locomotion biomechanics characteristics between ethnicities and inform last shape and design so as to reduce injury risks and poor performance from mal-fit shoes.

Foot ulcers in the diabetic patient, prevention and treatment.

PubMed

Wu, Stephanie C; Driver, Vickie R; Wrobel, James S; Armstrong, David G

2007-01-01

Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order to diminish the detrimental consequences associated with diabetic foot ulcers, a common-sense-based treatment approach must be implemented. Many of the etiological factors contributing to the formation of diabetic foot ulceration may be identified using simple, inexpensive equipment in a clinical setting. Prevention of diabetic foot ulcers can be accomplished in a primary care setting with a brief history and screening for loss of protective sensation via the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy, plantar foot pressure, and assess vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, may enable clinicians to stratify patients based on risk and help determine the type of intervention. Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care. Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced wound healing modalities in the treatment of diabetic foot ulcers. However, it is imperative to remember the fundamental basics in the healing of diabetic foot ulcers: adequate perfusion, debridement, infection control, and pressure mitigation. Early recognition of the etiological factors along with prompt management of diabetic foot ulcers is essential for successful outcome.

Foot preferences in wild-living ring-necked parakeets (Psittacula krameri, Psittacidae).

PubMed

Randler, Christoph; Braun, Michael; Lintker, Stephanie

2011-03-01

Evidence for foot preferences has been reported in parrots and the majority of parrot species uses the left foot to hold and process food objects. Here we assessed the footedness of ring-necked parakeets (Psittacula krameri) in a wild-living non-native population in Heidelberg, Baden-Wurttemberg, Germany. Observations were made when parrots fed on catalpa trees Catalpa sp., with 20- to 50-cm-long fruits. Parakeets tend to bite off catalpa fruits with their beak, using one foot holding the fruit. Further, we established an experimental set-up (feeding location) and prepared pieces of apple in an adequate size to force parrots to handle the food with one foot. From 184 individuals feeding on the catalpa trees, 102 were recorded using the left foot and 82 the right foot. At the feeding location, 24 individuals were left-footed and 11 were right-footed. These observations suggest a foot preference in the ring-necked parakeet both on the population level and on the individual level.

A clinically applicable six-segmented foot model.

PubMed

De Mits, Sophie; Segers, Veerle; Woodburn, Jim; Elewaut, Dirk; De Clercq, Dirk; Roosen, Philip

2012-04-01

We describe a multi-segmented foot model comprising lower leg, rearfoot, midfoot, lateral forefoot, medial forefoot, and hallux for routine use in a clinical setting. The Ghent Foot Model describes the kinematic patterns of functional units of the foot, especially the midfoot, to investigate patient populations where midfoot deformation or dysfunction is an important feature, for example, rheumatoid arthritis patients. Data were obtained from surface markers by a 6 camera motion capture system at 500 Hz. Ten healthy subjects walked barefoot along a 12 m walkway at self-selected speed. Joint angles (rearfoot to shank, midfoot to rearfoot, lateral and medial forefoot to midfoot, and hallux to medial forefoot) in the sagittal, frontal, and transverse plane are reported according to anatomically based reference frames. These angles were calculated and reported during the foot rollover phases in stance, detected by synchronized plantar pressure measurements. Repeated measurements of each subject revealed low intra-subject variability, varying between 0.7° and 2.3° for the minimum values, between 0.5° and 2.1° for the maximum values, and between 0.8° and 5.8° for the ROM. The described movement patterns were repeatable and consistent with biomechanical and clinical knowledge. As such, the Ghent Foot model permits intersegment, in vivo motion measurement of the foot, which is crucial for both clinical and research applications. Copyright © 2011 Orthopaedic Research Society.

Methicillin-Resistant Staphylococcus aureus in Foot Osteomyelitis.

PubMed

Ashong, Chester N; Raheem, Shazia A; Hunter, Andrew S; Mindru, Cezarina; Barshes, Neal R

Conflicting studies exist regarding the impact of methicillin-resistant Staphylococcus aureus (MRSA) on increased time to wound healing, future need for surgical procedures, and likelihood of treatment failure in patients with diabetic foot osteomyelitis. The purpose of this study is to determine the overall significance of MRSA in predicting treatment failure in bone infections of the foot and to determine an appropriate pre-operative and empiric post-operative antibiotic regimen. Patients presenting with an initial episode of "probable" or "definite" foot osteomyelitis were included for review and analysis if the following criteria were met: (1) Osteomyelitis occurred in the foot (i.e., distal to the malleoli of the ankle); episodes occurring above the ankle were excluded. (2) Patients received either no antibiotics or only oral antibiotics for long-term treatment; episodes managed with long-term parenteral antibiotics were excluded. (3) The infection was managed initially with medical therapy or conservative surgical therapy; episodes managed with major (above-ankle) amputation as the initial treatment were excluded. The primary objective of this study was to assess whether episodes of foot osteomyelitis associated with MRSA resulted in treatment failure more frequently than not. Of 178 episodes included in the study, 50 (28.1%) episodes had treatment failure. Median time-to-treatment failure was 60 days (range 7-598 days). In 28.1% (9/32 episodes) in which treatment failure occurred and 39.0% (41/105) episodes in which no treatment failure occurred, MRSA was present. The presence of MRSA was not significantly associated with treatment failure (p = 0.99). The presence of MRSA in bone culture and whether antibiotic use had anti-MRSA activity was not associated with increased treatment failure of diabetic foot osteomyelitis in our institution. Empiric antibiotic coverage of MRSA may not be necessary for many patients presenting with foot osteomyelitis.

Investigation of the mechanical behaviour of the foot skin.

PubMed

Fontanella, C G; Carniel, E L; Forestiero, A; Natali, A N

2014-11-01

The aim of this work was to provide computational tools for the characterization of the actual mechanical behaviour of foot skin, accounting for results from experimental testing and histological investigation. Such results show the typical features of skin mechanics, such as anisotropic configuration, almost incompressible behaviour, material and geometrical non linearity. The anisotropic behaviour is mainly determined by the distribution of collagen fibres along specific directions, usually identified as cleavage lines. To evaluate the biomechanical response of foot skin, a refined numerical model of the foot is developed. The overall mechanical behaviour of the skin is interpreted by a fibre-reinforced hyperelastic constitutive model and the orientation of the cleavage lines is implemented by a specific procedure. Numerical analyses that interpret typical loading conditions of the foot are performed. The influence of fibres orientation and distribution on skin mechanics is outlined also by a comparison with results using an isotropic scheme. A specific constitutive formulation is provided to characterize the mechanical behaviour of foot skin. The formulation is applied within a numerical model of the foot to investigate the skin functionality during typical foot movements. Numerical analyses developed accounting for the actual anisotropic configuration of the skin show lower maximum principal stress fields than results from isotropic analyses. The developed computational models provide reliable tools for the investigation of foot tissues functionality. Furthermore, the comparison between numerical results from anisotropic and isotropic models shows the optimal configuration of foot skin. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Care of Patients with Diabetic Foot Disease in Oman.

PubMed

Al-Busaidi, Ibrahim S; Abdulhadi, Nadia N; Coppell, Kirsten J

2016-08-01

Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002-2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman.

Care of Patients with Diabetic Foot Disease in Oman

PubMed Central

Al-Busaidi, Ibrahim S.; Abdulhadi, Nadia N.; Coppell, Kirsten J.

2016-01-01

Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman. PMID:27606104

33 CFR 142.33 - Foot protection.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Foot protection. 142.33 Section 142.33 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES WORKPLACE SAFETY AND HEALTH Personal Protective Equipment § 142.33 Foot...

33 CFR 142.33 - Foot protection.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Foot protection. 142.33 Section 142.33 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES WORKPLACE SAFETY AND HEALTH Personal Protective Equipment § 142.33 Foot...

Foot Comfort for the Fashionable

NASA Technical Reports Server (NTRS)

2002-01-01

Modellista Footwear's new shoe line uses Tempur(TM) material, which conforms to each wearer's unique foot shape to absorb shock and cushion the foot. The foam's properties allow the shoe to change with the wearer's foot as it shrinks and swells throughout the day. Scientists at NASA's Ames Research Center originally developed temper foam in the early 1970s to relieve the intense pressure of G-forces experienced by astronauts during rocket launches. Tempur-Pedic, Inc., further developed the foam and granted Modellista a license to use it in footwear. The Modellista collection is the first shoe design and construction to be certified by the Space Awareness Alliance. The shoes, with designs ranging from traditional clog shapes to sling backs and open-toe sandals, are currently available nationwide at select specialty shoe stores and through catalogs. Tempur(TM) is a registered trademark of Tempur-Pedic, Inc.

Botulinum Toxin Type A Injection for Spastic Equinovarus Foot in Children with Spastic Cerebral Palsy: Effects on Gait and Foot Pressure Distribution

PubMed Central

Choi, Ja Young; Jung, Soojin; Rha, Dong-wook

2016-01-01

Purpose To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot. Materials and Methods Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection. Results Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data. Conclusion Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP. PMID:26847306

Link Between Foot Pain Severity and Prevalence of Depressive Symptoms.

PubMed

Awale, Arunima; Dufour, Alyssa B; Katz, Patricia; Menz, Hylton B; Hannan, Marian T

2016-06-01

Associations between pain and depression are well known, yet foot pain, common in populations, has been understudied. This cross-sectional study examined foot pain and severity of foot pain with depressive symptoms in adults. Framingham Foot Study (2002-2008) participants completed questionnaires that included questions about foot pain (yes/no; none, mild, moderate, or severe pain) and the Center for Epidemiologic Studies Depression Scale (scores ≥16 indicated depressive symptoms). Age and body mass index (BMI) were also assessed. Sex-specific logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations of foot pain with depressive symptoms, adjusting for age and BMI. In a subset, further models adjusted for leg pain, back pain, or other joint pain. Of 1,464 men and 1,857 women, the mean ± SD age was 66 ± 10 years. Depressive symptoms were reported in 21% of men and 27% of women. Compared to those with no foot pain and independent of age and BMI, both men and women with moderate foot pain had approximately a 2-fold increased odds of depressive symptoms (men with severe foot pain OR of 4 [95% CI 2.26-8.48], women with severe foot pain OR of 3 [95% CI 2.02-4.68]). Considering other pain regions attenuated ORs, but the pattern of results remained unchanged. Even after we adjusted for age, BMI, and other regions of pain, those reporting worse foot pain were more likely to report depressive symptoms. These findings suggest that foot pain may be a part of a broader pain spectrum, with an impact beyond localized pain and discomfort. © 2016, American College of Rheumatology.

A portable foot-parameter-extracting system

NASA Astrophysics Data System (ADS)

Zhang, MingKai; Liang, Jin; Li, Wenpan; Liu, Shifan

2016-03-01

In order to solve the problem of automatic foot measurement in garment customization, a new automatic footparameter- extracting system based on stereo vision, photogrammetry and heterodyne multiple frequency phase shift technology is proposed and implemented. The key technologies applied in the system are studied, including calibration of projector, alignment of point clouds, and foot measurement. Firstly, a new projector calibration algorithm based on plane model has been put forward to get the initial calibration parameters and a feature point detection scheme of calibration board image is developed. Then, an almost perfect match of two clouds is achieved by performing a first alignment using the Sampled Consensus - Initial Alignment algorithm (SAC-IA) and refining the alignment using the Iterative Closest Point algorithm (ICP). Finally, the approaches used for foot-parameterextracting and the system scheme are presented in detail. Experimental results show that the RMS error of the calibration result is 0.03 pixel and the foot parameter extracting experiment shows the feasibility of the extracting algorithm. Compared with the traditional measurement method, the system can be more portable, accurate and robust.

Etiology, pathophysiology and classifications of the diabetic Charcot foot

PubMed Central

Papanas, Nikolaos; Maltezos, Efstratios

2013-01-01

In people with diabetes mellitus, the Charcot foot is a specific manifestation of peripheral neuropathy that may involve autonomic neuropathy with high blood flow to the foot, leading to increased bone resorption. It may also involve peripheral somatic polyneuropathy with loss of protective sensation and high risk of unrecognized acute or chronic minor trauma. In both cases, there is excess local inflammatory response to foot injury, resulting in local osteoporosis. In the Charcot foot, the acute and chronic phases have been described. The former is characterized by local erythema, edema, and marked temperature elevation, while pain is not a prominent symptom. In the latter, signs of inflammation gradually recede and deformities may develop, increasing the risk of foot ulceration. The most common anatomical classification describes five patterns, according to the localization of bone and joint pathology. This review article aims to provide a brief overview of the diabetic Charcot foot in terms of etiology, pathophysiology, and classification. PMID:23705058

Evaluation of diabetic foot screening in Primary Care.

PubMed

Alonso-Fernández, Margarita; Mediavilla-Bravo, José Javier; López-Simarro, Flora; Comas-Samper, José Manuel; Carramiñana-Barrera, Francisco; Mancera-Romero, José; de Santiago Nocito, Ana

2014-01-01

To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening. A multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded. In the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P<.001), history of neuropathy (P=.005), and history of peripheral artery disease (P<.05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P<.001) and economic incentives for goal attainment (P<.001). Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Foot and Ankle Osteoid Osteomas.

PubMed

Gurkan, Volkan; Erdogan, Ozgur

2018-03-02

Foot and ankle osteoid osteomas (OOs) are often cancellous or subperiosteal and rarely present with a periosteal reaction. Additionally, the large number of disorders included in the differential diagnosis and the nonspecific findings on radiographs complicate the diagnosis. We performed a manual search of the senior surgeon's hospitals' operating room records for the terms "benign bone tumor," "foot," "ankle," and "osteoid osteoma" from January 2003 until December 2014. Of 87 surgically treated patients with lower extremity OOs, 9 patients (11%) with foot or ankle OOs were included. The mean age at presentation was 21 (range 6 to 30) years; all 9 (11%) patients were male. The patients were evaluated for swelling, pain, trauma history, night pain, response to pain relievers, duration of complaints, and interval to diagnosis. The mean follow-up period was 48 ± 24 months, and no recurrences had developed. The mean American Orthopaedic Foot and Ankle Society scale score was 59.04 ± 11 before surgery and 91.56 ± 6 after surgery. The difference was statistically significant at p ≤ .0003. Most previous studies have been limited to case reports. The need for findings from a case series was an essential determinant of our decision to report our results. Patients usually have been treated conservatively, often for a long period. However, delays in treatment cause social, economic, and psychological damage. In conclusion, the presence of atypical findings on radiographs has resulted in a preference for magnetic resonance imaging instead of computed tomography; however, the diffuse soft tissue edema observed on MRI can lead to the use of long-term immobilization and a delay in the diagnosis. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Comparing the Effect of Foot Reflexology Massage, Foot Bath and Their Combination on Quality of Sleep in Patients with Acute Coronary Syndrome.

PubMed

Rahmani, Ali; Naseri, Mahdi; Salaree, Mohammad Mahdi; Nehrir, Batool

2016-12-01

Introduction: Many patients in coronary care unit (CCU) suffer from decreased sleep quality caused by environmental and mental factors. This study compared the efficacy of foot reflexology massage, foot bath, and a combination of them on the quality of sleep of patients with acute coronary syndrome (ACS). Methods: This quasi-experimental study was implemented on ACS patients in Iran. Random sampling was used to divide the patients into four groups of 35 subjects. The groups were foot reflexology massage, foot bath, a combination of the two and the control group. Sleep quality was measured using the Veran Snyder-Halpern questionnaire. Data were analyzed by SPSS version 13. Results: The mean age of the four groups was 61.22 (11.67) years. The mean sleep disturbance in intervention groups (foot reflexology massage and foot bath groups) during the second and third nights was significantly less than before intervention. The results also showed a greater reduction in sleep disturbance in the combined group than in the other groups when compared to the control group. Conclusion: It can be concluded that the intervention of foot bath and massage are effective in reducing sleep disorders and there was a synergistic effect when used in combination. This complementary care method can be recommended to be implemented by CCU nurses.

Role of procalcitonin in infected diabetic foot ulcer.

PubMed

Park, Jung Ho; Suh, Dong Hun; Kim, Hak Jun; Lee, Yong In; Kwak, Il Hoon; Choi, Gi Won

2017-06-01

Procalcitonin (PCT) has been recently accepted as a marker for diagnosing infection. The aim of the present study was to determine whether PCT levels are associated with infection severity of diabetic foot ulcers and whether PCT levels would be helpful to differentiate infected diabetic foot ulcer (IDFU) from IDFU associated with other infectious diseases (IDFU+O). We prospectively included 123 diabetic patients hospitalized for IDFU. Infection severity of diabetic foot ulcers was graded according to the Infectious Diseases Society of America-International Working Group on the Diabetic Foot clinical classification of diabetic foot infection. Chest radiograph, urinalysis, urine microscopy, urine culture, and blood cultures (if fever was present) were performed for all patients to diagnose other infectious diseases. Laboratory parameters were measured from blood venous samples. PCT (Spearman's ρ=0.338, P<0.001) and C-reactive protein (Spearman's ρ=0.477, P<0.001) levels were significantly associated with infection severity of diabetic foot ulcers. However, only PCT levels could differentiate patients with associated infectious diseases from patients with no concomitant infection (area under the receiver-operator characteristic curve 0.869, P<0.0001; cut-off value 0.59; sensitivity 94.7; specificity 88.5). PCT and CRP levels positively correlated with infection severity of diabetic foot ulcers and PCT levels>0.59ng/mL in patients with IDFU may be associated with other systemic bacterial infection. Copyright © 2017 Elsevier B.V. All rights reserved.

Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

PubMed

Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

2013-01-01

Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

Sublethal foot-predation on Donacidae (Mollusca: Bivalvia)

NASA Astrophysics Data System (ADS)

Salas, Carmen; Tirado, Cristina; Manjón-Cabeza, Maria Eugenia

2001-08-01

The incidence of foot nipping was studied on the Donax spp. of the littoral of Málaga (Southern Spain, 2875 specimens collected from February 1990 to January 1991) and of Ré island (French Atlantic coast, 262 specimens of Donax vittatus (Da Costa, 1778) collected in May 1996). In Málaga, Donax trunculus L., 1758 was the species most regularly nipped (18% of individuals), with peaks in summer (25% in August and 48% in September) and winter (34% in December). In Ré island, 27% of the specimens showed a nipped foot. Logistic regression shows that in D. trunculus length is the variable that most influences the probability of foot nipping, followed by weight and chlorophyll a. However, the difference in length between damaged and undamaged individuals was not significant (U-Mann-Whitney test). The size class frequency and the values of Ivlev's index show that the small size classes were avoided, while for the other size classes predation remained balanced throughout the year. Therefore, the avoidance of the small size classes makes length the most influential variable. The logistic regression indicated a coefficient B=-0.03 for weight. This implies a slightly negative influence on the probability of foot nipping. However, without the data of September, there is a positive correlation ( r=0.76, p<0.01) between the monthly percentages of predation and the flesh dry weight of a standard individual (25 mm long). The peak in September could be due to the recruitment peak of bivalves, which may have attracted more predators to the area, and/or to the recruitment of predators such as crabs to the swash zone. Logistic regression and test of comparison of percentages indicate that there was not any influence of the sex of an animal on the probability of foot nipping. Only in February was a significantly higher percentage ( p<0.05) of females nipped (44.44%) than the total of females in the sample (20.20%). The biomass (as flesh dry weight) of D. trunculus lost by foot

Measurement of first ray of foot with reference to hallux valgus.

PubMed

Howale, Deepak S; Iyer, Kanaklata V; Shah, Jigesh V

2012-06-01

A study was carried out on 58 healthy volunteers. None of the volunteeres had any foot complaints. This was done to study Indian feet, as foot is an important part of human anatomy and its certain deformities eg, hallux valgus, can be very disabling. We have studied anatomical angles between 1st and 2nd rays of foot eg, angle of hallux valgus and angle of slant of distal facet of medial cuneiform and have shown significant correlation between them and development of hallux valgus. The coefficient of correlation (r) calculated between these two angles is significant, showing that this angle influences the angle of hallux valgus and hence development of hallux valgus. These are anatomical angles and indicate shapes of medial cuneiform and 1st metatarsal. Hence these seem to be inherited, making the feet anatomically predisposed to develop hallux valgus. This view is supported by Gray's Anatomy. The extrinsic factors such as narrow toes, closed, footwear worn for an extended period do increase the angle of hallux valgus. So, in predisposed feet, this is one of the extrinsic factor which can lead to development of hallux valgus. On studying these two angles, orthopaedicians should be on alert and should advise such individuals on wearing foot- friendly foot-wear.

Prostheses and orthoses for the foot and ankle.

PubMed

Rubin, G; Cohen, E

1988-07-01

The general nature and function of the AFO has been presented. These devices encompass the foot and leg crossing the ankle joint. They may insert into the shoe or attach to the shoe. The more recent AFOs are made of polypropylene and were formerly composed of steel. The indications for an AFO are for a basically ambulatory patient with problems walking, including various pathologic gaits especially drop-foot and spastic equinus. Other primary indications include ankle arthritis, Charcot foot, fractures, and post-surgery. Given the basic employment of AFOs to treat problems directly related to the foot, it is hoped that this introduction has stimulated practitioners to begin using this essential tool as an integral component of their practice.

Diabetic foot infections: stepwise medical and surgical management.

PubMed

Armstrong, David G; Lipsky, Benjamin A

2004-06-01

Foot complications are common among diabetic patients; foot ulcers are among the more serious consequences. These ulcers frequently become infected, with potentially disastrous progression to deeper spaces and tissues. If not treated promptly and appropriately, diabetic foot infections can become incurable or even lead to septic gangrene, which may require foot amputation. Diagnosing infection in a diabetic foot ulcer is based on clinical signs and symptoms of inflammation. Properly culturing an infected lesion can disclose the pathogens and provide their antibiotic susceptibilities. Specimens for culture should be obtained after wound debridement to avoid contamination and optimise identification of pathogens. Staphylococcus aureus is the most common isolate in these infections; the increasing incidence of methicillin-resistant S. aureus over the past two decades has further complicated antibiotic treatment. While chronic infections are often polymicrobial, many acute infections in patients not previously treated with antibiotics are caused by a single pathogen, usually a gram-positive coccus. We offer a stepwise approach to treating diabetic foot infections. Most patients must first be medically stabilised and any metabolic aberrations should be addressed. Antibiotic therapy is not required for uninfected wounds but should be carefully selected for all infected lesions. Initial therapy is usually empirical but may be modified according to the culture and sensitivity results and the patient's clinical response. Surgical intervention is usually required in cases of retained purulence or advancing infection despite optimal medical therapy. Possible additional indications for surgical procedures include incision and drainage of an abscess, debridement of necrotic material, removal of any foreign bodies, arterial revascularisation and, when needed, amputation. Most foot ulcers occur on the plantar surface of the foot, thus requiring a plantar incision for any drainage

Foot placement during error and pedal applications in naturalistic driving.

PubMed

Wu, Yuqing; Boyle, Linda Ng; McGehee, Daniel; Roe, Cheryl A; Ebe, Kazutoshi; Foley, James

2017-02-01

Data from a naturalistic driving study was used to examine foot placement during routine foot pedal movements and possible pedal misapplications. The study included four weeks of observations from 30 drivers, where pedal responses were recorded and categorized. The foot movements associated with pedal misapplications and errors were the focus of the analyses. A random forest algorithm was used to predict the pedal application types based the video observations, foot placements, drivers' characteristics, drivers' cognitive function levels and anthropometric measurements. A repeated multinomial logit model was then used to estimate the likelihood of the foot placement given various driver characteristics and driving scenarios. The findings showed that prior foot location, the drivers' seat position, and the drive sequence were all associated with incorrect foot placement during an event. The study showed that there is a potential to develop a driver assistance system that can reduce the likelihood of a pedal error. Copyright © 2016 Elsevier Ltd. All rights reserved.

Foot ulcers in the diabetic patient, prevention and treatment

PubMed Central

Wu, Stephanie C; Driver, Vickie R; Wrobel, James S; Armstrong, David G

2007-01-01

Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order to diminish the detrimental consequences associated with diabetic foot ulcers, a com-mon-sense-based treatment approach must be implemented. Many of the etiological factors contributing to the formation of diabetic foot ulceration may be identified using simple, inexpensive equipment in a clinical setting. Prevention of diabetic foot ulcers can be accomplished in a primary care setting with a brief history and screening for loss of protective sensation via the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy, plantar foot pressure, and assess vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, may enable clinicians to stratify patients based on risk and help determine the type of intervention. Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care. Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced wound healing modalities in the treatment of diabetic foot ulcers. However, it is imperative to remember the fundamental basics in the healing of diabetic foot ulcers: adequate perfusion, debridement, infection control, and pressure mitigation. Early recognition of the etiological factors along with prompt management of diabetic foot ulcers is essential for successful outcome. PMID:17583176

Foot Morphological Difference between Habitually Shod and Unshod Runners

PubMed Central

Shu, Yang; Mei, Qichang; Fernandez, Justin; Li, Zhiyong; Feng, Neng; Gu, Yaodong

2015-01-01

Foot morphology and function has received increasing attention from both biomechanics researchers and footwear manufacturers. In this study, 168 habitually unshod runners (90 males whose age, weight & height were 23±2.4years, 66±7.1kg & 1.68±0.13m and 78 females whose age, weight & height were 22±1.8years, 55±4.7kg & 1.6±0.11m) (Indians) and 196 shod runners (130 males whose age, weight & height were 24±2.6years, 66±8.2kg & 1.72±0.18m and 66 females whose age, weight & height were 23±1.5years, 54±5.6kg & 1.62±0.15m)(Chinese) participated in a foot scanning test using the easy-foot-scan (a three-dimensional foot scanning system) to obtain 3D foot surface data and 2D footprint imaging. Foot length, foot width, hallux angle and minimal distance from hallux to second toe were calculated to analyze foot morphological differences. This study found that significant differences exist between groups (shod Chinese and unshod Indians) for foot length (female p = 0.001), width (female p = 0.001), hallux angle (male and female p = 0.001) and the minimal distance (male and female p = 0.001) from hallux to second toe. This study suggests that significant differences in morphology between different ethnicities could be considered for future investigation of locomotion biomechanics characteristics between ethnicities and inform last shape and design so as to reduce injury risks and poor performance from mal-fit shoes. PMID:26148059

Repetitive sit-to-stand training with the step-foot position on the non-paretic side, and its effects on the balance and foot pressure of chronic stroke subjects

PubMed Central

Kim, Kyung; Kim, Young Mi; Kang, Dong Yeon

2015-01-01

[Purpose] This study aimed to improve the asymmetrical weight-bearing ratio by applying repetitive sit-to-stand training methods that feature a step-foot position to the paretic-side foot of hemiplegic patients; it sought also to provide the information needed to apply weight-bearing and balance training to hemiplegic patients. [Subjects and Methods] The subjects were divided into two groups: a spontaneous group and a step group. They all performed repetitive sit-to-stand training five times per week for a total of six weeks. The Biodex Balance System, TUG, and 5XSST were used to measure the static and dynamic standing balance of each patient. A foot mat system was used to measure foot pressure. [Results] In the balance measurements, differences in the Overall index, Ant-post index, Med-lat index, Fall risk index, TUG, and 5XSST after training was significantly different between the two study groups. In evaluating foot pressure measurements, we found that the COP (Ant-post), Peak pressure: hind foot, and Contact area: hind foot measurements significantly differed between the groups after the training. [Conclusion] Repetitive sit-to-stand training that involves positioning the non-paretic leg upward can be considered a significant form of training that improves the symmetric posture adjustment and balance of hemiplegic patients following a stroke. PMID:26357448

Does a foot-drop implant improve kinetic and kinematic parameters in the foot and ankle?

PubMed

Daniilidis, Kiriakos; Jakubowitz, Eike; Thomann, Anna; Ettinger, Sarah; Stukenborg-Colsman, Christina; Yao, Daiwei

2017-04-01

Unlike the drop foot therapy with ortheses, the therapeutic effect of an implantable peroneus nerve stimulator (iPNS) is not well described. IPNS is a dynamic therapy option which is placed directly to the motoric part of the peroneal nerve and evokes a dorsiflexion of the paralysed foot. This retrospective study evaluates the kinematics and kinetics in drop foot patients who were treated with an iPNS. 18 subjects (mean age 51.3 years) with a chronic stroke-related drop foot were treated with an implantable peroneal nerve stimulator. After a mean follow-up from 12.5 months, kinematics and kinetics as well as spatiotemporal parameters were evaluated and compared in activated and deactivated iPNS. Therefore, a gait analysis with motion capture system (Vicon Motion System Ltd®, Oxford, UK) and Plug-in-Gait model was performed. The study showed significantly improved results in ankle dorsiflexion from 6.8° to 1.8° at the initial contact and from -7.3° to 0.9° during swing phase (p ≤ 0.004 and p ≤ 0.005, respectively). Likewise, we could measure improved kinetics, i.a. with a statistically significant improvement in vertical ground reaction force at loading response from 99.76 to 106.71 N/kg (p = 0.043). Enhanced spatiotemporal results in cadence, douple support, stride length, and walking speed could also be achieved, but without statistical significance (p > 0.05). The results show statistically significant improvement in ankle dorsiflexion and vertical ground reaction forces. These facts indicate a more gait stability and gait efficacy. Therefore, the use of an iPNS appears an encouraging therapeutic option for patients with a stroke-related drop foot.

Progress in detailed modelling of low foot and high foot implosion experiments on the National Ignition Facility

NASA Astrophysics Data System (ADS)

Clark, D. S.; Weber, C. R.; Eder, D. C.; Haan, S. W.; Hammel, B. A.; Hinkel, D. E.; Jones, O. S.; Kritcher, A. L.; Marinak, M. M.; Milovich, J. L.; Patel, P. K.; Robey, H. F.; Salmonson, J. D.; Sepke, S. M.

2016-05-01

Several dozen high convergence inertial confinement fusion ignition experiments have now been completed on the National Ignition Facility (NIF). These include both “low foot” experiments from the National Ignition Campaign (NIC) and more recent “high foot” experiments. At the time of the NIC, there were large discrepancies between simulated implosion performance and experimental data. In particular, simulations over predicted neutron yields by up to an order of magnitude, and some experiments showed clear evidence of mixing of ablator material deep into the hot spot that could not be explained at the time. While the agreement between data and simulation improved for high foot implosion experiments, discrepancies nevertheless remain. This paper describes the state of detailed modelling of both low foot and high foot implosions using 1-D, 2-D, and 3-D radiation hydrodynamics simulations with HYDRA. The simulations include a range of effects, in particular, the impact of the plastic membrane used to support the capsule in the hohlraum, as well as low-mode radiation asymmetries tuned to match radiography measurements. The same simulation methodology is applied to low foot NIC implosion experiments and high foot implosions, and shows a qualitatively similar level of agreement for both types of implosions. While comparison with the experimental data remains imperfect, a reasonable level of agreement is emerging and shows a growing understanding of the high-convergence implosions being performed on NIF.

A musculoskeletal foot model for clinical gait analysis.

PubMed

Saraswat, Prabhav; Andersen, Michael S; Macwilliams, Bruce A

2010-06-18

Several full body musculoskeletal models have been developed for research applications and these models may potentially be developed into useful clinical tools to assess gait pathologies. Existing full-body musculoskeletal models treat the foot as a single segment and ignore the motions of the intrinsic joints of the foot. This assumption limits the use of such models in clinical cases with significant foot deformities. Therefore, a three-segment musculoskeletal model of the foot was developed to match the segmentation of a recently developed multi-segment kinematic foot model. All the muscles and ligaments of the foot spanning the modeled joints were included. Muscle pathways were adjusted with an optimization routine to minimize the difference between the muscle flexion-extension moment arms from the model and moment arms reported in literature. The model was driven by walking data from five normal pediatric subjects (aged 10.6+/-1.57 years) and muscle forces and activation levels required to produce joint motions were calculated using an inverse dynamic analysis approach. Due to the close proximity of markers on the foot, small marker placement error during motion data collection may lead to significant differences in musculoskeletal model outcomes. Therefore, an optimization routine was developed to enforce joint constraints, optimally scale each segment length and adjust marker positions. To evaluate the model outcomes, the muscle activation patterns during walking were compared with electromyography (EMG) activation patterns reported in the literature. Model-generated muscle activation patterns were observed to be similar to the EMG activation patterns. Published by Elsevier Ltd.

Contemporary Evaluation and Management of the Diabetic Foot

PubMed Central

Sumpio, Bauer E.

2012-01-01

Foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes with prevalence as high as 25%. Ulcers are breaks in the dermal barrier with subsequent erosion of underlying subcutaneous tissue that may extend to muscle and bone, and superimposed infection is a frequent and costly complication. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Even when properly managed, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents, and negative pressure wound therapy. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field. PMID:24278695

Contemporary evaluation and management of the diabetic foot.

PubMed

Sumpio, Bauer E

2012-01-01

Foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes with prevalence as high as 25%. Ulcers are breaks in the dermal barrier with subsequent erosion of underlying subcutaneous tissue that may extend to muscle and bone, and superimposed infection is a frequent and costly complication. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Even when properly managed, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents, and negative pressure wound therapy. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field.

Back to School Foot Pain (Flip-Flops)

MedlinePlus

... ankle surgeons can usually reduce or eliminate students' foot pain with simple treatment methods, including stretching exercises, ice massage, anti-inflammatory medications and custom or over-the- ...

Comparison of dynamic balance ability in healthy university students according to foot shape.

PubMed

Hyong, In Hyouk; Kang, Jong Ho

2016-01-01

[Purpose] This study aimed to compare dynamic balance ability according to foot shape, defined as normal, pronated, or supinated on the basis of the height of the medial arch. [Subjects] In this study, 14 subjects for the pronated foot group, 14 for the supinated foot group, and 14 for the normal foot group were selected from among 162 healthy university students by using the navicular drop test proposed by Brody. To measure dynamic balance ability, a star excursion balance test (SEBT) was conducted for each group, in which a cross-shaped line and lines at 45° in eight directions were drawn on the floor. In this study, only three directions were used, namely anterior, posterolateral, and posteromedial. The mean of the SEBT was calculated by measuring three times for each group, and the values were standardized using the following equation: measured value/leg length × 100. [Results] No significant differences in dynamic balance ability were found between the normal, pronated, and supinated foot groups. [Conclusion] No significant differences in dynamic balance ability according to the foot shape were found among the healthy university students with normal, pronated, and supinated feet.

Comparing the Effect of Foot Reflexology Massage, Foot Bath and Their Combination on Quality of Sleep in Patients with Acute Coronary Syndrome

PubMed Central

Rahmani, Ali; Naseri, Mahdi; Salaree, Mohammad Mahdi; Nehrir, Batool

2016-01-01

Introduction: Many patients in coronary care unit (CCU) suffer from decreased sleep quality caused by environmental and mental factors. This study compared the efficacy of foot reflexology massage, foot bath, and a combination of them on the quality of sleep of patients with acute coronary syndrome (ACS). Methods: This quasi-experimental study was implemented on ACS patients in Iran. Random sampling was used to divide the patients into four groups of 35 subjects. The groups were foot reflexology massage, foot bath, a combination of the two and the control group. Sleep quality was measured using the Veran Snyder-Halpern questionnaire. Data were analyzed by SPSS version 13. Results: The mean age of the four groups was 61.22 (11.67) years. The mean sleep disturbance in intervention groups (foot reflexology massage and foot bath groups) during the second and third nights was significantly less than before intervention. The results also showed a greater reduction in sleep disturbance in the combined group than in the other groups when compared to the control group. Conclusion: It can be concluded that the intervention of foot bath and massage are effective in reducing sleep disorders and there was a synergistic effect when used in combination. This complementary care method can be recommended to be implemented by CCU nurses. PMID:28032074

Gait patterns in hemiplegic patients with equinus foot deformity.

PubMed

Manca, M; Ferraresi, G; Cosma, M; Cavazzuti, L; Morelli, M; Benedetti, M G

2014-01-01

Equinus deformity of the foot is a common feature of hemiplegia, which impairs the gait pattern of patients. The aim of the present study was to explore the role of ankle-foot deformity in gait impairment. A hierarchical cluster analysis was used to classify the gait patterns of 49 chronic hemiplegic patients with equinus deformity of the foot, based on temporal-distance parameters and joint kinematic measures obtained by an innovative protocol for motion assessment in the sagittal, frontal, and transverse planes, synthesized by parametrical analysis. Cluster analysis identified five subgroups of patients with homogenous levels of dysfunction during gait. Specific joint kinematic abnormalities were found, according to the speed of progression in each cluster. Patients with faster walking were those with less ankle-foot complex impairment or with reduced range of motion of ankle-foot complex, that is with a stiff ankle-foot complex. Slow walking was typical of patients with ankle-foot complex instability (i.e., larger motion in all the planes), severe equinus and hip internal rotation pattern, and patients with hip external rotation pattern. Clustering of gait patterns in these patients is helpful for a better understanding of dysfunction during gait and delivering more targeted treatment.

Gender and age related differences in foot morphology.

PubMed

Tomassoni, Daniele; Traini, Enea; Amenta, Francesco

2014-12-01

This study has assessed age-related changes of foot morphology for developing appropriate footwear with particular reference to the elderly. Anatomical parameters such as foot length, circumference and height and ankle length, circumference and height were assessed in a sample of males (n=577) and females (n=528) divided into three age groups. The groups included young-adult, aged between 20 and 25 years; adult, aged between 35 and 55 years; and old, aged between 65 and 70 years individuals. In terms of gender differences, in young-adult individuals the sex-related morphological differences observed, are just related to a significantly lower length of foot in females. In adult subjects morphological parameters investigated were significantly lower in females even after normalization for foot length. In old individuals, no differences of the parameters were found after normalization for foot length. Comparative analysis of morphometric data between young-adult and adult individuals revealed that the instep length was smaller in adults. The opposite was observed for the great toe and medial foot arch height. Length of ankle was higher in adult than in young-adult individuals, whereas ankle circumference and height were smaller. In old vs adult individuals foot circumference showed the most relevant age-related differences. Feet anatomy presents specific characteristics in different ages of life. The ideal footwear should take into account these characteristics. This is true primarily for the elderly for minimizing the risk of falls or of other problems related to inappropriate footwear. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A neuromechanical strategy for mediolateral foot placement in walking humans.

PubMed

Rankin, Bradford L; Buffo, Stephanie K; Dean, Jesse C

2014-07-15

Stability is an important concern during human walking and can limit mobility in clinical populations. Mediolateral stability can be efficiently controlled through appropriate foot placement, although the underlying neuromechanical strategy is unclear. We hypothesized that humans control mediolateral foot placement through swing leg muscle activity, basing this control on the mechanical state of the contralateral stance leg. Participants walked under Unperturbed and Perturbed conditions, in which foot placement was intermittently perturbed by moving the right leg medially or laterally during the swing phase (by ∼50-100 mm). We quantified mediolateral foot placement, electromyographic activity of frontal-plane hip muscles, and stance leg mechanical state. During Unperturbed walking, greater swing-phase gluteus medius (GM) activity was associated with more lateral foot placement. Increases in GM activity were most strongly predicted by increased mediolateral displacement between the center of mass (CoM) and the contralateral stance foot. The Perturbed walking results indicated a causal relationship between stance leg mechanics and swing-phase GM activity. Perturbations that reduced the mediolateral CoM displacement from the stance foot caused reductions in swing-phase GM activity and more medial foot placement. Conversely, increases in mediolateral CoM displacement caused increased swing-phase GM activity and more lateral foot placement. Under both Unperturbed and Perturbed conditions, humans controlled their mediolateral foot placement by modulating swing-phase muscle activity in response to the mechanical state of the contralateral leg. This strategy may be disrupted in clinical populations with a reduced ability to modulate muscle activity or sense their body's mechanical state.

Congenital hypertrophy of multiple intrinsic muscles of the foot.

PubMed

Shiraishi, Tomohiro; Park, Susam; Niu, Atushi; Hasegawa, Hiromi

2014-12-01

Congenital hypertrophy of a single intrinsic muscle of the foot is rare, and as far as we know, only six cases have been reported. We describe a case of congenital anomaly that showed hypertrophy of multiple intrinsic muscles of the foot; the affected muscles were all the intrinsic muscles of the foot except the extensor digitorum brevis or extensor hallucis. Other tissues such as adipose tissue, nervous tissue, or osseous tissue showed no abnormalities. To reduce the volume of the foot we removed parts of the enlarged muscles.

Gas Gangrene of the Diabetic Foot.

PubMed

Kuy, SreyRam; Romero, Ramon A L; Kuy, SreyReath

2015-01-01

A 67-year old man presented with a painful left foot and a putrid odor. His past medical history was significant for poorly controlled diabetes mellitus, coronary artery disease, and peripheral vascular disease. His surgical history included a prior right below-knee amputation for a diabetic foot infection three years prior, and a left third toe amputation for osteomyelitis one month ago. He was an active smoker. His laboratory data revealed a white blood count of 22 k/uL and a blood glucose of 381 mg/dL. Physical exam demonstrated an erythematous and edematous left foot with subcutaneous crepitus along the plantar surface. Plain film x-rays of the left foot demonstrated gas pockets in the soft tissue and acute osteomyelitis (Figure 1). The patient was diagnosed with gas gangrene and was taken emergently to the operating room. In order to obtain source control of this life threatening infection, a left below-knee amputation was performed and broad spectrum empiric antibiotics were initiated immediately with vancomycin and piperacillin/tazobactam. Cultures were not obtained at the time of surgery and the organisms causing this infection are unknown. The patient survived and was discharged to a rehabilitation facility.

Schwannomatosis on a single foot: a case report.

PubMed

Min, Hak-Jin; Kim, Ki Chun; Jun, Sung Han; Lee, Young Gun

2015-06-01

Schwannomatosis has been recently recognized as the third major type of neurofibromatosis. It causes multiple schwannomas without the vestibular tumors that are diagnostic of neurofibromatosis type 2. Schwannoma is rarely found in the foot, and it is still rarer to find multiple schawannomas in a single peripheral nerve on the foot. In this article, we describe a case of schwannomatosis case on a single foot. Case report, Level IV. © 2014 The Author(s).

Foot orgasm syndrome: a case report in a woman.

PubMed

Waldinger, Marcel D; de Lint, Govert J; van Gils, Ad P G; Masir, Farhad; Lakke, Egbert; van Coevorden, Ruben S; Schweitzer, Dave H

2013-08-01

Spontaneous orgasm triggered from inside the foot has so far not been reported in medical literature. The study aims to report orgasmic feelings in the left foot of a woman. A woman presented with complaints of undesired orgasmic sensations originating in her left foot. In-depth interview, physical examination, sensory testing, magnetic resonance imaging (MRI-scan), electromyography (EMG), transcutaneous electrical nerve stimulation (TENS), and blockade of the left S1 dorsal root ganglion were performed. The main outcomes are description of this clinical syndrome, results of TENS application, and S1 dorsal root ganglion blockade. Subtle attenuation of sensory amplitudes of the left suralis, and the left medial and lateral plantar nerve tracts was found at EMG. MRI-scan disclosed no foot abnormalities. TENS at the left metatarso-phalangeal joint-III of the left foot elicited an instant orgasmic sensation that radiated from plantar toward the vagina. TENS applied to the left side of the vagina elicited an orgasm that radiated to the left foot. Diagnostic blockade of the left S1 dorsal root ganglion with 0.8 mL bupivacaine 0.25 mg attenuated the frequency and intensity of orgasmic sensation in the left foot with 50% and 80%, respectively. Additional therapeutic blockade of the same ganglion with 0.8 mL bupivacaine 0.50 mg combined with pulsed radiofrequency treatment resulted in a complete disappearance of the foot-induced orgasmic sensations. Foot orgasm syndrome (FOS) is descibed in a woman. Blockade of the left S1 dorsal root ganglion alleviated FOS. It is hypothesized that FOS, occurring 1.5 years after an intensive care emergency, was caused by partial nerve regeneration (axonotmesis), after which afferent (C-fiber) information from a small reinnervated skin area of the left foot and afferent somatic and autonomous (visceral) information from the vagina on at least S1 spinal level is misinterpreted by the brain as being solely information originating from

The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country

PubMed Central

Sibbald, R. Gary; Martin, Carlos

2015-01-01

Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases. Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P < 0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented. Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years. PMID:26089901

[S2-Guideline: Pediatric Flat Foot].

PubMed

Hell, Anna K; Döderlein, Leo; Eberhardt, Oliver; Hösl, Matthias; von Kalle, Thekla; Mecher, Frauke; Simon, Angela; Stinus, Hartmut; Wilken, Bernd; Wirth, Thomas

2018-04-09

In pediatric flat foot a differentiation has to be made between the flexible and the rigid form. The diagnosis is based on the history, clinical examination as well as pedobarography, gait analysis and imaging techniques. It is important to rule out neuropediatric conditions such as muscular dystrophies, Ehlers-Danlos- or Marfan syndrome. In children six years of age and younger a flexible flat foot is nearly always physiological (97% of all 19 months old children). Up to the age of ten years the medial column of the foot is developing. Only a minority of children (4% in ten year olds) has a persistent or progressive deformity. Beyond to age of ten there is a danger of deformity decompensation as well as an increased rigidity. Only a minority of children develops some pain (< 2%). A clear risk factor for persistent pediatric flat foot is obesity (62% of six year old children with flat foot are obese). Pathogenetic factors include muscular, bony or soft tissue conditions. However, there specific rule is still unclear. Prevention consists in a thorough parent information about the normal development as well as encouragement of regular sportive activities. Soft and large enough shoes should be carried as a protection. Barfoot walking has to be encouraged on uneven grounds. If physiotherapy is needed different methods can be applied. Orthosis treatment should include a proprioceptive approach. Surgical interventions in children are rare. If surgical treatment is planned a detailed algorhythm should be used before utilizing one of the many different surgical methods. Georg Thieme Verlag KG Stuttgart · New York.

Foot-and-mouth disease virus receptors: multiple gateways to initiate infection

USDA-ARS?s Scientific Manuscript database

Since its discovery over 100 years ago as the causative agent of foot-and-mouth disease (FMD), research has been directed at understanding the biology of the foot-and-mouth disease virus (FMDV) so as to be able to control this devastating and highly contagious disease of cloven-hoofed livestock. Giv...

Gender differences in adult foot shape: implications for shoe design.

PubMed

Wunderlich, R E; Cavanagh, P R

2001-04-01

To analyze gender differences in foot shape in a large sample of young individuals. Univariate t-tests and multivariate discriminant analyses were used to assess 1) significant differences between men and women for each foot and leg dimension, standardized to foot length, 2) the reliability of classification into gender classes using the absolute and standardized variable sets, and 3) the relative importance of each variable to the discrimination between men and women. Men have longer and broader feet than women for a given stature. After normalization of the measurements by foot length, men and women were found to differ significantly in two calf, five ankle, and four foot shape variables. Classification by gender using absolute values was correct at least 93% of the time. Using the variables standardized to foot length, gender was correctly classified 85% of the time. This study demonstrates that female feet and legs are not simply scaled-down versions of male feet but rather differ in a number of shape characteristics, particularly at the arch, the lateral side of the foot, the first toe, and the ball of the foot. These differences should be taken into account in the design and manufacture of women's sport shoes.

Metatarsal Shape and Foot Type: A Geometric Morphometric Analysis.

PubMed

Telfer, Scott; Kindig, Matthew W; Sangeorzan, Bruce J; Ledoux, William R

2017-03-01

Planus and cavus foot types have been associated with an increased risk of pain and disability. Improving our understanding of the geometric differences between bones in different foot types may provide insights into injury risk profiles and have implications for the design of musculoskeletal and finite-element models. In this study, we performed a geometric morphometric analysis on the geometry of metatarsal bones from 65 feet, segmented from computed tomography (CT) scans. These were categorized into four foot types: pes cavus, neutrally aligned, asymptomatic pes planus, and symptomatic pes planus. Generalized procrustes analysis (GPA) followed by permutation tests was used to determine significant shape differences associated with foot type and sex, and principal component analysis was used to find the modes of variation for each metatarsal. Significant shape differences were found between foot types for all the metatarsals (p < 0.01), most notably in the case of the second metatarsal which showed significant pairwise differences across all the foot types. Analysis of the principal components of variation showed pes cavus bones to have reduced cross-sectional areas in the sagittal and frontal planes. The first (p = 0.02) and fourth metatarsals (p = 0.003) were found to have significant sex-based differences, with first metatarsals from females shown to have reduced width, and fourth metatarsals from females shown to have reduced frontal and sagittal plane cross-sectional areas. Overall, these findings suggest that metatarsal bones have distinct morphological characteristics that are associated with foot type and sex, with implications for our understanding of anatomy and numerical modeling of the foot.

Gait kinematics of subjects with ankle instability using a multisegmented foot model.

PubMed

De Ridder, Roel; Willems, Tine; Vanrenterghem, Jos; Robinson, Mark; Pataky, Todd; Roosen, Philip

2013-11-01

Many patients who sustain an acute lateral ankle sprain develop chronic ankle instability (CAI). Altered ankle kinematics have been reported to play a role in the underlying mechanisms of CAI. In previous studies, however, the foot was modeled as one rigid segment, ignoring the complexity of the ankle and foot anatomy and kinematics. The purpose of this study was to evaluate stance phase kinematics of subjects with CAI, copers, and controls during walking and running using both a rigid and a multisegmented foot model. Foot and ankle kinematics of 77 subjects (29 subjects with self-reported CAI, 24 copers, and 24 controls) were measured during barefoot walking and running using a rigid foot model and a six-segment Ghent Foot Model. Data were collected on a 20-m-long instrumented runway embedded with a force plate and a six-camera optoelectronic system. Groups were compared using statistical parametric mapping. Both the CAI and the coper group showed similar differences during midstance and late stance compared with the control group (P < 0.05). The rigid foot segment showed a more everted position during walking compared with the control group. Based on the Ghent Foot Model, the rear foot also showed a more everted position during running. The medial forefoot showed a more inverted position for both running and walking compared with the control group. Our study revealed significant midstance and late stance differences in rigid foot, rear foot, and medial forefoot kinematics The multisegmented foot model demonstrated intricate behavior of the foot that is not detectable with rigid foot modeling. Further research using these models is necessary to expand knowledge of foot kinematics in subjects with CAI.

Sports Injuries to the Foot and Ankle

MedlinePlus

... read the article, Foot Health Facts for Athletes . Baseball Basketball Field Hockey Football Injuries Golf Injuries Lacrosse Rugby Running Soccer Softball Tennis Volleyball Find an ACFAS Physician Search Search ...

Biomechanics of the ankle-foot system during stair ambulation: implications for design of advanced ankle-foot prostheses.

PubMed

Sinitski, Emily H; Hansen, Andrew H; Wilken, Jason M

2012-02-02

Unilateral lower limb prosthesis users display temporal, kinematic, and kinetic asymmetries between limbs while ascending and descending stairs. These asymmetries are due, in part, to the inability of current prosthetic devices to effectively mimic normal ankle function. The purpose of this study was to provide a comprehensive set of biomechanical data for able-bodied and unilateral transtibial amputee (TTA) ankle-foot systems for level-ground (LG), stair ascent (SA), and stair descent (SD), and to characterize deviations from normal performance associated with prosthesis use. Ankle joint kinematics, kinetics, torque-angle curves, and effective shapes were calculated for twelve able-bodied individuals and twelve individuals with TTA. The data from this study demonstrated the prosthetic limb can more effectively mimic the range of motion and power output of a normal ankle-foot during LG compared to SA and SD. There were larger differences between the prosthetic and able-bodied limbs during SA and SD, most evident in the torque-angle curves and effective shapes. These data can be used by persons designing ankle-foot prostheses and provide comparative data for assessment of future ankle-foot prosthesis designs. Published by Elsevier Ltd.

Persistent medial foot pain in an adolescent athlete.

PubMed

Hensley, Craig P; Reischl, Stephen F

2013-03-01

The patient was a 15-year-old adolescent male who was referred to a physical therapist for a chief complaint of worsening right medial foot pain. Given the worsening nature of the patient's right medial foot pain, palpatory findings, and a prior recommendation for computed tomography from a radiologist, the patient was referred to his physician. Subsequent computed tomography imaging of the right foot revealed a nondisplaced fracture through the dorsal-medial aspect of the navicular.

Reliability, validity and responsiveness of the German Manchester-Oxford Foot Questionnaire (MOXFQ) in patients with foot or ankle surgery.

PubMed

Arbab, Dariusch; Kuhlmann, Katharina; Ringendahl, Hubert; Bouillon, Bertil; Eysel, Peer; König, Dietmar

2017-06-13

Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopaedic procedures. The intention of this study was to develop and culturally adapt a German version of the Manchester-Oxford Foot Questionnaire (MOXFQ) and to evaluate reliability, validity and responsiveness. According to guidelines forward and backward translation has been performed. The German MOXFQ was investigated in 177 consecutive patients before and 6 months after foot or ankle surgery. All patients completed MOXFQ, Foot and Ankle Outcome Score (FAOS), Short form 36 and numeric scales for pain and disability (NRS). Test-Retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German MOXFQ demonstrated excellent test-retest reliability with ICC values >0.9 Cronbach's alpha (α) values demonstrated strong internal consistency. No floor or ceiling effects were observed. As hypothesized MOXFQ subscales correlated strongly with corresponding FAOS and SF-36 domains. All subscales showed excellent (ES/SRM >0.8) responsiveness between preoperative assessment and postoperative follow-up. The German version of the MOXFQ demonstrated good psychometric properties. It proofed to be a valid and reliable instrument for use in foot and ankle patients. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Ascending infection of foot tendons in diabetic patients.

PubMed

Mismar, Ayman; Yousef, Mohammad; Badran, Darwish; Younes, Nidal

2013-12-01

Bone and soft tissue infection in the foot of diabetic patients is a well-described issue in the literature. A sound anatomical knowledge of the foot anatomy and compartments is mandatory to understand the mechanisms of infection spread. We describe four cases of diabetic foot infection complicated by long ascending infection. All did not respond initially to antibiotic treatment and the usual surgical debridement and were cured only after excision of the infected tendons. We highlight a rare but serious complication of the diabetic foot disease not commonly seen by the surgical community. We hope that this report raises the awareness of this condition so that a prompt diagnosis is made and appropriate treatment started, thereby reducing the risk of major lower limb amputations.

Foot overuse diseases in rock climbing: an epidemiologic study.

PubMed

Buda, Roberto; Di Caprio, Francesco; Bedetti, Letizia; Mosca, Massimiliano; Giannini, Sandro

2013-01-01

Literature examining the incidence of foot diseases in rock climbing is limited to traumatic injuries. We examined a large sample of climbers, assessed the chronic diseases of the foot, and correlated them with foot morphology, shoe type, and type of climbing practiced. Between May 1 and September 30, 2009, 144 climbers (mean age, 31.7 years) were examined to analyze the effect of rock climbing on the various foot diseases found at the time of the evaluation. Eighty-six percent of the climbers were affected by a pathologic condition. Nail disease was found in 65.3% of patients, followed by recurrent ankle sprains (27.8%), retrocalcaneal bursitis (19.4%), Achilles tendinitis (12.5%), metatarsalgia (12.5%), and plantar fasciitis (5.6%). Male sex, the use of high-type shoes, the high degree of climbing difficulty, and the competitive level were often related to the onset of foot diseases. Climbing shoes are usually smaller than common footwear. This "shoe-size reduction" averaged 2.3 sizes, forcing the foot into a supinated and cavus posture that favors lateral instability. The posterior edge of the shoe aperture produces increased pressure on the heel, with retrocalcaneal bursitis. Overuse foot diseases related to rock climbing are particularly frequent and debilitating. Detailed knowledge of these diseases and their predisposing factors may help us implement effective preventive or therapeutic measures, including changes in the type of climbing, correction of body weight, degree of difficulty, footwear, orthoses, and measures that maximize the support of the foot to the ground.

Association between Foot Temperature and Sudomotor Dysfunction in Type 2 Diabetes

PubMed Central

Papanas, Nikolaos; Papatheodorou, Konstantinos; Papazoglou, Dimitrios; Kotsiou, Stamatia; Maltezos, Efstratios

2010-01-01

Background and Aims Increased foot skin temperature has been described as a feature of diabetic neuropathy. The aim of this present study was to investigate the association between foot temperature and sudomotor dysfunction in type 2 diabetes mellitus. Patients and Methods This study included 51 patients (group A: 25 men, mean age 61.14 ± 6.11 years) without sudomotor dysfunction and 52 patients (group B: 25 men, mean age 59.54 ± 6.18 years) with sudomotor dysfunction. Sudomotor dysfunction was defined as time until complete Neuropad® color change from blue to pink exceeding 600 s in at least one foot. Time until complete color change of the test was also recorded. Foot skin temperature was measured with a handheld infrared thermometer on the plantar aspect of the foot at the level of the first metatarsal head. Results On both feet, temperature was significantly higher in group B than in group A (right foot, group A versus group B, 30.62 ± 1.13 °C versus 32.12 ± 1.06 °C, p < .001; left foot, group A versus group B, 30.65 ± 1.06 °C versus 32.19 ± 1.10 °C, p < .001). There was a significant positive correlation between time to complete Neuropad color change and foot skin temperature (right foot, r = 0.742, p < .001; left foot, r = 0.758, p < .001), which was confirmed in both groups. Conclusions Patients with sudomotor dysfunction have significantly higher foot temperature than those without sudomotor dysfunction. Foot temperature is positively correlated with severity of sudomotor dysfunction, as evaluated by the time to complete Neuropad color change. PMID:20663441

A New Mobile Application for Standardizing Diabetic Foot Images.

PubMed

Yap, Moi Hoon; Chatwin, Katie E; Ng, Choon-Ching; Abbott, Caroline A; Bowling, Frank L; Rajbhandari, Satyan; Boulton, Andrew J M; Reeves, Neil D

2018-01-01

We describe the development of a new mobile app called "FootSnap," to standardize photographs of diabetic feet and test its reliability on different occasions and between different operators. FootSnap was developed by a multidisciplinary team for use with the iPad. The plantar surface of 30 diabetic feet and 30 nondiabetic control feet were imaged using FootSnap on two separate occasions by two different operators. Reproducibility of foot images was determined using the Jaccard similarity index (JSI). High intra- and interoperator reliability was demonstrated with JSI values of 0.89-0.91 for diabetic feet and 0.93-0.94 for control feet. Similarly high reliability between groups indicates FootSnap is appropriate for longitudinal follow-ups in diabetic feet, with potential for monitoring pathology.

Direct inpatient burden caused by foot-related conditions: a multisite point-prevalence study

PubMed Central

Lazzarini, Peter A; Hurn, Sheree E; Kuys, Suzanne S; Kamp, Maarten C; Ng, Vanessa; Thomas, Courtney; Jen, Scott; Kinnear, Ewan M; d'Emden, Michael C; Reed, Lloyd

2016-01-01

Objective The aims of this point-prevalence study were to investigate a representative inpatient population to determine the prevalence of people admitted to hospital for the reason of a foot-related condition, and identify associated independent factors. Methods Participants were adult inpatients in 5 different representative hospitals, admitted for any reason on the day of data collection. Maternity, mental health and cognitively impaired inpatients were excluded. Participants were surveyed on a range of self-reported demographic, social determinant, medical history, foot disease history, self-care, footwear, past foot treatment prior to hospitalisation and reason for admission variables. Physical examinations were performed to clinically diagnose a range of foot disease and foot risk factor variables. Independent factors associated with being admitted to hospital for the primary or secondary reason of a foot-related condition were analysed using multivariate logistic regression. Results Overall, 733 participants were included; mean (SD) age 62 (19) years, male 55.8%. Foot-related conditions were the primary reason for admission in 54 participants (7.4% (95% CI 5.7% to 9.5%)); 36 for foot disease (4.9%), 15 foot trauma (2.1%). Being admitted for the primary reason of a foot-related condition was independently associated with foot infection, critical peripheral arterial disease, foot trauma and past foot treatment by a general practitioner and surgeon (p<0.01). Foot-related conditions were a secondary reason for admission in 28 participants (3.8% (2.6% to 5.6%)), and were independently associated with diabetes and current foot ulcer (p<0.01). Conclusions This study, the first in a representative inpatient population, suggests the direct inpatient burden caused by foot-related conditions is significantly higher than previously appreciated. Findings indicate 1 in every 13 inpatients was primarily admitted because of a foot-related condition with most due to foot

A kicking simulator to investigate the foot-ball interaction during a rugby place kick.

PubMed

Minnaar, Nick; van den Heever, Dawie J

2015-01-01

Foot-ball interaction is an important aspect in rugby place kicking but has received very little attention in literature. This preliminary study presents an adjustable mechanical kicking simulator used to investigate different foot positions and orientations during the foot-ball interaction on resultant ball motion. It was found that changes in foot position and orientation during ball contact can have a large influence on ball motion. It is believed that with further research an optimal place-kicking technique can be found to maximize energy transfer to the ball while still maintaining accuracy.

Patients' perspectives on foot complications in type 2 diabetes: a qualitative study

PubMed Central

Gale, Lone; Vedhara, Kavita; Searle, Aidan; Kemple, Terry; Campbell, Rona

2008-01-01

Background Foot ulceration is a major health problem for people with diabetes. To minimise the risk of ulceration, patients are advised to perform preventive foot self-care. Aim To explore beliefs about diabetic foot complications and everyday foot self-care practices among people with type 2 diabetes. Design of study Qualitative study using one-to-one interviews. Setting A suburban primary care health centre. Method Semi-structured interviews with a purposive sample of adults with type 2 diabetes but with no experience of foot ulceration. Results Most participants were unsure of what a foot ulcer is and unaware of the difficulties associated with ulcer healing. Prevention of accidental damage to the skin was not considered a priority, as few participants knew that this is a common cause of foot ulceration. Although it was recognised that lower-limb amputation is more common in people with diabetes, this was perceived to be predominantly caused by poor blood supply to the feet and unrelated to foot ulceration. Therefore, preventive foot care focused on stimulating blood circulation, for example by walking barefoot. Consequently, some of the behaviours participants considered beneficial for foot health could potentially increase the risk of ulceration. In some cases the uptake of advice regarding preventive foot care was hampered because participants found it difficult to communicate with health professionals. Conclusion Patients with type 2 diabetes may have beliefs about foot complications that differ from medical evidence. Such illness beliefs may play a role in foot-related behaviours that have previously been unrecognised. Health professionals need to explore and address the beliefs underlying patients' foot self-care practices. PMID:18682014

Prevalence of foot problems in people with inflammatory arthritis in Singapore.

PubMed

Carter, K; Lahiri, M; Cheung, P P; Santosa, A; Rome, K

2016-01-01

Foot problems are highly prevalent in people with inflammatory arthritis reported from studies in the UK, Europe and New Zealand, but there is limited evidence from Southeast Asia. The study aim was to evaluate the prevalence of foot problems in people with inflammatory arthritis in Singapore. People with inflammatory arthritis were recruited from the rheumatology outpatient clinic of a tertiary hospital in Singapore. Disease and clinical characteristics included age, sex, disease duration, current blood tests and medications. The Leeds Foot Impact Scale was used to evaluate foot impairment/disability and the Modified Health Assessment Questionnaire was used to assess global function. We recruited 101 people with inflammatory arthritis, of which 50 % were female. The majority of participants were Chinese (70 %). The mean (SD) age was 52 (15) years, and the mean (SD) disease duration was 9.3 (0.3) years. The most commonly reported inflammatory arthritic conditions were rheumatoid arthritis (46), gout (31) and spondyloarthritis (15 %). The mean (SD) of the total Leeds Foot Impact Scale was 17 (13) indicating moderate to severe levels of foot impairment and activity limitation. Over 80 of participants reported foot pain during the course of their condition, and 48 % reported current foot pain. Despite the high prevalence of foot pain, only 21 participants (21 %) had been referred to a podiatrist. This is the first study to investigate the prevalence of foot problems in people with inflammatory arthritis from Singapore. The majority of the participants reported foot problems, but had not been referred to a podiatry service.

The lives of Mary Foote: painter and Jungian.

PubMed

Trousdell, Richard

2016-11-01

Mary Foote (1872-1968) was a successful early twentieth century American artist who suddenly closed her New York studio in 1926 to go to Zurich to study with Jung. There she joined his 'Interpretation of Visions' seminars (1930-1934), which she recorded and edited. This work won Jung's praise and his friendship, but all too often Foote was seen merely as a secretary or background figure. Deirdre Bair's biography of Jung suggested that Foote's life and work deserved fuller study, if only to rebalance our view of Jung's early women followers. This paper takes up that work to ask how Foote's early life and career led to her important work in preserving and describing Jung's earliest attempts to apply his theories to clinical practice. © 2016, The Society of Analytical Psychology.

How I Manage Athlete's Foot.

PubMed

Stauffer, L W

1986-07-01

In brief: Athlete's foot is a term used to describe a variety of dermatological problems. This article is limited to the management of contact dermatitis and fungal infection. To cure contact dermatitis the cause must be discovered and eliminated. Often a substance used in manufacturing shoes is at fault. Fungal infections can be treated with topical fungicides. Athletes can reduce the playing time lost because of foot problems by seeking treatment as soon as itching, peeling, or swelling occur. Proper diagnosis and careful selection of treatment modalities keep feet functioning at peak capacity.

The Dutch version of the Oxford Ankle and Foot Questionnaire for Children: Useful for evaluation of pediatric foot problems in groups.

PubMed

Burger, Elise; Selles, Ruud; van Nieuwkasteele, Shelly; Bessems, Gert; Pollet, Virginie; Hovius, Steven; van Nieuwenhoven, Christianne

2017-11-04

The purpose of this study is to develop a Dutch version of the Oxford Ankle and Foot Questionnaire for Children (OxAFQ-c) to allow evaluation of pediatric foot care. The OxAFQ-c was translated into Dutch, according to the ISPOR-guidelines. Children with different foot and ankle complaints completed the OxAFQ-c at baseline, after two weeks, and after 4-6 months. Measurement properties were assessed in terms of reliability, responsiveness, and construct validity. Test-retest reliability showed moderate intraclass correlation coefficients. Bland-Altman plots showed wide limits of agreement. After 4-6 months, the group that experienced improvement also showed improved questionnaire outcomes, indicating responsiveness. Moderate correlation between the OxAFQ-c and the Kidscreen and foot-specific VAS-scores were observed, indicating moderate construct validity. The Dutch OxAFQ-c showed moderate to good measurement properties. However, because we observed limited sensitivity to changes and wide limits of agreement in individual patients, we think the questionnaire should only be used in groups. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Foot volume estimates based on a geometric algorithm in comparison to water displacement.

PubMed

Mayrovitz, H N; Sims, N; Litwin, B; Pfister, S

2005-03-01

Assessing lower extremity limb volume and its change during and after lymphedema therapy is important for determining treatment efficacy and documenting outcomes. Although leg volumes may be determined by tape measure and other methods, there is no metric method to routinely assess foot volumes. Exclusion of foot volumes can under- or overestimate therapeutic progress. Our aim was to develop and test a metric measurement procedure and algorithm for practicing therapists to use to estimate foot volumes. The method uses a caliper and ruler to measure foot dimensions at standardized locations and calculates foot volume (VM) by a mathematical algorithm. VM was compared to volumes measured by water displacement (Vw) in 30 subjects (60 feet) using regression analysis and limits of agreement (LOA). Vw and VM (mean +/- sd) were similar 857 +/- 150 ml vs. 859 +/- 154 ml, and were highly correlated VM = 1.00Vw + 1.67 ml, r = 0.965, p < 0.001. The LOA for absolute volume differences and percentages were respectively +/- 79.6 ml and +/- 9.28 %. These results indicate that this metric method can be a useful alternative to water displacement when foot volumes are needed, but the water displacement method is contraindicated, impractical to implement, too time consuming or is not available.