Podiatry Research Papers - Academia.edu (original) (raw)

Lower extremity complications in diabetes patients are extremely common worldwide and the most common one to occur is ulcer in the foot though other complications also occur frequently like abscess, gangrene, cellulitis, etc. With the... more

Lower extremity complications in diabetes patients are extremely common worldwide and the most common one to occur is ulcer in the foot though other complications also occur frequently like abscess, gangrene, cellulitis, etc. With the increasing incidence of diabetes worldwide, there is an increased incidence of these complications in different parts of the world. Most of these complications are preventable. The author had recently introduced 2 terminologies namely the diabetic foot delay and diabetic foot push, which are aimed at decreasing the complications in diabetic foot. This article provides a brief discussion on diabetic foot push.

Abnormal foot motion impacts the position of the cranial bones. Section I of this paper describes this foot-cranial-dental coupling. Section II describes the Ascending Foot Cranial Model Section III describes an embryonic foot type that... more

Abnormal foot motion impacts the position of the cranial bones. Section I of this paper describes this foot-cranial-dental coupling. Section II describes the Ascending Foot Cranial Model Section III describes an embryonic foot type that is frequently responsible for cranial imbalances and Class II malocclusions Section IV describes a proprioceptive therapy, using insoles, to reverse or stabilize cranial imbalances and malocclusions.

Mueller-Weiss disease is an alteration of the tarsal navicular that is primarily due to anomalous ossifi-cation of the bone and lateral deviation of the talar head associated with screw-like movement through the axis of the subtalar... more

Mueller-Weiss disease is an alteration of the tarsal navicular that is primarily due to anomalous ossifi-cation of the bone and lateral deviation of the talar head associated with screw-like movement through the axis of the subtalar joint. This syndrome tends to be associated with various degrees of flatfoot and hindfoot valgus combined with subtalar joint varus. Ancient cases of Mueller-Weiss disease have not been described in specialized literature. We present the case of an adult male from the Hellenistic period (Ptole-maic dynasty; fourth to first century BC), the skeleton for which was found inside a sarcophagus in the archaeological site of Sharuna (middle Egypt) with Mueller-Weiss disease. The specimen is, in all likelihood , the earliest case of this type of foot pathology in the archaeological record.

Abstract Background: This paper explores the notion of professional status from the perspective of a sample of Australian podiatrists; how it is experienced, what factors are felt to affect it, and how these are considered to influence... more

Abstract Background: This paper explores the notion of professional status from the perspective of a sample of Australian podiatrists; how it is experienced, what factors are felt to affect it, and how these are considered to influence professional standing within an evolving healthcare system. Underpinning sociological theory is deployed in order to inform and contextualise the study.

This small-scale study examined the role that bare footprint collection and measurement processes have on the Reel method of measurement in forensic podiatry and its use in the Criminal Justice System. Previous research indicated that the... more

This small-scale study examined the role that bare footprint collection and measurement processes have on the Reel method of measurement in forensic podiatry and its use in the Criminal Justice System. Previous research indicated that the Reel method was a valid and reliable measurement system for bare footprint analysis but various collection systems have been used to collect footprint data and both manual and digital measurement processes were utilized in forensic podiatry and other disciplines. This study contributes to the debate about collecting bare footprints; the techniques employed to quantify various Reel measurements and considered whether there was asymmetry between feet and footprints of the same person. An inductive, quantitative paradigm used the Podotrack gathering procedure for footprint collection and the subsequent dynamic footprints subjected to Adobe Photoshop techniques of calculating the Reel linear variables. Statistical analyses using paired-sample t tests were conducted to test hypotheses and compare data sets. Standard error of mean (SEM) showed variation between feet and the findings provide support for the Reel study and measurement method.

Aim: This paper reports on the results of stakeholder consultation in the development of “high risk” foot services in the Australian Capital Territory. Method: Three consultation approaches were used including a survey of service users,... more

Aim: This paper reports on the results of stakeholder consultation in the development of “high risk” foot services in the Australian Capital Territory.
Method: Three consultation approaches were used including a survey of service users, two workshops with a range of stakeholders and in-depth interviews with thirteen people with diabetes who have a previous history of a lower extremity ulcer or amputation.
Results: The consultation phase identified a number of important issues for the improvement of lower limb services, including the need to improve communication between health service providers, the need for services to be accessible, and the barriers accessing appropriate footwear. Service users did not want a single, co-located tertiary model of foot care. Instead, the consultation led to an integrated, 'virtual' approach to the delivery of foot care services.

An abnormal foot structure is described in which the 1st metatarsal is structurally elevated and inverted relative to the 2nd metatarsal. This foot structure is termed Primus Metatarsus Supinatus (aka Rothbarts Foot). Embryological... more

An abnormal foot structure is described in which the 1st metatarsal is structurally elevated and inverted relative to the 2nd metatarsal. This foot structure is termed Primus Metatarsus Supinatus (aka Rothbarts Foot).
Embryological studies suggest that this foot structure is the end result of a failed or incomplete unwinding of the talar head.
Clinically, the 1st metatarsal and hallux are off the ground when the standing foot is placed into its anatomical neutral position.
This foot structure is biomechanically dysfunctional, demarcated by its prolonged mid-stance hyperpronation. Global postural distortions are linked to this foot structure, including:
(1) anterior rotation of the innominates
(2) unleveling of the pelvis
(3) augmenting of the scoliotic and kyphotic spinal curves
(4) shoulder protraction
(5) forward head position
(6) malocclusion
This postural shift is termed Bio-Implosion.

This study examined the role that bare footprint collection and measurement processes have on the Reel method of measurement in forensic podiatry and its use in the Criminal Justice System. Previous research suggested the Reel method of... more

This study examined the role that bare footprint collection and measurement processes have on the Reel method of measurement in forensic podiatry and its use in the Criminal Justice System. Previous research suggested the Reel method of linear measurements was a valid and reliable measurement system for bare footprint analysis. Various collection systems have been used by studies to collect footprint data and both manual and digital measurement processes were utilized in forensic podiatry and other disciplines. This study contributes to the debate about collecting bare footprints; the techniques employed to quantify linear measurements and considered whether there were any differences between the methods of measurements employed. An inductive, quantitative paradigm used the Inkless Shoeprint Kit gathering procedure for footprint collection and the subsequent dynamic footprints subjected to Adobe Photoshop techniques of calculating the Reel linear variables as well as the traditional manual method of using a ruler and pen on an acetate sheet overlaid the original footprint. Statistical analyses using Paired-sample t tests were conducted to test hypotheses and compare data sets. Standard Error (SE) showed variation between feet and the findings provide support for the Reel study and measurement method. The study also suggests little difference between measurements using the two measurement methods although the digital system is preferred as it allows traceability of all aspects of the process compared to that of the manual method also allowing greater precision of measurements which may be required in the criminal justice system.

Both single and multiple toe amputations biomechanically alter foot function to varying degrees. In patients with diabetic neuropathy, these changes often lead to increases in deformity, plantar pressure and risk for ulceration, infection... more

Both single and multiple toe amputations biomechanically alter foot function to varying degrees. In
patients with diabetic neuropathy, these changes often lead to increases in deformity, plantar pressure
and risk for ulceration, infection and reamputation. While a philosophy that strives to maximize limb
length and function by performing the fewest and most distal amputations possible is likely a good one,
we believe that a basic ‘‘formula’’ might help serve as a guide for surgeons to balance limb function with
tissue preservation. Digital amputations that exceed a ‘‘hallux plus one lesser toe’’ or ‘‘lesser toe plus
two’’ digital/ray amputations in our experience often surpass a threshold of mechanical function. For any
clinical scenario in which amputation would extend beyond this threshold, a transmetatarsal
amputation (TMA) or pan metatarsal head resection (PMHR) should strongly be considered to avoid
costly foot complications and the need for excessive revisional surgery. Such an approach still maintains
an underlying philosophy of functional limb preservation. We are unaware of any other attempt to
standardize the advancement of surgical intervention from multiple toe resections to a full metatarsal
level or higher resection. Therefore, we present this simple formula for surgical planning in the hopes of
providing the most durable and efficient care of the high-risk diabetic foot when multiple toe
amputations are needed.

This article analyzes a phenomenon that has been reported in only one other footprint collection article: Reel's thesis. The phenomenon is that of a ghost image that appears at the end of the toe impressions collected in two-dimensional... more

This article analyzes a phenomenon that has been reported in only one other footprint collection article: Reel's thesis. The phenomenon is that of a ghost image that appears at the end of the toe impressions collected in two-dimensional exemplar footprints and found using two different collection methods. The collection methods were those of the Podotrack and the inkless shoe print systems. The footprints were collected in a dynamic phase of gait using a 4th step protocol. The great toe displayed the appearance of a ghost image more often than other toes, but all five toes can display the phenomenon. This phenomenon has implications for the collection and interpretation and thus the comparison made between unknown and known footprints in the criminal justice system. The Podotrack system appears to produce this phenomenon more often than the inkless shoe print system, but the phenomenon does not appear repeatable by participants and there are times where this occurs on only one occasion. There are differences between feet as well as between systems as to the appearance of the ghosting.

The following 4 points were delineated and clarified in my response to Dr Craig's challanges: (1) Retention of talar supinatus is the embryological cause of a structurally elevated first metatarsal (2) The elevated first metatarsal is a... more

The following 4 points were delineated and clarified in my response to Dr Craig's challanges:
(1) Retention of talar supinatus is the embryological cause of a structurally elevated first metatarsal
(2) The elevated first metatarsal is a common cause of foot hyperpronation
(3) A structurally elevated first metatarsal can be stabilized using medial column support
(4) Prior research projects presented (clinical outcomes) that validate the efficacy of the medial column support insoles

The objective of this study was to determine whether a correlation exists between abnormal pronation and functional leg-length discrepancies. Visual assessment and a pelvic thrust maneuver were used to identify the functionally short leg... more

The objective of this study was to determine whether a correlation exists
between abnormal pronation and functional leg-length discrepancies. Visual
assessment and a pelvic thrust maneuver were used to identify the
functionally short leg in 56 indigenous Mexicans (20 males and 36 females;
mean age, 33 years; mean weight, 59 kg; and mean height, 1.60 m). The
Foot Posture Index was used with a modified stance position to identify
the more pronated foot. The posterosuperior iliac spines were used to
identify the “relative” position of the innominate bones. The raw data obtained
from this study were evaluated using the McNemar test for paired
proportions. A significant positive correlation was found between abnormal
pronation and hip position and between hip position and functional
leg-length discrepancy. These results are consistent with a theoretical
ascending dysfunctional pelvic model: Abnormal pronation pulls the innominate
bones anteriorly (forward); anterior rotation of the innominate
bones shifts the acetabula posteriorly and cephalad (backward and upward);
and this shift in the acetabula hyperextends the knees and shortens
the legs, with the shortest leg corresponding to the most pronated
foot. (J Am Podiatr Med Assoc 96(6): 499-507, 2006)

At the end of an anatomical peninsula, the foot in diabetes is prone to short- and long-term complications involving neuropathy, vasculopathy, and infection. Effective management requires an interdisciplinary effort focusing on this... more

At the end of an anatomical peninsula, the foot in diabetes is prone to short- and long-term complications involving neuropathy, vasculopathy, and infection. Effective management requires an interdisciplinary effort focusing on this triad. Herein, we describe the key factors leading to foot complications and the critical skill sets required to assemble a team to care for them. Although specific attention is given to a conjoined model involving podiatric medicine and vascular surgery, the so-called toe and flow model, we further outline three separate programmatic models of care--basic, intermediate, and center of excellence--that can be implemented in the developed and developing world.

Background: Static assessments of the foot are commonly advocated within the running community to classify the foot with a view to recommending the appropriate type of running shoe. The aim of this work was to determine whether selected... more

Background: Static assessments of the foot are commonly advocated within the running community to
classify the
foot with a view to recommending the appropriate type of running shoe. The aim of this work was to
determine whether selected static foot assessment could predict medial longitudinal arch (MLA)
motion during running.
Methods: Fifteen physically active males (27 ± 5 years, 1.77 ± 0.04 m, 80 ± 10 kg) participated in
the study. Foot Posture Index (FPI-6), MLA angle and rearfoot angle were measured in a relaxed
standing position. MLA motion was calculated using the position of retro-reflective markers tracked
by a VICON motion analysis system, while participants ran barefoot on a treadmill at a
self-selected pace (2.8 ± 0.5 m.s−1). Bivariate linear regression was used to determine whether the
static measures predicted MLA deformation and MLA angles at initial contact, midsupport and toe
off.
Results: All three foot classification measures were significant predictors of MLA angle at initial
contact, midsupport and toe off (p < .05) explaining 41–90 % of the variance. None of the static
foot classification measures were significant predictors of MLA deformation during the stance phase
of running.
Conclusion: Selected static foot measures did not predict dynamic MLA deformation during running.
Given that MLA deformation has theoretically been linked to running injuries, the clinical
relevance of predicting MLA angle at discrete time points during the stance phase of running is
questioned. These findings also question the validity of the selected static foot classification
measures when looking to characterise the foot during running. This indicates that alternative
means of assessing the foot to inform footwear selection are required.
Keywords: Foot, Running, Kinematics, Medial longitudinal arch, Static foot assessment

Diabetic foot problems are common in clinical practice. Once a complication sets in, they many require surgeries to be done based on the type of complication. Numerous procedures are available for diabetic foot and many are frequently... more

Diabetic foot problems are common in clinical practice. Once a complication sets in, they many require surgeries to be done based on the type of complication. Numerous procedures are available for diabetic foot and many are frequently performed and some require expertise and training. The author extended his 'SCC' classification for diabetic foot surgery wherein one can categorize them into 3 type's namely simple, complex and complicated procedures. The article aims to discuss this new classification for diabetic foot surgery.

Professional and occupational burnout is a recognized syndrome among healthcare professionals, although the point at which burnout begins is unclear. There is a dearth of research investigating burnout and occupational stress in relation... more

Professional and occupational burnout is a recognized syndrome among healthcare professionals, although the point at which burnout begins is unclear. There is a dearth of research investigating burnout and occupational stress in relation to podiatric medicine, although two recent studies have reported high levels of burnout expressed by podiatric medical practitioners. This study was undertaken to compare the levels of burnout in newly qualified practitioners in Australia and the United Kingdom. The results suggest that levels of burnout are higher in these groups than indicated by the published normative medical data. Occupational stress was associated with lack of professional status and with geographic and professional isolation. Within these two themes, there were clear differences between the two groups.

Background: Across the Western world, demographic changes have led to healthcare policy trends in the direction of role flexibility, challenging established role boundaries and professional hierarchies. Population ageing is known to be... more

Background: Across the Western world, demographic changes have led to healthcare policy trends in the direction
of role flexibility, challenging established role boundaries and professional hierarchies. Population ageing is known
to be associated with a rise in prevalence of chronic illnesses which, coupled with a reducing workforce, now
places much greater demands on healthcare provision. Role flexibility within the health professions has been
identified as one of the key innovative practice developments which may mitigate the effects of these demographic
changes and help to ensure a sustainable health provision into the future. However, it is clear that policy drives to
encourage and enable greater role flexibility among the health professions may also lead to professional resistance and
inter-professional role boundary disputes. In the foot and ankle arena, this has been evident in areas such as podiatric
surgery, podiatrist prescribing and extended practice in diabetes care, but it is far from unique to podiatry.
Methods: A systematic review of the literature identifying examples of disputed role boundaries in health professions
was undertaken, utilising the STARLITE framework and adopting a focus on the specific characteristics and outcomes of
boundary disputes. Synthesis of the data was undertaken via template analysis, employing a thematic organisation and
structure.
Results: The review highlights the range of role boundary disputes across the health professions, and a commonality
of events preceding each dispute. It was notable that relatively few disputes were resolved through recourse to legal or
regulatory mandates.
Conclusions: Whilst there are a number of different strategies underpinning boundary disputes, some common
characteristics can be identified and related to existing theory. Importantly, horizontal substitution invokes more overt
role boundary disputes than other forms, with less resolution, and with clear implications for professions working
within the foot and ankle arena.
Keywords: Contested boundaries, Professional boundaries, Inter-professional boundaries

When there is a language barrier between healthcare providers and their patients, medical interpreters are used. These might be trained professionals or untrained “ad hoc” individuals. Oftentimes, when ad hoc interpreters such as family... more

When there is a language barrier between healthcare providers and their patients, medical interpreters are used. These might be trained professionals or untrained “ad hoc” individuals. Oftentimes, when ad hoc interpreters such as family members are used, the podiatric physician’s instructions to a patient are lost in translation. Studies have found that professional medical interpreters are more accurate than ad hoc interpreters in the general practitioner setting. However, there is limited literature on how ad hoc interpreters convey terminology used specific to diabetic foot care. Language specific to diabetic foot evaluation includes words that describe pain and sensation of the feet, anatomy of the foot, and self-care instructions. These uncommonly used words and phrases might be difficult for an untrained interpreter to accurately relay. In our study, we will look at how often and to what severity common podiatric phrases are misinterpreted by untrained individuals.