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Infection in diabetic foot ulcers puts patients at risk of hospitalisation and amputation. Microorganisms populate chronic wounds on a continuum from non-pathological surface contamination to local infection and/or deep compartment infection. Early diagnosis of infection based on relevant clinical signs and symptoms is critical, and treatment reflects the degree of infection. Treatment of superficial infection can involve dressings impregnated with antimicrobial agents. Dressing choice recommendations in clinical practice guidelines, however, are primarily used to ensure optimal moisture balance is achieved and facilitate autolytic debridement. Current evidence, although weak, favours antimicrobial dressings. Future research should be more robust and adequately powered. peer-reviewed

Background Randomised controlled trials are generally regarded as the ‘gold standard’ experimental design to determine the effectiveness of an intervention. Unfortunately, many trials either fail to recruit sufficient numbers of participants, or recruitment takes longer than anticipated. The current embedded trial evaluates the effectiveness of optimised patient information sheets on recruitment of participants in a falls prevention trial. Methods A three-arm, embedded randomised methodology trial was conducted within the National Institute for Health Research-funded REducing Falls with ORthoses and a Multifaceted podiatry intervention (REFORM) cohort randomised controlled trial. Routine National Health Service podiatry patients over the age of 65 were randomised to receive either the control patient information sheet (PIS) for the host trial or one of two optimised versions, a bespoke user-tested PIS or a template-developed PIS. The primary outcome was the proportion of patients in each group who went on to be randomised to the host trial. Results Six thousand and nine hundred patients were randomised 1:1:1 into the embedded trial. A total of 193 (2.8%) went on to be randomised into the main REFORM trial (control n = 62, template-developed n = 68; bespoke user-tested n = 63). Information sheet allocation did not improve recruitment to the trial (odds ratios for the three pairwise comparisons: template vs control 1.10 (95% CI 0.77–1.56, p = 0.60); user-tested vs control 1.01 (95% CI 0.71–1.45, p = 0.94); and user-tested vs template 0.92 (95% CI 0.65–1.31, p = 0.65)). Conclusions This embedded methodology trial has demonstrated limited evidence as to the benefit of using optimised information materials on recruitment and retention rates in the REFORM study. Trial registration International Standard Randomised Controlled Trials Number registry, ISRCTN68240461. Registered on 01 July 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1797-7) contains supplementary material, which is available to authorized users.

Bespoke user-tested patient information sheet. (PDF 328Â kb)

Original, control patient information sheet. (DOC 103Â kb)

Template-developed patient information sheet. (PDF 162Â kb)

Georgina Gethin,1 Caroline McIntosh,2 Sebastian Probst3 1School of Nursing and Midwifery, National University of Ireland, Galway, 2Discipline of Podiatric Medicine, National University of Ireland, Galway, Ireland; 3School of Health, University of Applied Sciences Western Switzerland, Geneva, Switzerland Abstract: Malignant fungating wounds (MFWs) affect an estimated 5%–10% of all people with cancer. They have a profound effect on the individual, and their associated symptoms such as bleeding, odor, exudate, and pain cause much distress, anxiety, and social isolation. Odor is cited by patients and clinicians as the worst aspect of such wounds. Strategies to manage odor at the wound site include the use of complementary and alternative therapies. This review aimed to synthesize the current evidence for the use of complementary and alternative therapies in the management of odor in MFWs. No restrictions on date, language, or care setting were applied. Nine databases were searched yielding four papers meeting our criteria. Of the four papers, one was a randomized controlled trial (RCT), and three were case studies. Two papers investigated the use of green tea teabags as a secondary dressing, while others used essential oils either combined with a cream applied directly to the wound or as a secondary dressing. In an RCT, green tea was used as a solution to cleanse the wound followed by the application of green tea teabag as a secondary dressing versus metronidazole powder for the management of odor over 7 days. All patients reported a reduction in odor and physical discomfort, and an improvement in social interaction and appetite, but the difference between groups was not statistically significant. The case studies all reported an improvement in odor management. The use of complementary and alternative therapies in the management of MFW-associated malodor is not supported by evidence from RCTs. Green tea may have potential as a secondary dressing to manage odor. Further research in this area is warranted. Keywords: malignant fungating wound, odor, complementary medicine, alternative medicine&nbsp

Background Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. The influence of footwear on MLA development is also unknown. Aim This study aims to (i) clarify whether the MLA is still changing in children from age 7 to 9 years old and (ii) explore the relationship between footwear usage and MLA development, using a longitudinal approach. Methods We evaluated the MLA of 111 healthy school children [age = 6.9 (0.3) years] using three parameters [arch index (AI), midfoot peak pressure (PP) and maximum force (MF: % of body weight)] extracted from dynamic foot loading measurements at baseline, 10-month and 22-month follow-up. Information on the type of footwear worn was collected using survey question. Linear mixed modelling was used to test for differences in the MLA over time. Results Insignificant changes in all MLA parameters were observed over time [AI: P = .15; PP: P = .84; MF: P = .91]. When gender was considered, the AI of boys decreased with age [P = .02]. Boys also displayed a flatter MLA than girls at age 6.9 years [AI: mean difference = 0.02 (0.01, 0.04); P = .02]. At baseline, subjects who wore close-toe shoes displayed the lowest MLA overall [AI/PP/MF: P < .05]. Subjects who used slippers when commencing footwear use experienced higher PP than those who wore sandals [mean difference = 31.60 (1.44, 61.75) kPa; post-hoc P = .04]. Discussion and conclusion Our findings suggested that the MLA of children remained stable from 7 to 9 years old, while gender and the type of footwear worn during childhood may influence MLA development. Clinicians may choose to commence therapy when a child presents with painful flexible flat foot at age 7 years, and may discourage younger children from wearing slippers when they commence using footwear.

Table of content P3 Medial longitudinal arch development of school children Jasper W.K. Tong, Veni P. Kong P4 Is measuring the subtalar joint reliable? Lily Sze, Susie Gale, John Veto, Carla McArdle P5 Comparison of turning gait biomechanics between able-bodied and unilateral transtibial amputee participants Thanaporn Tunprasert, Victoria Bradley, Siobhan Strike P6 Comparison of walking gait biomechanics between able-bodied and unilateral transtibial amputee participants using a new model of energy-storage-and-return (ESAR) prosthetic Thanaporn Tunprasert, Victoria Bradley, Siobhan Strike P7 An observational study of in-shoe plantar and dorsal pressures of skilled downhill skiers on a dry ski slope Robert Ashford, Roozbeth Naemi, Nachiappan Chocklingam, Xavi de Blasc P8 If the shoe fits: a footwear choice toolkit informed by social science methodologies Lisa Farndon, Vicki Robinson, Emily Nicholls P9 The identification of emotions from gait Tabitha Birch, Ivan Birch P11 Experience of foot problems in patients with systemic lupus erythematosus Simon Otter, Sunil Kumar, Peter Gow, Nicola Dalbeth, Michael Corkill, Kevin Davies, Sam Panthakalam, Maheswaran Rohan, Keith Rome P14 Negative pressure wound therapy for the management of foot wounds in the diabetic population: a review of the literature Chloe Egan, Lisa Chandler P15 Lower limb vascular assessment in diabetes: a multifaceted assessment of objective screening techniques Peta Tehan, Vivienne Chuter, Jennifer Sonter, Sean Lanting P16 Improving outcomes for diabetes foot complications Lorna Hicks P17 Acupuncture… an alternative or adjunctive treatment option for diabetes-related neuropathic pain? Christopher Joyce, David Watterson, Caroline McIntosh P18 “My back is in agony” – A cross-sectional study into the relationship between musculoskeletal complaints and a whole body postural risk assessment in podiatry students Christopher Joyce, Nigel Roberts P19 Swabs of the treatment couches: Does the material type and texture of podiatric treatment couches increase microorganism contamination? Jacqueline Forss, Chrystalla Charalambous, Jack Kirby, Oluwakemi Ojo P20 Does increased exudate viscosity effect the absorption rate of exudate into four different wound dressings? Jacqueline Forss, Sarah Caukill, Jacqueline Capon, Radiance Fong, Louis Loy P21 An investigation into the microbial load of a 40 °C and 60 °C wash Matthew Diment, Madeleine Murray, Mairghread Ellis, Carla McArdle P23 The sensitivity and specificity of the toe brachial index in detecting peripheral arterial disease: a systematic review and meta-analysis Peta Tehan, Vivienne Chuter, Christopher Oldmeadow P24 Medicines management activities and non-medical prescribing within podiatry and physiotherapy: an integrative review of the literature Nicola Carey, Karen Stenner, Heather Gage, Jane Brown, Peter Williams, Simon Otter, Ann Moore, Jude Edwards, Freda Mold, Molly Courtenay A7.2 Non-invasive vascular assessment in the foot with Diabetes: Diagnostic accuracy of ankle brachial index, toe brachial index and continuous wave Doppler Peta Tehan, Alan Bray, Vivienne Chuter A7.5 The efficacy of dressings on post nail surgery phenolised wounds Pamela Hindmoor B7.1 Cross-sectional study investigating the role of proximal and distal factors in the development of patellofemoral joint pain Craig Gwynne, Sarah Curran B7.2 Podiatrist’s interpretation and use of evidence in MSK practice Andy Bridgen B7.4 Predictors of falling in older podiatry patients – findings from the REFORM study Caroline Fairhurst, Dr Joy Adamson, Belen Corbacho Martin, Sarah Cockayne, Prof Catherine Hewitt, Kate Hicks, Anne-Maree Keenan, Lorraine Loughrey-Green, Hylton Menz, Anthony Redmond, Sara Rodgers, Jude Watson, David Torgerson, Robin Hull, Sarah Lamb, Caroline McIntosh, Wesley Vernon, Lisa Farndon B7.5 The REFORM study: Insole preference, requirements and compliance of podiatry patient’s aged 65 and over and at risk of falling Lorraine Loughrey-Green, Sarah Cockayne, Anthony Redmond, Anne-Maree Keenan, Sara Rodgers, Lisa Farndon, Wesley Vernon, David Torgerson, Caroline Fairhurst, Jude Watson, Hylton Menz, Sarah Lamb, Robin Hull B7.6 A podiatry intervention to reduce falls in care home residents is feasible and demonstrates benefits: results from PIRFECT, a feasibility randomised controlled trial Gavin Wylie, Zoe Young, Brian Williams, Frank Sullivan, Hylton Menz, Simon Ogston, Jacqui Morris C7.1 A survey exploring footwear habits in people with stroke and people with Parkinson’s Cathy Bowen, Dorit Kunkel, Mark Cole, Margaret Donovan-Hall, Ruth Pickering, Malcolm Burnett, Dan Bader, Judy Robison, Louis Mamode, Ann Ashburn C7.2 Painful foot osteoarthritis; a common symptom in a common pathology? Peter McQueen, Maxine Daniels, Michael Doherty, Nigel Arden, Cathy Bowen C7.4 Clinical diagnosis of symptomatic forefoot neuroma in the general population: Delphi based recommendations Charlotte Dando, Lindsey Cherry, Cathy Bowen C7.5 The development and implementation of a Clinical Quality Improvement Framework suitable for use in community services Nichola Stefanou C7.6 The REFORM study - methodological considerations in running a cohort randomised controlled trial within a podiatry patient caseload Sarah Cockayne, Joy Adamson, Caroline Fairhurst, Catherine Hewitt, Anne-Maree Keenan, Sally Lamb, Lorraine Loughrey-Green, Caroline McIntosh, Hylton Menz, Anthony Redmond, Sara Rodgers, Wesley Vernon, Jude Watson, Lisa Farndon, Belen Corbacho, Robin Hull, David Torgerson A31 Jewel in the crown: Exploring the factors contributing to the development and impact of foot problems in Systemic Sclerosis (SSc) Begonya Alcacer-Pitarch, Anthony Redmond, Maya Buch, Anne-Maree Keenan

Objective To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts. Design A multicentre, open, two arm randomised controlled trial. Setting University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland. Participants 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. Interventions Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks. Main outcome measures Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment. Results There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI ¿8.33 to 9.63), P=0.89). The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients¿ preferences at baseline. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference ¿3.15% (¿16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). There was also no evidence of a difference in the number of plantar warts at 12 weeks (incident rate ratio 1.08 (0.81 to 1.43), P=0.62). Conclusions Salicylic acid and the cryotherapy were equally effective for clearance of plantar warts. UK National Institute for Health Research peer-reviewed

This case study explores the\ud management of a chronic diabetic\ud foot ulcer complicated by severe\ud soft tissue infection (cellulitis) and\ud bony infection (osteomyelitis) in a\ud patient with type 2 diabetes.

Motor neuropathy in patients with diabetes can lead to weakness in the muscles of the foot and lower leg, which in turn can lead to characteristic changes to the structure of the foot, such as an altered arch profile. Such structural changes often occur at sites of abnormally high pressure, which can result in tissue breakdown and ulceration particularly in individuals who also have sensory neuropathy.

Background: Nurses and podiatrists are frequently involved in the management of complex wounds, however, despite evidence demonstrating the benefits of interprofessional working, there is often little collaboration between these professions when caring for patients with wounds. This partly stems from a lack of awareness of each other’s roles as well as inconsistent educational strategies. The University of Huddersfield has started to address this issue by developing an interprofessional strand to undergraduate wound care education. Aim: To develop an IT-based learning resource to convey evidence-based concepts in wound care to pre-registration, undergraduate nursing and podiatry students. Method: A CD-ROM has been developed utilising a problem-based learning format bringing theory to life with the use of case scenarios centred on the management of common wounds.Conclusion: This initiative aims to introduce an IT resource to pre-registration nursing and podiatry students to encourage them to embrace evidencebased concepts, appreciate the importance of an interprofessional approach and be better prepared for independent practice. Conflict of interest: None

Falls are a major cause of morbidity and mortality in older adults and evidence suggests that fall rates are rapidly increasing likely due to an aging population, which is placing a significant financial burden on health care systems across the world. Falls present one of the highest risks for the older population and many factors contribute to the increased risk of falls and fear of falling in older adults, such as reduced physical activity and mobility, decreased muscle mass and balance and lack of walking. Rehabilitation and falls prevention exercises are required to help older adults improve their mobility and independence. Therefore, this research aimed to investigate the effectiveness of a Pilates intervention, that included a supplementary home-based exercise programme, to decrease the risk of falls in healthy older adults in Ireland. A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out. A PICOS approach was adopted to set the inclusion and exclusion criteria and evaluate the outcome measures: mobility, functional mobility, fear of falling, gait, postural balance and the number of falls during the Pilates intervention programme. Twelve randomised controlled trials (RCTs) of Pilates interventions, including comparisons with control groups and other forms of exercise were included. Overall, there were 702 participants, with 308 allocated to Pilates groups, 316 to control groups and 78 to a three-arm exercise group. Pilates showed an effect in postural stability in the mediolateral sway comparison to control groups (MD = -1.77, 95% CI, -2.84 to -0.70, p = 0.001, heterogeneity: I² = 3%), mobility (MD = 9.23, 95% CI, 5.74 to 12.73, p < 0.00001, 15 heterogeneity: I² = 75%) and fear of falling (MD = -8.61, 95% CI, -10.16 to -7.07, p < 0.00001, heterogeneity: I² = 88%). In relation to other exercises group, Pilates showed positive effects in functional mobility (MD= -1.21, 95% CI, -2.30 to -0.11, p = 0.03, heterogeneity: I² = 80%), mobility (MD = 3.25, 95% CI, 1.46 to 5.04, p < 0.0004, heterogeneity: I² = 0%). The first and the second studies that are included in this thesis describe the mat Pilates intervention, including the supplementary 6-week home-based exercise programme, with the pre- and post-intervention testing. The first study examined the feasibility of a Pilates intervention for healthy older adults using the following outcomes: functional mobility, mobility, fear of falling, physical activity, postural balance and the spatiotemporal parameters of gait for six participants. Exploratory results were reported of the 6-week intervention. The second study, a cohort study, used snowballing to recruit participants. With 32 eligible participants included in the study. The results participants with previous experienced of Pilates suggests that functional mobility (p < 0.001), mobility (p < 0.001), gait velocity (p = 0.022), swing time (p = 0.049), stance time (p = 0.013) and double support time (p = 0.040). Postural stability in the mediolateral (p = 0.025) and anteroposterior sway (p = 0.037), and Physical activity (p = 0.017) were positively affected after the 6-week mat Pilates intervention. The third study of this thesis reports on the prospective, open-label randomised crossover study. This third study was carried out over a 7-month period, with a one-month washout period. Volunteer participants (n = 61) were randomly assigned to Group 1 (Control-Pilates) or Group 2 (Pilates-Control) for twelve weeks. The Pilates intervention included accessories and supplementary home-based exercises. The primary outcome measures were gait velocity, the postural stability parameter of mediolateral sway and fear of falling. The secondary outcome measures included cadence, stride length, step length, stance time, swing time, step time, double support time of gait, the postural stability parameter of anteroposterior sway, functional mobility, mobility and physical activity. The results of this twelve-week Pilates intervention indicated that Pilates had an effects in functional mobility (p = 0.002), mobility (p = 0.001), postural stability in the mediolateral sway (p = 0.040) and the spatiotemporal parameters of gait: cadence (p = 0.019), step time (p = 0.028), stance time (p = 0.012), and double support time (p = 0.031). In conclusion, the Pilates interventions were found to improve functional mobility, mobility, gait, fear of falling and postural stability for the meta-analysis. The results of six- and 12-week Pilates intervention indicated that Pilates may reduce the risk of falls and suggests that Pilates interventions for healthy older people may change their functional mobility, mobility, postural stability and spatiotemporal parameters of gait. However, high-quality RCTs that include the number of falls during the intervention program and participants with and a without history of falls still needed. Further, Pilates intervention programmes with longer follow-up periods are required.