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Aiming to ascertain whether frequency and severity of knee and foot problems were different between morbid obesity (MO) and superobesity (SO), a prospective clinical study was designed.Bariatric candidates (N = 81, body mass index 40-81.3 kg/m(2), 43.2 % with SO) were submitted to knee and foot radiologic assessment, baropodometric footprint measurement, and the questionnaires Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Foot and Ankle Outcome Score (FAOS). Main outcome measures were imaging diagnosis of knee osteoarthritis and flatfoot, along with functional impact on activities of daily living estimated by the questionnaires.Knee osteoarthritis was radiologically diagnosed in 74.1 % (60/81), and the entire cohort suffered from flatfoot according to both footprint index and talar-first metatarsal radiographic angle; nevertheless, distribution was not different between SO and MO. However, WOMAC and FAOS scores were markedly worse in SO, affecting joint pain, stiffness, and general mobility. This is the first protocol of our knowledge to address foot and knee derangements in SO.Functional impairment was more severe in SO, despite a morphologic pattern similar to MO. Even though amelioration is probable with weight loss, long-term orthopedic assistance might be required in such circumstances.

Background Unstable shoe designs should support the muscle activity and promise the treatment of leg, back and foot problems. According to manufacturers, they should activate additional muscles and reduce joint reaction forces. Goal of this study is to investigate the effect of an unstable shoe design to gait patterns of healthy volunteers and by the means of inverse dynamic multi-body simulation.

The authors report the results of a literature survey of corrective surgical treatment based on FDL and FDB tendon transfer for dynamic claw toe deformities. The study revealed that FDL transfer was first described in 1967 by Malcolm A. Brahms in "Common Foot Problems", and FDB transfer was first mentioned in 1993 in the first edition of the treatise by G. Pisani "Trattato di Chirurgia del Piede". The paper also discusses the functional effect of FDB transfer, compared to FDL transfer.

The incorrect ambulatory habit affects our body temporarily as well as permanently. In this paper we propose Ambulatory Remedial Clinic Helper (ARCH), shoes detecting wrong ambulatory habit. It is easy to let patients know strange signals promptly after getting & analyzing the data of them in everyday life. ARCH system uses pressure sensors and 3-axis acceleration sensor to measure degree of wrong ambulatory habit and report the acquired data to host PC. By implementing this system, we can check the ambulatory pattern in real time, ward off plenty of foot diseases, and prevent deterioration of the existing foot problems.

Information derived from imaging studies can play an important role in the management of complicated foot problems in the diabetic patient. This chapter reviews the various modalities available for imaging of the diabetic foot—radiography, nuclear medicine studies such as bone scans, labeled leukocyte scans, bone marrow scans, and FDG PET scans, cross-sectional studies such as MRI, CT, and ultrasound, and various forms of catheter and noninvasive angiography—and highlights their relative strengths and weaknesses for the diagnosis of osteomyelitis, soft tissue infection, and neuroarthropathy. A suggested imaging algorithm for the diagnosis of osteomyelitis in the diabetic foot is presented.

Podiatry screening of children is a common practice, which occurs largely without adequate data to support the need for such activity. Such programs may be either formalised, or more ad hoc in nature, depending upon the use of guidelines or existing models. Although often not used, the well-established criteria for assessing the merits of screening programs can greatly increase the understanding as to whether such practices are actually worthwhile. This review examines the purpose of community health screening in the Australian context, as occurs for tuberculosis, breast, cervical and prostate cancers, and then examines podiatry screening practices for children with reference to the criteria of the World Health Organisation (WHO). Topically, the issue of paediatric foot posture forms the focus of this review, as it presents with great frequency to a range of clinicians. Comparison is made with developmental dysplasia of the hip, in which instance the WHO criteria are well met. Considering that the burden of the condition being screened for must be demonstrable, and that early identification must be found to be beneficial, in order to justify a screening program, there is no sound support for either continuing or establishing podiatry screenings for children.

This article discusses the common foot problems seen in association with rheumatoid arthritis. The biomechanics of the foot and the pathogenic mechanisms of the problems seen in rheumatoid arthritis are briefly discussed. The article then turns to the conservative methods used to prevent or treat the common foot deformities associated with this disease.

A retrospective controlled study sought to determine the effect of podiatric surgery on the need for chiropody treatment among patients with painful corns and callus on their lesser toes. Patients who had been receiving chiropody for at least 1 year prior to podiatric surgery were compared with patients with similar foot problems, who although suitable for surgery had only been provided with conservative chiropody care. In the 33 patients (mean age 62, SD 19) who underwent podiatric surgery, 24% continued to require regular chiropody while 48% did not require any further treatment postoperatively. In the 25 patients (mean age 72, SD 9) who received chiropody only, 72% continued to require regular chiropody treatment. Podiatric surgery is more likely to resolve painful corns and callus on the lesser toes than regular chiropody care. Podiatric surgery is recommended as an effective and cost-efficient treatment which promotes the discharge of patients from the National Health Service chiropody service.

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.

Foot problems are common in older people and altered biomechanical parameters under the foot sole has been proposed as a key risk factor for foot lesions. Therefore the aim of this study was to investigate the age-related differences in the hardness of foot sole skin.Twenty-six healthy volunteers without foot problems, aged from 26 to 65 years, were examined using shore meter. The hardness of the foot sole under the big toe (area 8), 1st metatarsal head (area 5), 3rd metatarsal head (area 6), 5th metatarsal head (area 7), mid foot (area 3, 4) and hind foot (area 1, 2) were measured. The correlation between age and hardness of foot sole was examined and comparisons were made between two age groups.From the result we observe statistical significant (p0.05; p0.01; p0.005) differences in hardness between age groups in hind foot, metatarsal heads (1st, 3rd5th) and big toe. Strong positive correlations between age and hardness of the foot sole were found at the big toe (r=0.57; p0.005), 1st metatarsal head (r=0.567; p0.00001), 3rd metatarsal head (r=0.565; p0.00001), 5th metatarsal head (r=0.55; p0.00001), and heel (r=0.59; p0.0001).The loss of compliance in the foot sole may be one of the factors responsible for the higher incidence of foot problems in aged people. Routine foot examination and appropriate therapeutic intervention including the use of foot orthoses and optimal hardness of foot wear insole may help to prevent the serious foot injuries.

Background Plantar fascia stretch plays an important role in the treatment of plantar fasciitis. Existing stretch splints mostly provide stretch to Achilles tendon but not to the plantar fascia. The ones that do are inefficient and uncomfortable because of their static nature. In this paper a dynamic stretch splint featured both ankle and metatarsophalangeal joint stretch was designed and developed. This splint should provide continuous stable stretch and be able to monitor the load of stretch during clinical application. To validate the design, twenty volunteers were tested under two stretch conditions, static and dynamic. Forces generated between the splint and the foot across 30-min testing were registered. Level of comfort and joint range-of-motion changes after splint application were evaluated. Statistical results demonstrated significant differences in load of stretch and in level of comfort between the static and dynamic conditions, but not in joint range-of-motion. The findings indicated that the designed splint could provide a continuous load of stretch, eliminate discomfort and increase user compliance comparing to static splint. Its long term effect onto joint angle improvement needs further investigation. Potentially it may be used on subjects with plantar fasciitis, and subjects with foot problems accompanying plantar tissue contracture.

Background The severity of hallux valgus is easily appreciated by its clinical appearance, however x-ray measurements are also frequently used to evaluate the condition, particularly if surgery is being considered. There have been few large studies that have assessed the validity of these x-ray observations across a wide spectrum of the deformity. In addition, no studies have specifically focused on older people where the progression of the disorder has largely ceased. Therefore, this study aimed to explore relationships between relevant x-ray observations with respect to hallux valgus severity in older people. Methods This study utilised 402 x-rays of 201 participants (74 men and 127 women) aged 65 to 94 years. All participants were graded using the Manchester Scale - a simple, validated system to grade the severity of hallux valgus - prior to radiographic assessment. A total of 19 hallux valgus-related x-ray observations were performed on each set of x-rays. These measurements were then correlated with the Manchester Scale scores. Results Strong, positive correlations were identified between the severity of hallux valgus and the hallux abductus angle, the proximal articular set angle, the sesamoid position and congruency of the first metatarsophalangeal joint. As hallux valgus severity increased, so did the frequency of radiographic osteoarthritis of the first metatarsophalangeal joint and a round first metatarsal head. A strong linear relationship between increased relative length of the first metatarsal and increased severity of hallux valgus was also observed. Conclusions Strong associations are evident between the clinical appearance of hallux valgus and a number of hallux valgus-related x-ray observations indicative of structural deformity and joint degeneration. As it is unlikely that metatarsal length increases as a result of hallux valgus deformity, increased length of the first metatarsal relative to the second metatarsal may be a contributing factor to the development and/or progression of hallux valgus.

Foot problems are highly prevalent in older people. To treat such problems in this age-group prefabricated ('off-the-shelf') foot orthoses are frequently prescribed. However, such devices are susceptible to material compression and deformation, which may reduce their effectiveness over time. Therefore, the aim of this study was to compare the pressure-redistributing properties of new prefabricated orthoses to orthoses worn for at least 12 months. Thirty-one adults (10 males, 21 females) aged over 65 years (mean 75.4, SD 5.2) participated. Plantar pressure data were collected under the rearfoot, midfoot and forefoot using the Pedar(®) in-shoe system while participants walked along an 8m walkway wearing shoes only, new orthoses and old orthoses (orthoses were full length, dual-density prefabricated Formthotic™ devices). Compared to the shoe-only condition, both the new and old orthoses produced significant reductions in peak pressure and maximum force in the rearfoot with corresponding increases in force and contact area in the midfoot. Compared to the new orthoses, the old orthoses exhibited small but significant increases in peak pressure in the rearfoot (6%, p=0.001) and maximum force in the rearfoot (5%, p

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.

Foot problems in the elderly represent one of the most distressing and disabling afflictions associated with old age. As society considers the basic needs of the older population, it is recognised that health is but one of those needs, and not always the highest priority. There are two primary factors in the elderly patient’s ability to remain as a vital part of society. They are a keen mind and the ability to walk. Foot problems in the older patient represent a significant health concern, in both prevalence and incidence. The immobility that results from a local foot problem can have a significant impact on the patient’s ability to maintain life as a useful member of society. Diseases which commonly affect the foot are listed in Table 1.

The foot is in use in virtually every sport and even in those sports where it plays little part, such as shooting, a foot problem giving rise to pain can distract the sportsman and produce a poor performance. The foot ranks in functional importance with the hip and knee, for equivalent weight and stress is taken by it. Analysis of the reasons for consultations during the Olympic Games (1980) reveals that foot problems were responsible for some 18% of the visits. Of these, 70% of the problems were avoidable, 50% were due to deficient footwear and 20% avoidable by foot hygiene and nail care. Of the remainder 28% arose because of intrinsic disorders of shape and alignment and other pathology and only 2% were due to direct injury in the course of the sport.

In Australia workers in many industries are required to wear safety footwear (footwear incorporating a steel toe cap). An investigation of the problems reported by 321 workers (70 per cent male) employed in a broad range of work activities and required to wear safety footwear was conducted in 1990 and 1991. Respondents were interviewed by a professionally trained podiatrist using a structured questionnaire followed by a foot examination. An extremely high percentage (91 per cent) of subjects reported one or more foot problems (which were verified by the podiatrist), and most considered that the safety footwear either caused the problem or adversely affected an existing foot condition. The main shoe concerns reported were excessive heat (65 per cent of all respondents), inflexible soles (52 per cent), weight (48 per cent) and pressure from steel toe cap (47 per cent). Certain gender differences were identified. General recommendations are made.

Foot problems such as pain and calluses are common for high-heeled shoe wearers. These problems may be related to the excessive local plantar loading, including pressure and shear stress. The shear stress is important on such a declined support surface of high-heeled shoe. The purpose of this study was to investigate the distribution of contact pressures and shear stresses simultaneously between plantar surface and high-heeled insole over specific regions utilizing in-shoe triaxial force transducers. The results showed that both the peak pressure and the peak shear stress occurred at the 2nd metatarsal head during walking and the average magnitudes of ten subjects were 386.9 kPa and 79.7 kPa respectively. The directions of anteroposterior and mediolateral shear stresses transferred from the posterior to anterior and from the lateral to medial respectively as the foot rolled forward from heel strike to toe off. The information on the distribution of plantar stresses may be useful for understanding of the foot biomechanics with high-heeled shoe and improvement of the high-heeled shoe design.

Background The foot is often the first area of the body to be systematically affected by rheumatoid arthritis. The multidimensional consequences of foot problems for patients can be subjectively evaluated using patient-reported outcome measures (PROMs). However, there is currently no systematic review which has focused specifically upon the PROMs available for the foot with rheumatoid arthritis. The aim of this systematic review was to appraise the foot-specific PROMs available for the assessment and/or evaluation of the foot affected with rheumatoid arthritis. Methods A systematic search of databases was conducted according to pre-defined inclusion/exclusion criteria. PROMs identified were reviewed in terms of: conceptual bases, quality of construction, measurement aims and evidence to support their measurement properties. Results A total of 11 PROMs were identified and 5 papers that provided evidence for the measurement properties of some of the PROMs. Only one of the PROMs was found to be RA disease-specific. The quality of construction, pretesting and presence of evidence for their measurement properties was found to be highly variable. Conceptual bases of many of the PROMs was either restricted or based on reductionist biomedical models. All of the PROMs were found to consist of fixed scales. Conclusions There is a need to develop an RA-disease and foot-specific PROM with a greater emphasis on a biopsychosocial conceptual basis, cognitive pre-testing methods, patient preference-based qualities and evidence to support the full complement of measurement properties.

Purpose: The purpose of the study was to identify the prevalence, risk factors and clinical meanings of geriatric foot problems and to suggest implications for the future. Methods: One hundred eighty nine elderly aged 60 and over from institution as well as community were investigated for their foot conditions by means of a questionnaire including general characteristics, self care capacity, risk factors, foot problem checklist, X-ray, podoscopy and foot scan. Descriptive statistics and χ²-test was performed as appropriate utilizing SPSS version 14. Less than .05 of p-value was adopted as statistical significance level. Results: All subjects had at least one kind of foot problem and the most prevalent ones were nail problems, foot deformities in order. Prevalence of foot pain and edema was relatively low. Conclusion: Foot problem in lderly is prevalent and geriatric foot is expected to emerge as one of the most important problems in the geriatric field. Therefore strategies to deal with geriatric foot should be developed and practiced for better quality of life in later life.

Background The Visual Analogue Scale (VAS) and the Foot Health Status Questionnaire (FHSQ) are two commonly used outcome measures for evaluating foot health. This study aimed to calculate the Minimal Important Difference (MID) of the VAS and the FHSQ. Methods 184 participants with plantar heel pain were recruited from the general public to take part in two randomised trials (92 participants in each trial) that studied the effectiveness of two conservative interventions for plantar heel pain. Data from these participants were used to calculate the MIDs of the VAS and the FHSQ. An anchor-based method was used to calculate the MIDs. Two distinct types of pain were investigated for the VAS: average pain and first-step pain. All four domains of the FHSQ were investigated: foot pain, foot function, footwear and general foot health. Results The MID for the VAS using the anchor-based approach was -8 mm (95% CI: -12 to -4) for average pain and -19 mm (95% CI: -25 to -13) for first-step pain on the 100 mm VAS. The MID for the FHSQ was 13 points (95% CI: 6 to 19) for pain and 7 points (95% CI: 1 to 13) for function. The MID for the footwear domain of the FHSQ was -2 points (95% CI: -8 to 4) and 0 points (95% CI: -7 to 6) for the general foot health domain of the FHSQ. Conclusion The results of this study provide additional evidence for MID values of the VAS and the FHSQ for plantar heel pain. This is important for clinicians and researchers as it provides a greater understanding of how much improvement is required by a patient before a minimal, worthwhile change is experienced. The calculated MIDs will also assist researchers with prospective sample size calculations.

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 (P0.02), ankle brachial ratio was 1.05 +/- 0.19 and 1.14 +/- 0.18 (P0.05), 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 (P0.01), 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.

Reasons for performing study: There are ethical concerns regarding the loss of horses from various equine industries and their corresponding slaughter. However, to date, no empirical evidence regarding the extent of this loss, nor of the condition of horses involved, exists within Australia. Objectives: To determine the approximate ages, brand type and condition of feet of horses relinquished to an export abattoir in Australia. Method: Data were collected from 340 horses processed at an Australian abattoir from November 2007-January 2008. Foot abnormalities, injuries and hoof indicators of overgrown and untrimmed hooves were assessed together with a dental inspection. Observations of brand were used to determine horse origin. Results: The dental age of 60% of horses was ≤7 years, and 53% originated from the racing industry (40% Thoroughbred and 13% Standardbred). A total of 81% of the horses had overgrown or untrimmed hooves. Standardbred horses had fewer grass cracks and more injuries to the coronary band than Thoroughbreds, probably due to pacing and trotting activities. Conclusions: Just over half of the horses slaughtered at an Australian abattoir on 3 working days were aged ≤7 years and emanated from the racing industry. Foot problems were common. Potential relevance: Future research should identify means of reducing the number of horses slaughtered and preventative measures for foot disorders.

Foot problems are very common in captive Asian elephants (Elephas maximus). The purpose of this study was to investigate whether an association exists between floor type, the occurrence of repetitive behaviour and foot problems. For this research project, information about the enclosure floor type, the occurrence of repetitive behaviour and the occurrence of foot problems was collected for adult (older than 11 years) Asian elephants in European zoos, using a brief questionnaire (response rate = 38.09 %). Data on indoor and outdoor housing were pooled for statistical purposes. Information was obtained for 87 adult individuals, out of the 254 adult elephants that are incorporated in the EAZA European Studbook. Most of the elephants had access to areas with sand (87.36 %) or concrete (71.26 %) flooring. A considerable proportion of the animals (72.41 %) displayed repetitive behaviour (stereotypies). The most common type was weaving (37.93 %). The respondents observed foot problems in 59 individuals (67.82 %). Within the latter group, 53 elephants displayed repetitive behaviours, of which weaving was the most common type (34.38 %), followed by nodding (18.75 %) and pacing (15.63 %). The statistical analysis showed that elephants that had access to an enclosure with straw flooring had less chance of displaying stereotypic behaviour than elephants that were kept on other floor types (Prevalence ration (PR) = 0.12; P < 0.01). Elephants partly kept on dirt were less likely to have foot problems than animals standing on other substrates (PR = 0.67; P = 0.01). It was shown that elephants in this study that showed stereotypic behaviour were 337 times more likely to have foot problems than elephants that showed no stereotypic behaviour (PR = 3.37; P < 0.01). However, the results of this study should be interpreted with caution. Adhering to the advice of the EEP coordinator, questionnaire length was restricted and, consequently, certain factors (e.g., distribution of time spent indoors and outdoors, enclosure maintenance, elephant sleeping patterns) were no longer included. Future research elaborating on the development of stereotypic behaviours and foot problems should account for these factors.

In-shoe plantar pressure measurement has the potential to play a crucial role in the screening, treatment and behavior modification of patients who are at risk of, or are experiencing a variety of foot problems. In this article we review the instrumentation, methodology, applications, and rationale for in-shoe plantar pressure measurement. Possible new applications in the future are also discussed. In-shoe techniques are advantageous compared to the more traditional platform devices because they permit the most important interface, that between the foot and shoe, to be monitored and they allow for increased versatility of measurement for the calculation of more robust statistical estimates. Both discrete transducers and matrix systems have been developed; each approach has its advantages and disadvantages but, in general, matrix systems are preferable. Although there are still device limitations which must be overcome the technique of in-shoe measurement has opened the door to a whole new realm of pressure studies both in research and clinical practice.

This article focuses on the causative physiology of foot problems in the diabetic and discusses preventative measures. In addition to teaching foot care to prevent problems, the home health care staff is often the first to recognize the symptoms of complications. This article provides information to assist the caregiver to do both.

People with diabetes are liable to suffer potentially disastrous foot problems, including gangrene with subsequent amputation. This article describes the risk factors, management, and ulcer-prevention methods which are essential knowledge for nurses working with this patient group.

Objective: To describe features of footwear worn at the time of hip fracture-related falls. Method: Subjects were 107 persons (mean age 77 years) admitted with a hip fracture-related fall to a hospital in the Illawarra region of New South Wales, Australia, between February 1995 and February 1996. All subjects resided in private homes or hostels at the time of their fall. An interviewer-administered questionnaire was used to collect data from participants on foot problems, falls history, and age and use of footwear worn at the time of hip fracture. A standardised approach was used to physically examine features of footwear worn at the time of fracture. Results: Most subjects wore slippers (33 %} or were not wearing any footwear (24%) when they fell and fractured their hip. Among the 79 subjects in footwear, most (70%) fell in footwear they wore every day and 43% of their footwear was less then six moths old. Participants chose to wear their footwear for comfort, not safety. Conclusion: Enthusiasm for developing a ‘;safe shoe’ should be tempered somewhat by the fact that many people who suffer a hip fracture are not wearing shoes at the time they fall.

Foot problems are common in elderly people and stiffened plantar soft tissues may lead to ulceration in people with Diabetes Mellitus. It is unclear how the biomechanical properties of plantar soft tissues change with advancing age. Therefore, this study examined the age-related differences in the biomechanical properties of plantar soft tissues.Sixty healthy volunteers without foot problems, aged from 41 to 83 years, were examined using tissue ultrasound palpation system. The thickness and stiffness of the plantar soft tissues under the big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and heel were measured. The load-deformation curve of the plantar soft tissues was plotted. The correlation between age and biomechanical properties was examined and comparisons were made between four age groups.The mean stiffness of the plantar soft tissues at big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and the heel significantly increased with age (P0.001). The plantar soft tissues at the heel were the thickest (P0.001), with the plantar soft tissue tending to be increasingly thicker with age, although there was no statistical significance. Strong positive correlations between age and stiffness of the plantar soft tissues were found at the big toe (r=0.608), first metatarsal head (r=0.549), third metatarsal head (r=0.657), fifth metatarsal head (r=0.633), and heel (r=0.584) (all P0.001).The loss of compliance in the plantar soft tissues may be one of the factors responsible for the higher incidence of foot problems in elderly individuals.

BACKGROUND: In recent decades, studies on the management of common foot problems in children have suggested that in many cases, there is no indication for treatment. It is not known whether these studies have changed daily practice.OBJECTIVE: Our aim was to establish and compare incidence and referral rates for foot problems in children in 1987 and 2001.METHODS: A comparison was made of two large consecutive surveys in Dutch general practice performed in 1987 (86 577 children aged 0-17 years) and 2001 (87 952 children aged 0-17 years), which were carried out by The Netherlands Institute for Health Services Research. Both surveys included a representative sample of the Dutch population. Incidence and referral rates were calculated and, data were stratified for age group and gender.RESULTS: Compared to 1987, in 2001 the overall incidence rate of foot problems presented to the family physician (FP) decreased substantially from 80.0 [95% confidence interval (CI) 77.0-84.7] to 17.4 (95% CI 16.5-18.3) per 1000 person-years (P < 0.0001). The incidence rate of flat feet decreased from 4.9 (95% CI 4.0-5.9) per 1000 person-years in 1987 to 3.4 (95% CI 3.0-3.8) per 1000 person-years in 2001 (P = 0.001). The distribution of referrals to other primary health care professionals and medical specialists has almost reversed in favour of primary health care professionals.CONCLUSION: Total incidence rate of musculoskeletal foot problems seen by the FP has decreased substantially, between 1987 and 2001.

Exercise often has many positive effects on diabetes management, including improved glycemic control, assistance with weight maintenance, increases cardiorespiratory fitness, and general sense of well-being. However, as diabetic patients can also have other conditions that can be invest affected by exercise, such as cardiovascular disease and neuropathy that makes them vulnerable to foot problems and retinopathy, exercise should be carefully monitored by the health provider, especially during the initiation period. Therefore, careful evaluation of patients for complications that may present incremental risks or interfere with the capacity for exercise is an important first step in planning an appropriate exercise program. This chapter will review the currently available guidelines and will provide practical information regarding the implementation of exercise programs in all diabetic patients, including those with conditions that may interfere with exercise and will need additional attention.

In a survey of 56 consecutive, non-urgent referrals to a hospital diabetic clinic, the majority (57%) were because of unsatisfactory glycaemic control. Non-urgent referrals of patients with ‘at-risk’ feet (n = 6) were fewer than urgent referrals or admissions for acute foot problems (n = 11). There were very few referrals for proteinuria (n = 1) or dyslipidaemia, and none for inadequately controlled hypertension. There were only two (3.6%) referrals which were considered inappropriate. Extrapolation from these results, and those of a simultaneous district audit of diabetes care, indicates a considerable unmet need for referral for specialist care which, if implemented, would result in a three-fold increase in non-urgent referrals.

Background: High peak plantar pressures predispose to foot problems and may exacerbate existing conditions. For podiatric physicians to make educated recommendations to their patients, it is important and necessary to begin to look at different shoes and how they affect peak plantar pressure. Methods: To determine how flip-flops change peak plantar pressure while walking, we compared peak plantar pressures in the same test subjects wearing flip-flops, wearing athletic shoes, and in bare feet. Ten women with size 7 feet and a body mass index less than 25 kg/m2 were tested with an in-shoe pressure-measurement system. These data were collected and analyzed by one-way analysis of variance and computer software. Results: Statistically significant results were obtained for nine of the 18 comparisons. In each of these comparisons, flip-flops always demonstrated higher peak plantar pressures than athletic shoes but lower pressures than bare feet. Conclusion: Although these data demonstrate that flip-flops have a minor protective role as a shock absorber during the gait cycle compared with pressures measured while barefoot, compared with athletic shoes, they increase peak plantar pressures, placing the foot at greater risk for pathologic abnormalities. (J Am Podiatr Med Assoc 98(5): 374–378, 2008)

Our knowledge of frequency of foot involvement in rheumatoid arthritis (RA) is still often based on a study from Finland in 1956. Great changes in the treatment of RA may have led to a different situation. We investigated the distribution of joint involvement in RA patients today, with special attention given to the feet and subjective walking ability.1,000 RA patients answered a questionnaire concerning joints affected, joint surgery, foot problems, and subjectively experienced reasons for walking incapacity.In 45% of the patients, the forefoot was involved at the start of the disease. In 17%, the hindfoot/ankle was involved at the start. Only hand symptoms were commoner. 80% of patients reported current foot problems, 86% in the forefoot and 52% in the hindfoot/ankle. Difficulty in walking due to the feet was reported by 71%. For 41% of patients, the foot was the most important part of the lower extremity causing reduced walking capacity, and for 32% it was the only part.After the hand, the foot was the most frequently symptomatic joint complex at the start of the disease, but also during active medical treatment. The foot caused walking disability in three-quarters of the cases and-4 times as often as the knee or the hip-it was the only joint to subjectively impair gait.

A casual comment made regarding the amount of "mole skin" being dispensed to airmen to handle blisters, pressure points, and foot pain led to the development of an impromptu voluntary survey in an attempt to quantify the number of personnel with foot care concerns and the spectrum of those problems. With only a small number of sick call visits related to foot and ankle problems, the amount of mole skin being dispensed was surprising. This survey represents the results of a comprehensive evaluation of a base population involved in support of the first 2 months of Operation Iraqi Freedom.

This study investigated foot/ankle roll-over characteristics for different joint alignments of the ankle-foot orthosis(AFO). Seven volunteers without any musculoskeletal or foot problems participated in motion analyses. To obtain roll-over shape of the ankle-foot complex, we used trajectories of ankle and knee joints and the center of pressure(COP) between initial contact (lC) and opposite initial contact(OIC). After the roll-over shape was determined for each data, it was represented by a circular arc using the least-square method. Results showed that for the more dorsiflexed AFOs, the more distally the roll-over trajectory moved at initial contact. Also, we found that the radius of curvature significantly increased and the center of roll-over shape moved posteriorly and superiorly in dorsiflexed AFOs. Present results might provide a better understanding for the proper alignment of the orthotics as well as a single roll-over shape during walking.

Background Problems from improper shoe fitting are common, but there are limited foot data for the older Thai population. Objectives To study foot dimensions and determine proper shoe sizes for Thai elderly. Methods Healthy older people: 108 men, 105 women, aged 60–80 years, who were independent in walking, were recruited. Thirteen foot dimensions and current shoes used were measured. Side-to-side, gender difference, and correlations of main foot measurements were analyzed. Results About 50% women and 34% men wore too narrow shoes, and this was found to be associated with foot pain. At the same foot length (FL), men had larger foot width (FW) and toe depth. Foot width = 2.39 + (0.29 × FL), r = 0.50, p = 0.001 for women and = 2.48 + (0.31 × FL), r = 0.56, p = 0.002 for men. Arch length = 1.0 + (0.7 × FL), r = 0.93, p = 0.001 for both genders. Toe depth had constant values in all shoe sizes of each gender. Correlations of other foot parameters were reported. Conclusions These anthropometric data is essential for proper shoe fitting in order to provide foot ergonomics and prevent foot problems for older Thai people.