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This first of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey the state of scientific knowledge related to incidence, diagnosis, pathologic mechanisms, and injection treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 3, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Part 1 overviews areas of epidemiology and pathophysiology, current approaches in imaging, diagnostic and therapeutic injections, and genetics. Opportunities for future research are discussed. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the needs of patients that suffer from arthritis of foot and ankle. The foot and ankle contain a myriad of interrelated joints and tissues that together provide a critical functionality. When this functionality is compromised by OA, significant disability results, yet the foot and ankle are generally understudied by the research community. Level of Evidence: Level V - Review Article/Expert Opinion., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online., (© The Author(s) 2022.)

This second of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey current treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 10, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Topics were chosen by meeting organizers, who then identified and invited the expert speakers. Part 2 overviews the current treatment options, including orthotics, non-joint destructive procedures, as well as arthroscopies and arthroplasties in ankles and feet. Opportunities for future research are also discussed, such as developments in surgical options for ankle and the first metatarsophalangeal joint. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the importance to patients of addressing the foot and ankle with improved basic, translational, and clinical research., Level of Evidence: Level V, review article/expert opinion., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online., (© The Author(s) 2022.)

Background: Conservative pedorthic management of the diabetic foot has been shown to be an effective method to prevent ulcers, amputations, and re-amputations. This article exhibits why and how pedorthics plays such an important role via modalities such as footwear, shoe modifications, custom foot orthoses, and partial foot prostheses., Objective: The objective of this article is to demonstrate how pedorthics has been shown to be an integral part of conservative diabetic foot care. The authors' goal was to educate the reader about the different modalities that are available for use., Study Design: This article is based largely on review of previously published research and scholarly articles, augmented by the more than 60 years of pedorthic and orthotic clinical experience of the authors., Methods: Approximately 60 journal articles and book chapters were reviewed by the authors. Articles were located via online resources such as PubMed as well as the authors' own libraries., Results: It was repeatedly noted that pedorthic modalities such as shoes, foot orthoses, and shoe modifications may be utilized in the treatment and prevention of diabetic foot wounds and other complications., Conclusion: Pedorthic devices may be successfully integrated into a comprehensive treatment plan for patients with diabetes and foot ulcers., Clinical Relevance: This information is of special interest to those who treat patients with diabetes. The article demonstrates the efficacy of pedorthic intervention through the compilation and review of relevant previously published data., (© The International Society for Prosthetics and Orthotics 2014.)

The use of footwear with contoured soles is common in treatment and care of patients with diabetes; these rocker sole shoes are designed to alleviate loading in key areas on the plantar surface of the foot, reducing pressure in key areas and alleviating pain, and potential soft tissue damage. While investigations of pressure changes have been conducted, no quantitative study to date has addressed the three-dimensional (3D) kinematic and kinetic changes that result from using these shoes. Forty subjects were tested wearing both unmodified and double rocker sole shoes, and the resulting motion patterns were compared to assess change caused by the rocker sole. Overall walking speed remained unchanged throughout testing; slightly increased flexion (<5 degrees ) was apparent at the hip, knee, and ankle during early and mid-stance. These results demonstrate the maintenance of gait function with minimal kinematic changes when using the rocker sole shoe. Investigations of multisegmental foot motion may reveal additional information about the contour effects; analysis of contour variations may also be warranted to investigate the possibility of controlling motion based on rocker sole parameters.

This paper reports the kinematic and kinetic changes in gait with bilateral double rocker sole shoe modifications. Three-dimensional motion analysis techniques were used to evaluate gait characteristics (temporal-spatial, kinematic, and kinetic measures) of forty (40) subjects while wearing baseline and double rocker sole shoes. Walking speed was unchanged by the double rocker modification. Sagittal plane motions showed significant change at the pelvis, hip, knee, and ankle. (p = 0.01). The toe-only rocker consistently resulted in increase in posterior pelvic tilt (p =0.01). Kinetic changes were observed at the hip in the sagittal and transverse planes, and at the knee and ankle in the sagittal planes. Changes in pelvic tilt and hip rotation were hypothesized to result from feelings of imbalance during ambulation with the double rocker sole shoe.

Objective: To examine the effect of different types of rocker soles on plantar pressures., Design: In-shoe plantar pressures were measured in subjects without deformity with baseline shoes and 3 types of rockers: toe-only, negative heel, and double., Setting: Medical college., Participants: Forty healthy patients (20 men, 20 women) without foot deformity., Interventions: Plantar pressures were recorded over a 2 1/2-hour test period with over 400 steps analyzed for each type of rocker sole. Peak pressures, pressure-time integral (PTI), and sensor contact duration were computed for each step., Main Outcome Measures: Peak plantar pressure PTI, and contact duration were compared for each rocker with a baseline shoe., Results: Significant reduction (P<.01) in peak pressure and PTI were recorded across the forefoot for all 3 rockers. The reduction of pressure at the forefoot was balanced by shifting pressure to the midfoot with the negative heel and toe-only rockers., Conclusion: This study lends scientific credence to the prescription of rocker soles for patients who need forefoot pressure reduction, such as in diabetic neuropathy and possible ulceration.

On 9 October 2002, the British Columbia Court of Appeal upheld a ruling of a BC court that the BC government must not discriminate against a disabled and disadvantaged group when choosing what medical treatments it will fund. The Court of Appeal ordered the BC government to pay for a particular form of treatment. The case is significant in the context of HIV/AIDS because it could lend support to arguments that a government must make appropriate accommodation for the health-care needs of other disabled and marginalized groups--for example, safe injection supervision for the treatment of addiction.

The Board Certified Pedorthist can be a valuable member of the team of healthcare professionals involved in the treatment of arthritis of the foot and ankle. In addition to providing prescription footwear, the pedorthist can assist in educating the patient, postoperative care, and long term monitoring of the patient's progress. The objectives in the pedorthic care of arthritis of the foot and ankle are to reduce shock and shear; to relieve excessive pressure from sensitive or painful areas; to accommodate, correct, and support deformities; and to control or limit painful motion of joints. Specific types of prescription footwear used to accomplish these objectives include shoes, external shoe modifications, and custom made foot orthoses.

Current research emphasizes the importance of prevention in caring for the diabetic foot. Prescription footwear has been shown to be a significant factor in prevention of both ulcer recurrence and amputation. In addition, scientific evidence demonstrates the ability of insole materials to reduce shock and shear, the effectiveness of insoles in providing pressure relief, and the ability of rocker soles to relieve metatarsal pressure. This evidence, however, is limited and is often based on clinical investigation rather than on objective, quantitative measurements. Recent advances in biomechanical modeling and in-shoe pressure measurement should allow more objective data on a wider variety of prescription footwear to become available. The importance of prescription footwear as a preventive measure is nonetheless widely recognized. The knowledge and experience of pedorthists make them uniquely qualified to provide the needed shoes, modifications, and insoles for the long-term management of the diabetic foot.

The use of orthoses, in conjunction with appropriate shoes and external shoe modifications, is an important part of the overall treatment program for foot and ankle injuries in sports. Prescription footwear can also be a significant factor in injury prevention. Similarly, the CPed is an important member of the team involved in treating and preventing foot and ankle injuries in sports. By providing footwear, patient education, and follow-up assistance, the CPed can make a valuable contribution to a comprehensive program of treatment and injury prevention.

The two primary components of achieving proper shoe fit are shoe shape and shoe size. Shoe shape refers to the shape of both the sole and the upper. Proper fit is achieved when shoe shape is matched to foot shape. Shoe size is determined by arch length rather than overall foot length. The proper shoe size is the one that accommodates the first metatarsal joint in the widest part of the shoe. A set of seven guidelines for achieving proper shoe fit is offered. Properly fitting shoes are important in avoiding foot discomfort and deformity, and are absolutely essential in patients with arthritis, diabetes, and other foot disorders.