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Abstract Aims/Introduction This study aimed to assess if patients can be divided into different strata, and to explore if these correspond to the risk of diabetic foot complications. Materials and Methods A set of 28 demographic, vascular, neurological and biomechanical measures from 2,284 (1,310 men, 974 women) patients were included in this study. A two‐step cluster analysis technique was utilised to divide the patients into groups, each with similar characteristics. Results Only two distinct groups: group 1 (n = 1,199; 669 men, 530 women) and group 2 (n = 1,072; 636 men, 436 women) were identified. From continuous variables, the most important predictors of grouping were: ankle vibration perception threshold (16.9 ± 4.1 V vs 31.9 ± 7.4 V); hallux vibration perception threshold (16.1 ± 4.7 V vs 33.1 ± 7.9 V); knee vibration perception threshold (18.2 ± 5.1 V vs 30.1 ± 6.5 V); average temperature sensation threshold to cold (29.2 ± 1.1°C vs 26.7 ± 0.7°C) and hot (35.4 ± 1.8°C vs 39.5 ± 1.0°C) stimuli, and average temperature tolerance threshold to hot stimuli at the foot (43.4 ± 0.9°C vs 46.6 ± 1.3°C). From categorical variables, only impaired sensation to touch was found to have importance at the highest levels: 87.4% of those with normal sensation were in group 1; whereas group 2 comprised 95.1%, 99.3% and 90.5% of those with decreased, highly‐decreased and absent sensation to touch, respectively. In addition, neuropathy (monofilament) was a moderately important predictor (importance level 0.52) of grouping with 26.2% of participants with neuropathy in group 1 versus 73.5% of participants with neuropathy in group 2. Ulceration during follow up was almost fivefold higher in group 2 versus group 1. Conclusions Impaired sensations to temperature, vibration and touch were shown to be the strongest factors in stratifying patients into two groups with one group having almost 5‐fold risk of future foot ulceration compared to the other.

Introduction The use of volatile anaesthetic agents for the sedation of patients requiring critical care treatment offers several theoretical advantages over intravenous sedation, which may be of benefit in neurocritical care. However, there are concerns that they may increase intracranial pressure. The objective of this systematic review is to assess whether, and if so, to what extent volatile anaesthetic agents affect intracranial pressure, cerebral blood flow (CBF), cerebral oximetry and cerebrovascular autoregulation. If sufficient data exist, subgroup analyses will be conducted in traumatic brain injury and decompressive craniectomy patients.Methods and analysis A database search of PubMed, Medline (including Medline plus), CINAHL (including CINAHL Plus), Embase databases and the Cochrane Central Controlled Trials Register without time limits will be conducted. The search results will be screened by title and abstract by two independent researchers on a rule-in basis against predetermined criteria—controlled studies in humans of contemporary fluorinated volatile anaesthetic agents against a control, which measures intracranial pressure, CBF, cerebral oximetry or cerebrovascular autoregulation. Articles responsive to screening will then be reviewed in full text by two independent researchers, requiring consensus or a tie-break by a third independent researcher. Reference lists and a non-generative AI tool will be examined for missed articles, with all identified articles being reviewed in full text by two independent researchers. The included articles will be assessed for risk of bias and will have data extracted by two independent researchers. If sufficient data exist, a meta-analysis will be performed; otherwise, a narrative description of outcomes will be performed.Ethics and dissemination No ethics approval will be sought for this systematic review. This study has no explicit funding. The results of this study will be disseminated in a peer-reviewed journal, in a conference presentation and on PROSPERO.Trial registration number PROSPERO number CRD42023474587

Abstract The introduction of Integrated Care Systems (ICS) in England aimed to increase joint planning and delivery of health and social care, and other services, to better meet the needs of local communities. There is an associated duty to undertake collaborative research across ICS partners to inform this new integrated approach, which might be challenging given that organisations span health, local authority, voluntary and community sector, and research. This study aimed to explore the appetite for collaborative Research and Innovation (R&I) across ICSs, potential barriers and solutions. This qualitative study involved semi-structured interviews with 24 stakeholders who held senior positions within organisations across two ICS areas (Staffordshire and Stoke-on-Trent; Shropshire, Telford and Wrekin). Interview transcripts were analysed using inductive and deductive analysis, first mapping to the Theoretical Domains Framework (TDF), then considering key influences on organisational behaviour in terms of Capability, Opportunity and Motivation from the COM-B Behaviour Change Wheel. There were fundamental limitations on organisational opportunities for collaborative R&I: a historical culture of competition (rather than collaboration), a lack of research culture and prioritisation, compounded by a challenging adverse economic environment. However, organisations were motivated to undertake collaborative R&I. They recognised the potential benefits (e.g., skill-sharing, staff development, attracting large studies and funding), the need for collaborative research that mirrors integrated care, and subsequent benefits for care recipients. Related barriers included negative experiences of collaboration, fear of failing and low confidence. Capability varied across organisations in terms of research skills and confidence, which reflected the range of partners (from local authorities to NHS Trusts, primary care, and academic institutions). These findings indicate a need to shift from a culture of competition to collaboration, and to help organisations across ICS to prioritise research, and share resources and skills to mitigate the limiting effects of a constrained economic environment. This could be further explored using a systems change approach, to develop the collaborative research efforts alongside the overarching move towards integrated care.

Abstract Background Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always been challenging due to this information being held across different organisations. An understanding of the prosthetic and orthotic (P&O) workforce is essential to ensure that it is adequately equipped to meet the evolving needs of users of P&O services. The study aims to estimate the size and composition, for the first time, of the UK P&O workforce and P&O service provision. Methods To gather the required information, two surveys (one for the UK P&O workforce and one for UK P&O private company) and two freedom of information (FOI) requests [one for all NHS Trusts and Health Boards (HB) in the UK and one for the higher education institutes in the UK offering programmes leading to registration as a PO were developed and distributed from September to December 2022. Results The P&O workforce survey received a 74% response rate (863 POs) and 25 private companies reported employing one or more P&O staffing groups. From the FOI requests, 181 of a potential 194 Trusts/Health Boards and all four higher education institutions responded. The study indicated a total of 1766 people in the UK P&O workforce, with orthotists and orthotic technicians representing the largest percentage of the workforce at 32% and 30%, respectively. A greater percentage of prosthetists (65%) and orthotists (57%) were employed by private companies compared to the NHS. Only 34% of POs stated that they “definitely” planned to remain in the workforce for the next 5 years. The current UK PO employment levels are 142 to 477 short of the World Health Organisation’s (WHO) recommendation. Conclusions The low job satisfaction amongst many POs and the projected increase in the number of people who will require prosthetic and/or orthotic care in the UK are challenges for future UK P&O services. Strategies are required to create a sustainable and resilient workforce that can meet the needs of a changing healthcare landscape.

BackgroundDiabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. ObjectiveThis protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. MethodsThis is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. ResultsThe quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. ConclusionsThis study’s survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. International Registered Report Identifier (IRRID)DERR1-10.2196/54852

Plantar fasciopathy is a very common musculoskeletal complaint that leads to reduced physical activity and undermines the quality of life of patients. It is associated with changes in plantar fascia structure and biomechanics which are most often observed between the tissue’s middle portion and the calcaneal insertion. Sonographic measurements of thickness and shear wave (SW) elastography are useful tools for detecting such changes and guide clinical decision making. However, their accuracy can be compromised by variability in the tissue’s loading history. This study investigates the effect of loading history on plantar fascia measurements to conclude whether mitigation measures are needed for more accurate diagnosis. The plantar fasciae of 29 healthy participants were imaged at baseline and after different clinically relevant loading scenarios. The average (±standard deviation) SW velocity was 6.5 m/s (±1.5 m/s) and it significantly increased with loading. Indicatively, five minutes walking increased SW velocity by 14% (95% CI: −1.192, −0.298, t(27), p = 0.005). Thickness between the calcaneal insertion and the middle of the plantar fascia did not change with the tissues’ loading history. These findings suggest that preconditioning protocols are crucial for accurate SW elastography assessments of plantar fasciae and have wider implications for the diagnosis and management of plantar fasciopathy.

Key messages Nationally accepted guidelines for AHP telehealth consultations are needed, with collaboration required between the NHS and AHP professional bodies. Future telehealth guidelines need to include advice and clear recommendations on patient eligibility criteria, consultation length, training requirements and safety considerations to limit unintended risks to patients, avoid AHPs’ liability exposure and widening health inequalities of vulnerable groups. Telehealth implementation processes should be given equal consideration as technological aspects within guidelines and staff training to ensure a successful digital transformation of the NHS AHP services. Digital inclusion approaches are needed to ensure that vulnerable population groups at risk of exclusion can benefit from digital technologies as digitally enabled care goes mainstream across the NHS. Training should include not only technical but also practical skills in telehealth consultations. AHPs must be trained to respond to emergencies to reduce the risk of unnecessary harm to patients and to improve their confidence and engagement in the usage of telehealth. Telehealth education should be incorporated into AHP curricula to equip the future AHP workforce with the knowledge and skills necessary to deliver telehealth.

This study aimed to investigate whether running kinematics can be accurately estimated through an artificial neural network (ANN) model containing GPS-based accelerometer variables and anthropometric data. Thirteen male participants with extensive running experience completed treadmill running trials at several speeds. Participants wore a GPS device containing a triaxial accelerometer, and running kinematics were captured by an 18-camera motion capture system for each trial. Multiple multilayer perceptron neural network models were constructed to estimate participants’ 3D running kinematics. The models consisted of the following input variables: 3D peak accelerometer acceleration during foot stance (g), stance time (s), running speed (km/h), participant height (cm), leg length (cm), and mass (kg). Pearson’s correlation coefficient (r), root mean squared error (RMSE), and relative root mean squared error (rRMSE) showed that ANN models provide accurate estimations of joint/segment angles (mean rRMSE = 13.0 ± 4.3%) and peak segment velocities (mean rRMSE = 22.1 ± 14.7%) at key gait phases across foot stance. The highest accuracies were achieved for flexion/extension angles of the thorax, pelvis, and hip, and peak thigh flexion/extension and vertical velocities (rRMSE < 10%). The current findings offer sports science and medical practitioners working with this data a method of conducting field-based analyses of running kinematics using a single IMU.

Shore hardness (SH) is a cost-effective and easy-to-use method to assess soft tissue biomechanics. Its use for the plantar soft tissue could enhance the clinical management of conditions such as diabetic foot complications, but its validity and reliability remain unclear. Twenty healthy adults were recruited for this study. Validity and reliability were assessed across six different plantar sites. The validity was assessed against shear wave (SW) elastography (the gold standard). SH was measured by two examiners to assess inter-rater reliability. Testing was repeated following a test/retest study design to assess intra-rater reliability. SH was significantly correlated with SW speed measured in the skin or in the microchamber layer of the first metatarsal head (MetHead), third MetHead and rearfoot. Intraclass correlation coefficients and Bland–Altman plots of limits of agreement indicated satisfactory levels of reliability for these sites. No significant correlation between SH and SW elastography was found for the hallux, 5th MetHead or midfoot. Reliability for these sites was also compromised. SH is a valid and reliable measurement for plantar soft tissue biomechanics in the first MetHead, the third MetHead and the rearfoot. Our results do not support the use of SH for the hallux, 5th MetHead or midfoot.

The overall aim of this study was to determine the effects of running kinematics on the peak upper trunk segmental accelerations captured with an accelerometer embedded in a commonly used GPS device. Thirteen male participants (age: 27 ± 3.7 years, height: 1.81 ± 0.06 m, mass: 82.7 ± 6.2 kg) with extensive running experience completed a single trial of treadmill running (1 degree inclination) for 40 s at nine different speeds ranging from 10 to 18 km/h at 1 km/h increments. Three-dimensional peak upper trunk acceleration values were captured via a GPS device containing a tri-axial accelerometer. Participants’ running kinematics were calculated from the coordinate data captured by an 18-camera motion capture system. A series of generalized linear mixed models were employed to determine the effects of the kinematic variables on the accelerometer acceleration peaks across the key gait phases of foot contact. Results showed that running kinematics had significant effects on peak accelerometer-measured accelerations in all axes (p < 0.05). Overall, peak segment velocities had a larger effect than joint/segment kinematics on resultant (F values = 720.9/54.2), vertical (F values = 149.8/48.1) and medial–lateral (F values = 55.4/33.4) peak accelerometer accelerations. The largest effect on peak accelerometer accelerations were observed during the impact subphase of foot contact at the adduction/abduction velocity of the shank (F value = 129.2, coefficient = −0.03) and anterior/posterior velocity of the pelvis (F value = 58.9, coefficient = 0.01). Axis-dependent effects of running kinematics were also observed, specifically at the trunk segment in the vertical and anterior–posterior peak accelerometer accelerations. This study showed the intersegmental relationship between joint/segment kinematics, segment velocities and the resulting peak accelerations of the upper trunk during running over several speeds. These findings provide insights into the lower body’s GRF attenuation capacity and its contribution to trunk stability whilst running.

Abstract Background The COVID-19 pandemic resulted in a rapid shift to remote consultations. The study aimed to explore the prevalence of telehealth consultations amongst allied health professional (AHP) services in the UK National Health Service (NHS), and the potential impact on health inequities and burden of treatment for patients. Methods Cross-sectional online survey. Participants were practising UK registered AHP and/or AHP service manager in an NHS/social care/local authority service. Data was collected between May – June 2021. Results 658 participants took part in this study, including 119 AHP service managers, managing a total of 168 AHP services, and 539 clinicians. 87.4% of clinicians and 89.4% of services represented were using telehealth consultations as a method of delivering healthcare, the majority reported their services were planning to continue using telehealth post COVID-19 restrictions. Participants reported a lack of technological skills for patients as the most prevalent barrier affecting the patient’s ability to conduct a telehealth consultation, followed by a lack of technology for patients. These were also reported as the biggest disadvantages of telehealth for patients. The majority of clinicians reported a reduction in the cost of parking/transport to attend hospital appointments as a patient benefit of telehealth consultations. Reported benefits for clinicians included saving travel time/costs and allowing flexible working, while benefits to the AHP service included patient flexibility in how their appointments are conducted and reducing the potential exposure of staff to communicable diseases. Conclusions The current large-scale implementation of telehealth in NHS AHP services may increase disparities in health care access for vulnerable populations with limited digital literacy or access. Consequently, there is a danger that telehealth will be considered inappropriate and thus, underutilised, negating the potential benefits of sustainability, patient empowerment and the reduction in the burden of treatment.

Abstract This proof-of-concept study demonstrates that repetitive loading to the pain threshold can safely recreate overloading-induced soft tissue damage and that localised tissue stiffening can be a potential marker for injury. This concept was demonstrated here for the soft tissue of the sole of the foot where it was found that repeated loading to the pain threshold led to long-lasting statistically significant stiffening in the overloaded areas. Loading at lower magnitudes did not have the same effect. This method can shed new light on the aetiology of overloading injury in the foot to improve the management of conditions such as diabetic foot ulceration and heel pain syndrome. Moreover, the link between overloading and tissue stiffening, which was demonstrated here for the first time for the plantar soft tissue, opens the way for an assessment of overloading thresholds that is not based on the subjective measurement of pain thresholds.

(1) Background: Frequent exposure to ionising radiation is often used to determine the diagnosis of adolescent idiopathic scoliosis (AIS), a lateral curvature of the spine in those aged between 10 and 18 years, and a treatment plan according to Cobb angle. This narrative review outlines the clinical utility of surface topography (ST), a radiation-free imaging modality. (2) Methods: Publicly available databases were searched to yield literature related to ST. Identified articles were classified based on the equipment used and in order of how it was developed, i.e., historical, recent developments, and state-of-the-art developments. (3) Conclusions: ST is a reliable cost-effective non-invasive technique that provides an alternative to radiation-based imaging to aid with the diagnosis and potential screening of AIS. Several scanning methods are available, which allows ST to be used in several clinical environments. Limitations of inter-reliability and differences of apparatus resulting in variations of data have been noted through this narrative review.

Abstract Background Managing and rehabilitating Achilles tendinopathy can be difficult, and the results are often unsatisfactory. Currently, clinicians use ultrasonography to diagnose the condition and predict symptom development. However, relying on subjective qualitative findings using ultrasound images alone, which are heavily influenced by the operator, may make it difficult to identify changes within the tendon. New technologies, such as elastography, offer opportunities to quantitatively investigate the mechanical and material properties of the tendon. This review aims to evaluate and synthesise the current literature on the measurement properties of elastography, which can be used to assess tendon pathologies. Methods A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. CINAHL, PubMed, Cochrane, Scopus, MEDLINE Complete, and Academic Search Ultimate were searched. Studies assessing the measurement properties concerning reliability, measurement error, validity, and responsiveness of the instruments identified in healthy and patients with Achilles tendinopathy were included. Two independent reviewers assessed the methodological quality using the Consensus‐based Standards for the Selection of Health Measurement Instruments methodology. Results Out of the 1644 articles identified, 21 were included for the qualitative analysis investigating four different modalities of elastography: axial strain elastography, shear wave elastography, continuous shear wave elastography, and 3D elastography. Axial strain elastography obtained a moderate level of evidence for both validity and reliability. Although shear wave velocity was graded as moderate to high for validity, reliability obtained a very low to moderate grading. Continuous shear wave elastography was graded as having a low level of evidence for reliability and very low for validity. Insufficient data is available to grade three‐dimensional shear wave elastography. Evidence on measurement error was indeterminate so evidence could not be graded. Conclusions A limited number of studies explored quantitative elastography on Achilles tendinopathy as most evidence was conducted on a healthy population. Based on the identified evidence on the measurement properties of elastography, none of the different types showed superiority for its use in clinical practice. Further high‐quality studies with longitudinal design are needed to investigate responsiveness.

Abstract Background and Aims The COVID‐19 pandemic accelerated the adoption of telemedicine in general. Its use has been widely adopted in the healthcare sector, but relatively little research has been conducted on the use of telemedicine for podiatry. This review aimed to explore and compare existing guidelines on telemedicine related to foot and ankle pathologies within a primary care setting. Methods The preferred reporting guidelines for the extension of scoping reviews were used in this review, and a set of inclusion and exclusion criteria were developed and implemented. This study made use of both databases and gray literature searches. Between 2012 and 2022, these databases were searched using various subject headings and free‐text terms for the keywords “telemedicine” “foot health” and “guidelines” with appropriate Boolean operators. Results The search yielded 356 articles, which were reduced to 283 after removing duplicates. Six more records were discovered through a Google and Google Scholar search and one through an article reference search. Six articles and three institutional practice guidelines were selected for synthesis after screening. The findings were classified according to the level of evidence and research quality, the function of telemedicine and the communication used, the research outcomes sought, and the type of recommendations and guidelines made available. Conclusion This review highlights the lack of podiatric telemedicine guidelines for foot and ankle pathologies. Although foot and ankle guidelines for orthopedic and musculoskeletal virtual consultations have been mentioned, they do not cover the full range of potential case scenarios that fall within the remit of podiatric consultations in a primary care setting. This review suggests the development of foot and ankle telemedicine guidelines with recommendations on how they can better provide accessible care to their patients, making foot and ankle care management not only a hand‐on‐one but also reachable virtually, where applicable.

Olympic-style sliding-seat rowing is a sport that has been extensively researched, with studies investigating aspects related to the physiology, biomechanics, kinematics, and the performance of rowers. In contrast, studies on the more classic form of fixed-seat rowing are sparse. The aim of this study is to address this lacuna by analysing for the first time the specific kinematics of fixed-seat rowing as practised by able-bodied athletes, thus (i) documenting how this technique is performed in a manner that is replicable by others and (ii) showing how this technique compares and contrasts with the more standard sliding-seat technique. Fixed-seat rowing was replicated in a biomechanics laboratory where experienced fixed-seat rowers, marked with reflective markers following the modified Helen–Hayes model, were asked to row in a manner that mimics rowing on a fixed-seat boat. The findings from this study, complimented with data gathered through the observation of athletes rowing on water, were compared to sliding-seat ergometer rowing and other control experiments. The results show that, in fixed-seat rowing, there is more forward and backward thoracic movement than in sliding-seat rowing (75–77° vs. 44–52°, p < 0.0005). Tilting of the upper body stems was noted to result from rotations around the pelvis, as in sliding-seat rowing, rather than from spinal movements. The results also confirmed knee flexion in fixed-seat rowing with a range of motion of 30–35°. This is less pronounced than in standard-seat rowing, but not insignificant. These findings provide a biomechanical explanation as to why fixed-seat rowers do not have an increased risk of back injuries when compared with their sliding-seat counterparts. They also provide athletes, coaches, and related personnel with precise and detailed information of how fixed-seat rowing is performed so that they may formulate better and more specific evidence-based training programs to meliorate technique and performance.

Abstract Introduction This prospective cohort study aimed to identify the characteristics of patients with diabetic foot ulcer who are at higher risk of amputation and at increased risk of death. Methods About 103(M/F:60/43) participants, with active foot ulcer at baseline, participated in this study and followed for 22 years till death or lost to follow‐up. Ten clinical measures were collected at baseline. During the follow‐up of 4.2 ± 5.4 years, 22(M/F:14/8) participants had an amputation and 50(M/F:32/18) participants passed away during 5.5 ± 5.8 years follow‐up period. Results Cox Proportional Hazard regression (HR[95%CI]) indicated neuropathy (6.415[1.119–36.778]); peripheral arterial disease (PAD) (9.741[1.932– 49.109]); current smoking (16.148[1.658–157.308]); diabetes type‐ 1 (3.228[1.151–9.048]) and longer delay attending appointment after ulcer (1.013[1.003–1.023]) were significantly (p

Abstract Background It is estimated that 2% of the global childhood population is living with some form of mobility impairment. Although footwear interventions are proposed to aid ambulation, there appears to be a paucity in the understanding of the effects of therapeutic footwear. This review aims to explore the effectiveness of footwear as an intervention for mobility impairment in children. Methods A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus and Scopus databases were performed. Studies which focused on children with some form of mobility impairment, age of 9 months to 18 years, therapeutic footwear that allowed walking, and outcome measures that had explored biomechanical or skeletal geometry or psychosocial aspects were included in this review. Modified Downs and Black quality assessment index of randomised and non-randomised studies were used to assess the methodologies of included papers. Results Out of 5003 articles sourced, 13 met the inclusion criteria for this review. These were grouped into two titled “corrective and “functional” based on the types of footwear used for intervention. Studies within the corrective footwear group included participants aged 11 months to 5 years with moderate congenital talipes equino varus or mobile pes planus. While using skeletal geometry as an outcome, there was a limited fair quality (level II) evidence that corrective footwear has no significant effect on the development of pes planus but may assist in the reduction of deformity in congenital talipes equino varus. The functional footwear group included participants aged 3 to 17 years, predominantly with mobile pes planus or cerebral palsy. Based on biomechanical measures as an outcome, there was a limited fair quality (level III) evidence that functional footwear alters biomechanical parameters in mobile pes planus (spatiotemporal) and cerebral palsy (spatiotemporal, kinematic). Although psychosocial outcomes were considered within two studies, the analysis was limited. Conclusion Only a limited number of studies have explored the effects of therapeutic footwear and only in a narrow range of mobility impairments. Further high-quality research is required to improve the evidence base for the effectiveness of therapeutic footwear. This should include a wide range of mobility impairments and should focus both on physical and psychosocial outcomes.

Abstract Footwear has been documented as a significant factor in the aetiology of foot pain in the general population. Assessing footwear in a clinical setting continues to be practitioner specific and there is limited guidance to direct advice. Health professionals must have access to clinically appropriate and reliable footwear assessment tools to educate patients on healthier footwear choices. The primary aim of this study was to critique what elements should be in a footwear assessment tool with a secondary aim of testing the agreed tool for validity. A combined Nominal Group Technique and then a Delphi technique from purposively sampled experts of foot health professions were employed to critique elements of footwear assessment. The agreed tool was then tested by practising podiatrists on 5 different shoes to assess the validity and reliability of the measures. Twelve test evaluation criteria were identified receiving significant ratings to form the final footwear assessment tool consisting of five footwear themes. Application of the tool in a clinical setting validated the themes of footwear characteristics, footwear structure, motion control and wear patterns. However, the assessment of footwear fit was not reliable. The footwear tool was refined based on the collective consensus achieved from the rounds creating a more clinically appropriate tool. The validity of this tool was assessed as high in some of the themes but for those that were lower, a training need was identified.

Background: Injectable glucocorticoids are widely used in the management of foot pathology, in particular for the treatment of osteoarthritis of the great toe - hallux limitus/rigidus. Injections can be performed using anatomical (blind) guided methods or performed with needle placement aided by the use diagnostic imaging with ultrasound or fluoroscopy, with or without the use of contrast media. Aim: Palpation and image guided injection techniques have been studied in other joints of the body but less so for the first metatarsophalangeal joint of the foot, where palpation guidance is commonly performed. The aim of this study was to investigate the injection accuracy of palpation guided injections of the first metatarsophalangeal joint in six cadaveric feet using radio-opaque contrast media. Methods: The injection equipment consisted of a 2.5 ml Luer lock syringe and a 23-gauge needle used to inject iohexol (Omnipaque 300) into the first metatarsophalangeal joint in six cadaveric specimens. The needle was placed into the joint space by a single practitioner using palpation guidance. The contrast media was injected under live (cine) view without further movement or ingress of the needle. The injectate was considered accurate if the media coated the inside of the synovial membrane and/or outlined the joint shape. Findings: Failure of technique was seen in one of six feet, and extravasation of contrast media beyond the joint margins noted in three out of six feet. Conclusions: Further study on a large sample of live subjects using a variance of technique is required to expand the confidence of these findings but the high failure rate calls into question the confidence of palpation guided techniques for injection of the first metatarsophalangeal joint.

This work presents a qualitative and quantitative pilot study which explores the kinematics of Venetian style forward-facing standing rowing as practised by able-bodied competitive athletes. The technique, made famous by the gondoliers, was replicated in a biomechanics laboratory by a cohort of four experienced rowers who compete in this style at National Level events in Malta. Athletes were marked with reflective markers following the modified Helen Hayes model and asked to row in a manner which mimics their on-water practise and recorded using a Vicon optoelectronic motion capture system. Data collected were compared to its equivalent using a standard sliding-seat ergometer as well as data collated from observations of athletes rowing on water, thus permitting the documentation of the manner of how this technique is performed. It was shown that this rowing style is characterised by rather asymmetric and complex kinematics, particularly upper-body movements which provides the athlete with a total-body workout involving all major muscle groups working either isometrically, to provide stability, or actively.

This study examined the effects of obesity on cartilage mechanics and longitudinal failure probability at the medial tibiofemoral compartment, using combined musculoskeletal simulation and probabilistic failure modelling approaches. The current investigation examined twenty obese females (BMI > 30.0 kg/m2) and 20 healthy weight (BMI < 25.0 kg/m2) females. Walking kinematics were obtained via an 8-camera optoelectric system, and a force plate was used to collect ground reaction forces. Musculoskeletal simulation and probabilistic failure modelling were utilized to explore medial tibiofemoral forces and cartilage probability. Comparisons between groups were undertaken using linear mixed-effects models. Net peak cartilage forces, stress and strain were significantly larger in the obese group (force = 2013.92 N, stress = 3.03 MPa & strain = 0.25), compared to health weight (force = 1493.21 N, stress 2.26 MPa & strain = 0.19). In addition, medial tibiofemoral cartilage failure probability was also significantly larger in the obese group (42.98%) compared to healthy weight (11.63%). The findings from the current investigation show that obesity has a profoundly negative influence on longitudinal medial knee cartilage health and strongly advocates for the implementation of effective weight management programs into long-term musculoskeletal management strategies.

Diabetic foot syndrome is one of the most costly complications of diabetes. Damage to the soft tissue structure is one of the primary causes of diabetic foot ulcers and most of the current literature focuses on factors such as neuropathy and excessive load. Although the role of blood supply has been reported in the context of macro-circulation, soft tissue damage and its healing in the context of skin microcirculation have not been adequately investigated. Previous research suggested that certain microcirculatory responses protect the skin and their impairment may contribute to increased risk for occlusive and ischemic injuries to the foot. The purpose of this narrative review was to explore and establish the possible link between impairment in skin perfusion and the chain of events that leads to ulceration, considering the interaction with other more established ulceration factors. This review highlights some of the key skin microcirculatory functions in response to various stimuli. The microcirculatory responses observed in the form of altered skin blood flow are divided into three categories based on the type of stimuli including occlusion, pressure and temperature. Studies on the three categories were reviewed including: the microcirculatory response to occlusive ischemia or Post-Occlusive Reactive Hyperaemia (PORH); the microcirculatory response to locally applied pressure such as Pressure-Induced Vasodilation (PIV); and the interplay between microcirculation and skin temperature and the microcirculatory responses to thermal stimuli such as reduced/increased blood flow due to cooling/heating. This review highlights how microcirculatory responses protect the skin and the plantar soft tissues and their plausible dysfunction in people with diabetes. Whilst discussing the link between impairment in skin perfusion as a result of altered microcirculatory response, the review describes the chain of events that leads to ulceration. A thorough understanding of the microcirculatory function and its impaired reactive mechanisms is provided, which allows an understanding of the interaction between functional disturbances of microcirculation and other more established factors for foot ulceration.

Abstract Modern ventilators are increasingly compact and able to deliver a wide range of ventilator modes and sophisticated monitoring capabilities. However, the global availability of ventilators is woefully short of demand. Data on intensive care units (ICUs), a proxy measure for hospital ventilator capacity in low and middle‐income countries (LMIC's), suggest that capacity is extremely limited where it exists at all. In LMIC's, the four most common indications for mechanical ventilation (MV) in ICUs are post‐surgical care, sepsis, trauma, and maternal peripartum or neonatal complications. A significant majority of these cases can be managed with intervention involving a short course of MV. Widespread and timely access to MV can thus effectively be used to help patients in these settings and improve outcomes. This paper implores this need and highlights the requirements for a low‐cost ventilator or a respiratory support device.

Objectives This study aimed to achieve an expert consensus on how to define and group footwear interventions for children, with a further focus on the design characteristics and prescription of off-the-shelf stability footwear for children with mobility impairment.Setting A group of multinational professionals, from clinicians to those involved in the footwear industry, were recruited to ensure a spectrum of opinions.Participants Thirty panellists were contacted, of which 24 consented to participate and six withdrew before round 1, a further two withdrew after round 1. Sixteen panellists completed the consensus exercise.Primary and secondary outcome measures A Delphi consensus method was employed with round 1 split into three sections: (1) terms and definitions, (2) specifics of off-the-shelf stability footwear design and (3) criteria for clinical prescription of off-the-shelf stability footwear. The panel was asked to rate their level of agreement with statements and to provide further insights through open-ended questions. The opinions of the experts were analysed to assess consensus set at 75% agreement or to modify or form new statements presented through the subsequent two rounds.Results Therapeutic footwear was the agreed term to represent children’s footwear interventions, with grouping and subgrouping of therapeutic footwear being dependent on their intended clinical outcomes (accommodative, corrective or functional). Both the heel counter and topline as well as the stiffness and width of the sole were identified as potentially influencing mediolateral stability in children’s gait. A consensus was achieved in the prescription criteria and outcome measures for off-the-shelf stability therapeutic footwear for cerebral palsy, mobile symptomatic pes planus, Duchenne muscular dystrophy, spina bifida and Down’s syndrome.Conclusions Through a structured synthesis of expert opinion, this study has established a standardisation of terminology and groupings along with prescription criteria for the first time. Reported findings have implications for communication between stakeholders, evidence-based clinical intervention and standardised outcome measures to assess effectiveness.

Background: Patient-reported outcomes (PROMs) are an integral part of national joint registers in measuring outcomes of operative procedures and improving quality of care. There is lack of literature comparing outcomes of total ankle replacement (TAR) to total knee replacement (TKR) and total hip replacement (THR). The aim of this study was to compare PROMs between TAR, TKR, and THR patient groups at 1, 5, and 10 years. Methods: Prospective PROMs from patients who underwent a TAR, TKR, or THR procedure between 2003 and 2010 were studied. Patients were divided into 3 groups based on their index joint replacement (hip, knee, or ankle). Patient demographics (age, gender, body mass index), patient-reported outcome scores (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 36-Item Short Form Health Survey [SF-36]) and patient satisfaction scores (4-point Likert scale) at follow-up were compared between the 3 groups. Results: Data was available on 1797 THR, 2475 TKR, and 146 TAR patients. TAR patients were younger and reported fewer number of comorbidities. All 3 groups improved significantly from preoperative to 10 years for WOMAC scores ( P < .001). For SF-36 scores at 10 years, the THR group (32.2% follow-up) scored the highest for 3 domains ( P = .031) when compared to the TKR group (29.1% follow-up). All 3 groups had similar outcomes for 5 of 8 domains; P < .05). For patient satisfaction, the THR group reported overall 95.1% satisfaction followed by 89.8% for the TKR group and 83.9% in the TAR group (42.4% follow-up). Conclusion: In this cohort with diminishing numbers over the decade of time the patients were followed up we found that patients are equally happy with functional and general health outcomes from total ankle replacement vs other major lower extremity joint replacement. TAR surgery should be considered as a viable treatment option in this patient group. Level of Evidence: Level III, retrospective case series.

Identifying areas in the sole of the foot which are routinely overloaded during daily living is extremely important for the management of the diabetic foot. This work showcases the feasibility of reliably detecting overloading using a low-cost non-electronic technique. This technique uses thin-wall structures that change their properties differently when they are repeatedly loaded above or below a tuneable threshold. Flexible hexagonal thin-wall structures were produced using three-dimensional printing, and their mechanical behaviour was assessed before and after repetitive loading at different magnitudes. These structures had an elastic mechanical behaviour until a critical pressure (Pcrit = 252 kPa ± 17 kPa) beyond which they buckled. Assessing changes in stiffness after simulated use enabled the accurate detection of whether a sample was loaded above or below Pcrit (sensitivity = 100%, specificity = 100%), with the overloaded samples becoming significantly softer. No specific Pcrit value was targeted in this study. However, finite-element modelling showed that Pcrit can be easily raised or lowered, through simple geometrical modifications, to become aligned with established thresholds for overloading (e.g. 200 kPa) or to assess overloading thresholds on a patient-specific basis. Although further research is needed, the results of this study indicate that clinically relevant overloading could indeed be reliably detected without the use of complex electronic in-shoe sensors.

Abstract Background Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the key extrinsic factor affecting children’s gait and footwear modifications have been historically postulated to assist with locomotory difficulty. Although therapeutic footwear has been considered within the literature, there is a lack of consistency on terminology and paucity on the overall understanding. A scoping review was performed to chart the key concepts in children’s footwear and to establish the range of studies that considered therapeutic footwear. Methods A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus, and Scopus electronic databases was performed using MeSH headings and free text terms in relation to children’s footwear. All studies that used footwear as an intervention in children aged 9 months to 18 years with the outcome measures including design, fit, and the effects on development and health were included. Studies were charted by textual narrative synthesis into research groupings dependent on the topics discussed and the methods used in the studies. Results The search yielded a total of 5006 articles with 287 of these articles meeting the inclusion criteria. Two overarching areas of research were identified; articles that discussed footwear design and those that discussed the effects of footwear. Eight further general groupings were charted and apportioned between the overarching areas and therapeutic footwear was charted into three subgroupings (corrective, accommodative and functional). Conclusion Children’s footwear has become an increasing area of research in the past decade with a shift towards more empirical research, with most of the included articles examining biomechanical and anthropometric aspects. However, children’s therapeutic footwear has not shared the same recent impetus with no focused review and limited research exploring its effects. Empirical research in this area is limited and there is ambiguity in the terminology used to describe therapeutic footwear. Based on the findings of this review the authors suggest the term children’s therapeutic footwear be used as the standard definition for footwear that is designed specifically with the purpose to support or alleviate mobility impairment in childhood; with subgroupings of corrective, accommodative and functional dependent on the intended therapeutic role.

Existing approaches for automated tracking of fascicle length (FL) and pennation angle (PA) rely on the presence of a single, user-defined fascicle (feature tracking) or on the presence of a specific intensity pattern (feature detection) across all the recorded ultrasound images. These prerequisites are seldom met during large dynamic muscle movements or for deeper muscles that are difficult to image. Deep-learning approaches are not affected by these issues, but their applicability is restricted by their need for large, manually analyzed training data sets. To address these limitations, the present study proposes a novel approach that tracks changes in FL and PA based on the distortion pattern within the fascicle band. The results indicated a satisfactory level of agreement between manual and automated measurements made with the proposed method. When compared against feature tracking and feature detection methods, the proposed method achieved the lowest average root mean squared error for FL and the second lowest for PA. The strength of the proposed approach is that the quantification process does not require a training data set and it can take place even when it is not possible to track a single fascicle or observe a specific intensity pattern on the ultrasound recording.

Abstract Background Occupational musculoskeletal injuries are prevalent in healthcare workers and are reported to be profession‐specific. There is, however, a paucity of information around the injuries sustained from working as a podiatrist. This paper looks at the incidence of injury from working as a podiatrist, the aggravating factors to sustain these injuries and whether the changes in workload due to the COVID‐19 pandemic altered the incidence. Methods A modified work based musculoskeletal injury questionnaire was distributed in the UK via podiatry led social media platforms. Open and Closed questions explored the demographics of the sample, perceived injury 12 months prior to the COVID‐19 pandemic and then 6 months into the lockdown. Pre and post COVID‐19 data were analysed for differences and thematic analysis was included to categorise reported experiences. Results 148 podiatrists representing 3 % of HCPC registered practitioners responded to the questionnaire. Employment status altered as a result of the COVID‐19 pandemic with a 13 % reduction in those working full time. Environments also changed with domiciliary and telehealth significantly increasing (p > 0.00) and non‐clinical roles being extended (p > 0.002). Pain frequency and intensity significantly (p > 0.04) increased as a result of the pandemic with shoulder pain being most frequent before lockdown altering to the neck during the lockdown. Two main themes were identified that were attributed to the causes of pain including physical demands and working in awkward spaces. Conclusions Work‐related musculoskeletal pain in podiatrists is common with the shoulder and neck being the most frequently affected. Changes in work practices due to the restrictions enforced from the COVID‐19 pandemic increased the frequency and intensity of pain mostly associated with increased domiciliary and telehealth working environments.

Diabetes is a worldwide public health concern as it is associated with various complications. One of the major complications of diabetes is diabetic foot syndrome that results in catastrophic events such as ulceration and amputation. Therefore, the main four strategies of diabetic foot care involve risk prediction, prevention, and early diagnosis and prompt intervention. The drivers of ulceration are multifactorial, and importantly, include microcirculatory changes in the diabetic skin. Cutaneous microcirculation on the foot is greatly influenced by the small fibers which mediate thermal sensation and pain perception in addition to sympathetic activities such as thermoregulation and vasodilation. The interdependence between the neurovascular elements means with the loss of small fiber functions, the corresponding microcirculatory responses may be compromised. Thus, it can be hypothesized that the impairment of the microcirculation may follow the order of the corresponding small fiber nerve dysfunction or vice versa. In this review, select neurovascular investigations that inform the cutaneous microcirculatory and small fiber nerve function in response to pain, cold, and heat and pressure stimuli are reviewed and discussed in this order of sensory loss: the loss of pain, cold, warmth, touch and deep pressure sensation. We also discuss the neurological and vascular characteristics of each of these neurovascular responses. This review highlights the influence of small fibers on cutaneous microcirculation and the need for prospective studies that can determine the course of microcirculatory impairment over time. This, in turn, may help clarify the exact role of microcirculatory changes in the pathway of ulceration. The insights from this review can be pertinent to understand key microcirculatory disturbances and given that the microcirculatory impairment develops at an early stage, relevant interventions can be implemented to possibly reverse or regress the course of the disease. Therefore, knowledge of the neurovascular interactions aids to map the disease progression for early diagnosis and prevention of adverse complications.

ObjectivesStudies have shown conflicting characteristic thermographic patterns of the feet in patients with active rheumatoid arthritis (RA). However, to date no studies have compared thermographic patterns of patients with RA in remission and healthy controls. Thus this study aimed to investigate whether the thermal characteristics of the feet of RA patients, in clinical and radiological remission differ to those of healthy controls.MethodsUsing convenience sampling, RA patients were recruited upon confirmed absence of synovitis by clinical examination and musculoskeletal ultrasound. Thermal images of the feet were taken. Each foot was subdivided into medial, central, lateral, forefoot and heel regions. Subsequently, temperatures in the different regions were analyzed and compared to a cohort of healthy adults.ResultsData from 32 RA patients were compared to that of 51 healthy controls. The Independent samples T-Test demonstrated a significant difference in temperatures in all the regions of the forefoot between RA participants versus healthy subjects (Table 1). Using the One-Way ANOVA test, no significant difference was found between all the forefoot regions (p = 0.189) of RA patients. Independent sample T-test found significant differences in all heel regions between the two groups (Table 2). One-Way ANOVA demonstrated no significant differences (p = 0.983) between the different foot regions (n = 192) of RA patients.ConclusionThese findings suggest that RA patients in clinical and radiological remission exhibit significantly different feet thermographic patterns compared to healthy controls. This data will provide the basis for future studies to assess whether thermographic patterns change with disease activity.

Patellofemoral pain (PFP) is a common atraumatic knee pathology in runners, with a complex multifactorial aetiology influenced by sex differences. This retrospective case–control study therefore aimed to evaluate lower limb kinetics and kinematics in symptomatic and control male and female runners using musculoskeletal simulation. Lower extremity biomechanics were assessed in 40 runners with PFP (15 females and 25 males) and 40 controls (15 females and 25 males), whilst running at a self-selected velocity. Lower extremity biomechanics were explored using a musculoskeletal simulation approach. Four intergroup comparisons—(1) overall PFP vs. control; (2) male PFP vs. male control; (3) female PFP vs. female control; and (4) male PFP vs. female PFP—were undertaken using linear mixed models. The overall (stress per mile: PFP = 1047.49 and control = 812.93) and female (peak stress: PFP = 13.07 KPa/BW and control = 10.82 KPa/BW) comparisons showed increased patellofemoral joint stress indices in PFP runners. A significantly lower strike index was also shown in PFP runners in the overall (PFP = 17.75% and control = 33.57%) and female analyses (PFP = 15.49% and control = 40.20%), revealing a midfoot strike in control, and a rearfoot pattern in PFP runners. Peak rearfoot eversion and contralateral pelvic drop range of motion (ROM) were shown to be greater in PFP runners in the overall (eversion: PFP = −8.15° and control = −15.09°/pelvic drop ROM: PFP = 3.64° and control = 1.88°), male (eversion: PFP = −8.05° and control = −14.69°/pelvic drop ROM: PFP = 3.16° and control = 1.77°) and female (eversion: PFP = 8.28° and control = −15.75°/pelvic drop ROM: PFP = 3.64° and control = 1.88°) PFP runners, whilst female PFP runners (11.30°) exhibited a significantly larger peak hip adduction compared to PFP males (7.62°). The findings from this investigation highlight biomechanical differences between control and PFP runners, as well as demonstrating distinctions in PFP presentation for many parameters between sexes, highlighting potential risk factors for PFP that may be addressed through focused intervention modalities, and also the need, where appropriate, for sex-specific targeted treatment approaches.

Abstract Background A high percentage of the population report footwear related foot pain, yet there is limited research on the effect footwear has on the development of this pain. The aim of this study was to establish whether footwear purchased by patients have an association with foot pain and what choices determined a purchase decision. Methods Shape and size measurements of the dominant foot and footwear (length and width) were taken from 67 female participants who routinely received podiatric treatment. Participants were also asked to complete a short questionnaire to rate the shoe characteristics, emotions whilst wearing and reasons for the purchase. Results Results highlighted a high prevalence of structural foot pathology for those over 61 who preferred slip on shoes. This group also wore shoes that were significantly narrower than their feet with width difference correlating to the presence of Hallux Abductovarus (HAV). In addition, results indicate that individual footwear advice is more important than previously thought, as it is clear that choice of footwear worn to podiatry appointments are not always worn on a daily basis. Conclusions This study emphasises that the width of the shoe is an important part of fit, highlighting the need for patient specific footwear assessment and education for behaviour changes.

Elevated foot pressure and high temperatures have been proposed as predictive factors for diabetic foot ulceration; however, on their own, their predictive value is still questionable. This pilot study hypothesized that combining these two measurements in a thermo-pressure model could result in a more reliable risk assessment tool for providing risk categorization aimed to determine whether there is a correlation between foot plantar pressure and temperature in patients living with diabetes mellitus (DM) when compared with healthy individuals following a 15 min walk. Foot pressure and thermographic images were taken from 48 participants who were categorised into four groups following clinical evaluation into healthy individuals (Group A), living with DM with no complications (Group B), DM with peripheral arterial disease (Group C) and DM patients with neuropathy (Group D). This study demonstrated a positive correlation between pressure and temperature; as pressure increases, so does temperature. This was more pronounced in the groups with DM when compared to the healthy group. More research is warranted to further develop this innovative thermo-pressure model, which could hopefully be more sensitive in categorizing and identifying patients living with DM who are at risk of developing foot ulceration to initiate prompt care.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine which is usually not symptomatic and which can progress during growth and cause a surface deformity. In adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Although surgery is usually recommended for curvatures exceeding 40° to 50° to stop curvature progression, recent reviews have shed some light on the long-term complications of such surgery and to the lack of evidence for such complicated procedures within the scientific literature. Furthermore, a number of patients are very fearful of having surgery and refuse this option or live in countries where specialist scoliosis surgery is not available. Other patients may be unable to afford the cost of specialist scoliosis surgery. For these patients the only choice is an alternative non-surgical treatment option. To examine the impact of different management options in patients with severe AIS, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short-term (a few months) and the long-term (over 20 years). We searched CENTRAL, MEDLINE, EMBASE, CINHAL and two other databases up to January 2016 with no language limitations. We also checked the reference lists of relevant articles and conducted an extensive hand search of the grey literature. We searched for randomised controlled trials as well as prospective and retrospective controlled trials comparing spinal fusion surgery with no treatment or conservative treatment in AIS patients with a Cobb angle greater than 40°. We did not identify any evidence of superiority of effectiveness of operative compared to nonoperative interventions for patients with severe AIS. Within the present literature there is no clear evidence to suggest that a specific type of treatment is superior to other types of treatment.

Introduction: Inertial sensors generate objective and sensitive metrics of movement disability that may indicate fall risk in many clinical conditions including multiple sclerosis (MS). The Timed-Up-And-Go (TUG) task is used to assess patient mobility because it incorporates clinically-relevant submovements during standing. Most sensor-based TUG research has focused on the placement of sensors at the spine, hip or ankles; an examination of thigh activity in TUG in multiple sclerosis is wanting.Methods: We used validated sensors (x-IMU by x-io) to derive transparent metrics for the sit-to-stand (SI-ST) transition and the stand-to-sit (ST-SI) transition of TUG, and compared effect sizes for metrics from inertial sensors on the thighs to effect sizes for metrics from a sensor placed at the L3 level of the lumbar spine. Twenty-three healthy volunteers were compared to 17 ambulatory persons with MS (PwMS, HAI ≤ 2).Results: During the SI-ST transition, the metric with the largest effect size comparing healthy volunteers to PwMS was the Area Under the Curve of the thigh angular velocity in the pitch direction–representing both thigh and knee extension; the peak of the spine pitch angular velocity during SI-ST also had a large effect size, as did some temporal measures of duration of SI-ST, although less so. During the ST-SI transition the metric with the largest effect size in PwMS was the peak of the spine angular velocity curve in the roll direction. A regression was performed.Discussion: We propose for PwMS that the diminished peak angular velocity during SI-ST directly represents extensor weakness, while the increased roll during ST-SI represents diminished postural control.Conclusions: During the SI-ST transition of TUG, angular velocities can discriminate between healthy volunteers and ambulatory PwMS better than temporal features. Sensor placement on the thighs provides additional discrimination compared to sensor placement at the lumbar spine.

BACKGROUND:Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis. OBJECTIVE:The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. METHODS:Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis. RESULTS:A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible. CONCLUSIONS:At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness.

Aim. To evaluate the potential of thermography as an assessment tool for the detection of foot complications by understanding the variations in temperature that occur in type 2 diabetes mellitus (DM). Methods. Participants were categorized according to a medical examination, ankle brachial index, doppler waveform analysis, and 10-gram monofilament testing into five groups: healthy adult, DM with no complications, DM with peripheral neuropathy, DM with neuroischaemia, and DM with peripheral arterial disease (PAD) groups. Thermographic imaging of the toes and forefeet was performed. Results. 43 neuroischaemic feet, 41 neuropathic feet, 58 PAD feet, 21 DM feet without complications, and 126 healthy feet were analyzed. The temperatures of the feet and toes were significantly higher in the complications group when compared to the healthy adult and DM healthy groups. The higher the temperatures of the foot in DM, the higher the probability that it is affected by neuropathy, neuroischaemia, or PAD. Conclusions. Significant differences in mean temperatures exist between participants who were healthy and those with DM with no known complications when compared to participants with neuroischaemia, neuropathy, or PAD. As foot temperature rises, so does the probability of the presence of complications of neuropathy, neuroischaemia, or peripheral arterial disease.

Objectives. To collect normative baseline data and identify any significant differences between hand and foot thermographic distribution patterns in a healthy adult population. Design. A single-centre, randomized, prospective study. Methods. Thermographic data was acquired using a FLIR camera for the data acquisition of both plantar and dorsal aspects of the feet, volar aspects of the hands, and anterior aspects of the lower limbs under controlled climate conditions. Results. There is general symmetry in skin temperature between the same regions in contralateral limbs, in terms of both magnitude and pattern. There was also minimal intersubject temperature variation with a consistent temperature pattern in toes and fingers. The thumb is the warmest digit with the temperature falling gradually between the 2nd and the 5th fingers. The big toe and the 5th toe are the warmest digits with the 2nd to the 4th toes being cooler. Conclusion. Measurement of skin temperature of the limbs using a thermal camera is feasible and reproducible. Temperature patterns in fingers and toes are consistent with similar temperatures in contralateral limbs in healthy subjects. This study provides the basis for further research to assess the clinical usefulness of thermography in the diagnosis of vascular insufficiency.

We would like to comment on a recent review article published in Sensors by Razak et al. [1]. The authors provided a review of plantar pressure measurement systems which included the discussion of the recently developed WalkinSense® system. While the authors correctly identified that our group completed research using this system [2], they have inaccurately reported the manufacturer of the system and our research findings.