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Menz HB, Lim PQX, Hurn SE, Mickle KJ, Buldt AK, Cotchett MP, Roddy E, Wluka AE, Erbas B, Munteanu SE. Effectiveness of footwear and foot orthoses in reducing medial metatarsophalangeal joint pressure in women with hallux valgus. Gait Posture 2024; 111:156-161. [PMID: 38703444 DOI: 10.1016/j.gaitpost.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/24/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Hallux valgus is a common condition where the subluxation of the first metatarsophalangeal joint and lateral deviation of the hallux at the interphalangeal joint creates difficulty with footwear fit. Footwear and foot orthoses are commonly prescribed nonsurgical treatments for hallux valgus. RESEARCH QUESTION Do extra-width footwear and foot orthoses influence peak pressure at the medial aspect of the metatarsophalangeal and interphalangeal joints in women with hallux valgus? METHODS Community-dwelling women with symptomatic hallux valgus underwent gait testing when wearing their own shoes and when wearing extra-width footwear fitted with three-quarter length, arch-contouring prefabricated foot orthoses. Peak pressure (kPa) on the medial aspect of the metatarsophalangeal and medial interphalangeal joints and on the plantar surface of the foot (hallux, lesser toes, metatarsophalangeal joint 1, metatarsophalangeal joints 2-5, midfoot and heel) were measured using the novel pedar®-X system with the pedar® pad and pedar® insole, respectively (Novel, GmbH, Munich, Germany). Paired samples t-tests were used to calculate the differences between the two conditions, and the magnitude of observed differences was calculated using Cohen's d. RESULTS We tested 28 participants (aged 44-80 years, mean 60.7, standard deviation 10.7). Compared to their own footwear, wearing the intervention footwear and orthoses was associated with a statistically significant decrease in pressure on the medial aspect of the metatarsophalangeal joint (58.3 ± 32.8 versus 42.6 ± 32.8, p=0.026, d=0.49), increased pressure under the midfoot (70.7 ± 25.7 versus 78.7 ± 23.6, p=0.029, d=0.33) and decreased pressure underneath the heel (137.3 ± 39.0 versus 121.3 ± 34.8, p=0.019, d=0.45). SIGNIFICANCE The intervention footwear and orthoses significantly decreased peak pressure on the medial aspect of the first metatarsophalangeal joint but had no significant effect on the interphalangeal joint. Further studies are required to determine whether these changes are associated with improvements in symptoms associated with hallux valgus.
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Affiliation(s)
- Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia.
| | - Polly Q X Lim
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
| | - Karen J Mickle
- Applied Sport Science and Exercise Testing Laboratory, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, New South Wales 2258, Australia
| | - Andrew K Buldt
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Matthew P Cotchett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom; Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire ST6 7AG, United Kingdom
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
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Menz HB, Lim PQX, Hurn SE, Mickle KJ, Buldt AK, Cotchett MP, Roddy E, Wluka AE, Erbas B, Batra M, Munteanu SE. Nonsurgical management of hallux valgus: findings of a randomised pilot and feasibility trial. J Foot Ankle Res 2023; 16:78. [PMID: 37957676 PMCID: PMC10642001 DOI: 10.1186/s13047-023-00677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Hallux valgus is a common and disabling condition. This randomised pilot and feasibility trial aimed to determine the feasibility of conducting a parallel group randomised trial to evaluate the effectiveness of a nonsurgical intervention for reducing pain associated with hallux valgus. METHODS Twenty-eight community-dwelling women with painful hallux valgus were randomised to receive either a multifaceted, nonsurgical intervention (footwear, foot orthoses, foot exercises, advice, and self-management) or usual care (advice and self-management alone). Outcome measures were obtained at baseline, 4, 8 and 12 weeks. The primary outcome was feasibility, evaluated according to demand (recruitment rate and conversion rate), acceptability, adherence, adverse events, and retention rate. Limited efficacy testing was conducted on secondary outcome measures including foot pain, foot muscle strength, general health-related quality of life, use of cointerventions, and participants' perception of overall treatment effect. RESULTS Between July 8, 2021, and April 22, 2022, we recruited and tested 28 participants (aged 44 to 80 years, mean 60.7, standard deviation 10.7). This period encompassed two COVID-related stay-at-home orders (July 16 to July 27, and August 5 to October 21, 2021). The predetermined feasibility thresholds were met for retention rate, foot pain, mental health-related quality of life, and use of cointerventions, partly met for acceptability, adverse events, and muscle strength, and not met for demand (recruitment rate or conversion rate), adherence, physical health-related quality of life and perception of overall treatment effect. CONCLUSION In its current form, a randomised trial of footwear, foot orthoses, foot exercises, advice and self-management for relieving pain associated with hallux valgus is not feasible, particularly due to the low adherence with the intervention. However, it is difficult to determine whether the trial would be feasible under different circumstances, particularly due to COVID-19 stay-at-home orders. Future trials will need to consider improving the aesthetics of the footwear and making the exercise program less burdensome. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN12621000645853).
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Affiliation(s)
- Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Polly Q X Lim
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Karen J Mickle
- Applied Sport Science and Exercise Testing Laboratory, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW, 2258, Australia
| | - Andrew K Buldt
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Matthew P Cotchett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Mehak Batra
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
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Hatton AL, Williams K, Chatfield MD, Hurn SE, Maharaj JN, Gane EM, Cattagni T, Dixon J, Rome K, Kerr G, Brauer SG. Immediate effects of wearing textured versus smooth insoles on standing balance and spatiotemporal gait patterns when walking over even and uneven surfaces in people with multiple sclerosis. Disabil Rehabil 2023; 45:3379-3387. [PMID: 36107939 DOI: 10.1080/09638288.2022.2122600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the immediate effects of wearing novel sensory-stimulating textured insoles on balance and gait in 41 people with multiple sclerosis (pwMS). MATERIALS AND METHODS Assessments of balance (firm/foam surface; eyes open/closed) and walking (when negotiating even/uneven surfaces) were performed wearing textured insoles, smooth insoles, shoes only, and barefoot. Outcome measures were centre of pressure (CoP) movement during standing (elliptical area, sway path velocity) and spatiotemporal gait patterns (stride/step width, stride time, double-limb support time, stride length, velocity). RESULTS Wearing textured insoles led to reductions in CoP velocity measures when standing on foam with eyes open and closed when compared to barefoot (p values ≤0.02). Textured insoles did not appear to be consistently superior to smooth insoles or shoes only for improving gait. Relative to the insole/shoe conditions, walking barefoot led to poorer gait performance for the even and uneven surface tasks (p values ≤0.03). CONCLUSIONS For pwMS, stimulating the foot with "texture" appears to provide enhanced sensory input with the capacity to improve CoP movement control during standing; offering a potential new treatment option for balance rehabilitation. Further research is needed to identify which individuals may benefit most from textured insoles.Implications for rehabilitationTextured shoe insoles, designed to stimulate plantar mechanoreceptors, are a novel approach to improve standing balance and walking patterns in people with multiple sclerosis (pwMS).Wearing textured insoles for the first time can lead to improvements in centre of pressure movement control when standing on an unstable compliant supporting surface.Textured insoles offer a potential new treatment technique for balance rehabilitation in pwMS who show early signs of diminished foot sensation.
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Affiliation(s)
- Anna L Hatton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katrina Williams
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Mark D Chatfield
- Centre for Health Sciences Research, The University of Queensland, Brisbane, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Jayishni N Maharaj
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Elise M Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Thomas Cattagni
- Laboratory Movement, Interactions, Performance EA 4334, University of Nantes, Nantes, France
| | - John Dixon
- School of Health & Social Care, Teesside University, Middlesbrough, UK
| | - Keith Rome
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Graham Kerr
- Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Menz HB, Lim PQ, Hurn SE, Mickle KJ, Buldt AK, Cotchett MP, Roddy E, Wluka AE, Erbas B, Munteanu SE. Footwear, foot orthoses and strengthening exercises for the non-surgical management of hallux valgus: protocol for a randomised pilot and feasibility trial. J Foot Ankle Res 2022; 15:45. [PMID: 35655233 PMCID: PMC9162879 DOI: 10.1186/s13047-022-00553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hallux valgus is a common and disabling condition. This randomised pilot and feasibility trial aims to determine the feasibility of conducting a fully-powered parallel group randomised trial to evaluate the effectiveness of a multifaceted non-surgical intervention for reducing pain associated with hallux valgus. Methods Twenty-eight community-dwelling women with painful hallux valgus will be randomised to receive either a multifaceted, non-surgical intervention (footwear, foot orthoses, foot exercises, advice, and self-management) or advice and self-management alone. Outcome measures will be obtained at baseline, 4, 8 and 12 weeks. The primary outcome is feasibility, which will be evaluated according to demand, acceptability, adherence, adverse events, and retention rate. Limited efficacy testing will be conducted on secondary outcome measures including foot pain (the Manchester-Oxford Foot Questionnaire), foot muscle strength (hand-held dynamometry), general health-related quality of life (the Short Form-12), use of cointerventions, and participants’ perception of overall treatment effect. Biomechanical testing will be conducted at baseline to evaluate the immediate effects of the footwear/orthotic intervention on pressure beneath the foot and on the medial aspect of the first metatarsophalangeal joint and hallux. Discussion This study will determine the feasibility of conducting a fully-powered randomised trial of footwear, foot orthoses, foot exercises, advice and self-management for relieving pain associated with hallux valgus and provide insights into potential mechanisms of effectiveness. Trial registration Australian and New Zealand Clinical Trial Registry (ACTRN12621000645853). Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00553-4.
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Affiliation(s)
- Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Polly Q Lim
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Karen J Mickle
- School of Environment and Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Ourimbah, NSW, 2258, Australia
| | - Andrew K Buldt
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Matthew P Cotchett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, ST5 5BG, Staffordshire, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, ST6 7AG, Staffordshire, UK
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
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Hurn SE, Matthews BG, Munteanu SE, Menz HB. Effectiveness of non-surgical interventions for hallux valgus: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 2021; 74:1676-1688. [PMID: 33768721 DOI: 10.1002/acr.24603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/24/2021] [Accepted: 03/23/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis investigating the effectiveness of non-surgical interventions for hallux valgus (HV). METHODS The review protocol was registered with PROSPERO (CRD42019111711). Medline, CINAHL, Embase, and the Cochrane Library were searched to April 2020, including parallel-group and crossover studies investigating non-surgical interventions for HV. Two reviewers independently screened articles for inclusion, extracted data, performed risk of bias and GRADE assessments. Risk of bias was assessed using version 2 of the Cochrane risk of bias tool. Effect sizes (mean differences or risk ratios, and 95% confidence intervals) were calculated and pooled where possible for the primary outcomes, foot pain and HV angle. RESULTS Eighteen included studies investigated a wide range of non-surgical interventions for HV. Most studies had small sample sizes and concerns regarding risk of bias. Five separate meta-analyses for foot orthoses, splints, manual therapy, and taping added to foot exercises showed no significant effects on primary outcomes. However, results from eight studies showed a significant pain reduction with the use of foot orthoses, night splints, dynamic splints, manual therapy, taping added to foot exercises, multifaceted physical therapy program and Botox injections. Four studies reported a clinically significant reduction in HV angle with night splints, foot exercises, multifaceted physical therapy and Botox injections. CONCLUSION There is a low level of certainty surrounding the effectiveness of non-surgical interventions for HV, however a reduction in pain appears more likely than improvement in HV angle.
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Affiliation(s)
- Sheree E Hurn
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences
| | - Barry G Matthews
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences.,La Trobe University, College of Science, Health and Engineering, School of Allied Health, Human Services and Sport
| | - Shannon E Munteanu
- La Trobe University, College of Science, Health and Engineering, School of Allied Health, Human Services and Sport
| | - Hylton B Menz
- La Trobe University, College of Science, Health and Engineering, School of Allied Health, Human Services and Sport
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Barwick AL, van Netten JJ, Hurn SE, Reed LF, Lazzarini PA. Factors associated with type of footwear worn inside the house: a cross-sectional study. J Foot Ankle Res 2019; 12:45. [PMID: 31462929 PMCID: PMC6708142 DOI: 10.1186/s13047-019-0356-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background In specific populations, including those at risk of falls or foot ulcers, indoor footwear is an important aspect of preventative care. This study aims to describe the indoor footwear worn most over the previous year in a sample representative of the Australian inpatient population, and to explore the sociodemographic, medical, foot condition and foot treatment history factors associated with the indoor footwear worn. Methods This was a secondary analysis of data collected from inpatients admitted to five hospitals across Queensland, Australia. Sociodemographic information, medical history, foot conditions and foot treatment history were collected as explanatory variables. Outcomes included the self-reported type of indoor footwear (from 16 standard footwear types) worn most in the year prior to hospitalisation, and the category in which the self-reported footwear type was defined according to its features: 'protective', 'non-protective' and 'no footwear'. Multivariate analyses determined explanatory variables independently associated with each type and category. Results Protective footwear was worn by 11% of participants (including 4% walking shoes, 4% running shoes, 2% oxford shoes), and was independently associated with education above year 10 level (OR 1.78, p = 0.028) and having had foot treatment by a specialist physician (5.06, p = 0.003). Most participants (55%) wore non-protective footwear (including 21% slippers, 15% thongs/flip flops, 7% backless slippers), which was associated with older age (1.03, p < 0.001). No footwear was worn by 34% of participants (30% barefoot, 3% socks only). Those of older age (0.97, p < 0.001) and those in the most disadvantaged socioeconomic group (0.55, p = 0.019) were less likely to wear no footwear (socks or barefoot). Conclusions Only one in nine people in a large representative inpatient population wore a protective indoor footwear most of the time in the previous year. Whilst having education levels above year 10 and having received previous foot treatment by a specialist physician were associated with wearing protective footwear indoors, the presence of a range of other medical and foot conditions were not. These findings provide information to enable clinicians, researchers and policymakers to develop interventions aimed at improving indoor footwear habits that may help prevent significant health burdens such as falls and foot ulcers.
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Affiliation(s)
- Alex L Barwick
- 1School of Health & Human Sciences, Southern Cross University, Southern Cross Drive, Bilinga, Queensland 4225 Australia
| | - Jaap J van Netten
- 2School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland Australia.,3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland Australia.,4Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Sheree E Hurn
- 2School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland Australia.,3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland Australia
| | - Lloyd F Reed
- 2School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland Australia.,3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland Australia
| | - Peter A Lazzarini
- 2School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland Australia.,3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland Australia.,5School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland Australia
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Barwick AL, Hurn SE, van Netten JJ, Reed LF, Lazzarini PA. Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study. PLoS One 2019; 14:e0211140. [PMID: 30789920 PMCID: PMC6383933 DOI: 10.1371/journal.pone.0211140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/08/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few studies have investigated if people at risk of foot ulceration actually wear the footwear recommended by best practice guidelines to prevent foot ulceration. This study aimed to investigate the prevalence of, and factors associated with, wearing inadequate outdoor footwear in those with diabetes or peripheral neuropathy in an inpatient population. METHODS This was a secondary analysis of a multi-site cross-sectional study investigating foot conditions in a large representative inpatient population admitted into hospital for any medical reason on one day. A range of explanatory variables were collected from all participants including sociodemographic, medical and foot condition factors. The outcome variable for this study was the self-reported outdoor footwear type worn most by participants outside the house in the year prior to hospitalisation. The self-reported footwear type was then categorised into adequate and inadequate according to footwear features recommended in guidelines for populations at risk of foot ulceration. Logistic regression identified factors independently associated with inadequate footwear in all inpatient participants, and diabetes and neuropathy subgroups. RESULTS Overall, 47% of a total of 726 inpatients wore inadequate outdoor footwear; 49% of the 171 in the diabetes subgroup and 43% of 159 in the neuropathy subgroup. Wearing inadequate outdoor footwear was independently associated (Odds Ratio (95% Confidence Interval)) with being female in the diabetes (2.7 (1.4-5.2)) and neuropathy subgroups (3.7 (1.8-7.9)) and being female (5.1 (3.7-7.1)), having critical peripheral arterial disease (2.5 (1.1-5.9)) and an amputation (0.3 (0.1-0.7)) in all inpatients (all, p<0.05). CONCLUSIONS Almost half of all inpatients at risk of foot ulceration reported wearing outdoor footwear most of the time that did not meet recommendations for prevention. We found women were much more likely to wear inadequate footwear. More work needs to be done to increase the uptake of footwear recommendations in these populations to prevent foot ulceration.
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Affiliation(s)
- Alex L. Barwick
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia
| | - Sheree E. Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jaap J. van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
- Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Lloyd F. Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Footmotion Podiatry Brisbane, Queensland, Australia
| | - Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- * E-mail:
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Matthews BG, Hurn SE, Harding MP, Henry RA, Ware RS. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta-analysis. J Foot Ankle Res 2019; 12:12. [PMID: 30809275 PMCID: PMC6375221 DOI: 10.1186/s13047-019-0320-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background Morton’s neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits footwear choices and weight bearing activities. This paper aims to review non-surgical interventions for MN, to evaluate the evidence base for the clinical management of MN. Methods Electronic biomedical databases (CINAHL, EMBASE, MEDLINE and Cochrane) were searched to January 2018 for studies evaluating the effectiveness of non-surgical interventions for Morton’s neuroma. Outcome measures of interest were treatment success rate (SR) (binary) and pain as measured using 100-point visual analogue scale (VAS) (continuous). Studies with and without control groups were included and were evaluated for methodological quality using the Downs and Black Quality Index. Results from randomised controlled trials (RCT) were compared between-groups, and case series were compared pre- versus post-treatment. Effect estimates are presented as odds ratios (OR) for binary data or mean differences (MD) for continuous data. Random effects models were used to pool effect estimates across studies where similar treatments were used. Heterogeneity was assessed using the I2 statistic. Results A total of 25 studies met the inclusion criteria, seven RCTs and 18 pre/post case series. Eight different interventions were identified, with corticosteroid or sclerosing injections being the most often reported (seven studies each). Results from a meta-analysis of two RCTs found corticosteroid injection decreased pain more than control on VAS (WMD: -5.3, 95%CI: -7.5 to − 3.2). Other RCTs reported efficacy of: manipulation/mobilisation versus control (MD: -15.3, 95%CI: -29.6 to − 1.0); extracorporeal shockwave therapy versus control (MD: -5.9, 95%CI: -21.9 to 10.1). Treatment success was assessed for extracorporeal shockwave therapy versus control (OR: 0.3, 95%CI: 0.0 to 7.1); and corticosteroid injection vs footwear/padding (OR: 6.0, 95%CI: 1.9 to 19.2). Sclerosing and Botox injections, radiofrequency ablation and cryoneurolysis have been investigated by case series studies, however these were of limited methodological quality. Conclusions Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. Although the evidence base is expanding, further high quality RCTs are needed. Electronic supplementary material The online version of this article (10.1186/s13047-019-0320-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Barry G Matthews
- 1School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Sheree E Hurn
- 1School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059 Australia.,2Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Michael P Harding
- 3School of Health Sciences, University of South Australia, Adelaide, SA 5000 Australia
| | - Rachel A Henry
- Rachel Henry Podiatry, Clayfield, Brisbane, QLD 4011 Australia
| | - Robert S Ware
- 5Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD 4111 Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. Foot Complications in a Representative Australian Inpatient Population. J Diabetes Res 2017; 2017:4138095. [PMID: 29164152 PMCID: PMC5661067 DOI: 10.1155/2017/4138095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023] Open
Abstract
We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p < 0.01). Previous amputation (4.1%) was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p < 0.01). Previous foot ulceration (9.8%) was associated with PN, PAD, past podiatry, and past nurse treatment (p < 0.02). PAD (21.0%) was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p < 0.02). PN (22.0%) was associated with older age, diabetes, mobility impairment, and PAD (p < 0.05). Foot deformity (22.4%) was associated with older age, mobility impairment, past podiatry treatment, and PN (p < 0.01). Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.
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Affiliation(s)
- Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| | - Sheree E. Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Suzanne S. Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Faculty of Health Sciences, School of Physiotherapy, Australian Catholic University, Brisbane, QLD, Australia
| | - Maarten C. Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD, Australia
| | - Ewan M. Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Michael C. d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Lloyd F. Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. The silent overall burden of foot disease in a representative hospitalised population. Int Wound J 2016; 14:716-728. [PMID: 27696693 DOI: 10.1111/iwj.12683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/19/2022] Open
Abstract
The aims of this study were to investigate the point prevalence, and associated independent factors, for foot disease (ulcers, infections and ischaemia) in a representative hospitalised population. We included 733 (83%) of 883 eligible adult inpatients across five representative Australian hospitals on one day. We collected an extensive range of self-reported characteristics from participants. We examined all participants to clinically diagnose foot disease (ulcers, infections and ischaemia) and amputation procedures. Overall, 72 participants (9·8%) [95% confidence interval (CI):7·2-11·3%] had foot disease. Foot ulcers, in 49 participants (6·7%), were independently associated with peripheral neuropathy, peripheral arterial disease, previous foot ulcers, trauma and past surgeon treatment (P < 0·05). Foot infections, in 24 (3·3%), were independently associated with previous foot ulcers, trauma and past surgeon treatment (P < 0·01). Ischaemia, in 33 (4·5%), was independently associated with older age, smokers and past surgeon treatment (P < 0·01). Amputation procedures, in 14 (1·9%), were independently associated with foot infections (P < 0·01). We found that one in every ten inpatients had foot disease, and less than half of those had diabetes. After adjusting for diabetes, factors linked with foot disease were similar to those identified in diabetes-related literature. The overall inpatient foot disease burden is similar in size to well-known medical conditions and should receive similar attention.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD,, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD,, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD,, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD,, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD,, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Michael C d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Kinnear EM, d'Emden MC, Reed L. Direct inpatient burden caused by foot-related conditions: a multisite point-prevalence study. BMJ Open 2016; 6:e010811. [PMID: 27324710 PMCID: PMC4916592 DOI: 10.1136/bmjopen-2015-010811] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aims of this point-prevalence study were to investigate a representative inpatient population to determine the prevalence of people admitted to hospital for the reason of a foot-related condition, and identify associated independent factors. METHODS Participants were adult inpatients in 5 different representative hospitals, admitted for any reason on the day of data collection. Maternity, mental health and cognitively impaired inpatients were excluded. Participants were surveyed on a range of self-reported demographic, social determinant, medical history, foot disease history, self-care, footwear, past foot treatment prior to hospitalisation and reason for admission variables. Physical examinations were performed to clinically diagnose a range of foot disease and foot risk factor variables. Independent factors associated with being admitted to hospital for the primary or secondary reason of a foot-related condition were analysed using multivariate logistic regression. RESULTS Overall, 733 participants were included; mean (SD) age 62 (19) years, male 55.8%. Foot-related conditions were the primary reason for admission in 54 participants (7.4% (95% CI 5.7% to 9.5%)); 36 for foot disease (4.9%), 15 foot trauma (2.1%). Being admitted for the primary reason of a foot-related condition was independently associated with foot infection, critical peripheral arterial disease, foot trauma and past foot treatment by a general practitioner and surgeon (p<0.01). Foot-related conditions were a secondary reason for admission in 28 participants (3.8% (2.6% to 5.6%)), and were independently associated with diabetes and current foot ulcer (p<0.01). CONCLUSIONS This study, the first in a representative inpatient population, suggests the direct inpatient burden caused by foot-related conditions is significantly higher than previously appreciated. Findings indicate 1 in every 13 inpatients was primarily admitted because of a foot-related condition with most due to foot disease or foot trauma. Future strategies are recommended to investigate and intervene in the considerable inpatient burden caused by foot-related conditions.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vanessa Ng
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, Queensland, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, Queensland, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Michael C d'Emden
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lloyd Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Hurn SE, Vicenzino BT, Smith MD. Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists. J Foot Ankle Res 2016; 9:16. [PMID: 27148407 PMCID: PMC4855349 DOI: 10.1186/s13047-016-0146-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/26/2016] [Indexed: 12/03/2022] Open
Abstract
Background Patients with hallux valgus (HV) frequently present to podiatrists for non-surgical management, with a wide range of concerns including pain, footwear difficulty and quality of life impacts. There is little research evidence guiding podiatrists’ clinical decisions surrounding non-surgical management of HV. Thus practitioners rely largely upon clinical experience and expert opinion. This survey was conducted to determine whether a consensus exists among Australian podiatrists regarding non-surgical treatment of HV, and secondly to explore common presenting concerns and physical examination findings associated with HV. Methods An online survey was distributed to Australian podiatrists in mid-2013 via the professional association in each state (approximately 1900 members). Podiatrists indicated common treatments recommended, presenting problems and physical examination findings associated with HV in juveniles, adults and older adults. Proportions were calculated to determine the most common responses, and Chi-squared tests were used to examine differences in treatment recommendations according to HV patient age group and podiatrist demographics. Results Of 210 survey respondents, 65 % (136) were female and 80 % (168) were private practitioners. Complete survey responses were received from 159 podiatrists for juvenile HV, 146 for adults and 141 for older adults. Seven different non-surgical treatment options were commonly recommended (by >50 % podiatrists), although recommendations differed between adult, older adult and juvenile HV. Common treatments included footwear advice or modification, custom and prefabricated orthotic devices, addition of padding, and muscle strengthening/retraining exercises. Padding was more likely to be utilised in older adults, while exercises were more likely to be prescribed for juveniles. A diverse range of presenting problems and physical examination findings were reported to be associated with HV. Conclusions Despite the lack of empirical evidence in this area, there appears to be a consensus among Australian podiatrists regarding non-surgical management of HV, and these recommendations are largely aligned with available clinical consensus documents. Presenting concerns and physical examination findings associated with HV are diverse and have implications for treatment decisions. Management strategies differ across patient age groups, thus any updated clinical guidelines should differentiate between adult and juvenile HV. This study provides useful data to inform clinical practice, education, policy and future research. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0146-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheree E Hurn
- Queensland University of Technology, School of Clinical Sciences, Kelvin Grove, QLD 4059 Australia ; Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD 4059 Australia
| | - Bill T Vicenzino
- Division of Physiotherapy, University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD 4072 Australia
| | - Michelle D Smith
- Division of Physiotherapy, University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD 4072 Australia
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Lazzarini PA, Hurn SE, Fernando ME, Jen SD, Kuys SS, Kamp MC, Reed LF. Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis. BMJ Open 2015; 5:e008544. [PMID: 26597864 PMCID: PMC4663442 DOI: 10.1136/bmjopen-2015-008544] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To systematically review studies reporting the prevalence in general adult inpatient populations of foot disease disorders (foot wounds, foot infections, collective 'foot disease') and risk factors (peripheral arterial disease (PAD), peripheral neuropathy (PN), foot deformity). METHODS A systematic review of studies published between 1980 and 2013 was undertaken using electronic databases (MEDLINE, EMBASE and CINAHL). Keywords and synonyms relating to prevalence, inpatients, foot disease disorders and risk factors were used. Studies reporting foot disease or risk factor prevalence data in general inpatient populations were included. Included study's reference lists and citations were searched and experts consulted to identify additional relevant studies. 2 authors, blinded to each other, assessed the methodological quality of included studies. Applicable data were extracted by 1 author and checked by a second author. Prevalence proportions and SEs were calculated for all included studies. Pooled prevalence estimates were calculated using random-effects models where 3 eligible studies were available. RESULTS Of the 4972 studies initially identified, 78 studies reporting 84 different cohorts (total 60 231 517 participants) were included. Foot disease prevalence included: foot wounds 0.01-13.5% (70 cohorts), foot infections 0.05-6.4% (7 cohorts), collective foot disease 0.2-11.9% (12 cohorts). Risk factor prevalence included: PAD 0.01-36.0% (10 cohorts), PN 0.003-2.8% (6 cohorts), foot deformity was not reported. Pooled prevalence estimates were only able to be calculated for pressure ulcer-related foot wounds 4.6% (95% CI 3.7% to 5.4%)), diabetes-related foot wounds 2.4% (1.5% to 3.4%), diabetes-related foot infections 3.4% (0.2% to 6.5%), diabetes-related foot disease 4.7% (0.3% to 9.2%). Heterogeneity was high in all pooled estimates (I(2)=94.2-97.8%, p<0.001). CONCLUSIONS This review found high heterogeneity, yet suggests foot disease was present in 1 in every 20 inpatients and a major risk factor in 1 in 3 inpatients. These findings are likely an underestimate and more robust studies are required to provide more precise estimates.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia Podiatry Service, Kirwan Community Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Scott D Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Ipswich, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Hurn SE, Vicenzino B, Smith MD. Functional Impairments Characterizing Mild, Moderate, and Severe Hallux Valgus. Arthritis Care Res (Hoboken) 2014; 67:80-8. [DOI: 10.1002/acr.22380] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 06/03/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Sheree E. Hurn
- Queensland University of Technology, Brisbane; Queensland Australia
| | - Bill Vicenzino
- The University of Queensland, Brisbane; Queensland Australia
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Hurn SE, Vicenzino BT, Smith MD. Correlates of foot pain severity in adults with hallux valgus: a cross-sectional study. J Foot Ankle Res 2014; 7:32. [PMID: 25028598 PMCID: PMC4099097 DOI: 10.1186/1757-1146-7-32] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Hallux valgus (HV) is highly prevalent and associated with progressive first metatarsophalangeal joint subluxation and osteoarthritis. The link between structural HV deformity and foot pain is unclear. This study investigated possible explanatory factors surrounding foot pain in HV, including radiographic HV angle and signs of joint degeneration. Methods Participants were 60 adults (53 female) with HV aged 20 to 75 years. Participant demographics and a range of radiographic, clinical and functional measures were considered potential correlates of foot pain. Self-reported foot pain (visual analogue scales and a dichotomous definition) was considered the dependent variable. Multivariate modelling was used to determine which characteristics and measures explained pain, with univariate analyses first used to screen potential variables. Results Approximately 20 to 30% of the variance in foot pain associated with HV could be explained by patient characteristics such as poorer general health status, lower educational attainment and increased occupational physical activity levels, in combination with some dynamic physical characteristics such as hallux plantarflexion weakness and reduced force-time integral under the second metatarsal during gait. Neither increasing lateral deviation of the hallux (HV angle) nor presence of first metatarsophalangeal joint osteoarthritis was associated with foot pain. Conclusions This study shows that passive structural factors, including HV angle, do not appear to be significant correlates of foot pain intensity in HV. Our data demonstrate the importance of considering patient characteristics such as general health and physical activity levels when assessing foot pain associated with HV.
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Affiliation(s)
- Sheree E Hurn
- Queensland University of Technology, School of Clinical Sciences, Kelvin Grove, QLD 4059, Australia ; Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD 4059, Australia
| | - Bill T Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, St Lucia, QLD 4072, Australia
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, St Lucia, QLD 4072, Australia
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Beale AS, Faulds E, Hurn SE, Tyler J, Slocombe B. Comparative activities of amoxycillin, amoxycillin/clavulanic acid and tetracycline against Chlamydia trachomatis in cell culture and in an experimental mouse pneumonitis. J Antimicrob Chemother 1991; 27:627-38. [PMID: 1885420 DOI: 10.1093/jac/27.5.627] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The activity of amoxycillin, amoxycillin/clavulanic acid and two tetracycline antibiotics was investigated against three strains of Chlamydia trachomatis in vitro. McCoy cells were infected and single doses of antibiotic administered 24 h after infection. The percentage of infected cells was calculated at intervals up to 72 h after infection. Amoxycillin and clavulanic acid, alone and in combination, reduced the incidence of inclusion formation of all three strains. Particularly good activity was observed against the laboratory-adapted strain C. trachomatis Sa2f and a clinical isolate C. trachomatis LB1, where a progressive reduction in numbers of inclusions was observed with time. Minocycline and oxytetracycline were the most active agents tested. In an experimental animal model, mice were inoculated intranasally with C. trachomatis MoPn (ATCC VR123) which caused a fatal pneumonia within 16 days, and treated orally for four days commencing at 24 h after infection. At doses producing clinically achievable serum concentrations, amoxycillin (10 mg/kg), amoxycillin/clavulanic acid (10 + 5 mg/kg) and minocycline (5 mg/kg) all protected the mice over a 21-day period. The majority of the animals treated with clavulanic acid alone (20 mg/kg) survived the infection. Treatment with oxytetracycline was less effective, a dose of 160 mg/kg being required to protect 70% of the mice. The results indicate that amoxycillin and amoxycillin/clavulanic acid were more effective against C. trachomatis MoPn in vivo than might be predicted from in-vitro data, suggesting that amoxycillin/clavulanic acid may have potential for the treatment of polymicrobial infections involving C. trachomatis.
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Affiliation(s)
- A S Beale
- SmithKline Beecham Pharmaceuticals, Betchworth, Surrey, UK
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