Oral presentations
O1 How population data informs the science of foot disorders and health
Marian Hannan
Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School,
Boston, MA, USA
This presentation will provide an epidemiological overview of the current population
levels of foot pathologies, including current challenges and viewpoints. This session
will also addressed the need for a data-driven approach as we consider common etiologies
and causal pathways, for example, the links between obesity and pedal pathologies
as well as special considerations regarding clinical trial designs for the foot and
ankle research.
The past decade has brought many new insights to the epidemiology of foot and ankle
disorders as well as insights into early pathology, and even possible prevention of
impaired foot structure and function. Clinical cases and laboratory studies have provided
information on treatment and insights into mechanisms. Yet, we still know relatively
little of the population impact and informed prevention that may help people NOT become
patients.
The objective of this presentation is to provide a population-based understanding
of foot type, pathologies and function in the population from major studies in the
United States. We will consider how populations inform science and medicine, how to
obtain complex measurements from large groups outside the laboratory, and highlight
major findings of population-based foot studies. A better understanding of these issues
can help to inform the public as well as disseminate clinical and scientific information.
How do all of these data sources inform our understanding of foot biomechanics and
translation of research? Epidemiology may serve as a bridge between our current knowledge
base and how to grow this foundation to the next level of insights and interventions
in the 21st century. Such a focus will encourage the integration of our knowledge
of biomechanics and movement with “Big Data” collections, taking our field to the
next level.
O2 The value of population data on foot problems: perspectives from Australia and
the United Kingdom
Hylton Menz2,1
1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University , Melbourne,
VIC, Australia; 2School of Allied Health, La Trobe University, Bundoora, VIC, Australia
Epidemiology can be defined as the study of how often diseases occur in different
groups of people and the factors that may influence patterns of disease distribution
in the community. By understanding the prevalence and risk factors for a particular
disease, its burden can be quantified, and targets for treatment and prevention can
be identified. Epidemiology is therefore a cornerstone of public health and provides
valuable information for shaping health policy.
Although it has long been recognised that foot problems are highly prevalent, disabling
and costly, foot problems have historically been ignored in population-based epidemiology
studies. This lack of epidemiological data has prevented the podiatry profession from
being able to demonstrate its value in relation to public health and has made it difficult
for researchers to attract research funding. Fortunately, this has changed in recent
years, with the initiation of several well-designed population-based studies incorporating
detailed information on foot problems.
This presentation will provide an overview of five population-based studies that the
presenter has had the privilege of being involved in over the past decade: (i) the
North West Adelaide Health Study, (ii) the Australian Longitudinal Study of Women’s
Health, (iii) the Geelong Osteoporosis Study, (iv) the Tasmanian Older Adult Cohort
Study and (v) the Clinical Assessment Study of the Foot. Strengths and limitations
of each of these studies will be discussed, along with a summary of their key findings.
Finally, the presentation will discuss the recent establishment of a foot and ankle
consortium to enhance research capacity and facilitate international collaboration
using these resources.
O3 Global update on physical activity – are we making progress in Australia and internationally?
Adrian Bauman
University of Sydney, Sydney University, NSW, Australia
Physical inactivity is a major contributor to the global burden of disease, both in
high income earned in low middle income countries. Despite the advocacy efforts of
NGOs, professional societies, and the Lancet series on physical activity in 2012 and
2016, much remains to be done to increase population levels of activity. This talk
will review the policy framework and efforts to promote physical activity in Australia
and internationally over the past three decades. Despite having many physical activity
researchers, and having a national NCD plan, Australia has no physical activity plan
or strategy to promote physical activity or reduced sitting time. Since 1989, rates
of physical activity amongst Australian adults have remained unchanged or declined
slightly, especially with respect to moderate to vigorous forms of structured physical
activity and exercise. Rates of inactivity are also high amongst adolescents and children.
The one area which may show some improvement is in population levels of walking, which
is an accessible and feasible activity for almost all adults of all ages. Globally,
there are also many challenges to resourcing physical activity strategies at the population
level. These challenges posed an urgent public health crisis.
O4 Athlete data and relevance for public health and physical activity across the lifespan
Michael K Drew1,2,3
1Athlete Availability Program, Australian Institute of Sport, Canberra, ACT, Australia;
2Australian Centre for Research into Injury in Sport and its Prevention, Melbourne,
VIC, Australia; 3Research Institute for Sport and Exercise , University of Canberra,
Canberra, ACT, Australia
Olympic athletes provide an opportunity to understand the nth degree of human potential.
One of these potentials is the ability to withstand high workloads – both physical
and mental. This lecture will outline the current activities undertaken by the Athlete
Availability Program at the Australian Institute of Sport and detail the requirements
to keep athletes healthy. A key focus of the talk will be how learnings can be translated
to ‘everyday athletes’ and emerging areas that all clinicians should be aware of when
managing injuries in active populations whether they are recreational or Olympians.
O5 Training athletes to optimise performance
Jon Buckley
Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South
Australia, Adelaide, SA, Australia
Athletes undergo training to induce adaptations that can improve performance. Too
little training can result in suboptimal performance but, conversely, too much training
with inadequate recovery can also lead to adverse performance effects. In order to
optimise athletic performance training programs must achieve the correct balance between
training load and recovery.
Technological advances have allowed for training loads to be quantified quite readily,
but quantification of the load being performed does not provide any insight into how
an athlete is responding to that load. A large number of biomarkers have been evaluated
to determine how athletes are responding to different training loads, but currently
there is insufficient evidence to support the use of any given biomarker.
Our team has been evaluating various parameters that can be assessed during submaximal
exercise that correlate with changes in athletic performance following changes in
training load. These parameters include heart rate acceleration during the transition
from rest to exercise, and changes in movement and gait patterns. This presentation
will provide insights into these novel methods for assessing how an athlete is responding
to training, and how they can be used to inform changes in athletic training programs
to optimise performance.
O6 Efficacy of heel lifts in the treatment of mid-portion Achilles tendinopathy: a
randomised trial
Chantel L Rabusin1, Hylton B Menz1, Jodie A McClelland1, Angela M Evans1, Karl B Landorf1,
Peter Malliaris2, Sean I Docking1, Shannon E Munteanu1
1La Trobe Sport and Exercise Medicine, La Trobe University, Melbourne, Victoria, Australia;
2Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
Correspondence: Chantel L Rabusin
Background
Mid-portion Achilles tendinopathy (AT) is a common overuse musculoskeletal condition
causing pain and disability. There are two commonly used conservative interventions.
Calf muscle eccentric exercise has been found to be effective in decreasing pain and
improving function in people with AT. Heel lifts reduce ankle joint dorsiflexion and
Achilles tendon strain, however the efficacy of this intervention for AT has not been
determined. The aim of this trial, therefore, was to compare the efficacy of heel
lifts against calf muscle eccentric exercise for reducing pain and improving function
in AT.
Methods
One hundred participants aged between 22 to 66 years (45.9 ± 9.4) with AT were randomised
to receive either Clearly Adjustable® 12 mm heel lifts (n = 50) or a calf muscle eccentric
exercise program (n = 50). Outcome measures were obtained at baseline, 2, 6 and 12
weeks, the primary end-point. The primary outcome measure was the Victorian Institute
of Sports Assessment-Achilles questionnaire (VISA-A). Secondary outcome measures included
thickness and integrity of the Achilles tendon, global impression of change (pain
and function), severity of pain (100 mm visual analogue scale) and calf muscle function
(calf rise test). Data was analysed using the intention to treat principle. VISA-A
and global impression of change in symptoms at 12 weeks are presented below.
Results
Both groups improved in pain and function. After 12 weeks, there was no significant
difference in VISA-A scores between the two groups (adjusted mean difference at week
12 = 4.5 points, 95% CI -3.0 to 12.1, p=0.232). However, statistically significant
differences between groups were found for patient global impression of change in symptoms
in favour of heel lifts at 12 weeks (pain: RR 1.41, CI 1.02 to 1.95; function RR 1.55,
CI 1.04 to 2.31).
Discussion and clinical relevance
There is no difference in efficacy between heel lifts and calf muscle eccentric exercise
for AT. Heel lifts can be considered a simpler and alternative intervention to calf
muscle eccentric exercise for AT.
O7 Profiling footwear use, training habits, running related injuries, and injury management
behaviours in recreational runners in the Australian community
Benjamin J Peterson1, Martin J Spink1, Fiona E Hawke1, Vivienne H Chuter1, Robin Callister2
1School of health sciences, The University of Newcastle, Ourimbah, NSW, Australia;
2School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan,
NSW, Australia
Correspondence: Benjamin J Peterson
Background
Running-related injuries (RRI) have become more prevalent as recreational running
has gained popularity. The aetiology of RRI is considered to be multifactorial, and
related to both intrinsic and extrinsic factors. This study describes the demographics,
training habits, footwear selection, and injury patterns in recreational runners in
the Australian community.
Methods
Recreational runners were recruited through community running events in New South
Wales and completed self-report surveys, regarding footwear use, training habits,
previous injuries, and demographic data. Descriptive statistics, correlations, and
regression analyses were performed.
Results
Ninety-five runners (56 females) were recruited. Mean age was 47.2 + 13.0 years, weight
75.4 + 19.0 kg and height 169.3 + 9.2cm. Runners completed 2.87 + 1.39 weekly running
sessions, covering 19.48 + 17.0 km per week, most commonly on concrete (58.9%; n=56)
and bitumen (51.5%; n=49).
Footwear was prescribed by a podiatrist or footwear retailer for 20% (n=19) of runners,
with 57.9% (n=55) using a neutral shoe and 25.3% (n=24) using motion-controlling footwear.
Asics was the most commonly worn footwear brand (24.2%; n=23) and Asics Kayano the
most commonly worn shoe overall (10.5%; n=10). The average age of current running
shoes was 11.33 + 10.1 months. Increased weekly mileage was associated with a lower
shoe age (r=0.324, p=0.002).
The rate of RRI within three months prior to recruitment was 50% (n=49). The most
common injury sites were the ankles (20%; n=13), feet (16.9%; n=11), and knees (15.4%;
n=10). Foot orthoses were worn by 20% (n=19) of runners and use was associated with
previous injury (r=0.242, p=0.019). One third (n=15) of runners who sustained a RRI
reported seeing a health professional, most commonly podiatrists (n=4) and physiotherapists
(n=4). Those who saw a health professional were more likely to wear foot orthoses
(r=0.441, p=0.002), and to have less time-loss from running, however this did not
reach statistical significance (r=-0.272, p=0.061).
Discussion and Clinical Relevance
Injuries are common among Australian recreational runners. Injured runners frequently
seek the advice of health professionals, and this behaviour may result in less time-loss
due to injury, however further research with larger sample sizes is required to confirm
this.
O8 A systematic review into the diagnostic accuracy of clinical tests for detecting
Posterior Tibial Tendon Dysfunction
Stephanie Lubcke, Ryan S Causby, Ian Fulton, Sandy Maranna, Steve Milanese
School of Health Sciences, University of South Australia, Adelaide, SA, Australia
Correspondence: Ryan S Causby
Background
Posterior Tibial Tendon Dysfunction (PTTD) is a progressive foot condition caused
by overuse or degeneration of the Posterior Tibial Tendon. The condition is seen in
orthopaedic, podiatry and physiotherapy clinics. Diagnosis is attained primarily through
clinical tests and occasionally confirmed with MRI or ultrasound.
However, the evidence supporting the clinical tests is not clear. Thus, to determine
the diagnostic accuracy of clinical tests for detecting PTTD in people with medial
foot pain and associated symptoms we undertook a systematic review.
Methods
Searches of AMED, Medline, Embase, CINAHL, PubMed and Scopus were conducted. Two independent
reviewers were involved in study selection and quality appraisal using Covidence and
the QUADAS-2 tool, respectively.
Results
The initial database search yielded 813 articles. After title and abstract screening
and duplicate removal, 47 studies remained. From these, 42 studies were excluded based
on set criteria such as study population, study design, having a suitable index test
and language; leaving five studies which had investigated the diagnostic accuracy
of clinical tests for PTTD.
These studies comprised nine clinical tests, including: Unipedal standing balance
test, Posterior Tibial Edema Sign, First Metatarsal Rise Sign, Single Leg Heel Raise
(SLHR), Double Heel Raise, ‘Too many toes sign’ and Passive and Active muscle testing. The
most common being the SLHR. Of the included studies, MRI was the reference standard
in three studies, surgical exploration in one study and a control group was used in
one study instead of a reference standard. Ultrasound was also utilised in two studies
as an additional comparison reference standard.
However, all studies reviewed were at risk of bias and had concerns regarding their
applicability.
Discussion and Clinical Relevance
This review finds that there is limited evidence of the diagnostic accuracy of clinical
tests for PTTD. A discussion of the findings of the review and the identified clinical
tests will be provided, with the aim of providing clinicians with the evidence underpinning
tests commonly used in podiatry practice. Future research should be conducted into
this area with a focus on high quality, well-powered studies investigating different
clinical tests compared to a gold standard.
O9 A cross-sectional study comparing clinical and psychosocial features in tibialis
posterior tendinopathy with controls: preliminary findings
Megan H Ross, Michelle D Smith, Bill Vicenzino
The University of Queensland, St Lucia, QLD, Australia
Correspondence: Megan H Ross
Background
Tibialis posterior tendinopathy is associated with pain during activities that load
the tibialis posterior tendon and limited participation in daily and physical activities.
Little is known about factors such as quality of life and psychosocial features in
tibialis posterior tendinopathy. The aim of this preliminary study was to investigate
clinical and psychosocial characteristics of individuals with tibialis posterior tendinopathy.
Methods
We compared individuals with tibialis posterior tendinopathy (currently n = 19, age:
42±14; BMI: 27±8) and asymptomatic controls (n = 26, age: 43±17, BMI: 23±5). Diagnosis
was made clinically based on medial foot/ankle pain plus one or more of: tenderness
on palpation or swelling of the tibialis posterior tendon or pain/difficulty with
resisted plantarflexion inversion or single leg heel raise. Clinical measures of foot
posture, function, range of motion, strength at the foot and hip, and self-reported
psychosocial measures were assessed. Preliminary between group differences were explored
using independent t-tests. Standardised mean differences (SMDs) were calculated to
evaluate effect sizes. Interpretation of SMDs was as follows: <0.6 small, 0.61-1.2
moderate, >1.2 large.
Results
Preliminary analyses suggest large effects (SMD > 1.2) for more pain, poorer self-reported
function and quality of life, in addition to more pronated foot posture, poorer single
leg heel raise endurance and greater time to complete stair descent/ascent in tibialis
posterior tendinopathy compared to controls (p<0.01). Data collection is still ongoing
and results will be updated at the conference.
Discussion and Clinical Relevance
Altered foot posture and poorer physical function appear to be accompanied by pain,
stiffness, social limitations, and lower quality of life in tibialis posterior tendinopathy.
A biopsychosocial approach should be considered for assessment and management of tibialis
posterior tendinopathy.
O10 The WHO Global Action Plan for Physical activity, taking the world to a more active
2030
Adrian Bauman
University of Sydney, Sydney University, NSW, Australia
In 2017, the World Health Organisation started the process of developing a global
action plan for physical activity (GAPPA). This was a major step forward by WHO as
part of its commitment to non-communicable disease prevention. This talk will describe
the process of developing GAPPA, as it was somewhat different to usual WHO planning
processes. Unlike the usual health-centric consultation, WHO used a broader and cross-sectoral
base for the consultations around physical activity, including discussions with a
broad range of health professionals, sport, education, urban planning and transport,
all of whom have an important direct or indirect role in physical activity promotion.
WHO has also set targets of a 10% relative reduction in physical inactivity by 2025,
and a 15% reduction by 2030. The global action plan, launched in 2018, was comprised
of four sections: [i] creating active societies and changing social norms to become
more supportive of physical activity in everyday life; [ii] creating environments
that are conducive to active living; [iii] supporting people through health sector
advice and counselling to be more active, and including physical activity promotion
in clinical consultations; and [iv] building an integrated system in which physical
activity is easier in society, which involves collaboration across agencies and sectors,
to create a more active world. This is a bold action plan by WHO and warrants as much
support and advocacy to governments at every level as we can muster.
O11 Avoid tripping over obesity
Gary Wittert
Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA,
Australia
Excessive accumulation of lipid laden adipose tissue has adverse effects on health.
These are due to the mechanical effects of excess body weight, metabolic/inflammatory
consequences related to the anatomical distribution of the adipose tissue, concomitant
co-morbid conditions, the effects of a range of health-related behaviours and psychosocial
factors including stigma. Increased amounts, and more importantly function, of skeletal
muscle abrogates the deleterious effects of adipose tissue.
Obesity has been reported to be associated with planus foot posture and when walking-
pronated dynamic foot function and increased mid-foot plantar pressures, nonspecific
foot pain and plantar heel pain. The amount and distribution of adipose tissue and
presence of depression, but not lean mass or BMI have been shown to be independent
mediators of obesity related foot pain
Use of podiatry services is significantly increased in people with moderate to severe
obesity as compared to those people of healthy weight or mild obesity. Accordingly,
podiatrists are well placed not just to manage end organ consequences of obesity and
complications of obesity, but also to address the underlying cause and prevent further
problems. This presentation will provide some suggestions for how that may be done.
O12 Fat mass, but not fat-free mass, predicts increased foot pain with morbid obesity,
independent of bariatric surgery
Tom P Walsh1,2, Stephen J Quinn3, Angela M Evans4, Alison Yaxley1, Jacob A Chisholm5,
Lilian Kow5, E Michael Shanahan1,5
1Flinders University, Bedford Park, South Australia, Australia; 2School of Clinical
Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia; 3Swinburne
University of Technology, Melbourne, Victoria, Australia; 4La Trobe University, Bundoora,
Victoria, Australia; 5Flinders Medical Centre, Bedford Park, South Australia, Australia
Correspondence: Tom P Walsh
The full article version of this abstract has already been published and can be found
at https://www.sciencedirect.com/science/article/abs/pii/S1550728918303290.
O13 Bone marrow oedema is important: medical imaging findings in people with and without
plantar heel pain
Karl B Landorf1, Hylton B Menz1, Michelle R Kaminski1, Gerard V Zammitt2, Tom Entwisle3,
David Connell3, Shannon E Munteanu1
1La Trobe University, VIC., Australia; 2Medical Foot Care, Altona North, Victoria,
Australia; 3Imaging @ Olympic Park, Melbourne, Victoria, Australia
Correspondence: Karl B Landorf
Background
Medical imaging is frequently used to assist in the diagnosis of plantar heel pain
(PHP). However, no studies investigating the association of imaging features with
PHP have combined x-ray, ultrasound and MRI, nor have they used a control group matched
for important characteristics. The aim of this study was to investigate the association
of imaging findings with PHP.
Methods
In this cross-sectional study, 50 participants with PHP were compared to 25 participants
without PHP (i.e. controls) matched for age, sex and body mass index (BMI). Imaging
included x-ray, ultrasound and MRI.
Results
On x-ray, participants with PHP were 2.4x (95% CI 0.8, 6.7) more likely on the right
and 3.7x (95% CI 1.3, 10.5) more likely on the left foot to have a plantar calcaneal
spur. On ultrasound, plantar fascia thickness was 0.85 mm (95% CI 0.31, 1.40) thicker
on the right and 0.74 mm (95% CI 0.23, 1.25) thicker on the left foot. Hypoechogenicity
was 5.2x (95% CI 1.8, 14.7) more likely in the right and 3.0x (95% CI 1.1, 8.0) more
likely in the left plantar fascia. On MRI, delamination was 5.0x (95% CI 1.7, 14.3)
more likely in the right and 3.6x (95% CI 1.3, 10.0) more likely in the left plantar
fascia. A tear of the plantar fascia was at least 9.3x (95% CI 1.2, 75.5) more likely
in the right and at least 5.9x (95% CI 1.2, 28.2) more likely in the left foot. Bone
marrow oedema of the calcaneus was 10.6x (95% CI 2.3, 49.9) more likely in the right
and 5.3x (95% CI 1.4, 20.1) more likely in the left foot.
Discussion and Clinical Relevance
Our study is the first of its kind to compare participants with and without PHP when
matched for age, sex, and significantly, BMI. Our findings highlight that PHP does
not just involve the plantar fascia. While pathology of the plantar fascia is part
of the clinical picture, increased odds of bone marrow oedema – an indication of bone
stress – is an important finding from our study. Our findings may impact treatment
of this condition.
O14 The reliability of a two-probe ultrasound imaging procedure to measure strain
in the Achilles tendon
Prue Molyneux, Richard Ellis, Matthew Carroll
Auckland University of Technology, Northcote, AUCKLAND, New Zealand
Correspondence: Prue Molyneux
Background
Alteration in the strain properties of the Achilles tendon may lead to adaptations
such as pathological stiffening. Stiffer tendons have less adaptive ability, which
may predispose to the development of tendinopathy. There is a current lack of methods
to measure in-vivo tissue strain. A two-probe ultrasound procedure has been proposed
to reduce measurement error associated with a one-probe procedure. However, reliability
of the two-probe procedure has not been established. The study aimed to determine
intra-rater, inter-session and inter-rater reliability of a two-probe ultrasound procedure
to measure Achilles tendon strain.
Methods
Twentynine healthy participants (19 females, 10 males mean age 33.6 years) were included.
Achilles tendon images were acquired with a two-probe ultrasound procedure as the
ankle moved through a standardised range of motion (20° plantarflexion to 10° dorsiflexion).
Both probes were positioned longitudinally, one probe over the musculotendinous junction
and the second over the calcaneal insertion of the Achilles tendon. Repeat measurements
were taken at a second session at the initial study visit and four weeks later. Strain
measures were calculated from the pre-captured images using Motion Analysis 2014v1
software by two independent raters. Intra-rater, inter-session and inter-rater reliability
were calculated using intraclass correlation coefficients (ICC). In addition, 95%
confidence intervals for the ICC and the standard error of measurement (SEM) were
also calculated.
Results
Excellent intra-rater within-session reliability (ICC = 0.84, P < 0.001), poor inter-session
reliability (ICC = 0.18, p = 0.397) and excellent inter-rater reliability (ICC = 0.88,
p = 0.003) was demonstrated for the measurement of Achilles tendon strain using the
two-probe procedure.
Discussion and Clinical Relevance
The two-probe procedure to measure Achilles tendon strain is reliable for repeated
measurements within the same day. However, measurement error increased when strain
was measured on different days, which may be due to a combination of examiner error
and participant factors. Measurement of Achilles tendon strain offers an additional
tool for the evaluation of the tendon’s mechanical characteristics. The ability to
reliably quantify strain may allow clinicians to identify those at risk of Achilles
tendinopathy and to formulate more effective management plans.
O15 Foot orthoses or corticosteroid injection for plantar heel pain: which is more
effective and who is more likely to respond?
Glen A Whittaker1, Shannon E Munteanu1, Hylton B Menz1, James M Gerrard1, Ayman Elzarka2,
Karl B Landorf1
1La Trobe University, Bundoora, Victoria, Australia; 2Southern Cross Medical Imaging,
Bundoora, Victoria, Australia
Correspondence: Glen A Whittaker
Background
Plantar heel pain is a common foot complaint that causes significant disability and
poor health-related quality of life. Foot orthoses and corticosteroid injection are
effective treatments for plantar heel pain, however it is unclear if one is more effective
than the other. It is also unclear whether there are characteristics that can predict
who is more likely to respond to each treatment. The aim of this research was to:
(i) evaluate the effectiveness of foot orthoses and corticosteroid injection, and
(ii) investigate if any parameters can predict who is more likely to respond to each
treatment.
Methods
A parallel-group, assessor-blinded randomised trial (the SOOTHE trial) was conducted.
Participants were randomly allocated to receive either prefabricated, arch-contouring
foot orthoses or a single ultrasound-guided corticosteroid injection. The primary
outcome measure was the foot pain subscale of the Foot Health Status Questionnaire
at 4 and 12 weeks. To define responders, response to treatment was achieved by dichotomising
each participant’s overall improvement measured on a 15-point Likert scale.
Results
A total of 103 participants aged 21 to 72 years (63 female) with plantar heel pain
were recruited from the community and received an intervention. For the primary outcome
of foot pain, corticosteroid injection was more effective at week 4 (adjusted mean
difference 8.2 points; 95% CI 0.6, 15.8). However, foot orthoses were more effective
at week 12 (adjusted mean difference 8.5 points; 95% CI 0.2, 16.8). Although these
findings were statistically significant, they did not meet the previously calculated
minimal important difference value of 12.5 points. The analysis of parameters that
predict response is underway and will be complete prior to the conference.
Discussion and clinical relevance
Based on the findings of this trial, health professionals can advise patients with
plantar heel pain that a single ultrasound-guided corticosteroid injection is effective,
however the effect is relatively short-lived. However, this may be extended with appropriately
contoured foot orthoses, which are more effective in the longer-term. Parameters that
predict response will be discussed when the data analysis is complete.
O16 Fifty active years after 50®? The challenges of exercise and activity with joint
pain
Anne-Maree Keenan1,2
1Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom; 2NIHR
Leeds Biomedical Research Centre , Leeds Teaching Hospitals Trust, Leeds, United Kingdom
Musculoskeletal conditions (MSK) conditions are the single most common cause of chronic
disability and one of the most expensive to treat. The global burden of MSK diseases
has increased by 25 percent over the past decade. The musculoskeletal conditions that
have the largest economic and personal burden are immune mediated inflammatory diseases
(IMIDs) and osteoarthritis (OA). IMIDs affect over 5% of the population and result
in joint damage, physical disability and reduced life expectancy. While not as aggressive,
OA presents a wider challenge: worldwide estimates of OA indicate that one in ten
men and one in five women aged over 60 have symptomatic OA and treatment options remain
poor. The prevalence of OA will increase with changing ageing and obesity rates, with
an expected increase in joint replacement surgery in younger people who will subsequently
be living longer with their replacements, requiring thought to be placed on how we
can sustain 50 active years after 50®.
While research has established that exercise is key in reducing symptoms, long-term
damage and the impact of multi-morbidities, two main issues are evident in people
with joint pain. First, in those with IMIDs, health professionals have been responsible
for providing confusing advice aimed avoiding exercising and activity. While this
has been driven by the premise of avoiding long term harm, it has resulted in both
physical and psychosocial impact. Second, while people may understand the importance
of exercise for long term benefit for preventing and reducing symptoms in OA, promoting
exercise adherence and activity adoption remains the key clinical challenge.
This presentation will provide an overview of the benefits of exercise, strategies
which are aimed at promoting accurate information sharing, exercise adherence and
activity engagement for those with joint pain.
O17 Midfoot pain and osteoarthritis: finding solutions to keep people on their feet
John Arnold
University of South Australia, Adelaide, SA, Australia
Midfoot osteoarthritis (OA) is a common cause of midfoot pain, affecting 1 in 8 people
aged over 50 years. Often, midfoot OA is sufficiently painful to stop people walking.
Once this occurs, people descend on a spiral of disadvantage characterised not just
by painful feet, but all the established negative sequelae of inactivity. Clinically,
OA in the midfoot can be challenging to treat with variable effectiveness of conservative
interventions. Our ability to design effective treatments for midfoot OA has been
hampered by a limited understanding of the modifiable determinants of disease initiation
and progression. This is underpinned by two issues. First, early structural changes
in midfoot OA remain undefined and may require MRI to measure accurately and precisely.
Second, while joint loading is a key factor in the development and progression of
OA at other weight-bearing joints, its role in midfoot OA is not well understood.
This presentation will focus on recent research being conducted to unravel the mechanisms
by which midfoot OA may develop and progress. It will also cover clinical factors
related to symptoms and functional impairment that are future targets for intervention
in clinical practice. Ultimately, improving the treatment of midfoot OA presents an
opportunity to reduce the negative downstream effects of pain and foot-related disability
on physical inactivity and general health.
O18 Moving more and sitting less in the workplace
Tracy Kolbe-Alexander
University of Southern Queensland, Ipswich, QLD, Australia
The prevalence of non-communicable diseases (NCD’s) such as diabetes and coronary
artery disease is increasing both globally and in Australia. The prevalence of diabetes
in Australia has increased by approximately 200% in the past 20 years, and cardiovascular
disease remains the leading cause of death in Australians. Physical inactivity is
one of the main risk factors for non-communicable diseases like diabetes and cardiovascular
disease. If all inactive Australians became physically active, 10% of deaths (all-cause
mortality) could be prevented. Similarly, deaths due to coronary heart disease and
Type II diabetes would decrease by 6% and 8%, respectively, if inactive Australians
became physically active.
Prevention of life style and work related diseases include implementation of physical
activity (PA) and the worksite has been identified as an appropriate setting for health
promotion. To date, several initiatives have been taken by employers to promote a
healthy lifestyle including the promotion of physical activity. More recently, workplaces
have implemented various initiatives to reduce sitting and promote moving in the workplace.
This talk will include the recently updated physical activity guidelines. Evidence-based
practice of various workplace and community based health promotion programs that aim
to promote physical activity will be discussed. In addition, practical guidelines
and recommendations to encourage working adults to move more and sit less will be
presented.
O19 Efficacy of shoe-stiffening inserts for the treatment of first metatarsophalangeal
joint osteoarthritis: preliminary findings from the SIMPLE randomised controlled trial
Shannon E Munteanu1,2, Karl B Landorf1,2, Jodie A McClelland2,3, Edward Roddy4, Flavia
M Cicuttini5, Alan Shiell6, Maria Auhl1,2, Jamie J Allan1,2, Andrew K Buldt1,2, Hylton
B Menz1,2
1Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne,
Victoria, Australia; 2La Trobe Sport and Exercise Medicine Research Centre, School
of Allied Health, La Trobe University, Melbourne, Victoria, Australia; 3Discipline
of Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Victoria,
Australia; 4Arthritis Research UK Primary Care Centre, Research Institute for Primary
Care and Health Sciences, Keele University, Staffordshire, United Kingdom; 5Department
of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne,
Victoria, Australia; 6School of Psychology and Public Health, La Trobe University,
Melbourne, Victoria, Australia
Correspondence: Shannon E Munteanu
Background
The purpose of this trial was to assess the efficacy of shoe-stiffening inserts for
reducing pain associated with first metatarsophalangeal joint (MTPJ) osteoarthritis
(OA).
Methods
One hundred participants (45 men 55 women, mean age 57.5, SD 10.3 years) with first
MTPJ OA were randomised to receive either: (i) full-length carbon fibre shoe-stiffening
inserts plus rehabilitation therapy (intervention group) or (ii) sham shoe inserts
plus rehabilitation therapy (control group). The primary outcome measure was the foot
pain domain of the Foot Health Status Questionnaire (FHSQ) assessed at 12 weeks. Secondary
outcome measures included the function domain of the FHSQ, severity of first MTPJ
pain, general health status, use of rescue medication and co-interventions, adverse
events, physical activity levels and global change in symptoms (with ‘moderately better’
or above being considered a successful outcome). FHSQ and global change in symptoms
at 12 weeks are presented here. Multiple imputation was used to replace missing data.
FHSQ pain scores were analysed using analysis of covariance with the intervention
group and baseline scores entered as independent variables, and global change in symptoms
was analysed using absolute and relative benefit, and number needed to treat.
Results
Data were available for 91 participants at week 4 and 85 participants at week 12.
FHSQ pain scores improved in both groups. There was a statistically significant difference
in FHSQ pain scores between the groups at 12 weeks (adjusted mean difference 7.4 points,
95% confidence interval [95% CI] 1.3 to 13.5, p=0.018) in favour of intervention group.
Participants in the intervention group were also more likely to report that their
pain was at least moderately better (successful treatment) at 12 weeks compared to
the control group (61 versus 34%; absolute benefit increase 27% [95% CI 6 to 45], relative
benefit increase 79% [95% CI 11 to 189]). The number needed to treat was 4 (95% CI
2 to 18).
Discussion and Clinical Relevance
Carbon fibre shoe stiffening inserts are effective at reducing pain in people with
first MTPJ OA.
O20 A multi-faceted podiatry intervention compared to usual general practitioner care
for first metatarsophalangeal joint osteoarthritis: a randomised controlled feasibility
study
Kade L Paterson1, Rana S Hinman1, Ben r Metcalf1, Penny K Campbell1, Hylton B Menz2,
David J Hunter3, Kim L Bennell1
1The University Of Melbourne, Parkville, VIC, Australia; 2School of Allied Health,
La Trobe University , Melbourne; 3Northern Clinical School, Kolling Institute of Medical
Research, Institute of Bone and Joint Research, University of Sydney, Sydney
Correspondence: Kade L Paterson
Background
Osteoarthritis (OA) of the first metatarsophalangeal (MTP) joint is highly debilitating
with limited evidence for treatment options. This study aimed to determine the feasibility
of a randomised controlled trial comparing a multi-faceted podiatry intervention to
usual general practitioner (GP) care for people with first MTP joint OA.
Methods
People aged >45 years with symptomatic radiographic first MTP joint OA were recruited
from the community using advertisements and our existing networks. Participants in
the intervention arm had 3-5 visits with a podiatrist and received prefabricated foot
orthoses (>6hrs wear/day), home exercise and manual therapy (twice/day), and advice
concerning footwear, weight loss, physical activity, and analgesia. Participants in
the usual care arm had 1-2 visits with a GP and received medication advice/prescription,
and the same advice as the intervention group. Primary outcomes were measures of feasibility
assessed at 3-months (recruitment/retention rates, exercise sessions/week on an 11-point
numerical rating scale (NRS), and orthoses wear hours/day). Secondary outcomes included
walking pain (11-point NRS), function (foot health status questionnaire; FHSQ), global
rating of change (7-point Likert Scale), adherence (11-point NRS), and adverse events.
Results
Thirty people from 236 screened (12.7%) were included. All except one attended the
required clinical visits, and 26 completed final outcomes (14 in podiatry group, 12
in GP group). In the podiatry group, adherence was good with exercise (mean 9.3 sessions/week,
7.1/10 on NRS) and orthoses wear (6.2 hours/day, 7.0/10 on NRS). Adherence to medication
use in the GP group was lower (5.3/10 on NRS). There were three reported minor adverse
events in the podiatry group that all resolved. Both groups reported improved pain
(mean change in podiatry group: -2.2/10, GP group: -2.8/10 on NRS) and function (podiatry:
18.3/100, GP: 13.6/100 on FHSQ) above minimum clinically important differences. Seven
people (50%) in the podiatry group and 4 (33%) in the GP group rated themselves as
“moderately better” or “much better”.
Conclusion
A clinical trial comparing a multi-faceted podiatry intervention to usual GP care
for people with first MTP joint OA is feasible and safe, and both treatments improve
symptoms. Results will be used to help power a larger clinical trial.
O21 Structural characteristics associated with radiographical severity of 1st metatarsophalangeal
joint osteoarthritis
Andrew K Buldt1,2, Shannon E Munteanu1,2, Hylton B Menz1,2
1Discipline of Podiatry, School of Allied Health, La Trobe University, Bundoora, Victoria,
Australia; 2La Trobe Sport and Exercise Medicine Research Centre, School of Allied
Health, La Trobe University, Bundoora, Victoria, Australia
Correspondence: Andrew K Buldt
Background
Osteoarthritis (OA) of the 1st metatarsophalangeal joint (MTPJ) is a common and disabling
condition. The aims of this study were to determine if differences exist in the foot
structure of people with and without radiographically defined 1st MTPJ OA, and whether
structural differences are associated with radiographic severity of 1st MTPJ OA.
Methods
Weight-bearing dorso-plantar and lateral radiographs were obtained for the symptomatic
foot of 137 participants (60 men, 77 women, aged 22 to 85, mean 58.1 +/- 11.4 years)
with clinically diagnosed 1st MTPJ OA. Radiographic 1st MTPJ OA cases were identified
and participants were graded into four severity categories using a validated atlas. The
following radiographic measurements were performed: hallux abductus angle, hallux
abductus interphalangeus angle, intermetatarsal angle, metatarsal protrusion distance,
metatarsus adductus angle, first metatarsal declination angle, lateral intermetatarsal
angle, calcaneal inclination angle, 1st metatarsal length and width, hallux proximal
phalanx length and width and hallux distal phalanx length. Structural differences
were compared using univariate general linear models, adjusting for age, sex and body
mass index.
Results
One hundred and four participants were categorised as having radiographic 1st MTPJ
OA. The OA case group displayed a greater hallux abductus interphalageus angle compared
to the no OA case group. Participants were further categorised into no OA (n=6), mild
OA (n=27), moderate OA (n=49) or severe OA (n=55) categories. Participants of the
mild, moderate and severe OA categories displayed a longer 1st metatarsal compared
to the no OA category. The moderate and severe OA categories displayed a greater hallux
interphalangeus angle compared to the mild category OA.
Discussion and clinical relevance
Overall, there were few structural differences between OA cases and non-OA cases and
between OA severity categories, although there was some evidence to suggest greater
1st metatarsal length in more severe cases of 1st MTPJ OA. The greater abduction of
the hallux distal phalanx in OA cases and greater severity OA categories suggest a
structural adaptation secondary to biomechanical factors. Further research is required
to determine whether measures of dynamic foot function are associated with the presence
and/or severity of 1st MTPJ OA.
O22 Experience of finding footwear and factors contributing to footwear choice in
people with gout
Angela Brenton-Rule1, Nicola Dalbeth3,2, N Lawrence Edwards4, Keith Rome1
1Department of Podiatry, Auckland University of Technology, Auckland, North Island,
New Zealand; 2Department of Rheumatology, Auckland District Health Board, Auckland,
New Zealand; 3Faculty of Medicine and Health Science, University of Auckland, Auckland,
North Island, New Zealand; 4Department of Medicine, University of Florida, Gainesville,
Florida, USA
Correspondence: Angela Brenton-Rule
The full article version of this abstract has already been published and can be found
at https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0313-y.
O23 Can ultrasound measures of intrinsic foot muscles and plantar soft tissues predict
future diabetes-related foot disease? A systematic review
Troy Morrison1,2, Sara Jones3,1, Ryan S Causby1,2, Kerry Thoirs1,2
1School of Health Sciences, University of South Australia, Adelaide, South Australia,
Australia; 2International Centre for Allied Health Evidence , University of South
Australia, Adelaide, South Australia, Australia; 3Department of Rural Health, University
of South Australia, Adelaide, South Australia, Australia
Correspondence: Troy Morrison
The full article version of this abstract has already been published and can be found
at https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0199055.
O24 The effectiveness of non-surgical interventions for common plantar digital compressive
neuropathy (Morton's neuroma) a systematic review and meta-analysis
Barry G Matthews1, Sheree E Hurn1,2, Michael P Harding3, Rachel A Henry4, Robert S
Ware5
1School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland,
Australia; 2Institute of Health and Biomedical Innovation, Queensland University of
Technology, Brisbane, Queensland, Australia; 3School of Health Sciences, University
of South Australia, Adelaide, South Australia, Australia; 4Rachel Henry Podiatry,
Brisbane, Queensland, Australia; 5Menzies Health Institute Queensland, Griffith University,
Brisbane, Queensland, Australia
Correspondence: Barry G Matthews
The full article version of this abstract has already been published and can be found
at https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-019-0320-7.
O25 The child in the modern environment
Jennifer Couper
Womens and Childrens Hospital, Adelaide, SOUTH AUSTRALIA, Australia
Over the last 30 years non-communicable disorders have been on the rise in children:
overweight/obesity, diabetes, inflammatory bowel disease, coeliac disease, allergy
and neurodevelopmental disorders including autism spectrum disorder and attention
deficit hyperactivity disorder. Potential common drivers from pregnancy and early
life in the environment will be presented, using type 1 diabetes as the prototype
to illustrate the effect of the modern environment on the at-risk child.
O26 Exploring health professionals understanding of evidence and use of different
treatment strategies to manage idiopathic toe walking
Cylie Williams1, Kelly Gray2, Nina Davies3, Marybeth Barkocy4, Michael Fahey5, Jane
Simmonds6, Pasquale Accardo7, Deborah Eastwood8, Verity Pacey2
1Monash University, Frankston, VIC, Australia; 2Macquarie University, Macquarie Park;
3Staffordshire University, Stoke on Trent; 4University of New Mexico, Albuquerque;
5Monash Children's Hospital, Clayton; 6Great Ormond Street Institute of Child Health,
London; 7Virginia Commonwealth University School of Medicine, Richmond; 8Great Ormond
St Hospital and University College, London
Correspondence: Cylie Williams
Background
Idiopathic toe walking (ITW) is an exclusionary diagnosis1 and varies in severity,
from those children with full range of ankle motion2, to those with associated ankle
equinus2. Many clinicians are faced with challenges in understanding available evidence-based
treatment options in the absence of an evidence based treatment pathway. The primary
aim of this research was to understand the agreement between health professionals’
knowledge of evidence for common treatment strategies for ITW and if the health professional's support
these strategies being used in clinical practice.
Methods:
This was an international cross-sectional online survey between July 2017 and March
2018. This survey was open to registered health professionals who treat children with
ITW. This survey was advertised through professional associations, social media and
special interest groups. The survey had two components: 1) General demographic variables
and variables relating to knowledge of evidence about ITW treatments and 2) Their
support for common treatment strategies. Additional data on treatments, referrals,
and preference were collected. The Kappa statistic was used to describe the intra-rater
agreement between evidence knowledge and support. Regression analyses were used to
understand strategy use preference of the 10 most commonly preferred treatments.
Results:
There were 908 international survey responses primarily from medical doctors (n=24),
orthotists (n=80), physiotherapists (n=589) and podiatrists (n=149). Kappa agreement
for paired correct responses determined a fair agreement for evidence support knowledge for
four strategies including Watch and Wait (Kappa=0.24), Stretching (Kappa=0.30), Sensory
Integration Strategies (Kappa=0.40) and Motor Control Strategies (Kappa =0.24) and
moderate agreement for thirteen others. No strategies had greater than moderate agreement
between knowledge of evidence and the support for the strategy being used. Profession,
country of practice, average number of children treated per week, and not correctly
identifying the evidence factored into many of the most commonly used strategies for
ITW (p<0.05).
Discussion and Clinical Relevance
The results from this study confirm a large variety of interventions are utilised
for the management of ITW around the world. Furthermore, there remains a disconnect
between health professional's understanding of the evidence of common treatment strategies
of ITW and a consensus for the treatment of this condition.
1. Williams CM, Tinley P, Curtin M: The Toe Walking Tool: a novel method for assessing
idiopathic toe walking children. Gait & Posture 2010, 32:508—511. 2. Davies K, Black
A, Hunt M, Holsti L: Long-term gait outcomes following conservative management of
idiopathic toe walking. Gait & Posture 2018, 62:214-219.
O27 Developmental coordination disorder in children and the interface with the podiatry
profession
Mitchell Smith1, Helen Banwell1, Cylie Williams2, Emily Ward1
1University of South Australia, Adelaide, SA, Australia; 2Monash University, Melbourne,
VIC, Australia
Correspondence: Mitchell Smith
Background:
Developmental coordination disorder (DCD) is a common condition in children affecting
motor coordination with resulting impacts on academic performance and activities of
daily living. Literature surrounding intervention has focused mostly on physical and
occupational therapies, however it is known that children with DCD are seen clinically
by podiatrists due to abnormalities in gait and lower limb functioning. This presentation
combines current clinical knowledge and practices of Australian podiatrists and children
with DCD and the outcomes of a systematic review of differences in gait between children
with and without DCD.
Methods:
A single-round survey, developed using SurveyMonkey®, was completed by a sample of
Australian podiatrists through either online or paper means. Participants were asked
about familiarity with DCD and depending on their response, were directed via skip
logic to questions on presentation, assessment and management of DCD. Participants
were also asked about willingness to receive further education on DCD. Descriptive
statistics were used to present the data. A concurrent systematic review following
PRISMA guidelines was conducted.
Results:
365 Australian podiatrists completed the survey. 30% reported familiarity with DCD,
while 67% reported familiarity with alternate and outdated terminology. Those familiar
showed good knowledge of signs and symptoms associated with DCD. Both familiar and
unfamiliar participants favoured referral to other health professionals over completing
assessments. Common podiatric management strategies such as footwear advice, orthoses,
and strength training were the most frequently chosen by both groups, despite footwear
and orthoses having no current evidence base for DCD. Participants were willing to
receive education on DCD through a range of both online and in-person mediums. Through
the systematic review, children with DCD were found to have reduced endurance and
cardiorespiratory fitness than their typically developing peers.
Discussion and Clinical Relevance:
Lower endurance and fitness levels may contribute to the reduced participation of
children with DCD. A majority of Australian podiatrists were unfamiliar with DCD,
despite its prevalence and symptomology which falls within the podiatric scope. However,
participants overwhelmingly showed willingness to receive education on DCD. Further
research is required to establish the role of podiatrists in the assessment and management
of children with DCD.
O28 Comparison of hard soled shoes versus soft soled shoes in young children: Spatiotemporal
measures of gait
Simone Cranage1, Luke Perraton2, Kelly-Ann Bowles3, Cylie Williams4
1Podiatry, Peninsula Health, Frankston, VIC, Australia; 2Physiotherapy, Monash University,
Melbourne, VIC, Australia; 3Director of Research, Monash University, Melbourne, VIC,
Australia; 4Adjunct Research Lead, University of South Australia, Adelaide, SA, Australia
Correspondence: Simone Cranage
Background
There is little evidence to guide recommendations of footwear features, for young
children, in particular the sole hardness. The aim of this study was to investigate
the difference in spatiotemporal measures of gait in young children during walking
and running in different types of soft and hard soled footwear
Methods
Demographic and lower limb anthropometric data was collected from typically developing
children. Participants walked and ran along a GAITrite mat at a self-selected speed
with the condition order randomized. Duplicate footwear was tested in a boot, runner
and sandal with two different sole hardness; an exisiting industry standard (Shore
A) and a comparative sole being 20% outside of tolerance range (Shore B). Spatiotemporal
gait measures were extracted from the GAITrite. Linear regression clustered by participant
was used to understand the different gait variables.
Results
There were 47 typically developing children aged 2-4 years recruited. Soft-soled sandals
increased stride length compared to hard soled footwear (Coef=2.07, CI95%=-4.01 to
-0.08, p=0.04) during walking only. There were no differences between walking or running
in soft or hard soled sandals, boots or runners. There was a small increase in tripping
in soft-soled sandals during walking only.
Discussion and Clinical Relevance
Current perception is that sole hardness is an important feature in young children’s
shoes. These findings infer that sole hardness has a limited effect on the spatiotemporal
measures of young children’s gait in walking and running. Parents seeking advice from
health professionals about footwear and be informed that this shoe feature has limited
impact on walking and running in younger children which can therefore guide both clinician
and industry recommendations.
O29 International normative data for paediatric foot posture – from over 3000 cases
Angela M Evans1, Gabriel Gijon- Nogueron2, Alfonso Martinez-Nova3, Pilar Alfageme-Garcia3,
Jesus Montes-Alguacil2
1Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering,
La Trobe University, Melbourne, Victoria, Australia; 2Nursing and Podiatry, University
of Malaga, Malaga, ES, Spain; 3Nursing and Podiatry, University of Extremadura, Extremadura,
ES, Spain
Correspondence: Angela M Evans
Background
There is ongoing confusion about paediatric foot posture, and a lack of clearly defined
values results in overdiagnosis of ‘flatfoot’, and frequently unnecessary treatment.
The main objectives of our collaboration were to: enlarge reference data for foot
posture across childhood, and to clarify the influence of basic anthropometry (BMI)
on paediatric foot posture. It has long been cited that heavier children have flatter
feet, yet also refuted. This study both doubles the previous normative data for paediatric
foot posture, and extends the age range.
Methods
Amalgamation of datasets from cross-sectional studies in Spain, UK, and Australia
was undertaken.
The final dataset comprised 3217 healthy children, aged from three to 15 years. Foot
posture was described by means and z-score of the foot posture index (FPI). Height
and weight of each participating child was used to calculate the body mass index (BMI),
and percentiles were used to categorise BMI.
Results
A pronated foot posture (FPI ≥ +6) was found in 960 (29.8%), and a normal foot posture
(FPI 0 to +6) in 1776 (55.2%) of children. The less common foot postures, highly pronated
(FPI ≥ +10 ) were found in 127 (3.9%) children, and supinated foot (FPI < 0) in 354
(11.0%) children.
Approximately 20% of children were overweight/obese, but correlation between BMI and
FPI was weak and inverse (r = -0.066, p< 0.01), further refuting the relationship
between increased body mass and ‘flat’ or pronated feet.
Discussion and Clinical Relevance
This study confirms that the ‘flat’ or pronated foot is common in childhood, with
FPI score of +4(3) the average finding across all ages. A wide normal range of foot
posture across childhood is confirmed, with 68% of children having FPI range +1 to
+7.
Clinicians should be aware that both highly pronated feet (FPI > +10), and supinated
foot posture (FPI < 0) is unusual, and should prompt both differential diagnoses,
and gait evaluation.
A foot posture versus age ‘ready reckoner’ has been produced for clinical use and
parent education.
O30 The foot-health and mortality of adult patients with diabetes in Northern Tasmania:
findings from an epidemiological study with two-year follow-up
Byron Perrin1, Derek Condon2, Penny Allen3, Andrew Chappell2, Claire Massey4, Marcus
Gardner5, Bronwyn Phillips6, Isabelle Skinner7, Timothy Skinner8
1La Trobe University, Bendigo, VICTORIA, Australia; 2Tasmanian Health Service- North-West,
Devonport, Tasmania, Australia; 3Rural Clinical School, University of Tasmania, Launceston,
Tasmania, Australia; 4Tasmanian Health Service- North, Launceston, Tasmania, Australia;
5Bendigo Health, Bendigo, Victoria, Australia; 6Murray Primary Health Network, Bendigo,
Victoria, Australia; 7International Council of Nurses, Geneva, Switzerland; 8Department
of Psychology, University of Copenhagen, Copenhagen, Denmark
Correspondence: Derek Condon
Background
There is limited epidemiological research that reports on the foot-health of people
with diabetes within Australian regional settings. The objective of this two-year
follow-up analysis was to explore incident diabetes-related foot morbidity and mortality
in people residing in Northern Tasmania.
Methods
Adults with diabetes were recruited from predominately community-based, publicly-funded
podiatric services in regional Tasmania. The primary variable of interest was the
incidence of foot ulceration, lower limb amputation and death. Other variables of
interest were age, sex, rurality, socio-economic disadvantage, diabetes type and duration,
knowledge of diabetes and smoking status. The main outcome was incidence of foot morbidity
(foot ulceration, lower limb amputation or death) per 100 person-years. A survival
analysis was conducted to determine median time to each morbidity outcome.
Results
There were 445 Tasmanian patients (264 males and 181 females) who completed baseline
assessments. Mean age at baseline was 65 (SD 12.9, range 19-97). Sixty-two (13.9%)
participants had type I diabetes and 383 (86.1%) had type II. Three hundred and fifty-three
(79.3%) participants had at least one follow-up visit, with 285 (64.0%) participants
still being followed-up at 12 months, 248 (55.7%) at 18 months and 203 (45.6%) at
24 months. Median number of follow-up visits = 10 (IQR 4, 22, range 1, 98). There
were 57 deaths (12.8%). There were 157 (35.3%) new ulcers during the study period
and 24 (5.4%) new amputations. Risk factors for worsening foot morbidity over time
and the results of the survival analysis will also be presented.
Conclusions
Public podiatric services in regional Tasmania are managing patients at significant
risk of serious diabetes-related foot morbidity. The two-year incidence of ulceration
and amputation is high, and the proportion of participants who died after two years
is an important finding in the Australian context. Patients presenting to these regional
public podiatry services require multi-disciplinary health care in accordance with
national and international guidelines. There is a potential disparity between current
funding models for these services and the level of diabetes-related foot morbidity
the services are managing.
O31 Looking on the bright side of a diabetes diagnosis
Anna Horn, Luke Donnan, Emma Baker, Caroline Robinson
Charles Sturt University, Thurgoona, NEW SOUTH WALES, Australia
Correspondence: Anna Horn
Background
One in four adults over the age of 25 years are living with diabetes or what is known
as pre-diabetes, and in 2016 diabetes was the seventh leading cause of death in Australia.
It is therefore, no surprise that publically accessible diabetes resources commonly
highlight the potential negatives associated with a diagnosis of diabetes, such as
neurological and vascular complications, amputation, and higher rates of depression.
What is less commonly highlighted is that half of people diagnosed with diabetes report
coping well, and 72% are rarely restricted in their daily activities.
Methods
Random sampling was used to recruit 50 participants (31 female; 19 male; 71.78±9.64
years) to a foot health promotion event at the Charles Sturt University Community
Engagement and Wellness Centre. Student practitioners completed basic neurovascular
assessments to ascertain each participant’s arterial, venous and neurological status.
Participants also completed the Foot Health Status Questionnaire. With the exception
of age, absolute toe pressure and monofilament results, data was categorical in nature.
Pearson’s Chi-square was used to identify significant relationships between variables.
Results
Thirteen percent of participants reported they were currently managing diabetes. This
is below the 16.6% expected for Australians in the 65-74 years age range, however,
the sample was a random representation of the local over-55 population. Of those reporting
medical treatment for diabetes, significant findings suggest the feet of participants
did not restrict work activities (p=0.01), climbing stairs (p=0.04), or the ability
to shower and dress themselves (p=0.04). Significant interactions with a diagnosis
of diabetes were also noted for an excellent self-rating of health (p<0.00) and energy
level (p=0.04).
Discussion
The findings of this study indicate that the majority of older people living with
diabetes are feeling healthy and are not restricted by their diagnosis. It is known
that positive messaging in public health campaigns is more effective in changing behaviour
than reinforcing negative information. Despite the need to educate clients about the
risks associated with poorly controlled diabetes, clinicians also have a key role
in highlighting the benefits of positive behavioural change and improving health literacy
to enhance the health and wellbeing of clients.
O32 Calf muscle stretching is ineffective in increasing ankle range of motion or reducing
plantar pressures in people with diabetes and ankle equinus: a randomised controlled
trial
Martin J Spink1, Angela Searle1, Christopher Oldmeadow2, Simon Chiu2, Vivienne H Chuter1
1University of Newcastle, Ourimbah, NSW, Australia; 2Hunter Medical Research Institute,
Newcastle, New South Wales, Australia
Correspondence: Martin J Spink
Background
Elevated plantar pressures have been implicated in the development and non-healing
of foot ulcer in people with diabetes. Limited ankle dorsiflexion, or equinus, has
been associated with elevated plantar pressures. This trial investigated if a stretching
intervention could increase ankle dorsiflexion and reduce plantar pressures in people
with diabetes.
Methods
Two-arm parallel randomised controlled trial at an Australian university podiatry
clinic. Adults with diabetes and ankle equinus (≤ 5 degrees dorsiflexion) were randomly
allocated to receive an eight-week calf stretching intervention (n=34) or continue
with their normal activities for eight weeks (n=34). Primary outcomes were weight
bearing and non-weight bearing ankle dorsiflexion range of motion and forefoot peak
plantar pressures. Secondary outcome measures were forefoot pressure time integrals
and adherence to the stretching intervention. Differences between groups were analysed
with analysis of covariance.
Results
68 adults (mean (SD) age and diabetes duration 67.4 (10.9) years and 14.0 (10.8) years,
64.7% male) were recruited. Following the intervention, no significant differences
were found between groups for ankle dorsiflexion either non-weight bearing (adjusted
mean difference +1.3 degrees, 95% CI:-0.3 to 2.9, p=0.101) or weight bearing (adjusted
mean difference +0.5 degrees, 95% CI:-2.6 to 3.6, p=0.743). No differences were found
for forefoot in-shoe (adjusted mean difference 1.5kPa, 95% CI -10.0 to 12.9, p=0.803)
or barefoot peak pressures (adjusted mean difference -19.1kPa, 95% CI:-96.4 to 58.1,
p=0.628). Additionally no significant reductions in forefoot pressure time integrals
were identified. Seven (20.6%) of the intervention group and 2 (5.9%) of the control
group were lost to follow up.
Discussion and Clinical Relevance
Our data failed to show a statistically or clinically significant meaningful effect
of calf muscle stretching on ankle range of motion, or plantar pressures, in people
with diabetes and ankle equinus. Diabetes related changes to muscle-tendon or neural
structures may make stretching less effective in this group. While current guidelines,
including those from the American Diabetes Association, recommend stretching to maintain
joint range of motion in people with diabetes, it is not effective as a stand-alone
therapy to increase ankle joint range of motion in this population.
O33 Diabetes education retention: A Systematic Review
Julia Yuncken, Cylie Williams, Terry Haines
Monash Univeristy, Melbourne, Vic, Australia
Correspondence: Julia Yuncken
Background
Diabetes education remains crucial for the treatment and prevention of diabetes complications.
There is limited knowledge of long-term information retention or what are resultant
behaviour changes due to diabetes education. There is also limited guidance for the
most effective education methods to affect behaviour change. This systematic review
evaluated the findings of the literary body on the impact that education practices
have on behaviour change, knowledge or participant satisfaction.
Methods
Databases Medline, CINHAL, Science Direct, EMBASE, Web of Science and Cochrane were
searched for articles investigating behaviour change, knowledge, or participant satisfaction
in connection with diabetes education. The two reviewers screened articles independently
against inclusion criteria and educational methods, and outcomes and timeframes were
extracted from qualifying papers. Data were synthesized against Kirkpatrick’s Hierarchy
of Learning.
Discussion and clinical relevance
In total, 849 studies were found using primary search criteria, of those all but 39
studies were disqualified using inclusion criteria. Of the 39 qualifying studies,
18 were randomised trials, nine were cross sectional studies and the remaining studies
included quasi-experimental, observational and repeated measures design studies. Method
of education included verbal, written and visual modes, delivered by both multi-disciplinary
teams and single health care practitioners. Topics of education included general diabetes
complications, foot complications, diet, physical activity and self-foot care. Outcomes
reviewed included diabetes knowledge, foot care knowledge and HbA1C levels post education.
Conclusion
Diabetes education is ubiquitous in diabetes treatment however it remains unclear
if patients retain the educational information provided or if the information retained
causes behavioural change which in turn results in a decrease to complications.
O34 Affective and cognitive factors associated with pain and function in people with
plantar heel pain
Matthew P Cotchett1, Karl B Landorf1, Shannon E Munteanu1, Daniel Bonanno1, Glen Whittaker1,
Angus Lennecke1, Virginia Medica2
1Discipline of Podiatry, La Trobe University, Bundoora, VIC, Australia; 2Podiatry
Department, The Northern Hospital, Epping, VIC, Australia
Correspondence: Matthew P Cotchett
Background
It is widely accepted that psychological variables, including affective, cognitive
and behavioural factors, are associated with self-reported pain and self-reported
physical function in patients with musculoskeletal pain. However, the relationship
between psychological variables and foot pain and foot function, in people with plantar
heel pain (PHP), has received less attention. Therefore, the aim of this presentation
was to present the results from a series of cross sectional studies that evaluated
a range of psychological variables in people with PHP.
Methods
Three cross sectional studies were conducted separately at different time points.
The first cross sectional study evaluated 84 people with PHP to determine the association
between depression, anxiety and stress with foot pain and foot function. This was
followed by a second study involving 45 people with PHP and 45 people without PHP
to determine if symptoms of depression, anxiety or stress increased the likelihood
of having PHP. A third cross sectional study evaluated the association between kinesiophobia
and catastrophising with foot pain and foot function in 36 people with PHP. Hierarchical
and logistic regression models were used to evaluate the data.
Results
For participants with PHP, stress and depression scores were significantly associated
with foot function but not foot pain. When the data was stratified by sex, stress
and depression were significant predictors of foot pain and function in females. Symptoms
of depression, anxiety and stress were found to increase the likelihood of having
PHP. Finally, kinesiophobia and catastrophising were significantly associated with
foot function, while catastrophising was associated with ‘first step’ pain in people
with plantar heel pain.
Discussion and clinical relevance
In addition to addressing biological factors in the management of PHP, clinicians
should consider the potential role of affective factors such as mood, and cognitive
factors such as catastrophising and kinesiophobia which are equally important in the
experience of pain in people with PHP. Podiatrists should contemplate the use of outcome
measures to evaluate mood, anxiety, catastrophic thoughts and a fear of movement to
help guide treatment that is viewed through a broader biopsychosocial model of health.
O35 Insights from the Framingham Foot Study: Are key aspects of health being overlooked?
Marian Hannan
Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School,
Boston, MA, USA
Just as a good clinical examination asks directed queries about comorbidities and
health to a patient to obtain an integrated understanding of the patient’s needs,
so does a good research study add to our clinical insights. This session will use
examples from the population-based Framingham Foot Study to highlight important key
aspects of public health that may be overlooked yet essential perspectives as we consider
the role that feet play in health and disease. Specific examples of current research
evaluating the role of obesity will be presented. Important findings from the Foot
Study will be discussed in relation to race/ethnicity, arthritis of the knee or hip,
limitations in mobility, and disability. The need for early clinical intervention
will be discussed as well as the evaluation of progression of foot conditions in persons
prior to any clinical intervention. Finally, we will address what might be modifiable
and what is not apt to change with clinical interventions.
Research findings may provide understanding of underlying mechanisms for the diseases
we see in our patients. Epidemiology, as a specific focus, tells us the public health
impact… and the impact of foot disorders is huge: in the general population, the risk
of disability due to foot problems is much larger than heart problems, dementia or
lung disorders. And despite public demand for understanding of foot health, many clinicians
and public health advocates ignore the role of the foot.
Podiatry can merge with population sciences to encourage the integration of our knowledge
so that key aspects of health are not overlooked. Our insights and public health knowledge
are the keys to making a significant difference in foot health and advancing preventive
efforts.
O36 Preventing Overdiagnosis: how can we stop harming the healthy?
Ray Moynihan
Centre for Research in Evidence Based Practice , Bond University, Gold Coast, QLD,
Australia
This presentation will offer an overview of the complex and counter-intuitive health
challenge of overdiagnosis, which has been described as a ‘modern epidemic’ causing
harm and challenging the sustainability of health systems. It will explore both the
problem and potential solutions to it. The presentation will draw on national and
international evidence and analysis, and demonstrate how Australia is at the forefront
of national attempts to understand and address overdiagnosis.
In a nutshell, overdiagnosis happens when someone receives a diagnosis that does them
more harm than good. It happens for example when a healthy person is diagnosed with
a disease that will not actually ever cause them harm. The presentation will explain
the nature of this vexing problem, and evidence which has attempted to estimate its
extent across several conditions, including for example, thyroid, breast and prostate
cancers.
The presentation will also explore what might be driving this problem, such as changes
in diagnostic technology – often used in screening programs – which can identify ever-smaller
abnormalities, many of which will highly likely never to go on to cause harm. Drawing
on recent work published in the British Medical Journal, BMJ, the presentation will
also explore a wide range of potential solutions.
A former award-winning journalist and author, Dr Moynihan is recognised internationally
for his academic work on overdiagnosis, and the presentation will give a clear and
compelling introduction to this problem and how we might collectively address it.
O37 Overdiagnosis and overtreatment of musculoskeletal conditions in Australia and implications
for podiatric practice
Rachelle Buchbinder
Monash Department of Clinical Epidemiology, Cabrini Institute, Department of Epidemiology
and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University,
Melbourne, VIC, Australia
While early detection and treatment of disease brings benefits for many, there is
increasing evidence of unnecessary testing and treatment, harming patients and diverting
scarce resources from where they’re most needed. Overtesting and overtreatment is
driven by many factors including clinician concern about missing diagnoses, increasingly
sophisticated diagnostic tests which detect smaller and smaller abnormalities of uncertain
prognosis, and screening programs that save lives but can also detect disease that
won’t progress to cause harm. This leads to unnecessary treatment which can result
in complications and harm to patients.
There are many examples of overtesting, overdiagnosis and overtreatment of musculoskeletal
conditions. For example, an MRI of the knee will show some abnormality in 84% of people
over the age of 50 years who have knee pain, and in 20% it will show meniscal damage.
However these changes are equally as common in people without knee pain. Failing to
take account of the prevalence of these abnormalities in the asymptomatic population
can result in needless worry for the patient, and unnecessary treatments like arthroscopy. This
cascade of unnecessary tests and treatments harms the patient and places a financial
burden both on the individual and the health service.
This talk will provide examples of overdiagnosis and overtreatment relevant to podiatric
practice in Australia and present some of the work of Wiser Healthcare, an Australian
research collaboration that is investigating the cause and size of the problem and
testing new solutions.
O38 Palindromic rheumatism: Can arthritis that comes and goes hold the key to understanding
RA?
Anne-Maree Keenan1,2, Kulveer Mankia1,2, Paul Emery1,2
1Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom; 2NIHR
Leeds Biomedical Research Centre , Leeds Teaching Hospitals Trust, Leeds, United Kingdom
Correspondence: Anne-Maree Keenan
Palindromic rheumatism (PR) a diagnostic label applied to episodes of self-limiting
clinical arthritis, occasionally with skin disease. Symptoms are sudden onset of joint
swelling which develops rapidly, lasts for a few hours or days then disappears. Attacks
are usually mono-articular but with the site of joint pain often changing with each
episode. While symptoms may affect any joint in the body with wrists, knees, shoulders,
feet and ankles (in order of frequency) are most susceptible. Of note, almost half
of patients with PR later develop rheumatoid arthritis (RA): understanding these patients
may hold the key to understanding triggers for RA. Treatment for PR varies, but is
generally centred on reducing inflammation and pain. The clinical appearance, differential
diagnosis and imaging appearance is important for podiatrists to identify PR and refer
on for early treatment
This presentation will also present initial findings from our Birmingham-Leeds collaboration. With
colleagues at Birmingham, we have identified the substantial patient burden of PR:
patients experience a wide range of physical symptoms and report psychological and
emotional distress, frequently exacerbated by a lack of information and the apparent
therapeutic and prognostic uncertainty. Early results from imaging studies at Leeds
has indicated for the first time that active PR demonstrated greater peri-articular
soft tissue inflammation compared to active synovitis that is seen with RA, potentially
explaining the difference in clinical symptoms.
Poster presentations
P1 Are standard neuro-vascular assessments telling us more than we realised?
Emma Baker, Luke Donnan, Anna Horn, Caroline Robinson
Charles Sturt University, Thurgoona, NEW SOUTH WALES, Australia
Background
Neurovascular assessments are conducted routinely by podiatrists as a means of screening
for peripheral arterial disease and peripheral neuropathy, to reduce the risk of foot
ulceration, infection and amputation. Assessments commonly used to derive clinical
data include the palpation of pulses, and the use of Doppler ultrasounds, systolic
toe pressure sensors, monofilaments and tuning forks. Whilst it is common practice
to use these assessments to monitor foot health, this data has the potential to illuminate
a much more holistic perspective of a person’s health status.
Methods
Fifty participants (19 male, 31 female; 71.78±9.64 years) were recruited using random
sampling to participate in a foot health promotion event at the Charles Sturt University
Community Engagement and Wellness Centre. Basic neurovascular assessments were completed
by student practitioners to determine each patient’s neurological, arterial and venous
status. The Foot Health Status Questionnaire was also completed by all participants.
Age, monofilament results and absolute toe pressures were recorded as continuous values,
while all other data was categorical. Statistical interactions were identified using
Pearson’s Chi-square.
Results
Those participants who reported ability to lift or carry bags of shopping, showed
a statistically significant relationship with adequate vibration sensation (p=0.04),
a palpable tibialis posterior pulse (p=0.04) and a triphasic Doppler assessment (p<0.00).
The ability to get up from a sitting position (p<0.00) and independent showering and
dressing (p=0.04), shared a significant association with a 10/10 monofilament score.
It was also noted that a palpable tibialis posterior pulse shared a significant relationship
with never having foot pain (p<0.00) aching feet (p=0.01), and no limitation in occupational
capacity (p=0.02).
Discussion
These findings show significant interactions between standard neurovascular assessments
and a range of activities of daily living. While the authors are mindful that these
findings are correlational, not causational, a global view of neurovascular assessment
may allow patient results to be viewed more holistically. Determining the ability
to detect and heal tissue damage will not change, however, neurovascular findings
may be used to stimulate further discussion about the patient as a whole, not just
the presenting condition.
P2 A dancer’s foot in turnout: A multi-segment kinematic study
Sarah L Carter2,1, Alan Bryant2, Luke S Hopper1
1Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley,
WA, Australia; 2Podiatric Medicine and Surgery Division, School of Allied Health,
University of Western Australia, Nedlands, WA, Australia
The full article version of this abstract has already been published and can be found
at https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-019-0318-1.
P3 Idiopathic toe walking research update
Antoni Caserta1,2, Cylie Williams2,3, Prue Morgan2
1Monash Health, Pakenham; 2Monash University, Frankston; 3Peninsula Health, Frankston
Idiopathic toe walking (ITW) is a diagnosis of exclusion for children who walk on
their toes, with no medical cause. This presentation summarises two recent systematic
reviews, a Cochrane review, and a systematic review of published outcome measures
used for ITW.
The Cochrane review aimed to assess the effects of conservative and surgical interventions
on gait normalisation, ankle range of motion, and pain in children with ITW, identifying
adverse effects of the interventions and the frequency of recurrence. The systematic
review aimed to identify and evaluate the clinical utility, validity and reliability
of the outcome measures and tools used to quantify lower limb changes within this
population.
Both reviews registered a protocol for search criteria, and data extraction.
There were 4 studies included within the Cochrane review, however only one study had
data extracted reporting the difference between Botulinum Toxin A in addition to serial
casting versus serial casting alone. These results indicated there was no clinically
important differences
between the two intervention groups for improvement in toe walking to under 50% at
12 months as reported by parents, no change in passive ankle joint dorsiflexion range
of movement, or no change in recurrence of toe walking gait at 12 months.
There were 27 articles included for data extraction within the systematic review.
Results indicated that interventional studies were more likely to report range of
motion and gait analysis outcomes, than observational studies. The Alvarez classification
tool in conjunction with Vicon motion system, appeared as the contemporary choice
for describing ITW gait. There were no significant associations between the use of
range of motion and gait analysis outcomes and any other outcome tool or assessment
in all studies. There were limited reliability and validity reporting for many outcome
measures.
The results of the Cochrane review indicate a need for future good quality, interventional,
multiple-armed randomised control trials for treatment of ITW and to include functional
outcomes for treatment effectiveness measurement.The systematic review also highlighted
that a consensus statement should be considered to guide clinicians and researchers
in the choice of the most important outcome measures for this population.
P4 The effectiveness of non-surgical intervention (foot orthoses) for paediatric flexible
pes planus - a systematic review update
Sindhrani Dars, Helen Banwell, Hayley Uden, Saravana Kumar
University of South Australia, Adelaide, SA, Australia
The full article version of this abstract has already been published and can be found
at https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0193060.
P5 The footwear experiences of people with gout a qualitative study
Mike Frecklington1, Anita Williams2, Nicola Dalbeth3,4, Peter McNair1, Peter Gow5,
Keith Rome1
1Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand;
2School of Health Science, University of Salford, Salford, United Kingdom; 3Department
of Medicine, University of Auckland, Auckland, New Zealand; 4Auckland District Health
Board, Auckland, New Zealand; 5Counties Manukau District Health Board, Auckland, New
Zealand
The full article version of this abstract has already been published and can be found
at https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-019-0349-7.
P6 Effects of a footwear intervention on foot pain and disability in people with gout
a randomised controlled trial
Mike Frecklington1, Nicola Dalbeth2,3, Peter McNair1, Trish Morpeth1, Alain C Vandal4,5,
Peter Gow6, Keith Rome1
1Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand;
2Department of Medicine, University of Auckland, Auckland, New Zealand; 3Auckland
District Health Board, Auckland, New Zealand; 4Department of Biostatistics & Epidemiology,
AUT University, Auckland, New Zealand; 5Research & Evaluation Office, Ko Awatea, Counties
Manukau Health, Auckland, New Zealand; 6Counties Manukau District Health Board, Auckland,
New Zealand
The full article version of this abstract has already been published and can be found
at https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-019-1886-y.
P7 Effects of new and worn footwear on plantar pressure in people with gout
Mike Frecklington1, Nicola Dalbeth2,3, Peter McNair1, Alain C Vandal4,5, Peter Gow6,
Keith Rome1
1Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand;
2Department of Medicine, University of Auckland, Auckland, New Zealand; 3Auckland
District Health Board, Auckland, New Zealand; 4Department of Biostatistics & Epidemiology,
AUT University, Auckland, New Zealand; 5Research & Evaluation Office, Ko Awatea, Counties
Manukau Health, Auckland, New Zealand; 6Counties Manukau District Health Board, Auckland,
New Zealand
Background
Footwear with good characteristics offers short-term improvements in foot pain and
disability in people with gout, however, these are not sustained in the long-term.
One reason for this may be wear and reduced structural integrity of the shoe over
the six-month period. This study tested the effects of wear by comparing the plantar
pressures in athletic shoes that had been worn for six months, compared to a new shoe
of the same model and size in people with gout.
Methods
40 people with gout participated in a cross-sectional repeated measures study. Plantar
pressure variables (peak plantar pressure and pressure time integrals) across seven
regions of the foot were measured in random order in two footwear conditions; (1)
a new pair of the same model of footwear (new footwear) and; (2) a pair of commercially
available athletic footwear that had been worn for six months (worn footwear). Data
were analysed using linear mixed models.
Results
The worn shoes had higher medial midsole hardness (P<0.0001), lateral midsole hardness
(P<0.0001) and heel midsole hardness (P<0.0001). Signs of outsole wear was evident
in the worn shoes, with the majority displaying normal upper (P<0.0001), midsole (P=0.05)
and outsole (P<0.0001) wear patterns. No significant differences in peak plantar pressures
were observed across the seven masked regions (P<0.007). Lower pressure time integrals
were observed at the first metatarsophalangeal joint (P<0.0001), second metatarsophalangeal
joint (P<0.0001) and hallux (P=0.003) with the worn shoes compared to the new shoes,
consistent with off-loading of this area.
Discussion and clinical relevance
Signs of upper, midsole and outsole wear were evident in the worn footwear following
six-months of use. These changes in the mechanical properties of the footwear may
impact foot function, as observed by pressure time integral reductions at at the first
metatarsophalangeal joint, second metatarsophalangeal joint and hallux.
P8 Utilising foot posture index (FPI) as a static assessment in orthotic dispense
fitting for hypermobile pes planus
Marabelle Heng1,2, Melissa Phua3
1Singapore General Hospital, Singapore, SINGAPORE; 2University of South Australia,
Adelaide, Australia; 3Tan Tock Seng Hospital, Singapore
Background Structural deviations in the foot and ankle predispose patients to changes
in load-bearing, muscle imbalances and dynamic gait, resulting in compensatory strategies
and overuse injuries. Orthotics are often fitted in such cases. During an orthotic
dispense fitting, a podiatrist checks the static and dynamic response of the patient’s
foot to the orthotic. The orthotic calcaneal stance position (OCSP) is a static objective
measure, however it only shows the calcaneus positional changes, and does not reflect
posture changes to the talus, mid foot and forefoot. Internationally, there is no
common standard objective measures for static assessment during orthotic dispense
fitting.
The foot posture index (FPI) is a validated clinical assessment tool that considers
the foot positions in all planes (frontal, transverse, and saggital) and various anatomical
segments (forefoot, mid foot and rearfoot). In the authors’ clinics, foot posture
index (FPI) is used as a static assessment in orthotic dispense fitting in reducible,
correctable conditions such as hypermobile pes planus.
Methods FPI was taken (i) weightbearing barefooted (‘before’) and (ii) in orthotic
stance (OS; ‘after’). We sampled a total of 20 hypermobile pes planus feet with orthotic
intervention across the two clinics. Data was deidentified. Mean and standard deviation
for each FPI component was computed and ‘before-after’ difference were tested using
paired t-test.
Results Mean (SD) of barefoot FPI = 9.9 (1.5); orthotic stance FPIos = 3.9 (1.7).
Mean difference in ‘before-after’ FPI = 6.0 (p <.001). Discussion & Clinical Relevance
The orthotic stance FPI (FPIos) is able to assess and score foot posture corrections
achieved through the orthotic prescription in hypermobile pes planus. Hypermobile
flat feet (FPI≥6) were corrected to within normal range. The FPIos could be a way
forward in improving documentation of clinical outcomes in podiatric setting. Future
studies could assess treatment outcome in large populations to establish norms and
expected outcomes. Established norms and expected outcomes could in turn increase
patients’ confidence and manage clients’ expectations in podiatric orthotic intervention.
P9 Management of hallux valgus by general practitioners in Australia
Hylton B Menz, Glen A Whittaker, Shannon E Munteanu, Karl B Landorf
School of Allied Health, La Trobe University, Bundoora, VIC, Australia
Background
Hallux valgus is a common and disabling foot condition, however very little is known
about how frequently hallux valgus presents to general practitioners (GPs), the treatments
they provide, or the extent to which they refer patients to other health professionals.
Methods
We analysed data from the Bettering the Evaluation and Care of Health Program April
2000 to March 2016 inclusive. Patient and GP encounter characteristics were extracted.
Data were classified by the International Classification of Primary Care, Version
2 (ICPC-2) using two
codes: hallux valgus (ICPC-2 L98007) and bunion (ICPC-2 L98001). Data were summarised
using descriptive statistics and 95% confidence intervals (95% CIs) around point estimates.
Results
The dataset included 1,568,100 patient encounter records among which hallux valgus
was managed 658 times, which equates to an estimated 60,000 GP encounters annually.
Females accounted for 82% of all hallux valgus encounters, and the management rate
was highest among patients aged 45 to 64 years. Hallux valgus was most frequently
managed by referral to orthopaedic surgeons (28 per 100 encounters), counselling or
advice (25 per 100) and referral to podiatrists (16 per 100). Pharmacological management
was not frequently used (20 per 100) but primarily involved prescription of non-steroidal
anti-inflammatory drugs (4 per 100).
Discussion and Clinical Relevance
Hallux valgus is a commonly encountered problem in Australian general practice but
is mostly managed by referral to orthopaedic surgeons or podiatrists. Further research
is required to examine the factors that influence the selection of surgical and non-surgical
treatment pathways by Australian GPs.
P10 “You don’t talk about feet”: Understanding parent concerns about foot health in
infancy and early childhood
Lisa Hodgson1, Charlotte Growcott2, Anita Williams2, Chris Nester2, Stewart C Morrison1
1School of Health Sciences, University of Brighton, Eastbourne, East Sussex, United
Kingdom; 2School of Health & Society, University of Salford, Salford, UK
Background
There are considerable changes to the structure and function of the feet during infancy
and early childhood. These changes typically reflect the plasticity of the feet but
can cause concerns for parents, and lead to additional burden on health services.
The aim of this study was to explore parent’s knowledge, practice and perceptions
of foot health in infancy and early childhood.
Methods
A qualitative design was adopted and two researchers conducted semi-structured, one-to-one
interviews with parents of children aged five years and under. Two researchers undertook
data collection and a flexible, time-efficient approach was adopted. Interviews were
conducted face-to-face, via telephone or via online telecommunication applications
(Sturges & Hanrahan, 2004). All transcripts were transcribed verbatim and thematic
analysis was used to explore the data. Coding and theme development were undertaken
inductively and directed by the content and responses within the data (Braun & Clarke,
2006). Informed consent was obtained from all participants and ethical approval granted
by the host institution(s) prior to undertaking the work.
Results
Eighteen interviews were conducted. Ten parents had one child under the age of five-years
and eight parents had more than one child within this age range. Seven themes were
identified relating to: (1) what parents understand about foot health in childhood;
(2) how parents use and share information about foot health; (3) activities for supporting
good foot health and development; (4) footwear choices and beliefs; (5) the role of
health professionals; (6) accessing and understanding information; (7) developing
practices to support parents.
Discussion and Clinical Relevance
The findings from this study provide insight into how parents view foot health in
early infancy and childhood. The study depicts how parents learn about their children’s
feet, receive and access support for their concerns, and what parents believe to be
important. The findings from this work highlight that parents want accurate, accessible
foot health information and that health professionals have an important role in supporting
parents with easily identifiable, trustworthy sources that convey consistent advice.
1. Sturges, JE, Hanrahan KJ. Comparing telephone and face-to-face qualitative interviewing:
A research note. Qualitative Research 2004; 4:107-118.
2. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research
Psychology. 2006; 3:77–101.
P11 Foot-care needs in children and young people with intellectual and developmental
disabilities
Stewart C Morrison, Laura Barrett, David Haines
School of Health Sciences, University of Brighton, Eastbourne, East Sussex, United
Kingdom
Background
Healthcare needs in children and young people with intellectual and developmental
disabilities are high. Foot problems have been reported to be very common in adults
with intellectual disabilities; foot problems in children and young people are however,
poorly understood. The aim of this study was to explore foot-care needs of children
and young people with intellectual and developmental disability.
Methods
An exploratory, cross-sectional online survey was undertaken across a four-month period.
A purposive snowball sampling approach was adopted in which parents / caregivers of
children and young people with a diagnosis of intellectual or developmental disability
were recruited. The survey tool was piloted before launch and comprised three domains.
The first domain elicited information relating to parent/caregiver status, diagnosis
of intellectual or developmental disability, secondary diagnoses, and age of the child/young
person. The second domain explored foot-care and sought to obtain information about
foot problems, access to health services, and existing knowledge about foot health.
The third domain focused on footwear. Prior to launching the survey, ethical approval
was granted from the host institution and all participants provided electronic consent
before completing the survey.
Results
Complete data was collected from 49 respondents. Forty-five were parents and four
were caregivers of a child or young person with intellectual and/ or developmental
disability. Eighteen of the children had a diagnosis of Down syndrome and seven had
a rarer chromosomal deletion (e.g Potocki-Lupski syndrome). Seventeen reported developmental
disability (e.g. autism). Foot problems were common (75%) and tended to be musculoskeletal.
‘Pes planus’ was the most common foot concern (51%). Twenty-four parents/caregivers
reported difficulties with finding appropriate shoes (48%) and this was often due
to a mismatch between foot shape and the shoe (30%), or due to complications with
orthotic devices (14%).
Discussion and Clinical Relevance
The results from this survey demonstrated that the burden of foot problems in children
and young people with intellectual and developmental disabilities is considerable.
The data offers a snapshot of the concerns that parents/caregivers encounter and the
findings highlight the importance of access to foot-care services for these children
and young people.
P12 The effect of dynamic movement tasks on the restrictive properties of rigid strapping
tape
Ainslee M. O'Connell, Herbert F. Jelinek, Luke Donnan
Charles Sturt University, Wodonga, VICTORIA, Australia
Background:
Ankle injuries are one of the most common sporting injuries in athletes. The combination
of plantarflexion and inversion during jumping and cutting tasks increases vulnerability
to a lateral ankle sprain injury during dynamic sports. Taping modalities are routinely
used to reduce the risk of ankle injury, even though some research suggests the restrictive
properties of tape may reduce during exercise. The purpose of this study was to determine
whether a time point exists where the restrictive properties of prophylactic ankle
taping reduces.
Method:
Forty-two participants (29 men, 13 women; age: 22.09±2.79yrs; height: 180.78±8.45cm;
mass: 79.35 ±13.35kg) were recruited to complete a repeat measures, randomized control
trial. Participants with taped (n=21) or untaped ankles (n=21) completed sets of ten
cut-tasks at zero minutes, and again at five-minute intervals up to and including
20 minutes. A dynamic fatigue protocol was also completed between sets of cut-task
trials to simulate sporting activity. Measures of ankle angles at the selected temporal
events, peaks of gastrocnemius, fibularis longus and vastus medialis muscle activity,
heart rate (HR) and rating of perceived exertion (RPE) were collected.
Results:
Significant increases in RPE and HR were noted in both the taped and non-taped groups
at all time points, suggesting fatigue effects were consistent across both groups.
The taped group showed significant increases in foot adduction at initial contact
from 0-10min (p=0.03), 0-15min (p=0.04) and 0-20min (p≤0.001), and increased peak
ankle dorsiflexion from 0-15min (p≤0.001). Non-significant increases in plantar-flexion
were also observed from 15-20 minutes. The taped-group showed a significant increase
in gastrocnemius activation during the load acceptance phase from 10-20mins (p≤0.05).
Sagittal and transverse plane ankle angle peaks were also shown to converge from 15-20
minutes, although the taped group consistently displayed a reduced range of motion.
Discussion:
The findings of this study indicated that the restrictive benefits of self-adherent
strapping tape decreased following 15 minutes of fatigue inducing dynamic activity,
although the available movement is still less than the non-taped group. An awareness
of such functional limitations following dynamic movement tasks will enable more appropriate
use of ankle taping as an injury prevention tool.
P13 Muscle strength differences in people with and without plantar heel pain
John W Osborne, Hylton B Menz, Glen A Whittaker, Karl B Landorf
Podiatry, La Trobe University, Bundoora, Victoria
Background: Plantar heel pain is a common condition but little is known about the
relationship between muscle strength and plantar heel pain.
Objectives: To review the evidence relating to muscle strength in those with and without
plantar heel pain.
Methods: We systematically reviewed the literature by searching key databases. Included
studies assessed muscle strength (or endurance or size as proxies) in those with and
without plantar heel pain. A modified quality index was used to assess risk of bias.
Meta-analysis was performed where possible.
Results: Seven studies met the eligibility criteria. The quality of studies was generally
high (score range 11 to 16 out of 17). Hallux plantarflexion, lesser toe plantarflexion,
ankle dorsiflexion, ankle inversion and ankle eversion strength were reduced in those
with heel pain compared to those without, however there was inconsistency in the findings
between studies. Calf muscle endurance found no difference between those with and
without plantar heel pain. Generally, foot muscle volume was smaller for people with
plantar heel pain compared to those without.
Conclusion: People with plantar heel pain have reduced strength and volume of the
foot muscles, but there is no discernible change in calf muscle endurance. It is unclear
whether muscle weakness is a cause or consequence of plantar heel pain. However, these
findings suggest that the role of muscle strengthening in the treatment of plantar
heel pain is worthy of further investigation.